Opioid flood charted

Billions of pain pills distributed, more than a million years of life lost, thousands of deaths by overdose.

Reports and data released last week offered a breathtaking view of the numbers behind Ohio's epidemic of drug addiction, from county-by-county tallies of the opioid medications that flooded communities to the sharply reduced life expectancy of people who became hooked.

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According to a U.S. Drug Enforcement Administration database published by The Washington Post, nearly 3.4 billion prescription pain pills were supplied to Ohio from 2006 to 2012. More than 700 million of them came from Dublin-based Cardinal Health, one of the nation's biggest wholesale distributors of drugs.

"And the money made? I'm furious," said Robin Harris, who heads the Alcohol, Drug Addiction and Mental Health Services Board for southeastern Ohio's Gallia, Jackson and Meigs counties.

Drug companies remained sloppy and cavalier as entire communities were swallowed whole, she said. "I know the pain firsthand. I know how hard families try, and still it happens," Harris said. "I lost my own 24-year-old nephew."

The DEA information — released as part of the largest civil action in U.S. history — tracks shipments of oxycodone and hydrocodone pills, which account for three-quarters of the total shipments of opioid pills to pharmacies. Distributors sent 76 billion opioid pills throughout the nation from 2006 to 2012, far more than previously known. 

A look at the flow of pills throughout Ohio during that seven-year span shows:

• Three southern Ohio counties saw the biggest distributions: Jackson County received what amounted to 107 pills for every resident per year; Gallia County received 88 pills per person per year; and Scioto County received 68 pills per person per year. The lowest rate was in Holmes County in Amish country: nine opioid pills per person per year.

• Statewide, drug distributors sent an average of 42 of the opioid pills per person each year. In Franklin County, the shipments amounted to 51 pills per person.

• The number of opioid pills shipped in Ohio in a year had topped the half-billion mark by 2009. In 2006, it was 367 million, peaking in 2011 at 561 million and dropping slightly to 547 million in 2012. The increase between 2006 and 2012 was 49 percent.

• The biggest distributor of the drugs in Ohio, a state with one of the highest rates of overdose deaths, was an Ohio company: Cardinal Health. In 2006, the company shipped 86 million pills. That rose to 120 million pills by 2012, a 40 percent increase.

Also last week, Ohio University released a study that found that more than 1 million years of life were lost in Ohio to drug overdoses in the decade that ended in 2018.

That means that each of the 26,375 people who died from an overdose lost, on average, 39 years — half of their expected life span. Of the years lost, 81 percent involved opioids.

The report comes from the private-public Ohio Alliance for Innovation in Population Health, which was formed by Ohio University and the University of Toledo in 2017. It's among the first to analyze the overdose crisis using years of lost life, not number of deaths, said Dr. Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University and executive director of Physicians for Responsible Opioid Prescribing.

"It's striking, and ... I believe a more accurate way of trying to capture the impact of the crisis, because when you count a death, I think we can become immune to what it really means," he said.

The number indicates that many overdose deaths struck people in the prime of life, Kolodny said. That pain is felt at every family occasion where a loved one is not at the table, at every birthday, and when the peers of a young person who never married are walking down the aisle.

Harris, of the Gallia-Jackson-Meigs board in hard-hit Appalachia, said a good friend's son — a veteran injured in the line of duty — became dependent on opioid painkillers during his hospitalization and recovery. The man soon will be incarcerated for offenses committed in the throes of addiction.

"He's on his way to prison — with a Purple Heart," Harris said. "And that's a tragedy."

In an emailed statement, Cardinal Health said it "shares the judgment of top policymakers that too many prescriptions have been written for too many opioid pills over the past decade. This is a direct reflection of the number of prescriptions written by healthcare providers and filled by licensed dispensers, neither of which wholesale distributors can influence."

Cardinal and several other drug distributors and manufacturers are being sued in federal court in Cleveland by nearly 2,000 cities, towns and counties over the companies' role in the opioid crisis.

Cardinal said it "cannot stop physicians from writing prescriptions" or block the ability of licensed pharmacies to dispense medication. Cardinal also noted that the DEA, which sets an annual production quota for the amount of opioids allowed to be manufactured, raised it by 140% from 2006 to 2014.

Still, Cardinal said it has halted suspicious orders for the shipment of hundreds of millions of dosage units of controlled substances over the past decade.

Dr. Margy Temponeras of Wheelersburg in Scioto County was the top Ohio practitioner to receive shipments of opiate drugs between 2006 and 2012, with nearly 1.7 million pills. That included 828,310 pills in 2010 and 655,300 pills in 2009, the DEA data show.

Temponeras was convicted in federal court for her role in operating a "pill mill," pleading guilty in 2017 to conspiracy to distribute a controlled substance.

According to investigators, Temponeras owned and was a physician at Unique Pain Management, where her father, John Temponeras, also was a physician. The two saw more than 20 patients per day, charging $200 in cash for exams and writing monthly prescriptions for opioids. When some pharmacies began declining their prescriptions, Margy Temponeras opened a dispensary called Unique Relief LLC to fill the prescriptions she wrote.

Scott Weidle of Germantown in southwestern Ohio lost his 30-year-old son, Daniel, to an opioid overdose in 2015, and he said there is blame to go around. "If it wasn't for a loose prescription pad, Big Pharma wouldn't have orders to fill," he said.

Daniel Weidle left behind three children. And his absence means that the Weidle family's sand-and-gravel business, founded in 1959, will eventually fold when he is not there to take over. Scott Weidle also lost a stepson, nephew and brother to opioid overdoses between 2005 and 2018.

"I've walked through the fire, I have felt the pain, and I've done my homework to understand the things the state could have done," he said. "It's almost like there are two cartels: the legal cartel and the illegal cartel."

Dr. Mark Hurst, medical director of the Ohio Department of Health, said there is hope amid the numbers, as progress has been made in addressing drug prescribing and addiction.

He said guidelines for writing prescriptions have been established in Ohio for emergency departments, the treatment of acute pain, and the treatment of chronic pain. And over the past several years, he added, formal rules have been established to allow enforcement.

He said the changes have been followed by significant drops in prescription doses and in deaths from prescription drug overdoses. Estimates from the federal Centers for Disease Control and Prevention indicate that Ohio had 4,002 overdose deaths last year. That was 1,153 fewer than the year before, one of the biggest drops in the country, Hurst said.

“Our job is not done, and when we see improvement in the numbers, we can’t say it is time for us to press pause,” he said. “We need keep to keep our feet on the gas, keep doing this to turn things around.”

In Jackson County, the superintendent of the Jackson city schools, Phil Howard, and other community leaders were fielding questions from reporters last week after the release of the DEA database on pill distribution. They asked what happens when a small county in southern Ohio becomes saturated with opioids.

Kids lose their parents, Howard said. They live amid trauma and chaos. They need crisis counseling and speech therapy and tutoring. They wind up with disabilities and delays and problems that teachers can't fix.

A few years ago, the district started an after-school program for all grades, keeping the doors open and the lights on even for the oldest students.

"They'd stay here for help with their homework and a snack," Howard said. "It was a couple more hours that they didn't have to go home to a bad situation."

Dispatch Reporter Megan Henry contributed to this story.

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