Westmoreland County flooded with 124M pain pills during critical period of opioid crisis
Inside Roadway Pharmacy, customers mill through aisles stocked with cough and cold medicines, colorful greeting cards and other drugstore fare.
Playing over the sound system is “Come on Eileen,” the 1982 hit.
Some people fill prescriptions after picking up groceries at Ideal Market. The businesses sit next to each other in a shopping plaza on the edge of State Game Lands No. 42, a nearly 16,000-acre site largely in northeastern Westmoreland County.
The typical small-town pharmacy serves tiny Seward, which has fewer than 500 residents, and St. Clair Township, with a population of 1,500. Shoppers’ next closest options are seven miles southeast in Johnstown, Cambria County, and more than a dozen miles to the west in Burrell Township, Indiana County.
Seward’s drug problem, however, is as real as anywhere, councilwoman Nancy Pennell said.
“It’s a real mess in this town,” she said.
From 2006 through 2012, prime years for the country’s ongoing opioid crisis, Roadway Pharmacy distributed 1.9 million narcotic pain pills, U.S. Drug Enforcement Administration records show. That’s a yearly average of 227,000 pills — or 138 for every man, woman and child who lived in Seward and St. Clair Township during that time.
Roadway management declined to comment for this story.
No federal or state officials allege that any of the pharmacies included in the database did anything illegal. The Automation of Reports and Consolidated Orders System, or ARCOS, is used by drug manufacturers and distributors, such as pharmacies and hospitals, to report transactions involving controlled substances — such as prescription opioids — to the DEA.
Across Westmoreland County, 124 million prescription opioids were shipped to 73 pharmacies over that span, fueling a crisis that experts said has been worsening for decades. That is roughly 50 pills per person annually, according to census figures.
By comparison, Allegheny County saw 468 million opioid pills distributed through 621 pharmacies from 2006 through 2012. That came to 54.5 pills a year for every man, woman and child living there.
Those numbers come as no big shock to those on the front lines fighting opioid-fueled crime, addiction and overdose deaths.
“That’s huge, I’m not surprised by that … because of the addiction rate we have in this county,” said Tony Marcocci, a Westmoreland County detective who has worked in narcotics for much of his decades-long career.
Likewise, Dr. Donald Burke, professor of epidemiology and former dean at the University of Pittsburgh’s Graduate School of Public Health, said, “We know there was this tsunami of opioids being prescribed.”
Tracking the storm
A federal judge this summer ordered the DEA drug shipment data to be released publicly as part of a consolidated civil case in Cleveland involving nearly 2,000 local and state governments suing drug manufacturers. ARCOS data showed that 76 billion prescription opioids were funneled to pharmacies around the country from 2006 through 2012, according to the Associated Press. Three billion of those pills were distributed in Pennsylvania.
County- and state-level data were made available by the Associated Press and The Washington Post, which sought the release of the information over objections from DEA lawyers and drug companies.
For years before 2006, the country saw pockets of opioid abuse, said David Herzberg, an assistant professor of history at the University of Buffalo who has studied the addiction crisis. Problems emerged in working-class, yet socially struggling towns with largely white populations where doctors were accessible, he said. They first appeared in places such as southern Ohio, Appalachia, Florida and New England.
“It took both things — community suffering but also good access to doctors willing to prescribe for them,” Herzberg said.
Purdue Pharma introduced OxyContin — a brand name formulation of the painkiller oxycodone — in 1996, the same year the American Pain Society launched its “pain as the 5th vital sign” campaign.
In 1999 and 2000, prescription opioid overdose deaths started to rise, according to the Centers for Disease Control.
Members of U.S. Congress in 2000 passed a bill providing for a “Decade of Pain Control and Research.” President Clinton signed it into law.
In 2001, the Joint Commission — which accredits thousands of U.S. health care facilities — introduced new standards to address pain, which was widely believed to be undertreated in patients. This included an increased use of opioid medications and assessing pain along with other vital signs: body temperature, blood pressure, pulse and breathing rate.
OxyContin was among the top drugs being abused across the country by 2004, according to a study published on the National Institutes of Health website. By 2006, the country was well into the throes of the opioid crisis, said Herzberg, who wrote a book set for publication next year about the epidemic’s history.
Purdue Pharma and three of its executives pleaded guilty in 2007 to misrepresenting, among other things, the opioid’s addiction risk and abuse potential, according to The New York Times.
But the prescription opioid deaths continued to increase nationally until 2010 — a turning point (or second wave of the opioid crisis) when overdose deaths from heroin, an illicit opioid, sharply increased and fatal prescription opioid deaths began to fall, according to the CDC.
“That’s the moment” the crisis changed, Herzberg said.
From 2006 through 2011, prescription drug monitoring systems and other enforcement efforts came into play nationwide. Those efforts could have been helpful to people suffering addictions but, instead, ended up being harmful, Herzberg said.
Instead of ushering people to treatment and other forms of help, they were simply cut off from receiving prescription opioids.
Many shifted to the streets to find their fix.
From there, the epidemic continued to morph and ushered in the modern, or third, wave of fatal overdoses fueled by fentanyl, a powerful opioid once used to alleviate cancer pain that now is cranked out in clandestine labs. The number of overdose deaths involving any type of opioid (heroin, fentanyl or prescription) in 2017 reached 47,600 — a sixfold increase from 1999.
From 1999 through 2017, about 400,000 people died from an opioid overdose, according to the CDC. Total overdose deaths in the U.S. topped 700,000 over that span, the CDC reports.
In the late 1990s, about 5% of admissions at Greenbriar Treatment Center were for patients whose primary problem was opioid dependence, said Holly Martin, psychologist and chief operating officer. She estimated that in 2006, that figure rose as high as 30% at their centers located in Allegheny, Washington and Westmoreland counties.
Six years later, nearly half of new admissions were for people who primarily were abusing opioids. That number peaked at 54% in 2015, Martin said.
“That ‘pain is the 5th vital sign’ thing was a disaster,” she said.
Greenbriar saw many patients with legitimate prescriptions for painkillers.
“And that was it, they got addicted to them,” Martin said.
Westmoreland County saw 405 overdose deaths from 2002 through 2010. In 2011, about a third of drug overdose deaths here were caused, in part, by oxycodone, the generic opioid pain reliever also sold as OxyContin and other brands.
Over the next eight years, overdose deaths in Westmoreland County more than doubled.
From 2011 to 2018, the county experienced 930 fatal drug overdoses, according to coroner statistics. And while deaths attributed to illicit heroin and fentanyl have risen, prescription opioids were present in 36% of local overdose deaths in 2018.
In Seward, the drug problem has been going on for years. The closest place to get treatment is miles away.
“I really don’t know what could help it,” said Pennell, the councilwoman.
Other places in central Westmoreland County have seen the effects drugs have had on communities. Larger pharmacies such as Giant Eagle, Rite Aid, CVS, Walgreens and Walmart accounted for the top number of prescription opioids shipped into the county from 2006 through 2012, according to the DEA data. Combined, those pharmacies distributed 52 million pills over those seven years, records show.
Giant Eagle pharmacists are trained on filling legitimate prescriptions responsibly and identifying potential red flags that might indicate abuse, spokesman Dick Roberts said.
“We recognize the severity of the opioid crisis affecting so many across our communities, and we are committed to doing our part to improve the health and well-being of those we serve,” he said.
Locally based operations, such as Accuserve Pharmacy in North Huntingdon (5.9 million pills) and Town & Country Pharmacy in New Kensington (4.7 million pills), also ranked high on the list. New Stanton Pharmacy distributed 2.4 million prescription opioid pills from 2006 through 2012.
Nicki Ross, a Greensburg resident, thinks those figures would be much higher if the tallies included benzodiazepines, prescription sedatives used to treat anxiety, insomnia and seizure disorders. More than 30% of opioid overdoses also involve benzodiazepines, according to the National Institute on Drug Abuse.
Ross, 50, has been in recovery for more than three years. She got hooked on painkillers prescribed from a 2001 surgery and spent the next 14 years in active addiction. She believes underlying emotional issues as a result of trauma during her life contributed.
Research shows that people who experience trauma are more likely to engage in risky behavior, including drug abuse.
“If you haven’t dealt with it and you have a prescription drug, look out,” Ross said.
Stemming Rx addiction
Pennsylvania’s prescription drug monitoring system started in 2016. Before that, pharmacists didn’t have a way to track customers who brought in legitimate prescriptions but may have had an addiction problem, said Ed Christofano, owner of Hayden’s Pharmacy, which has locations in Donegal, Greensburg, Mt. Pleasant and Youngwood.
“We have now been given the tools needed to better harness prescription drug abuse,” he said.
Patients should work closely with their doctor to get off prescription opioids as quickly as possible and seek other options for pain management, Martin said.
“If you take opioids on a regular basis, you’re going to become dependent on them,” she said.
From the time a person becomes addicted to when they overdose is about seven years, said Burke, the Pitt professor. And now, the country is in the middle of that problem that grew out of the overprescribing of prescription opioids.
“The right way to think about this is not by year, but almost by generation,” Burke said. “We now have a generation where there are … many adults who are addicted and will be addicted.”
Renatta Signorini is a Tribune-Review staff writer. You can contact Renatta at 724-837-5374, [email protected] or via Twitter .