A12 EZ RE THE WASHINGTON POST.TUESDAY, AUGUST 13 , 2019
Shearer Drug is among thou-
sands of small, independent
pharmacies — from Smith County
Drug Center in Carthage, Tenn.,
to Zion Pharmacy in Kanab, Utah
— that handled large volumes of
hydrocodone and oxycodone
from 2006 through 2012 and until
now have largely avoided public-
ity for their roles in the epidemic.
The pharmacies and the opi-
oids they purchased are revealed
in the DEA’s Automation of Re-
ports and Consolidated Orders
System, known as ARCOS, which
tracks every pain pill distributed
nationwide. The Post and HD
Media, which publishes the
Charleston Gazette-Mail in West
Virginia, waged a year-long legal
battle for access to the database,
which the government and the
drug industry had sought to keep
secret. A judge recently ordered
the release of seven years of data-
base records, which expose the
paths of more than 70 billion pain
pills distributed to about 83,
pharmacies.
The DEA has maintained this
database for roughly two decades
but did not regularly mine the
records to identify pharmacies
buying unusual quantities of opi-
oid pills, according to current and
former DEA officials. The agency
relies on drug companies and
pharmacies to monitor and re-
port suspicious purchases. Let-
ting the industry police itself
helped fuel the epidemic that has
devastated communities and
claimed nearly 100,000 lives from
2006 through 2012, lawyers for
the local governments who are
suing the drug companies con-
tend.
“There’s plenty of blame to go
around. I don’t know that anyone
has been perfect in doing every-
thing possible to eliminate the
epidemic,” said B. Douglas Hoey,
chief executive of the National
Community Pharmacists Associ-
ation, which represents about
15,000 independent pharmacies.
“I do look to the DEA for leader-
ship.”
Hoey cautioned against judg-
ing pharmacies based only on the
number of opioids they handled.
There are legitimate reasons
small pharmacies can have out-
size volumes, including proximity
to a surgical center.
“The numbers don’t always tell
the whole story,” Hoey said.
To study the pharmacies, The
Post examined the total number
of pills that contained oxycodone
and hydrocodone sold to each
pharmacy over the seven years,
and other metrics, such as year-
over-year orders and overdose
death rates in the counties where
the pharmacies are located. The
review excluded some small cities
that are designated as counties,
which inflates the per capita cal-
culations.
The analysis reveals nearly half
of the opioid pills were purchased
by just 15 percent of the drug-
stores, which include Shearer
Drug and the other seven phar-
macies mentioned in this article.
Many of the high-volume phar-
macies had annual double-digit
growth in pain pills and bought
far more opioids than competi-
tors in the same counties. The
analysis also considered proximi-
ty to urban centers.
In Paintsville, Ky., where a
winding creek snakes through
the town of roughly 4,000 people,
Value-Med Pharmacy and Medi-
cine Cabinet Pharmacy pur-
chased almost 20 million pills
that contained oxycodone and
hydrocodone from 2006 through
2012.
These two pharmacies ac-
counted for 79 percent of the total
opioid pills distributed to five
drugstores in surrounding John-
son County.
The number of pain pills ob-
tained by Medicine Cabinet
surged more than 30 percent in
both 2008 and 2009. Meanwhile,
the death rate in the county
climbed to nearly nine times the
national rate. Owners for Value-
Med and Medicine Cabinet did
not return messages seeking
comment.
Some of the pharmacies re-
viewed by The Post have had
trouble with regulators or law
enforcement, but for others there
is no public record of any scrutiny
by authorities. A DEA spokesman
said he could not provide a com-
plete list of all enforcement ac-
tions by the agency against phar-
macies nationwide for violations
of the Controlled Substances Act.
An hour east of Nashville, in
the small town of Carthage,
Tenn., orders of pills that con-
tained oxycodone and hydro-
codone skyrocketed about 74 per-
cent from 2006 through 2012 at
Smith County Drug Center, a
stately brick pharmacy with
white columns.
Smith County Drug Center
bought 9.5 million opioid pills, or
more than half the painkillers
distributed to the county’s five
pharmacies in those seven years.
Smith County has roughly 19,
people.
In all, Smith County Drug Cen-
ter acquired enough opioids to
give each person in the county 72
pills every year from 2006
through 2012. In that time, a total
of 21 people died of opioid over-
doses in the county, nearly three
times the national death rate.
Janet Trainham, who identi-
fied herself as an owner of the
pharmacy, declined to discuss the
store’s opioid sales when reached
by phone.
“I’m not going to comment on
that,” Trainham said and then
hung up. Follow-up calls and
messages were not returned.
On Aug. 25, 2016, the DEA sent
the pharmacy a “Letter of Admo-
nition” identifying certain defi-
ciencies, according to Kevin
McWilliams, a DEA spokesman in
the agency’s Louisville field of-
fice. These DEA letters are not
public and the agency would not
reveal specifics. But McWilliams
said the letters are “issued for
matters relating to errors in re-
cord-keeping or security deficien-
cies.”
He said the concerns raised in
the letters are not criminal and
provide pharmacies with the abil-
ity to take corrective action.
McWilliams said there are no
subsequent regulatory actions on
file for Smith County Drug Cen-
ter.
Even with repeated scrutiny
from regulators, some pharma-
cists and their drugstores have
continued to stay in business.
In 2000, James Fred Carrico
was fined $500 by the Kentucky
Board of Pharmacy for failing to
properly dispense Percocet,
among other issues, when he
served as a pharmacist at a Wal-
greens in Louisville, according to
board records.
Five years later, Carrico opened
Booneville Discount Drugs in
Owsley County, Ky., where a stat-
ue of the pioneer Daniel Boone is
perched above the store’s burgun-
dy sign. Carrico’s drugstore went
on to purchase about 2.9 million
pain pills from 2006 through
2012 — or more than 70 percent of
the total pain pills distributed to
the county’s three pharmacies,
according to the database.
That is the equivalent of 86
pills for each person every year in
this impoverished community
along the South Fork of the Ken-
tucky River. Like many parts of
Appalachia once rich in natural
resources, Owsley has been rav-
aged by the disintegration of the
timber and coal industries.
State records show that Carrico
has faced alcohol- or drug-related
charges eight times since 2009,
and five times, the charges result-
ed in convictions. The pharmacy
board suspended his license in
2011 and cited his arrest for driv-
ing under the influence several
SEE OPIOIDS ON A
Now, with the release and
analysis of a federal database
tracking every pain pill sold in the
United States at the height of the
opioid crisis, one Clinton County
pharmacy has come into sharp
focus: Shearer Drug, located less
than two miles from the funeral
home that Talbott runs in Albany,
Ky. The family-run pharmacy
purchased nearly 6.8 million pills
that contained hydrocodone and
oxycodone from 2006 through
2012 — enough to give 96 pills
each year to every person in the
county of roughly 10,000 resi-
dents.
During this period, Shearer
Drug procured more opioid pills
on a per capita basis per county
than any other retail pharmacy in
the United States, according to
The Washington Post’s analysis of
the federal database maintained
by the Drug Enforcement Admin-
istration. In 2012 alone, Shearer
Drug bought over 1.1 million pain
pills — a 55 percent increase from
2006.
Kent Shearer, a 67-year-old
pharmacist who has owned
Shearer Drug since the late 1990s,
according to state records, de-
clined to discuss the volume of
opioids dispensed at the pharma-
cy or answer other questions
about his business. Shearer oper-
ates his pharmacy out of a build-
ing he has shared with a doctor
who pleaded guilty in federal
court in March to illegally pre-
scribing opioids. Shearer and the
doctor are business partners who
co-own the building through a
limited liability company, accord-
ing to state records and the doc-
tor’s lawyer.
“I just can’t make any com-
ments,” said Shearer, whose name
is emblazoned in gold on the
pharmacy’s window.
OPIOIDS FROM A
THE OPIOID FILES
WASH.
ORE.
CALIF.
NEV.
IDAHO
MONT. N.D.
S.D.
NEB.
WYO.
UTAH
COLO.
N.M.
ARIZ.
TEX.
KAN.
OKLA.
LA.
ARK.
MO.
IOWA
MINN.
WIS.
MICH.
ILL. IND.
OHIO
PA.
N.Y.
VT.
N.H.
MAINE
MASS.
CONN. R.I.
N.J.
MD. DEL.
VA.
N.C.
S.C.
MISS. ALA. GA.
TENN.
KY.
FLA.
W.VA.
ALASKA
HAWAII
.
Atlanta
Dallas
Houston
Denver
Las Vegas
Seattle
Los Angeles
Louisville
Pittsburgh
New York
Philadelphia
D.C.
St. Louis
Chicago
GRAPHICS BY ARMAND EMAMDJOMEH, ANDREW BA TRAN, AARON WILLIAMS, DANIELLE RINDLER AND TIM MEKO/THE WASHINGTON POST
Circles in the map are scaled by the
total number of pills shipped to each
pharmacy from 2006 through 2012.
Circles are colored by the total number
of pills per person within a five-mile
radius of the pharmacy per year.
0 to 50 50 to 150 150 or more
‘Just too many
people dying
from these drugs’
Opioid death rates soared in the communities that were flooded with
pain pills. The national death rate from opioids was 4.6 deaths per
100,000 residents. But the counties that had the most pills distributed
per person — many in West Virginia, Kentucky and southern Ohio —
experienced more than three times that rate.
KENTUCKY
—Knoxville
Ashland—
—Logan
Lexington— Paintsville
Smith County Drug
Burden Drug Center
Shearer Drug
Value-Med
Medicine
Booneville Cabinet
Discount Drugs
Tug Valley Pharmacy
WEST
VIRGINIA
TENN.
N.C.
VIRGINIA
50 MILES
OHIO
PHARMACY TOTAL PILLS
PILLS PER
PERSON
SHEARER DRUG CLINTON COUNTY, KY 6,778,550 96
HARDIN COUNTY DISCOUNT PHA HARDIN COUNTY, IL 2,789,740 90
ARNZEN'S KAMIAH DRUG LEWIS COUNTY, ID 2,298,640 88
BOONEVILLE DISCOUNT DRUGS OWSLEY COUNTY, KY 2,850,040 86
C & R CLINIC PHCY MORTON COUNTY, KS 1,916,920 85
GLENN'S APOTHECARY CRITTENDEN COUNTY, KY 5,171,800 80
SMITH COUNTY DRUG CENTER INC. SMITH COUNTY, TN 9,508,190 72
STROSNIDER MINGO COUNTY, WV 13,168,350 70
MAIN STREET PHARMACY COMANCHE COUNTY, KS 915,740 70
HOWARD'S DRUGS LAKE COUNTY, OR 3,706,210 68
R&K PHARMACY INC. POLK COUNTY, TN 7,627,625 66
SAFEWAY INC. MINERAL COUNTY, NV 2,175,110 65
BOYDS FAMILY PHARMACY EMERY COUNTY, UT 4,843,750 65
MK STORES INC. LUCE COUNTY, MI 3,029,550 65
CLINIC PHARMACY HARMON COUNTY, OK 1,294,890 65
The 15 pharmacies with the most pills per person,
based on county population, 2006-
From 2006 through 2012, 15 percent of pharmacies ...
... received 48 percent of pain pills
1,000 pharmacies
100,000,000 pills
Source: Washington Post analysis of Drug Enforcement Administration data
“There’s plenty of
blame to go around....
I do look to the DEA
for leadership.”
B. Douglas Hoey,
chief executive of the National
Community Pharmacists Association
How many pills at your store?
A first-ever, granular look at the
opioids that were dispensed into
local communities: wapo.st/
pharmacies-pain-pill-map.