Almost 26.4 million prescription pain pills were dispensed in Victoria County over a seven-year period, enough for 43 pills per person per year, according to a newly released database.
The database, published by the Washington Post, shows the path of prescription pain pills in the U.S. from 2006 to 2012, laying bare the impact of the flood of prescription opioids as deaths by opioids in the U.S. skyrocketed.
In total, the data reveals that 76 billion oxycodone and hydrocodone pills were shipped to U.S. pharmacies during the seven-year time period, during which drug overdose deaths reached historic levels. In total, prescription and illegal opioids have killed more than 430,000 Americans since 2000, according to the U.S. Centers for Disease Control and Prevention.
The millions of pills distributed in Crossroads counties don’t show the full extent of the opioid epidemic here. The database only captures the paths of oxycodone and hydrocodone pills, which make up the majority, though not all, of prescription opioids. And although prescription pills can kill people, the majority of those who fall victim to opioid abuse disorder are killed after overdosing on illegal opioids, like heroin.
Dr. Joy Alonzo, an assistant clinical professor of pharmacy practice at Texas A&M University, said researchers and public health officials have been working in the dark without access to the newly released data, which the Drug Enforcement Administration maintained but refused to release to the public. She said the data’s release was long overdue.
“We’re in the throes of the opioid epidemic, and here we are with this really great resource that would tell us where controlled substances were distributed, and yet none of us had access to this data,” she said. “That’s actually stunning.”
What the data shows
The database, known as the Automation of Reports and Consolidated Orders System, shows the path of hydrocodone and oxycodone pills, from every manufacturer to distributor to pharmacy. The data is at the heart of what could be the largest civil litigation in U.S. history, as 2,000 state, local and tribal governments sue pharmaceutical companies over the country’s deadliest drug epidemic. The data was released to the plaintiffs in the case under protective order, but the Washington Post and HD Media, the publisher of West Virginia’s Charleston Gazette-Mail, argued that it should be made public. In June, the courts sided with the news organizations, and the data was made public in July.
During the seven-year timeframe, 43 pills were released per resident each year in Victoria County, more than the per capita average in Harris County, which is home to Houston.
“It’s actually relatively high, and I can’t explain that,” Alonzo said when looking at the Victoria County data. “I can’t explain that, and I wish I understood why, but we all just got access to this database last week.”
The only Crossroads county to have a higher per capita rate of prescription pain pills was Calhoun County, where the total number of pills broke down to 48 per person per year.
But although this data breaks down the paths of legal opioid pills, there’s still a lot that’s unclear about the cost of the opioid crisis in Texas.
In 2017, at least 1,458 people were killed by opioids, including prescriptions, synthetic opioids and heroin. But that number could be a serious undercount, Alonzo said, because of the state’s system for tracking deaths. Unlike in other states, most death certificates are not completed by a physician. That means that some deaths that could be caused by opioid overdoses are improperly attributed to natural causes.
Without additional research, Alonzo said it was too early to draw major conclusions about what the data shows about the opioid crisis in the Crossroads.
How Texas compares
The opioid crisis has not battered Texas as badly as other states, but the available data still shows that the legal drugs have drastically increased their prevalence. The number of opioid overdose deaths has more than quadrupled since 1999, according to research from the Hobby School of Public Affairs at the University of Houston. Nationwide, the number of drug overdose deaths peaked in 2017. Last year, 68,557 died of drug overdoses in the U.S., the first drop since 1990.
Experts like Alonzo and Jane Maxwell, a research professor at the University of Texas at Austin, said it’s unclear why certain regions of the country saw such a tremendous influx of pills, as illustrated by the DEA data across the U.S.
“I don’t know. Honestly,” Maxwell said.
Alonzo and Maxwell said the database would allow for researchers to develop a more nuanced understanding of how prescription pain drugs are entering communities. Because many heroin users develop opioid use disorder after taking prescription pain pills, the data can show how many people first interact with the drug.
The most critical switch, experts agree, is that addiction be viewed as a public health problem and not a law enforcement problem.
Some mortality data indicates that the worst of the opioid crisis might be behind us. Last year’s drop in the number of drug overdose deaths in the U.S. is mostly attributed to a decline in pain pill overdoses. But deaths caused by drugs like cocaine and meth are starting to increase across the country. In Texas, more overdose deaths are caused by meth and cocaine than by opioids.
At Billy T. Cattan Recovery Outreach Center, the only drug rehabilitation center in the region, executive director Daniel Barrientos said at least 25% of the 500 people who have sought treatment there in the past year have struggled with addiction to meth and another quarter with addiction to alcohol. From June 2018 to June 2019, he said, just a fraction of clients at Billy T. Cattan suffered from opioid abuse disorder.
Alonzo and Maxwell cautioned against looking at deadly drugs as separate issues, noting that many people who suffer from substance use disorders use more than one substance.
“I think we need to be careful that we don’t get drawn into a meth versus pain pill argument because they’re both deadly,” Maxwell said. “We can’t say, ‘Well, our problem is meth, and thank God they’re not using pain pills; therefore, we don’t have to worry about it.”