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Probing court records helps uncover West Virginia opioid profits Date: 05/05/17

Eric Eyre

By Eric Eyre

When my newspaper, the Charleston Gazette-Mail, went to court last year to unseal records detailing pain pill shipments to West Virginia, lawyers for the nation’s largest prescription drug distributors strongly objected. In court filings, they accused the Gazette-Mail of sticking its “intrusive journalistic nose” where it didn’t belong. They asserted the information was “highly confidential” and included “trade secrets.”

Ultimately, the judge sided with us and unsealed the records. Over the next several months, I used those records as a starting point to track a deluge of prescription opioids into West Virginia, following the shipments to individual counties, pharmacies and families. The search culminated with our series, “Painkiller Profiteers,” which was published in December.

Our data-driven investigation found that drug wholesalers had shipped 780 million hydrocodone and oxycodone pills to West Virginia in just six years, a period during which 1,728 people fatally overdosed on those two powerful painkillers. We showed the wholesalers supplied ever-higher doses of the pills – a telltale sign of growing addictions – even as the death toll climbed.

The largest shipments often went to mom-and-pop drugstores in poor, rural counties in southern West Virginia. Here’s one example: In Kermit, population 392, a single pharmacy received nearly 9 million hydrocodone (Lortab) pills over two years.

I first became familiar with drug wholesalers – companies that ship opioids and other drugs from manufacturers to pharmacies and hospitals – while investigating our state attorney general's financial ties to the drug industry in 2013. I had written extensively about rogue doctors who overprescribed opioids, which prompted the state to shutter many so-called "pill mill" clinics.

Eric Eyre’s investigative series, Painkiller Profiteers, chronicled massive pain pill shipments to West Virginia. This photo shows the cremated ashes of a West Virginia woman who died from a drug overdose. (Photo: Sam Owens, Charleston Gazette-Mail)

Now I wanted to examine the problem higher up in the supply chain. In April 2016, the Gazette-Mail filed a motion to unseal court records that included details about the companies' shipments of hydrocodone and oxycodone. In 2015, the attorney general had filed under seal a revised complaint against a group of drug wholesalers, which was part of a lawsuit filed three years earlier by his predecessor. It seemed highly unusual that the allegations raised in a state lawsuit could be kept hidden, so we filed a motion to intervene in the case, asking a judge to unseal the updated complaint. Our lawyers argued that the documents were of enormous public interest because of the growing opioid epidemic in West Virginia. The drug companies fought to keep their sales data secret. There were multiple court hearings and legal briefs filed back and forth. Ultimately, the judge ordered most of the complaint unsealed, although he kept under seal shipment information from smaller wholesalers that had previously settled claims with the state.

In October, the Gazette-Mail was back in court, filing another motion to unseal court records – this time in a case against drug giant Cardinal Health, the largest supplier of pain pills in West Virginia. The state had sued Cardinal separately in 2012. Cardinal Health's lawyers contended they had an agreement – a “protective order” – with the attorney general to keep allegations about their pill shipments under seal. The judge rejected that assertion and released the complaint.

The unsealed documents included snippets about the drug firms' shipments to a handful of counties and pharmacies, some of which referenced “DEA data.” I filed multiple Freedom of Information Act requests, or FOIAs, with the attorney general’s office to pry loose that data. After stalling for nearly three months, the attorney general released it. The documents disclosed that the number of pain pills sold to every pharmacy in the state and the drug wholesalers’ shipments to all 55 counties in West Virginia. We believe we are the first newspaper in America ever to obtain confidential sales data for drug distributors and pharmacies.

With a major assist from my colleague, Andrew Brown, we analyzed the data by type of drug (such as oxycodone or hydrocodone), pharmacy, wholesaler, county and year. The analysis identified pharmacies like the one that was shipped nearly 9 million hydrocodone pills in a two-year period. We also were able to identify counties where distributors dumped a disproportionate number of pills.

I next obtained from our state’s health statistics center county-by-county overdose data broken down by year. West Virginia has the highest drug overdose death rate in the nation, and counties in southern West Virginia had the highest percentage of fatal overdoses in the state. I then tapped the U.S. Centers for Disease Control and Prevention’s (CDC) Wonder database to compare overdose death rates in West Virginia counties with counties other states. The four counties with the highest prescription overdose deaths in the United States all were in West Virginia.

Our state’s Board of Pharmacy is supposed to regulate drug distributors and pharmacies, so I wondered why so little was done to turn off the spigot of pain pills. A local pharmacist tipped me off about a state rule requiring drug wholesalers to report pharmacies that order a suspicious number of pain pills.

This is the mother and daughter of a woman who died from a drug overdose in 2015. (Photo: Sam Owens, Charleston Gazette-Mail)

I made written request to see the reports. A pharmacy board staffer brought out two banker’s boxes stuffed with faxed reports. When I asked for a total, the board’s executive director said no one had ever counted them. In fact, no one had investigated a single suspicious order. Moreover, nobody had contacted any drug wholesaler or pharmacy about a report. So I started counting the suspicious drug order reports – by hand, one-by-one. There were more than 7,200 reports, and the pharmacy board had not acted on a single one.

Two weeks later – even before the series published – the pharmacy board voted unanimously to begin reviewing the reports and referring them to the proper authorities. At least 11 state legislators became co-sponsors of legislation that would require the board to log suspicious orders and forward copies to the attorney general.

It has been several months since the series ran, and I’m still hearing from recovering addicts and families who have lost loved ones to overdoses caused by heroin and prescription pain pills. I’ve also talked numerous journalists in other states who are digging into the causes and costs of the opioid problem. We are sharing ideas and shining a spotlight on an epidemic that claims more lives every day.

Eric Eyre is an investigative reporter with the Charleston Gazette-Mail in West Virginia. Since joining the newspaper in 1998, he has covered health, education, business and state government. His investigative stories have mostly spotlighted issues in rural West Virginia communities. His series Painkiller Profiteers took first place for investigations in AHCJ’s 2016 Awards for Excellence in Health Care Journalism and won the Pulitzer Prize for investigative reporting. Eyre will be among the speakers at the 2017 Rural Health Journalism Workshop.