A central argument leveled in lawsuits filed countrywide against pharmaceutical distributors, including my company, AmerisourceBergen, is the claim that we “overdistributed” opioid-based medication to particular geographies. These suits are fueled by data that distributors regularly provided on an individual basis to the Drug Enforcement Administration.
For many years, the DEA alone had access to the individual data of each distributor. Distributors only gained access to the combined data, including that of their competitors, thanks to the recent signing of the SUPPORT Act.
This past summer, media outlets also gained access to that data, (specifically from 2006-2012) and have sought to make it easily accessible to the public. One of the most common approaches to evaluating the data since its public release has been for local plaintiff lawyers and regional outlets alike to focus how many pills were distributed for each person living in their given region.
But, while that basic approach may seem logical on its surface, it doesn’t stand up to even a basic understanding of how pharmaceutical products reach patients.
For example, according to the data published by the Washington Post, South Carolina had the third-highest number of prescription opioids per person. Lost in these broad generalizations, however, was the fact that a single pharmacy in South Carolina received nearly 30% of all shipped prescription opioids. That pharmacy is the Ralph H. Johnson VA Medical Center, which provides mail order pharmacy services for the U.S. Department of Veterans Affairs. This single facility supplies all mail order controlled substances east of the Mississippi River.
Yet when South Carolina filed suit in August, the language in the lawsuit went as far as to quote this highly misleading fact, that Charleston County had the highest rate of pain pills per person per year of any county in the United States from 2006 to 2012 (248.3 pills per person per year). This ignores that approximately 86% of those pills went to a single VA medical center which presumably then mailed them, based on prescriptions, to patients across the eastern half of the U.S.
Although some might try to dismiss this as an extreme example, it is only one of many. For example, Tennessee was fourth on the list of average pills per person. ARCOS data made accessible by the Washington Post presents Rutherford County as receiving enough pain pills for each county resident to receive 67 pills per year. But it turns out that 40% of those pills went to a pharmacy owned by a state senator. That pharmacy provided pain medication to a hospice organization that treats patients throughout all of middle Tennessee.
Such examples should stand as a reminder that large hospitals, hospices, Veterans Affairs facilities, and other medical institutions dot the entire country. Patients travel across county and state borders to reach them, and sometimes prescriptions cross state and county lines to reach patients. The concentration of opioids in one particular county could be entirely meaningless, yet such concentrations are consistently presented by the media and even in court as supposed evidence of malicious intent by companies like mine.
If distributors were to bow to media pressure and ship opioid painkillers to counties, cities, and states on a “pills per person” basis, then patients living in counties with big hospitals — such as Olmstead, Minn. (where Mayo Clinic pharmacies received the most opioid pills), or Alameda, Calif. (where Kaiser hospitals were the top recipient), might not be able to access the medications they need.
Litigation and sensational headlines driving the “pills per person” narrative creates misconceptions that, if followed, could lead to serious unintended consequences that are being overlooked.
To truly address the crisis of opioid abuse, there must be collaboration between regulators, law enforcement, prescribers, and the pharmaceutical industry. It won’t do to toss about careless generalizations that could ultimately restrict access to needed medications.
Gabe Weissman is senior vice president for communications of AmerisourceBergen.
