TUESDAY, AUGUST 13 , 2019. THE WASHINGTON POST EZ RE A
THE OPIOID FILES
months earlier.
In 2012, Carrico and another
pharmacist at the store paid a
total of $60,000 to settle civil
allegations that they improperly
dispensed drugs, according to the
Lexington Herald Leader. A DEA
audit had found the Booneville
pharmacy failed to maintain in-
ventory records on controlled
substances 65 times over 18
months. A spokesman for the U.S.
attorney said he could not pro-
vide records on the case. Former
U.S. attorney Kerry B. Harvey in
the Eastern District of Kentucky
declined to comment.
Despite more than a decade of
documented problems, the Ken-
tucky Board of Pharmacy in 2013
voted to reinstate Carrico’s li-
cense with restrictions, according
to board minutes. Carrico, 66,
could not be reached for com-
ment, and has been hospitalized
since a fall in June, said his son,
Matthew Carrico.
His son told The Post his father
never worked behind the counter
of the pharmacy after 2012, when
the younger Carrico said he took
over the pharmacy.
Matthew Carrico, 36, said that
his father was a recovering alco-
holic and struggled again after
the 2009 killings of his wife and
mother-in-law, which remain un-
solved.
“You can only do so much to
help someone,” said the younger
Carrico, who serves on the board
of directors for the Kentucky
Pharmacists Association.
He said he fired his dad from
the pharmacy in 2018. State rec-
ords document a change in own-
ership a month after one of his
father’s arrests.
“I could not distance myself
more,” Matthew Carrico said.
Still, he defended the pharma-
cy’s high volume of opioids dur-
ing his father’s tenure, saying that
roughly 40 percent of his custom-
ers came from two nearby coun-
ties and that many of them were
recovering from injuries sus-
tained working in the coal indus-
try and other manual labor jobs.
He said opioid prescriptions at
Booneville have decreased since
2014, when the federal govern-
ment tightened rules for prescrib-
ing hydrocodone.
Carrico said he typically won’t
fill pain pill prescriptions for doc-
tors who aren’t in Owsley or the
surrounding counties and that he
is often berated for refusing to
refill prescriptions before they
are due. The pharmacy gives out
free naloxone, which can treat
opioid overdoses, a program that
is advertised in the drugstore
window.
“People might say the pharma-
cists don’t care. I do care,” Carrico
said. “This epidemic is destroying
this area. How would I have any
business if I helped facilitate this
problem? I don’t want people to
think I’m part of the problem
because I’m not.”
In New Mexico, Davis-Fleck
United Pharmacy bought nearly
4.5 million opioid pills from 2006
through 2012, or the equivalent of
53 pills for every person in Sierra
County, The Post’s analysis shows.
That volume may have attract-
ed the attention of the DEA sev-
eral years ago, according to owner
Ron Golubski, who said agents
visited him at the store located in
the town of Truth or Consequenc-
es. The pharmacist said he ex-
plained that he managed ac-
counts for four hospice facilities
and, for a long time, was the only
drugstore in a county that draws
many retirees and veterans.
“My numbers are greatly
skewed. I did not doubt that,”
Golubski said.
Golubski said he attempts to
combat the diversion of pain pills
by ensuring prescriptions are le-
gitimate, and reporting patients
who have attempted to use doc-
tored prescriptions and a physi-
cian suspected of running a pill
mill.
“I’m just one little drugstore in
the desert and we do our best to
try and curb it,” Golubski said.
“Once it leaves here, it’s out of my
control.”
Many of the top-dispensing
pharmacies nationwide have
changed hands since 2012, and
several of the new owners said in
interviews that opioid prescrip-
tions had fallen in recent years.
They attributed the decline to
more stringent prescribing habits
by doctors and increased scrutiny
by their pharmacists. The opioid
epidemic has also morphed: It
started with prescription pills,
which led to increased heroin use,
and has now spawned the fenta-
nyl crisis.
“There just weren’t any brakes
put on the supply and the volume
of opiates that went through our
pharmacies until the last four or
five years,” said Kurtney Stirland,
the former owner of Zion Phar-
macy in Kanab, Utah.
From 2006 through 2012, Stir-
land’s pharmacy purchased near-
ly 2.5 million pills that contained
hydrocodone and oxycodone, or
OPIOIDS FROM A
about 80 percent of the pills
distributed to the three retail
pharmacies in the county.
In 2009, state records show, he
was fined by the DEA and disci-
plined by the Utah Board of Phar-
macy for various problems at his
pharmacy, including failing to
conduct an annual inventory and
maintain required controlled
substance forms.
Stirland said he was “negli-
gent” with the record keeping but
never dispensed opioids without
prescriptions. He said he also
blames the drug manufacturers
and distributors for the opioid
epidemic.
“We all got caught off guard as
the years went by,” said Stirland,
who sold the business in 2016 and
still works there part-time. “I
think there’s a huge profit motive
by the manufacturers and the
wholesalers. I think they kind of
hung the independent pharma-
cies out to dry.”
Karsten Josie, a pharmacist
who started two years ago at Zion
Pharmacy under the new owner,
said the pharmacy takes a very
strict approach to pain pills.
Josie, whose grandmother died of
opioid-related problems several
years ago, said he counsels everycustomer on addiction risks and
symptoms of dependence, and
informs them about the anti-
overdose medication naloxone.
At the same time, he encourages
people to consider other pain
therapies.
“Taking an opioid shouldn’t be
a norm. It should be an excep-
tion,” Josie said. “I try not to
alienate patients.... However, it’s
my job to scrutinize that. There
has to be more education on
alternative options and more re-
alistic expectations of pain and
how much you’ve got to bear. I
give it my best shot.”
The pharmacy’s current owner,
Scott Robinson, said wholesalers
put a ceiling on opioid purchasesand he has never hit it.
Some of the stores with the top
pill counts have shuttered entire-
ly, including Tug Valley Pharmacy
in Williamson, W.Va., which
bought nearly 9 million opioid
pills from 2007 through 2012.
In July, Tug Valley Pharmacy’s
owner, Samuel “Randy” Ballen-
gee, was indicted as part of crimi-
nal charges filed against opioid
distributor Miami-Luken and two
of its former executives, accusing
them of conspiring to pour mil-
lions of addictive pain pills into
West Virginia, Kentucky and
Ohio. Ballengee and his attorney
did not return messages seeking
comment.
Three former DEA officials
who spoke with The Post said the
agency lacked the resources to
police pharmacies from 2006
through 2012. This was partly
because drugstores were rarely
the starting point for investiga-
tions, said Barbara J. Boockholdt,
who was then the chief of the
regulatory section of the DEA’s
Diversion Control Division.
“If you go into a pharmacy, you
have to show that the prescrip-
tions are not legitimate — we just
didn’t have time,” Boockholdt
said. “One of my favorite quotes
from that period of my life was:
Too many bad guys, too little
time.”
In Clinton County, Ky., it took
many years, and far too many
deaths, before law enforcement
began paying attention to the
crisis, according to Talbott, the
county coroner. Since 2006, 41
people have died of prescription
opioid overdoses in the county,
records show.
The federal investigation be-
gan in 2015 after Talbott noticed
multiple overdose deaths involv-
ing patients of a local physician,
Michael L. Cummings, and the
Kentucky Board of Medical Licen-
sure expert found Cummings’s
treatment of several patients fell
below minimum standards of
care, court records show.
In 2017, Cummings was
charged in federal court with the
illegal distribution of controlled
substances, which resulted in the
deaths of three patients, accord-
ing to court records. Between
2009 and 2014, Cummings wrote
prescriptions for an average of
over 249,000 oxycodone pills,
438,000 hydrocodone pills and
347,000 benzodiazepine pills per
year.
Court records do not identify
the name of the drugstore where
those prescriptions were filled
but note that “a pharmacy, locat-
ed in a small town and county in
southern Kentucky, was one ofPHOTOS BY MICHAEL S. WILLIAMSON/THE WASHINGTON POSTCLOCKWISE FROM TOP: Value-Med Pharmacy, in Johnson County, Ky., obtained about 10.4 million opioid pills from 2006 through
2012, enough for 64 pills per resident annually. Medicine Cabinet Pharmacy, also in Johnson County, handled about 9.2 million pain pills
in that same period, enough each year for 56 pills per resident. As deaths soared, Clinton County, Ky., Coroner Steve Talbott repeatedly
called the state police, hoping they could identify the source of opioids poisoning his community.the largest dispensers of con-
trolled substances in the entire
state. [Cummings] was far and
away the largest source of pre-
scriptions for the pharmacy.”
Cummings had his medical
practice in the same building as
Shearer Drug in Albany. The
6.8 million opioid pills bought by
Shearer Drug from 2006 through
2012 accounted for 66 percent of
the total ordered by the county’s
five pharmacies, according to The
Post’s analysis.
Shearer, who opened a second
pharmacy a few miles away in
2016, told The Post he had not
faced past enforcement action
and declined to discuss his busi-
ness relationship with Cum-
mings.
Cummings pleaded guilty in
federal court in March to 13
counts of illegally prescribing
controlled substances outside the
course of professional medical
practice and without a legitimate
purpose. He was sentenced on
July 24 to 30 months in prison
and ordered to pay a $400,
fine.
“Michael Cummings was a guy
who lived his life dedicated to his
family, his church and his pa-
tients. And he did a lot of good,”
said Kevin Tierney, an attorney
for Cummings.
Talbott, who said he grew up
with Shearer and attended the
same school, hasn’t talked to the
pharmacist in a few months.
When Talbott, 67, learned from
The Post’s analysis that Shearer
Drug had purchased nearly 6.
million pills that contained hy-
drocodone and oxycodone over
seven years, the county coroner
responded: “It’s a lot of pain
medication for this little town.”
Talbott said the overdose
deaths have waned since Cum-
mings was indicted in 2017, but
the epidemic is far from over.
“There were just too many peo-
ple dying from these drugs in
such a small place,” Talbott said.
“I hate these drugs. They are
awful.”
jenn.abelson@washpost.com
andrew.tran@washpost.com
beth.reinhard@washpost.com
aaron.davis@washpost.comSteven Rich, Aaron Williams, Julie
Tate, Scott Higham, Sari Horwitz and
Michael S. Williamson contributed to
this report.“If you go into a
pharmacy, you have to
show that the
prescriptions are not
legitimate — we just
didn’t have time.”
Barbara J. Boockholdt,
former chief of the regulatory
section of the DEA’s
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