Pills gained strength as opioid crisis grew: analysis

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Early this decade, the amount of opioids -- measured by their total potency -- kept going up, according to a new report, even as the number of pills distributed started to decline.

The reason? According to a new analysis, doctors were prescribing — and the industry was providing — stronger pills.

The Associated Press analyzed drug distribution data released as a result of lawsuits against the industry. The news agency found that the overall opioid amount shipped to pharmacies, medical providers and hospitals increased 55 percent from 2006 through 2012. The number of pills rose significantly over that period, too — but that increase was lower, about 44 percent. (The amount of medication was calculated via a standard measure of potency known as a morphine milligram equivalent, aka the MME.)

In 2012, as the death toll from the nation’s opioid crisis mounted, drug firms shipped out enough of the painkillers for every man, woman and child in the U.S. to have nearly 20 days' worth.

In some counties, mostly in Appalachia, that figure was far higher -- some 100 days' worth.

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In 2006 and 2007, the counties at the top of the list of those receiving the most opioids were scattered about the eastern U.S. By 2012, they were all in the Appalachian region -- and the numbers were up substantially, too.

For instance, in 2006, Tennessee’s Hamblen County received the most opioid medication per person in the U.S. — 70 days’ worth of a typical prescription for every man, woman and child. By 2012, the top county was Norton, Va., and the number of days’ worth of opioids was nearly doule, or 134.

In calculating days of medication, AP used 50 MMEs as a daily dosage. That is the upper limit beyond which the Centers for Disease Control and Prevention (CDC) urges doctors to apply caution.

The data comes from the Drug Enforcement Administration (DEA) collection of information from pharmaceutical companies about how controlled substances were distributed down to pharmacies, doctors and hospitals. It’s a key part of the case for some 2,000 state, local and tribal governments suing the industry over the opioid crisis.

“It shows it wasn’t just the number of pills being shipped that increased. The actual amount of opioids being prescribed and consumed went up,” said Anna Lembke, a Stanford University professor who researches opioids and is serving as a paid expert witness for plaintiffs in the litigation.

“We know that the higher the dose of prescribed opioids, and the longer patients are on them, even for a legitimate pain condition, the more likely they are to get addicted.”

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The first of the federal trials, involving claims from Ohio’s Cuyahoga and Summit Counties, is scheduled to start in October.

Last week, a judge agreed to make public the data covering 2006 through 2012. During that period, opioid overdose-related deaths in the U.S. increased from about 18,000 a year to more than 23,000. Since then, the number has doubled, and opioids have overtaken automobile accidents as the leading cause of accidental death in the country.

Heroin and even stronger illicit drugs such as fentanyl drove the increase for most of this decade. Studies have found that most new heroin users started with prescription drugs, theirs or someone else's.

Plaintiffs in the lawsuits claim drugmakers overstated the benefits of opioids and played down the addictive qualities, persuading doctors to offer the drugs to more patients and in higher amounts.

The government lawsuits also say the companies violated DEA policy by shipping orders even when they believed them to be suspicious because they were far larger than normal.

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The origins of the opioid crisis are largely traced to the mid-1990s, when Purdue Pharma introduced OxyContin. Up until then, opioids were generally reserved for surgery or cancer patients in extreme pain.

The Associated Press contributed to this report.