IRON RANGE — Nearly 20 million opioid pills were shipped to pharmacies on the Iron Range between 2006 and 2012, according to new data from the Drug Enforcement Administration.
In the DEA’s first comprehensive look into the front lines of a nationwide drug epidemic, the agency tracked roughly 70 billion opioid pills containing oxycodone and hydrocodone from manufacturers to retail pharmacies, some found in Minnesota. The data had not been released until the Washington Post published the information last week.
The details can appear striking for some small pharmacies in rural parts of the state including the Range, but pharmacists caution the data doesn’t take into account a number of factors, including proximity to surgery centers, adjustments for older patients who need smaller — therefore more — pills, and locations that may serve a population that travels long distances for medication.
In a region where the average age continues to creep up, some areas north of Virginia toward the Canadian border live as far as 30 miles from the nearest local pharmacy.
“I have been here for 36 years and pain medication has had its ups and downs often dictated by the medical community in our area,” said Jon Marcaccini, a pharmacist and owner of Jon’s Drug in Eveleth, noting more surgeons and oral surgeons are now working locally. “The factors that go into it are very complex and can’t be simply explained.”
Still, the numbers pull back the curtain on one of the biggest issues gripping rural society, tying up law enforcement and courts and squeezing county budgets on treatment and out-of-home placements for children.
The DEA doesn’t track the pills after leaving the pharmacy, a critical notation as pills diverted to the streets and black market have accounted for a large amount of the 100,000 deaths nationwide from 2006 to 2012, the time period covered by the database.
An analysis by the Washington Post of the data available measured the total number of pills shipped to each pharmacy and the average per person each year with a 5-10 mile radius.
Opioids on the Range
One of the standout numbers analyzed came from Frank’s Pharmacy in Cook, which received more than 1.2 million opioid pills between 2006 and 2012 for a city that had a population of 574 people as of the 2010 Census. That’s almost 300 pills per person in each of those six years.
A representative at Frank’s couldn’t be reached over the phone, but a possible driver of the pharmacy’s high shipments is the potential population it serves. Frank’s is the only pharmacy tracked by DEA within 30 miles of itself. That means the local pharmacy could also serve Tower, Soudan and a portion of the Bois Forte Reservation in Tower — all which sit a straight 30 miles from both Cook and Ely.
Baron’s Pharmacy and WalMart in Hibbing were both ranked as large distributors of opioid pills in St. Louis County, shipping in about 2.4 million and 1.9 million respectively between 2006 and 2012. Baron’s was among the top-five distributors in the county, as the other four being located in Duluth.
Minnesota received more than 841 million oxycodone and hydrocodone pills in those years. St. Louis County encountered the second highest rate in northeastern Minnesota distributed per person annually at 39.15 pills. Statewide the average was 22.67 pills with Carlton County at 40.22.
In Eveleth, Jon’s Drug received 964,600 pills over the six-year period, about 37 pills per person per year. But that doesn’t tell the whole story story, Marcaccini said. For example, opioid prescriptions are less than 3 percent of the total prescriptions shipped to the pharmacy.
Describing a fictional patient, Marcaccini said he may also have to change a prescription at times from larger pills to smaller pills because a hospice patient is having trouble swallowing.
“I could change a fictional patient’s prescription from taking three 5mg tablets to one-half of a 30mg tablet. This would reduce the number of pills that I need to have shipped to me by a factor of six making my six-year total closer to 160,766,” he said. “This is an extreme example and not all prescriptions could be manipulated in this fashion, but I wanted to make the point that the number presented is truly meaningless when the larger picture isn’t considered.”
A place for opioids?
Preventing opioids from hitting the streets is a different problem for communities, and one that’s harder to track.
OxyContin was being sold on the black market as early as 1997, according to a U.S. Justice Department investigation of the drug’s parent company Perdue Pharma, but it took almost two decades for the real impact of these drugs to be commonplace.
It isn’t uncommon for local law enforcement and pharmacies to collaborate when a new drug is found as being sold on the streets.
“I have a very good working relationship with our pharmacy in town and we will occasionally reach out to them for assistance in identifying certain drugs/pills that we come in contact with and cannot identify,” said Eveleth Police Chief Tim Koivunen.
With new limits on pain medication and more awareness about their use, Marcaccini is already seeing lower quantities of opioids coming in and new alternatives coming to the market. But those also come with their own risks.
“Chronic pain comes with its own list of problems,” he said. “It is important not to put these drugs into a negative spotlight, they have been helping people with pain for many years. Sometimes opioids are the drug of choice.”
His main concern is that the drugs are becoming vilified to the point that people with chronic pain are afraid they won’t have the same options available to them. Many people, he noted, do not become addicted to opioids and its those who misuse the pills that cause problems.
Moving forward Marcaccini wants to see more education and one-on-one conversations with patients by pharmacists, as well as fewer prescriptions issued by providers, in hopes of shifting the political landscape on opioids.
Not every prescription, he added, is “corrupt or unwarranted.” He continued, “Until a person has real pain, and I mean drop-to-your-knees-give-me-something-for-it pain, it may be hard to understand why anyone would want to take opioids.”