Nearly 47 million prescription opioids flowed into Whatcom County during a seven-year period starting in 2006, according to a Drug Enforcement Administration (DEA) database published by the Washington Post this summer.
Drug companies supplied Whatcom County with 46.9 million hydrocodone and oxycodone pills from 2006 through 2012, enough for everyone in the county to have 34 pills a year. That fueled the opioid epidemic locally, which led to 115 overdose deaths in Whatcom County in those years alone. Nationally, the prescription opiate epidemic resulted in nearly 100,000 deaths during that time, according to the Washington Post.
The Post released the data to media outlets across the country after going through a year-long legal battle to get it. The database tracks oxycodone and hydrocodone sent to pharmacies and medical providers throughout the county.
The staggering numbers released by the Washington Post weren’t surprising to the Whatcom County Health Department, which monitors state records on the number of prescriptions and overdoses. Whatcom County’s syringe exchange program, which provides addicts with clean needles, saw a nearly four-fold increase from 2009 to 2017. Nationwide, many prescription opiate addicts switched to heroin as drugs got more expensive and regulated in the early 2010s.
“We know unintended use rises when there is greater accessibility of a substance,” said Joe Fuller, program specialist at the county health department.
The problem’s roots go back decades. Many health care professionals falsely believed opioids weren’t addictive because of a 1980 letter to the editor published in the New England Journal of Medicine. The letter, which referred to a survey of patients who were monitored closely in a hospital, said, “we conclude that despite widespread use of narcotic drugs in hospitals, the development of addiction is rare in medical patients with no history of addiction.”
Drug marketing companies removed context from that quote and attributed it to the journal, without mentioning that it was written in a letter to the editor. That led to increases in opiate use throughout the country. More recent studies, including one in the New England Journal of Medicine, now disprove that theory.
Where the 47 million pills went
Countywide, the most pills went to Walgreens in Bellingham, which received 3.19 million pills at one branch and 2.78 million at another. Rite Aid in Blaine received 1.66 million pills – enough to supply the 2010 population of Blaine (4,684, according to the U.S. Census Bureau) with more than 50 pills per person per day. Rite Aid did not comment for this story.
Hoagland Pharmacy in Bellingham received the second highest number of pills of any pharmacy in the county, getting 3.1 million pills at its main pharmacy and nearly 1.7 million at its long term care pharmacy. Of the pharmacies that topped the DEA’s list, only Hoagland Pharmacy made someone available to talk.
Sonia Gale, Hoagland’s pharmacy manager, said about the number of pills: “Sadly, that sounds about right.” A small number of people taking 90 or 100 pills a month skew the average, she said.
Before the Washington State Department of Health (DOH) started a prescription monitoring program in 2012, pharmacists didn’t have data or power to do much about prescription pain pill abuse, she said.
That prescription monitoring program requires pharmacists to report all transactions and includes a database that pharmacists use to look up when and where patients last filled prescriptions. Before it existed, pharmacists wouldn’t be able to tell if a prescription had just been filled elsewhere; patients could drive down I-5 getting pills at different pharmacies, Gale said.
Using the database, pharmacists can also tell how often and for how long opiates are prescribed to their clients, and call doctors if they’re concerned about the amount.
“Every pharmacy records what they dispense that day,” Gale said. “That has been a huge tool to better regulate painkillers.”
The database also allows the DOH to send feedback reports to doctors and other prescribers, letting prescribers know if they are writing more prescriptions than their peers, said Blake Maresh, deputy director for the DOH’s office of health professions.
In addition to pharmacies, doctors, podiatrists, dentists and veterinarians also received prescription pills between 2006 and 2012. Seven different veterinarians received more than 1,000 opiates during the seven-year period.
Lori Maness, a traveling relief doctor of veterinary medicine who fills in for vets on maternity leave or other long-term breaks, said opiates are prescribed primarily to cats and dogs, and usually for end-of-life pain management or for back surgeries and hip replacements.
Maness is currently at Whatcom Veterinary Hospital in Ferndale, which received 9,500 prescription opiates from 2006 to 2012.
Since she began her career as a veterinarian in 1992, Maness has seen big changes in opioid regulation, she said; her first boss had a morphine addiction that he covered for years. “What I experienced with my boss was the community was sort of a protective. The board was like, oh send him to rehab,” she said. “That, I believe, has changed. And employers are much more conscious about their staff and the drugs.”
Now, most veterinarians don’t have pills at their offices, Maness said. Clients get their pets’ prescriptions filled at pharmacies instead. Veterinarians also have to report using the state prescription monitoring program.
“Things were different from 2006 to 2012. There was less regulation,” she said.
How does Whatcom compare?
Whatcom County’s average of 34.3 pills per person per year is on the low end for the state. Washington’s average for 2006-2012 is about 40 pills per person per year.
Clallam County, on the north end of the Olympic Peninsula, topped the list, receiving 76.6 pills per person per year. Klickitat County in south central Washington received 18.5 pills per person per year, the fewest of Washington’s counties. Closer to home, 49.5 pills per person per year went to Skagit County and 45.6 to Snohomish County.
Nationally, more than a dozen counties received enough pills to supply everyone living there with more than 100 pills per year.
Those making money on manufacturing and distributing the pain pills that came to Whatcom County from 2006 to 2012 are mostly multinational corporations. McKesson, a Texas-based pharmaceutical distributor, supplied Whatcom County with 13.6 million, or 29 percent of the pills tracked in the DEA database.
In a page on McKesson’s website dedicated to frequently asked questions about its role in the opioid crisis, the distributor with more than $200 billion in annual revenue said, “Any suggestion that McKesson influenced the volume of opioids prescribed or consumed in this country would reflect a misunderstanding of our role as a distributor.”
Among drug manufacturers, SpecGx LLC, a subsidiary of Ireland-based Mallinckrodt, shipped the most pills to Whatcom County (more than 20 million). Actavis and Par Pharmaceutical, two other makers of generic pharmaceuticals, ranked second and third, producing 13 million and 8.2 million of the pills that came to Whatcom County, respectively.
State DOH data on opioid overdoses shows little change since 2012 – the most recent year in the DEA data. The flood of pain pills across the country and subsequent regulation of prescription practices led many addicts to look elsewhere for opiates. Recent national studies show that about 80 percent of current heroin users first abused prescription opioids.
Since 2012, the county has averaged 14.4 deaths per year, according to the DOH. That’s about two per year less than from 2006 to 2012. The number of hospitalizations locally due to drug overdoses continues to climb.
The situation is only just beginning to improve, said Jennifer Moon, communications and public relations associate for Unity Care NW, a Whatcom County healthcare system with services ranging from primary care to dental, psychiatry and urgent care.
“In probably the last five or so years we’ve really reduced our prescribing of opioids,” she said. “We have developed a chronic pain program that offers qigong and yoga as part of alternative treatments.”
Unity Care NW has a medication drop box in its pharmacy aimed at getting unused drugs out of circulation and it also distributes naloxone, which is used to treat overdoses. Unity Care NW also has a program for medicated assisted treatment, which uses medication to block opioid receptors so that they become ineffective. The Ideal Option Clinic, which opened in Bellingham in March, also does medication-assisted treatment.
“There just haven’t been that many treatment resources in the community,” Moon said. “I feel like that’s now beginning to change.”