Last week marked yet another ill-conceived media attack on the drug distributors. In an attempt to paint the broader industry as a group of entirely bad actors, the press has yet again taken data out of context and pushed the false narrative that distributors knowingly fueled the opioid epidemic.
In this case, the public release of the Automated Reports and Consolidated Ordering System, or ARCOS, database spanning from 2006 to 2012 demonstrated that distributors document each order of prescription opioids and share that information exclusively with the Drug Enforcement Agency . However, what the majority of the reporting failed to point out is that DEA, which alone had access to that information, acted insufficiently, if it acted at all.
The DEA is the regulatory and enforcement agency in charge of controlled substances. It not only maintains the ARCOS database, but also sets and adjusts the quantity of prescription opioids that can be manufactured each year.
The DEA bases these drug quotas on clinical and research needs, including treatment for sufferers of chronic pain, palliative care, or acute pain following an operation.
Although DEA maintains the comprehensive ARCOS database of all opioid orders, its contents were historically sealed and unavailable to anyone except the DEA. This means that while the data is now available for media and the public to analyze in hindsight, it was not available at the time to distributors while they were attempting to make decisions about how to fulfill their regulatory duties.
Progress has been made in this area with the passage of the SUPPORT Act in late 2018. Today, distributors have access to the previous six months of orders made by any given pharmacy. While real-time access to data would be ideal, this increased visibility allows wholesalers to make more informed decisions about whether to fulfill an order from a specific pharmacy.
Needless to say, to treat the release of such data as a “smoking gun” is highly misleading. The DEA had it the whole time, as the information was provided by distributors. But only now are distributors also getting the opportunity to review and analyze it.
In addition to DEA’s role in regulating the distributors, there are several other safeguards in place to ensure a safe supply chain. For example, only licensed physicians are able to prescribe FDA-approved medications, which are then delivered to patients by state-licensed pharmacies. Given the level of federal and state oversight required for a drug to travel from a factory to a patient, you might assume that these government agencies would accept some responsibility for the current opioid epidemic.
Instead, the blame has been placed squarely on the supply chain — manufacturers, distributors, and pharmacies — without regard for what federal and state involvement or oversight have been. In addition, all large members of the supply chain are falsely painted with the same brush of misleading mathematics. While espousing rumors of corporate greed and negligence may sell newspapers, it quite simply misses the mark.
Let’s break it down: According to the ARCOS data, six companies shipped 75% of opioid medications from 2006 to 2012. While estimates indicate my company, AmerisourceBergen, has a 31.6% overall market share for prescription drugs, the ARCOS data shows we shipped just 11.7% of opioid medications.
Further, the very outlets that covered the ARCOS data last week have previously stated that we and our two largest competitors control 85% of the total market. Yet, our three companies accounted for just 44% of the opioid market during that time period.
There’s clearly a story here, but it’s opposite from the prevailing narrative. The data shows that while the majority of medicines were shipped by the three biggest distributors, the majority of opioids sold were shipped by other companies. Unfortunately, castigating the biggest distributors makes for a better headline, and perhaps a larger payout for trial lawyers.
Sensational headlines and public outrage aside, feverish and out-of-context judgments based on old ARCOS data paint the wrong picture. The media hype is leading to false, counterproductive accusations. To truly move forward in the fight against the opioid epidemic, data transparency and better regulation are imperatives.
Gabe Weissman is senior vice president for communications for AmerisourceBergen, one of the nation’s largest wholesale distributors of pharmaceuticals.
