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Opioid Epidemic

New Federal Data Confirms What We Already Know: Opioid Distributions Inundated Appalachia

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In this April 2, 2018, file photo, pharmacist Steve Protzel poses for photos holding a bottle of OxyContin at Daniel's Pharmacy in San Francisco. Photo: Jeff Chiu/AP Photo, File

On Monday, a federal district judge ordered the release of a government database that tracks the shipments of every single prescription pain pill manufactured in the U.S. In an analysis of that data, The Washington Post found between 2006 and 2012, 76 billion oxycodone and hydrocodone pills were shipped to pharmacies across the country. 

The pills were targeted, however, to some of the most rural communities in the country, largely in Appalachian West Virginia, Virginia and Kentucky. Those same communities saw overdose death rates skyrocket to as many as 8 times the national average as these pills inundated their communities. 

The release comes in the midst of a massive federal court case, in which more than 2,000 counties, cities and towns are suing prescription drug manufacturers and distributors for creating and fueling the nation’s opioid crisis. These local governments want compensation to help pay for the costs associated with the epidemic, including increased rehabilitation, jail and morgue costs.

Three reporters at The Washington Post were responsible for the analysis that shows just how concentrated the epidemic was in Appalachian communities, Scott Higham, Sari Horwitz and Steven Rich. Rich, a database editor, spoke with 100 Days in Appalachia’s Ashton Marra about the reporting.

AM: The federal district judge who is hearing the 2,000 cases filed against opioid manufacturers and distributors allowed for the release of a federal Drug Enforcement Agency database on the shipments of prescription pills and in your article you write that these were highly concentrated in rural parts of the country, especially in West Virginia, Virginia and Kentucky. For those of us living here, that’s not necessarily new information. We know this has been happening, in part because of some reporting by the Charleston Gazette-Mail, but also many of these communities watched it happen. So, why is having access to this database so important? What does it tell us that we didn’t know?

SR: It tells you where you stand in relation to everyone else. I mean, I think a lot of people in these communities are probably seeing where they are and thinking that it’s bad or thinking that everybody else might have it this bad. But the truth is that the areas in West Virginia and southern Virginia and in Kentucky really got hit much harder than the rest of the country, and so I think it’s very important for context, to know just how bad these states were, these counties were for the number of pills that were flowing in what they were seeing was abnormal, even though it was their normal.

AM: One finding in your analysis of the database that I thought was interesting is the market share that these companies had. In particular, there has been a lot of attention and a lot of blame placed on Purdue Pharma and their marketing tactics for selling OxyContin. But this data shows they only owned 3 percent of the market. That seems small compared to the amount of attention they’ve received.

SR: So, Purdue is sort of on the radar for a lot of people largely because of they in the late ‘90s, early 2000s, they really saturated the market with OxyContin, which is their version of oxycodone. But the reality is, by the time 2006 rolled around, and then well into that decade, they had really sort of have fallen off the map in terms of being a supplier for OxyContin and across the country. And some of these other very large manufacturers stepped in and really out-paced them by a mile.

AM: Do you anticipate that the public release of this database will have any impact on the outcome of the lawsuit?

SR: We have no idea how this will affect the lawsuit. We know that it is already causing ripples based on talking to both plaintiffs and defendants. But the reality is, it’s already gotten to this point in the lawsuit. So we’re not entirely sure what kind of effect it will have. Most of this would have become public at some point anyway, we think, but it may have been after the case. So this could really change things, but that will remain to be seen.

AM: In your article, you asked a number of these pharmaceutical companies and distributors to respond to the release of the database, but the group of distributors said that the data would not exist unless they had accurately reported shipments and they questioned why the government had not done more. That seems like a legitimate concern, have you gotten an answer to that question? If the government was monitoring these shipments, why didn’t they do more?

SR: What we’ve seen from reporting on this, and from reporting on a whole lot of other subjects, is that the government is mandated to keep a lot of data, but what they’re not mandated to do most of the time is to use it to create flagging systems or use it to identify really suspicious patterns in whatever they are looking at– in this case, pill shipments. 

And so what happened here is they collect the data, but it is in such a form that it’s not really easy to analyze. And no one there thinks to set up any sort of monitoring system, which is something that would in theory be under the purview of the federal government.

AM: Around the same time some of those rural communities received shipments of millions of pain pills, they were also experiencing overdose death rates that were sometimes 8 times the national average. As someone who is in this instance essentially reporting on Appalachia from the outside looking in, do you think about the vulnerability of these communities when your reporting these stories? 

SR: Data is sort of the beginning, it’s not the end, and so we are particularly curious with finding and using the data to find the areas that are the worst hit and then getting out there and trying to understand it. 

I mean, we understand a lot of the opioid crisis because the Charleston Gazette-Mail did an insanely good job a few years ago of reporting on a subset of this data for West Virginia, and we saw the impact that it had on those communities. And so really, what we what we want to do here is use the data as a guide to help us to find the most vulnerable communities and really tell their stories, because the numbers, they tell you how bad it is, but they can’t actually tell you how bad it is.

AM: What can we expect to happen next in this story?

SR: We are going to look at this data in any number of ways that we can. We want to let the data tell us what the story is instead of the other way around. 

Thursday, we made the data publicly available in county sized chunks so that anyone in their own communities can take a look at the shipments, shipment by shipment and really understand where the pills went in their communities over that seven years. 

So what we’re really hoping that we can do is to provide a resource for every journalist and every citizen in this country who is interested in this subject to be able to trace the impact of opioids on their communities.

I think this is a very important subject, which is why this is my fourth straight year reporting on this [issue]. I mean, I think it is, in a lot of ways, it’s the story of our time.

Steven Rich is a database editor for the Investigations Unit at The Washington Post. While at The Post, he has worked on investigations across virtually every beat, including stories on the National Security Agency, policing, tax liens, civil forfeiture, school shootings and college athletics.