The Washington Post - 13.08.2019

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.