A flowing river of painkillers, all perfectly legal, cuts through Allegheny County

Along with produce and the deli bar, Fuel Perks and meat sales, Giant Eagle pharmacies across the region distributed millions of opioid painkillers as the epidemic ballooned and morphed, according to a Drug Enforcement Administration database.

At the Brentwood Towne Square store, 3.4 million opioid pain pills were distributed over a seven-year span beginning in 2006.

From the Freeport Road location, the pills totaled 3.6 million during that time — more than a million days worth of doses.

No federal or state officials allege that any of the pharmacies contained in the database did anything illegal. The Automation of Reports and Consolidated Orders System, or ARCOS, used by drug manufacturers and distributors, such as pharmacies and hospitals, to report transactions involving controlled substances, including prescription opioids, to the DEA.

Dick Roberts, a spokesman for the grocery store chain, said pharmacists review all prescriptions.

“Our pharmacy team members are trained on a number of measures to ensure the legitimacy of prescriptions, to be mindful of red flags that may suggest prescription misuse and to provide education and other support regarding proper medication adherence,” Roberts said in a written statement.

As overdose deaths across the region began to soar, drug manufacturers and local doctors and pharmacies continued to pump out the powerful pain medication.

The mass distributing happened across the country: 76 billion pills from 2006 to 2012, according to the DEA’s Automation of Reports and Consolidated Orders System, or ARCOS, which tracks the flow of controlled substances from manufacture through distribution. Three billion of those pills were in Pennsylvania.

In Allegheny County, doctors and pharmacies in 2006 filled prescriptions for 56.2 million opioid pills — or about 46 for every man, woman and child living there. By 2012, the numbers of pills was up to 71.5 million, or 58 for everyone in the county. Pharmacies in the county distributed 468 million pills between 2006 and 2012, according to the data.

The number of pills does not include opioids shipped as liquids, patches, sprays or injections. Measured in terms of morphine milligram equivalents — that is, the opioids’ equivalence in morphine — the numbers are in the billions, according to data from The Associated Press.

The DEA data begins in 2006, well into the years of mass prescribing. Around that time, however, there were efforts to make pharmaceutical companies be more cautious in their sales.

David Herzberg, assistant professor of history at the University of Buffalo, called those initial efforts harmful and ineffective, as patients who found their pill supply shut off shifted into illicit drugs, like heroin, or other ways to get the pills.

Heroin use – which eventually evolved into illicit fentanyl use – got a foothold because people were addicted to their painkillers, and they needed a substitute regardless of where it came from.

Switching from a prescription pill that is measured and legitimate to an illicit substance like heroin represents a severe risk to users.

On average, there were 58 fatal overdoses a year in Allegheny County. Overdose deaths first topped 100 in 1998. By 2002, the figure doubled to more than 200 annually.

Allegheny County in 2008 saw 234 overdoses, according to data from the medical examiner’s office. Of the dead, 26 had oxycodone in their system, and heroin was listed in 106 of the toxicology reports.

By 2012, 36 of the 290 overdose deaths had oxycodone in their system. Heroin rose to 169.

In another four years, the death toll would rise to 650, with fentanyl seen most frequently, in 412 toxicology reports. Oxycodone was found in 74 of the dead, and heroin in 330.

While overdose deaths with oxycodone in their system rose, heroin and fentanyl deaths skyrocketed.

Experts said it was a byproduct of the mass prescribing of opioid painkillers.

Dr. Donald Burke, a professor of epidemiology and former dean at the University of Pittsburgh Graduate School of Public Health, said there is still a long way to go in terms of controlling the first step of the addiction process, which is the prescribing of drugs.

As an epidemiologist, Burke looks at the step-by-step connections among the historic over prescribing, someone becoming addicted, beginning to use illicit drugs and, eventually, overdosing.

In essence, what are the stages from first opioid prescription to the time that they overdose? It’s generally accepted that a person who becomes an addict will stay addicted for several years before they overdose.

“It looks like it’s about seven years,” he said. “That time may be shrinking as time goes by. A person who is starting opioids today and becoming addicted today will be addicted for years unless we do something different.”

Megan Guza is a Tribune-Review staff writer. You can contact Megan at 412-380-8519, [email protected] or via Twitter .