Drug Firms Shipped 20.8 Million Pain Pills To West Virginia Town of 2,900 (foxnews.com)

A congressional committee investigating the opioid crisis has discovered out-of-state drug companies shipped 20.8 million prescription painkillers over a decade to two pharmacies in a Southern West Virginia town with 2,900 people. From a report: Between 2006 and 2016, two drug wholesalers shipped 10.2 million hydrocodone pills and 10.6 million oxycodone pills to Tug Valley Pharmacy and Hurley Drug in the town of Williamson, in Mingo County, the Charleston Gazette-Mail reported. "These numbers are outrageous, and we will get to the bottom of how this destruction was able to be unleashed across West Virginia," the House Energy and Commerce Committee Chairman Greg Walden, R-Ore. and ranking member Frank Pallone Jr., D-N.J. said in a joint statement.

Comments

If I lived in West Virginia

[Anonymous Coward]

I would get high every day too.

Re:If I lived in West Virginia

[RavenLrD20k]

20.8M / 2900 ~ 7,172
7,172 / 10 (years) ~ 717
717 / 12 (months) ~ 60 pills.

Basically, everyone in town was given a standing prescription of take 2 pills per day as needed for pain. Up the script to 3 pills per day as needed and you've got a standing prescription for about 1,925 people. Consider that pharmacies often keep a stock of these pills for rapid fulfillment (Wal-greens will usually have whatever prescription my doc gives me ready within an hour; narc or not), and it's likely that not even that many people have standing scripts.

Also, how long do pharmacies keep med batches on hand? They often have expiration dates slated for 90 days. They're supposed to dispose of unused portions of batches, right? Well, how are they going to keep the stock up to handle the medicated population when they get their next round of scripts? This is going to inflate the order that the drug companies are going to get.

In short, this sounds like someone with an axe to grind trying to inflate emotional response by using a 10 year metric that only indicates how much opiates are getting shipped into community pharmacies, not how much is actually being doled out and prescribed to the community.

Re:If I lived in West Virginia

[plopez]

realistically how many people per thousand actually need heavy opiates? How many would be in a town that size? 1 in 3 adults are getting prescriptions from the numbers I am finding. https://www.cbsnews.com/news/m...

Let's adjust by 50% to cover children, pregnant women, macho men (I can take the pain), masochists, etc. and divide by 3. That works out to about 483.

483/60 = 8.05 which seems excessive.

Re:If I lived in West Virginia

[butchersong]

West Virginia is an absolutely beautiful place to live. What isn't so great is the current epidemic. Personally I'd like to do away with all prescription opiates. The "chronic pain" they address cannot outweigh the suffering they inflict on communities. Next remove them and all forms of welfare. Keep it if you want in your large cities but over here, it would be better that men would have to struggle and work to get by again. The biggest problem in these regions is lack of purpose. Men need work. One thing we have in WV and KY is plenty of soil to grow crops in. Not many though are going to work all day to grow some corn and beans if they can get a welfare/disability check that lets them buy more food at the grocery and spend the day sitting on their ass.

Re:If I lived in West Virginia

[gtall]

So, in your dog-eat-dog world, the children of the unemployed get squat which translates into a new generation of un-educated, malnourished sprogs who will be a burden when they turn to crime to make ends meet. Their parents might be able to give them pointers on how to do it well.

You can either pay them now or pay for them later, either way, you will pay.

Re:If I lived in West Virginia

[careysub]

The presumption that everybody in town has a prescription for a very powerful narcotic (instead of say, codeine) is the presumption that this is a "pill mill", rather that proof to the contrary.

National dispensing rates are something like 0.75 prescriptions per person per year, so this town would have had 22,000 units dispensed over the ten year period. People are not picking up bottles of 900 pills. Even assuming the rate for this town due to its composition is higher than normal, this is a factor of at least ten fold too high. And these opioid prescription rate are for all opioids not just these powerful and addicting ones. Most opioid prescriptions would normally be for less potent ones like codeine, propoxyphene (Darvon), and tramadol. So getting this much oxycodone and hydrocodone is something like a factor of 100 too high.

Re: If I lived in West Virginia

[reanjr]

So now that cities are thriving and suburbs and rural areas are the center for welfare queen drug abusers, you want to cancel welfare in the rural areas so your rural degenerates will flee to the city and prop up your collapsing home prices. Do I have that right?

Re:If I lived in West Virginia

[nomadic]

The problem with your theory is that opioids are prescribed for extreme pain, and typically only for short periods of time following things like surgery. An entire town being prescribed them is beyond insane and there is no way you can feasibly make it out to sound like everyone in town -- every man, woman, and child -- needs them.

Re:If I lived in West Virginia

[thegarbz]

1 in 3 adults are getting prescriptions from the numbers I am finding.

Let me just say: WHAT THE FUCK!

Re: If I lived in West Virginia

[ThurstonMoore]

You should probably read a little about the history of opium.

Re:If I lived in West Virginia

[rahvin112]

Small towns like that are often 50% or more elderly. By my calculations that would offer 962 people in town a monthly supply of 180pills which is a fairly typical maintenance dose (2 pills 3 times a day). Given the size of the town and the likely high numbers of elderly I find nothing wrong with this other than rather obvious political scapegoating. The real political story in this number is the large number of people with chronic pain and/or cancer. Is this is town a cancer cluster?

Short acting opiates take 20 minutes to affect you, require an hour to reach full potency and gradually fall off till the 4 hour point where they begin to drop off steeply until about 6 hours. Anyone that's taking pain meds for chronic pain is going to be taking doses 3-4 times a day minimum. Typically these people are also at least partly opiod tolerant and will need to take 2 pills at a time.

I see nothing out of the ordinary here.

Re:If I lived in West Virginia

[magarity]

Deliverance was set in Georgia, not West Virginia.

Re:If I lived in West Virginia

[sjames]

Now include the people living in unincorporated areas (so not counted as part of the town's population) for whom the town has the nearest to them pharmacy. Include that coal mining and other physically demanding work is quite common in West Virginia.

In many places, rural doesn't mean farms. It is more or less as dense as suburban areas but with no strip malls or corner stores. All of those people go into town for shopping, including the pharmacy.

Williamson is the county seat of the surrounding county with a population of 30,000. Suddenly, the numbers don't look that out of line, just sensationalistic.

Re:If I lived in West Virginia

[amicusNYCL]

Up the script to 3 pills per day as needed and you've got a standing prescription for about 1,925 people.

That's quitter talk, every baby should also be on opiates. You'll shit your pants when you see what happens to stock prices and revenue when we get babies addicted as earlier as possible. Because that's literally the only thing that matters, stock prices, and revenue. In fact, the real story here is that these babies ONLY get 2 doses of neo-heroin per day. Those are rookie numbers.

Re:If I lived in West Virginia

[amicusNYCL]

So anyway, yes, these numbers are notorious half-truths and trumped-up to boot. But at the same time they might still point at a problem.

Is that your takeaway from this story? 20.8 million doses of heavy opiates shipped to a town of 2,900 over a decade and you're takeaway is that this "might point to a problem?" I realize you don't live in the US, but do you understand the number and frequency of opiate overdose deaths that are occurring in the US? Do you understand that doctors and pharmaceutical companies are culpable for pushing this product to people who don't need it so that they make more money, while Congress passes laws to restrict it so that people who actually do need it can't get it? Nothing that I just said is political, people would only have a political position on that if they're being paid to have one, or if they have been preached to by a spokesperson with a profit motive.

And then it's fairly important to frame (or re-frame or counter-frame) the narrative into something reasonably solvable

Holding doctors accountable when their patients die from overdose on an unnecessary medication prescribed by the doctor is a good first step. Maybe it will drive some of them away from prescribing without another thought just because they're going to get a kickback when they do prescribe something the person doesn't need. In other words, the profit motive needs to be removed. A complete overhaul of the health care system would also do that, but there are too many people making too much money in order to expect any meaningful change there.

Re:If I lived in West Virginia

[plopez]

per 2010 census 21.3% over age 65. So I don't think that age range had a huge impact.

Re:If I lived in West Virginia

[plopez]

There are 7 pharmacies in town. Though no numbers on numbers of doses.

Re:If I lived in West Virginia

[amicusNYCL]

and you're takeaway is

I must now commit seppuku. Might as well stay on topic and overdose on oxy.

Re:If I lived in West Virginia

[amicusNYCL]

realistically how many people per thousand actually need heavy opiates?

According to drug manufacturers and wholesalers? About 1,000.

Re:If I lived in West Virginia

[amicusNYCL]

Do you have any friends taking 2 opiate pills 3 times per day, at least that you know of?

Re:If I lived in West Virginia

[amicusNYCL]

a new generation of un-educated, malnourished sprogs who will be a burden

Don't forget that they also have no health care to speak of, because that is the responsibility of the individual, as I've heard a number of so-called "pro-life" people try to tell me.

Re: If I lived in West Virginia

[Anonymous Coward]

The irony of narcotics regulation is that the drugs regarded as the "most powerful" are generally LESS harmful in absolute terms than the ones viewed as "less powerful". In terms of potential for direct individual harm, codeine is arguably much, MUCH worse than drugs like oxycodone. The whole REASON codeine is less-regulated is because it's SO UNPLEASANT (vs oxycodone), it has less appeal for recreational abuse (and greater likelihood of causing death when abused). For someone to abuse codeine, they have to be absolutely *desperate*.

The main thing that keeps long-term opoid users with pain problems addicted is a very real & justified fear of having them suddenly taken away. If people were free to take them until they overdosed, but could seek withdrawal-management assistance at any time -- without risk of getting their meds cut off permanently before their addiction & withdrawal has been fully managed -- I think a lot more people would voluntarily *attempt* to wean off... and keep trying, if the first attempt (or several) fails. As it is, if someone taking opioid pain meds even *hints* to having concerns about dependency or addiction, they'll usually be cut off *instantly* & left to fend for themselves at a point when they're the least ABLE to do so.

People also differ in their ability to handle pain. It's a spectrum. Some people seem oblivious to even horrific pain. Others can't have two coherent thoughts in a row if they have an itch. No degree of pain-intolerance should be shamed, nor should abnormally-high pain-tolerance be seen as morally-superior (though in America, it usually is).

Opioid dependence is the natural & expected outcome of long-term use, and should be treated as such. "Rapid opiod detox" (using anesthesia & other meds to rapidly get patients through withdrawal effects) should be no more viewed as shameful or a sign of weakness than getting sutures removed once a wound has closed up. Instead, we subject people who become dependent upon painkillers to judgment as 'addicts' for the rest of their lives, even though we know damn well that 99.9% of people who WERE dependent at one point & manage to stop tend to be averse to them ANYWAY going forward.

Re:If I lived in West Virginia

[sjames]

A typical prescription is one every three hours as needed, so 8/day/person.

Re: If I lived in West Virginia

[NeoMorphy]

How would they expire? They would be lucky to stay in supply. As long as they fifo the inventory, it's probably 2 weeks old at the most. I think it's as bad as it looks.

Re:If I lived in West Virginia

[plopez]

the 8 per day was only for 2 pharmacies, not counting the other 5. What probably happened was someone notices those 2 pharmacies were filling way more Rx per person than the other ones in the area, which includes a Wal-Mart.

Re:If I lived in West Virginia

[slacktide]

Did you read the link? It says that 1 out of every 3 adults was prescribed opiates at some point in the previous 12 months. That's not particularly concerning if you ask me - I was prescribed them twice in that time period, once for a tooth extraction and once for a broken finger. What I thought was interesting was the amounts that were prescribed - for the teeth, the doc issued a prescription for 3 days worth. (12 pills total) For the finger, that doc issued 30 days worth, which seemed REALLY excessive.

Re:If I lived in West Virginia

[plopez]

Including the offenders there are 7 pharmacies in town. Your est. looks better than mine (8) but neither of us of had any numbers on the other 5 pharmacies.

Re:If I lived in West Virginia

[slacktide]

It won't be possible to shit your pants, due to the opiod-induced constipation.

Re:If I lived in West Virginia

[Erik Hensema]

Where I live you wouldn't have gotten opiates in both cases. Ibuprofen in a slightly higher dosis then over-the-counter, if you're lucky. And then for a week max.

So yes, I think it's quite excessive what you got.

I live in the Netherlands by the way.

Re:If I lived in West Virginia

[K. S. Kyosuke]

Wouldn't Rocky Mountains be more appropriate for that?

Re:If I lived in West Virginia

[sjames]

Without appropriate figures including shipments to other pharmacies, it's hard to say much of anything about the situation. All we have is the total number of pills over a 10 year period.

The one thing I can say for sure is that the information appears to have been presented in a form to maximize sensationalism and minimize usefulness. That seems like a pretty good reason to be skeptical of the conclusion we are being lead ever so carefully to draw.

Re:If I lived in West Virginia

[Anonymous Coward]

If it sounds insane, suspect the story first. That town serves a county with a population of around 25K. In that area, the population is extremely spread. People often travel from other counties for service.

The misrepresentation of the population served is only one of many problems with this article.

Also, if you think opioids are only for short periods of time, you've never lived around a declining population of loggers, miners, and older people who were loggers and miners. Virtually all are suffering injuries sustained in a hard life that will never be fixed. Even if there are surgeries that could help, they can't afford them.

It is interesting that we have laws to require industries that destroy land to restore it, but they are rarely held accountable to restore the lives they used.

Re:If I lived in West Virginia

[Dread_ed]

And we can destroy complete industries, replace them with foreign manufactured goods, and not give a second thought to the people whose lives, communities, and families are devastated as a result.

The corporations just close up shop, the golden parachutes protect the owners and their hangers-on. Everyone else just falls straight to the ground without a shred of support. Even worse, you will see the displaced workers demonized and degraded. Not only no help, but brutal castigation from is what you can expect if you are so affected.

I call it "irresponsible progress."

Re:If I lived in West Virginia

[rahvin112]

I don't need friends taking that many, I do.

I'm a chronic pain sufferer and I take significantly more than that, but that's what happens when your bones have so many bones spurs on them they look like steak knives. Yes, someone that twisted an ankle shouldn't be taking anywhere near that much but you people have NO IDEA how many people in this country are in chronic unrelenting pain for various conditions. Destroyed nerves, damages joints, blown out muscle groups, out of control immune systems. Pain is a common problem.

The fact is you wouldn't even know if someone around you was on opiate pain treatment. It's highly stigmatized and most people outside an anonymous forum like this wouldn't tell you to save their lives. You probably know several people taking that level of treatment and don't even know it because people with chronic pain usually don't advertise it because of the social stigma.

Re:If I lived in West Virginia

[Swave An deBwoner]

And Germany, according to this article:

  https://www.nytimes.com/2018/01/27/opinion/sunday/surgery-germany-vicodin.html

Re:If I lived in West Virginia

[amicusNYCL]

My wife has chronic pain, as does a close friend. I realize the usefulness of opioids or any other pain relieving drug. But I don't think that it's likely that a majority of the people living in any one town all have chronic pain to the level that it requires opioids to treat. That's part of the problem. A doctor hears that someone has a toothache, so might as well give them some opioids because the pharmaceutical manufacturer will pay the doctor for every prescription. They are over-prescribed big time. This is the not the same thing as saying no one needs them. In fact, if they were not over-prescribed then the people who need them would probably have an easier time of getting them. Every person I know who needs and takes prescription medications, especially controlled ones, complain about the process to get what they need.

Re:If I lived in West Virginia

[amicusNYCL]

So, if we assume that 10 servings of neo-heroin per day is reasonable, and we extend that to this town of 2,900 people over 10 years, we learn that 20.8 million pills is enough to cover about 570 people at 10 per day. So, what do you think the likelihood is that 20% of the town (women, children, everything) are living in pain that is so bad that it requires 10 opioid pills per day, every day, for 10 years? Is that reasonable? Do you feel like the doctors in this town are just there to help and care for everyone?

Here's another question: how long does it take to become physically dependent on opioids or risk an overdose? If you're not sure, ask Tom Petty's wife. If your doctor said you need to smoke 10 cigarettes per day, because it's going to help you shit, are you just going to say "yeah, I need help shitting, so getting myself addicted to nicotine in the process is a reasonable tradeoff, and this doctor totally has my well-being foremost in his mind."

Re:If I lived in West Virginia

[rahvin112]

It's not the majority, it's the county seat and at 2600 people probably the only town in the entire county large enough to support pharmacy locations. When put in that perspective 900 people out of 26000 in the county isn't as bad and reduces the percentage by a factor of 10. You should also keep in mind that's averaging, a half a dozen stage 4 cancer patients would heavily skew the numbers because the volume of pills they'd be taking would skew the average and mean.

That's the point most of the rational posters have been trying to make, this is a statistic manipulation by a politician for political gain. From what I've seen of the Hillbilly Heroin epidemic most of the pharmaceuticals were being traffic'd in from out of state (Florida was a major source point for the entire south) and very few were being obtained with valid prescriptions locally. The addicts were buying their pills from local dealers, not going down to the local pharmacy.

Don't get me wrong, there's always going to be people doctor shopping and trying to abuse the system but their solution to this was to dramatically shut down all pain prescriptions hurting people with real pain and forcing all the addicts onto street drugs instead of pharmaceuticals. In the end the result was shifting the sales to out of country drug cartels with unregulated doses and killing lots and lots of people with those unregulated drugs. If those same people were taking their pharma Oxy they wouldn't be overdosing left and right and there wouldn't be a heroin tainted with fentinyl problem running rampant over the population. The very action to "solve" the drug problem made it 10 times worse. That's what's fucking crazy about this.

And the best part is the politicians are trying to blame pharmacies for filling prescriptions they were given which may not even be out of line for numbers of pills being dispersed because the politician is cooking the statistic to make it look awful. Drop the outrage and look at this logically. Every solution to "fix the problem" ends up making it worse.

Re:If I lived in West Virginia

[fafalone]

An entire town being prescribed them is beyond insane and there is no way you can feasibly make it out to sound like everyone in town -- every man, woman, and child -- needs them.

Thanks to the overcorrection in opioid prescribing, I know dozens of people who are in extremely severe pain (from injuries fully backed by MRIs etc, so not faking), who were basically told "I know you like playing with your grandchildren, but I'm cutting your dosage so much you'll no longer be able to get out of bed" or "Here's some tylenol to replace your morphine pump, I'm discharging you"... these people then drive hours, sometimes to entirely different states, to find a doctor that hasn't been pressured into sadism. Filling at the nearest pharmacy to the doctor is common.
What evidence is there that these pharmacies served only the local population? My scenario is the norm for pain doctors and pharmacies that keep enough opiates in stock to always fill scripts right away. Did you have evidence that's not the case here, or like the politicians and drug warriors are you engaging in scapegoating due to opioid hysteria when you don't actually know what life is like for people whose doctors deny them the only medications that make life tolerable? Is making sure the 1-2 in 100 people using their meds recreationally switch to street drugs and OD so much more important?
You've fallen for propaganda.

Re:If I lived in West Virginia

[fafalone]

You do realize the vast majority of suffering inflicted by opiates is because of the War on Drugs right? Your solution would increase total suffering by at least a couple orders of magnitude. Education, prevention, and treatment are what minimize the harm caused by dangerous drugs. Prohibition maximizes it, and you take it further by inflicting suffering on people who aren't even abusing drugs.
You're an ignorant sadomoralist of the worst kind, the kind that foolishly believes they're helping. Could you look down at your own young child, dying of cancer, crying from the pain all day and night, and say "Sorry, there's a 1-2% chance you'll start abusing pain meds, and we're obligated to financially destroy you, lock you in a cage as we flush your future down the toilet, and make you play Russian roulette with fentanyl analogs, instead of help you in the event that happens, so just toughen up buttercup!"?

Re: If I lived in West Virginia

[Brockmire]

I have a friend that had his face smashed in on a construction site 30 years ago and has had about 20 operations and various bolts and shit to fix his jaw. He'll take over a dozen pain pills a day, less if he can smoke weed. Some of his doctors wouldn't allow the weed smoking and were old cunts. Myself, I had a really fucked back the other year, and couldn't take 2 expired oxy pills before getting more sick from the pills. That was the most pain of my life as the pills had little to no effect. My grandmother at 3 times my age and less than half my size could take them better than me.

Re:If I lived in West Virginia

[Gr8Apes]

Well, it all depends upon how that tooth was extracted. I once had 2 wisdom teeth extracted and drove more than 2 hours at highway speeds to get home (student and needed them pulled during a dentist visit before going back to school). No real pain, no pain pills at all, although it was suggested that if I needed it, aspirin or ibuprofen that night could be taken. Fast forward a few years, and had 2 more pulled. Or to be more exact, one pulled, one hammered out of my jaw. Literally. Even then, just 5 doses of hydrocodone over 2 days and I was down to ibuprofen. But make no mistake, tooth extraction can vary by light years in pain, even in the same person.

As for the finger - beats me. Depends upon how it was broken. Minor cracked bone, no problem. Shattered bones? Different story. Not enough detail in either case to make a determination on pain levels, but 30 days of unknown strength pills does seem excessive.

Re:If I lived in West Virginia

[thegarbz]

once for a tooth extraction and once for a broken finger.

Yeah. I mean 1 in 3 people suffering that kind of pain yearly? What the fuck?
By the way why would you take an opiate for a tooth extraction? I've had 6 teeth pulled in my time. I was prescribed an opiate for one of them, but that was done under a general and tore a hole into my sinus wall as well.

Re:If I lived in West Virginia

[thegarbz]

I live in the Netherlands by the way.

While I just criticized the parent I too currently live in the Netherlands and you guys are nuts for the opposite reason. Yeah I think 1 in 3 people getting opiates is excessive. But likewise is the Dutch approach to pain management. Doctors aren't even able to write out a prescription for pseudoephedrine here because it's not a registered drug, yet it's available over the counter in all bordering countries. Codeine requires a prescription too and you don't normally get a prescription for anything, including surgery.

That said the Americans thought I was crazy coming out from surgery without a prescription and being told to get some Panadol Ultra (Paracetamol and Codeine) over the counter. Mind you the thinking was: If I needed anything tougher than that for pain management then I was not ready to be discharged from hospital yet.

Re: If I lived in West Virginia

[StikyPad]

Not only that, but in rural areas, thereâ(TM)s typically one town that serves as a hub for a vast swath of the area around it. The 2000 residents of the town were probably the minority of people using that town to fill their prescriptions (and buy groceries, household goods, etc.).

And thatâ(TM)s without even discussing whether that town served as a regional distribution hub. I donâ(TM)t know how prescription drug distribution networks work, but it seems plausible that one distributor would be responsible for acquiring supplies for other smaller shops in a region.

I agree that this sounds like statistics being abused to evoke an emotional response.

Re:If I lived in West Virginia

[Anonymous Coward]

This is an extreme reach and you know it

Re:If I lived in West Virginia

[dcw3]

Deliverance was set in Georgia, not West Virginia.

Different state, same demographic.

Re:If I lived in West Virginia

[dcw3]

"They often have expiration dates slated for 90 days"

A little searching found that hydrocodone ... Once they have been removed from the originally factory sealed bottle and exposed to the elements, then the expiration date is one year. If they are still in the original factory sealed bottle, then the expiration date is 3 years from the date of manufacture.

Re:If I lived in West Virginia

[stealth_finger]

Personally I'd like to do away with all prescription opiates... it would be better that men would have to struggle and work to get by again. The biggest problem in these regions is lack of purpose. Men need work. One thing we have in WV and KY is plenty of soil to grow crops in.

Ah yes, just what you need to get people off pain killers. Long hours of back breaking labour. Kudos, sir. You must be a very stable genius.

What exactly is your solution for the women? Constant pregnancy and housework you say? Brilliant.

Re:If I lived in West Virginia

[fafalone]

If you think that's a reach then you've obviously never dealt with pain management patients. I have, for 15 years. Even before the crackdown on doctors, good pain doctors were exceptionally hard to find. You talk to people in the lobby, majority are from hours away. Then, what pharmacy will have stock? Most people will go to the ones known for handling patients from pain management practices, because normal pharmacies often don't keep enough on hand (and timely filling is critical because there's no extras allowed so you'll get sick if it's wait til tomorrow). It's not a reach, it's the norm, especially post-crackdown, and I find the idea these pharmacies served exclusively in town customers absurd. As would everyone needing more than a few percs from their GP so had to find a pain specialist, people that account for the bulk of pills.
Pray you never have to find out how hard it is to get treatment for severe chronic pain.

Re:If I lived in West Virginia

[dcw3]

"The "chronic pain" they address cannot outweigh the suffering they inflict on communities. "

What an idiotic thing to say. You try to live in constant agony, and say that. My own mother is on these for multiple pain issues...knees, hip, neck, back. Without some kind of serious pain management, a lot of these folks would be suicidal.

Re:If I lived in West Virginia

[fafalone]

These pharmacies served a regional hospital and in all likelihood a pain management practice, which people from all over the state and even other states would be coming to. It's extremely hard for people in severe chronic pain to find a good pain specialist. Some people have a legit need for lots of opiates, and a doctor willing to prescribe them, even when clearly medically justified, is so rare that they'll attract patients statewide. Then they'll want to fill right away at a pharmacy prepared for the volume, since many don't stock large quantities and waiting on an order means withdrawal. The idea that all these pills were for exclusively in town patients is exceptionally unlikely, and all the people making that assumption are very unfamiliar with the realities of chronic pain patients and the large obstacles and hoops to jump through to get treatment these days. What I described is the exact scenario I've seen over and over in 15 years dealing with chronic pain, so would definitely explain this story. A bit less dramatic than the entire tiny town getting all the pills, but the politicians and media with their opioid hysteria aren't usually telling the whole story-- and refuse to acknowledge what the panic has done to the people who really need these drugs.

Re:If I lived in West Virginia

[barrygrommit]

Do you have any friends taking 2 opiate pills 3 times per day, at least that you know of?

Yes. Me. Twice:
First for a back issue: oxycodone 3 x/day. Later switched to tramadol when the oxy started to get, well, really really good.
Second for a shoulder injury: opiate 2x/day, plus lidocaine patch, plus 4 ibuprofen 4x/day. The pain had peaked so intensely that I could not sleep for 5 days straight.

Re:If I lived in West Virginia

[vandamme]

I had dental surgery recently (tooth extraction) and got a codeine scrip. After two pills, and the pain from the surgery went down, I threw them out and went to the OTC stuff.

Re:If I lived in West Virginia

[vandamme]

Yeah, I found that out after my hernia operation.

Re:If I lived in West Virginia

[vandamme]

Abortion is not "health care".

Re:If I lived in West Virginia

[amicusNYCL]

No shit, put away your straw man. I'm not talking about abortion. I'm talking about what happens after the baby leaves the vagina and every so-called "conservative" who believes in the "sanctity of life" decides that since that child is out of its mother it does not deserve health care it cannot pay for, it does not deserve an education it cannot pay for, and if it's born poor then fuck it. Oh, but life is so "sacred", so let's make sure to force every woman to give birth, but those sacred lives can go fuck themselves because we don't need no socialist health care. It's hypocritical bullshit, it's all over the place in both political parties but especially onerous when it comes to this particular issue. It's religious zealotry masquerading, very poorly, as some bullshit political position. Religious zealotry has no place in the US government.

I would believe so-called "pro-life" people were consistent if their "sanctity of life" extended to all living things instead of only unviable fetuses, but once that kid gets pushed out they think that little fucker better get to work if it wants health care and a decent chance at life. Their "sanctity" ends when they can't force women to do what they want them to do.

Re:If I lived in West Virginia

[amicusNYCL]

Cool story bro. I had wisdom teeth removed and was given a prescription for I don't even remember what, and I never took a single pill. We rule!

Not sure what the point of this little anecdote is, but I'm pretty sure we rule!

Re:If I lived in West Virginia

[amicusNYCL]

When put in that perspective 900 people out of 26000 in the county isn't as bad and reduces the percentage by a factor of 10. You should also keep in mind that's averaging, a half a dozen stage 4 cancer patients would heavily skew the numbers because the volume of pills they'd be taking would skew the average and mean.

I understand that, but the question is whether or not it's reasonable. Yes, I'm sure there are several people in chronic pain who need the medication. Yes, I'm sure certain patients with legitimate short-term needs of huge amounts of opiates exist. But we're talking about over 10 years. If you have chronic pain for 10 years you need surgery, not a lifetime of pills.

and very few were being obtained with valid prescriptions locally.

Indeed, so the per-pill-per-person average goes up when you factor in the black market over 10 years in addition to the 20.8 million pills shipped to 2 pharmacies.

And the best part is the politicians are trying to blame pharmacies

I don't think the pharmacies are the ones being blamed, I think the focus is on doctors who are prescribing opiates to people who either do not need or specifically should not be taking them.

Re:If I lived in West Virginia

[amicusNYCL]

That sounds shitty. I hope you were able to get the medication you legitimately needed.

Re:If I lived in West Virginia

[rahvin112]

If you have chronic pain for 10 years you need surgery, not a lifetime of pills.

Here's something no one told me when I started getting chronic pain. Depending on the problem, Surgery effectiveness is often so low it's not even worth the risk because if it fails like it often does it will only make the pain WORSE. For example I had bone spurs surgically removed from each shoulder. I did so only because I became concerned the spurs were tearing the rotator cuff (something that cannot be fixed if it's torn).

The resulting scar tissue from the arthroscopic surgery causes _constant_ pain for me but I can lift my hands above my head now. There's about a 60% chance those same bone spurs will grow right back. At least so far I'm in the lucky 40%. Depending on the problem the surgical effectiveness can be even lower, there are several kinds of back pain where surgery has an effectiveness rate of less than 10% and often in those cases surgery will make it worse if you aren't in that 10%.

Allow me to offer some advice, you don't understand chronic pain and likely never will unless you get to experience it yourself. Stop judging others when you haven't walked a mile in their shoes. I've been to more doctors than I can count as have almost all chronic pain patients. We seek solutions, we do the research and in most cases there is no solution, no treatment and no effective drugs. That's the reality of chronic pain, you are left with pain and no answer to solving the pain only treating it's symptoms or committing suicide and neither option is a good option.

Anyone with chronic pain would being lying if they told you they hadn't considered suicide, because that's how bad the pain is. I even made the decision at one point how I would do it. Have you ever been in so much pain you started fantasizing about suicide? Do you think you are capable of judging the actions of someone in that situation? Or are you so devoid of empathy you can't understand it at all till you experience it first hand?

Re:If I lived in West Virginia

[amicusNYCL]

Allow me to offer some advice, you don't understand chronic pain and likely never will unless you get to experience it yourself. Stop judging others when you haven't walked a mile in their shoes.

OK, step down from your cross, Jesus. No one is crucifying you. I don't know what you think this conversation is about, but it's not about whether or not people who have chronic pain should take pain killers, of any kind.

Re:If I lived in West Virginia

[rahvin112]

You're the jackass that made the comment:

Yes, I'm sure certain patients with legitimate short-term needs of huge amounts of opiates exist. But we're talking about over 10 years. If you have chronic pain for 10 years you need surgery, not a lifetime of pills.

If you want to be an unsympathetic dick head and personally attack me and everyone else in chronic pain you better be fucking prepared to be called out on it instead of being a whiny little bitch because you can't stand a hard discussion about facts. I stand by my comment, you don't know what the fuck you are talking about and like most people think you're a fucking expert on the subject. As I suggested far earlier in the thread you should shut your fucking mouth until you've personally experienced chronic pain. You don't even understand the problem let alone any type of solution to it.

This town is at the center of mine country, there are likely hundreds of people in permanent chronic pain (and NO SURGERY ISN'T A SOLUTION) in a town of 2,600 let alone a county of 26,000 where these are the primary pharmacies serving the area and that doesn't even include cancer patients. Your bullshit judgements of these people are asinine and just plain unacceptable. I don't know what it is about pain medicine that makes everyone such judgemental pricks but maybe you should think about this superiority complex you've demonstrated, swallow a humility pill and shut the fuck up.

The solution to a drug problem isn't to attack the only legitimate source of pain relief for hundreds of patients and get it shut down.

Re:If I lived in West Virginia

[amicusNYCL]

If you want to be an unsympathetic dick head and personally attack me and everyone else in chronic pain you better be fucking prepared to be called out on it instead of being a whiny little bitch because you can't stand a hard discussion about facts.

Easy there pal, I'm not the dude fucking your wife. I'm just suggesting that surgery is generally the long-term answer for chronic pain. I'm not aware of that opinion being some kind of unsympathetic personal attack on everyone in chronic pain omg , it's just a simple statement that for a lot of people in chronic pain, a surgical procedure is probably better than a lifetime of opiates. Not exactly a fringe opinion or anything to get your panties in a twist about. And, if you think this is me being whiny, well I don't know what to tell you.

About the rest of your post - you're obviously not interested in a discussion. You're super pissed about something that has nothing to do with me and I guess this is your outlet, so hope you feel better now. If not, maybe a couple dozen pills per day will fix that problem of yours.

The solution to a drug problem isn't to attack the only legitimate source of pain relief for hundreds of patients and get it shut down.

We're in total agreement on that. Maybe you don't understand me or my position. Regardless, glad you got your little rant out.

Re:If I lived in West Virginia

[rahvin112]

Which as I've already told you is exactly why you should just keep your opinions to yourself. You're wrong and you don't understand and you think you know better than everyone else what the answer is probably because you watched something on TV and are now the expert.

Life is not a cookie cutter system where the same solution works everywhere. Surgery isn't always effective and depending on the type of chronic pain it often can make it worse, far far worse. Conditions like bone spurs are often made worse by surgery and surgeries to improve things like back pain and damaged spinal columns have ridiculously low success rates even with the best surgeon in the world.

You're super pissed about something that has nothing to do with me and I guess this is your outlet, so hope you feel better now. If not, maybe a couple dozen pills per day will fix that problem of yours.

I'm not pissed about anything, I'm responding to you about not getting the point that you don't know it all and that your understanding and suggestion of solutions is uninformed and dangerous. You are ignorant of the subject and keep repeating the same bullshit over and over and your suggestions about how to fix things like chronic pain are improper and if anyone is stupid enough to believe them they could make some seriously misinformed choices.

If not, maybe a couple dozen pills per day will fix that problem of yours.

Yet another demonstration of your ignorance and exactly explains your worldview, everyone that uses opiates to relieve pain is a drug addict and surgery can fix all problems. Take comfort in the fact that your opinions are right up there with Jeff Sessions and the other hypocrites in Congress that think they know it all too, maybe you and he should have a drink and talk about how much you both know about everything. I'm sure your know-it-all attitude will allow you to bond.

My prayer to end the conversation, May God let you experience real chronic pain someday as Karma for your stupidity and judgement of others. Cheers.

Re:If I lived in West Virginia

[RockDoctor]

You were given pain relief pills for a tooth extraction? I was slated for all 4 wisdoms to be extracted at age 13, walked from school up to the dentist and went under the gas. The anaesthetist got the doses wrong and I woke up (but felt nothing) as they pulled the first. I felt them pulling the second. As they pulled the third, I thrashed about and managed to hit the dentist, at which point they realised there was something wrong and stopped treatment. I spat the blood, exercised my muffled and very lightweight collection of swear words, then walked back to school for the afternoon with an appointment for having the fourth tooth pulled. They did that one under the needle instead of gas.

Painkillers for use at home? Don't make me laugh!

Re:If I lived in West Virginia

[RockDoctor]

Yes, someone that twisted an ankle shouldn't be taking anywhere near that much but you people have NO IDEA how many people in this country are in chronic unrelenting pain for various conditions.

And this is the country whose president is lecturing us about the failings of our medical system.

Almost Heaven, West Virginia

[ColdWetDog]

What gets me about cases like this is how LONG it took to find the pharmacy pushing out 20E6 pills or the individual doctor prescribing hundreds of thousands a year. Yes, the do pop up now and again, but these drugs are tightly controlled. I have to fill out a triplicate form to get a couple of morphine ampules for our ambulances.

Does anybody actually LOOK at those forms. If I ordered 5000 ampules would anyone notice?

Asking for a friend.....

Re:Almost Heaven, West Virginia

[110010001000]

It wasn't detected until AI deep learning software was invented this year.

Re:Almost Heaven, West Virginia

[jebrick]

Most of this came abut due to the Congress neutering the Law enforcement (DEA) on behest of the Drug Companies that product the opioids.

https://www.cbsnews.com/news/e...

Look up Joe Rannazzisi. Former DEA chief prosecutor

JOE RANNAZZISI: If I was gonna write a book about how to harm the United States with pharmaceuticals, the only thing I could think of that would immediately harm is to take the authority away from the investigative agency that is trying to enforce the Controlled Substances Act and the regulations implemented under the act. And that's what this bill did.

The bill, introduced in the House by Pennsylvania Congressman Tom Marino and Congresswoman Marsha Blackburn of Tennessee, was promoted as a way to ensure that patients had access to the pain medication they needed.

Jonathan Novak, who worked in the DEA's legal office, says what the bill really did was strip the agency of its ability to immediately freeze suspicious shipments of prescription narcotics to keep drugs off U.S. streets -- what the DEA calls diversion.

Re:Almost Heaven, West Virginia

[pr0fessor]

They were shipped to two pharmacies in the small town but is also county seat and has the only hospital in the county. They are forgetting that this town with the only hospital serves other communities inside and outside that county of 26,000+ people.

Re:Almost Heaven, West Virginia

[Anonymous Coward]

I'm still having a hard time deciding which side of the fence I'm on here.

When I'm presented with the choice of:

A) Having access to the medications I'm legit prescribed by my surgeon or doctor, while abusers of the same drugs also have easy access to them
and
B) Not having access to the medications I'm legit prescribed and living in agony, while abusers of those drugs still maintain easy access to them

I find it very difficult to support "B"

As someone who recently had open heart surgery and could only get my initial five day prescription filled followed by my second five day refill being delayed a very miserably long three extra days and having to go without pain relief - I frankly don't at all care what law enforcement wants when their desires result in people immediately out of major surgery are left in agony with no other recourse than wasting (in essence) the ERs time and resources to deal with a problem that shouldn't exist and has a well laid out plan to manage.

Especially combined with the fact that only 4 or 5 less people out of 100 are able to abuse those drugs as a result.

However even if they could promise and follow through on claiming the reverse, that is preventing 95% of the abusers instead of just 5%, the cost of that is simply far too high.

Laws and enforcement isn't the right answer to this problem in the first place.
Laws that result in people out of major surgery being in agony are not an answer to anything.

A very small part of me almost wishes for people who support these laws, and people tasked with enforcing them such as those at the DEA, would get to experience some major surgery that involves their body sliced open and bones sawed apart and sent home with no pain relief, just so they are personally connected to and aware of exactly what they are doing to other human beings.
Yet far more so than that, I wish they actually just spontaneously developed the human ability of empathy instead, as no one deserves to experience such a thing.

Re:Almost Heaven, West Virginia

[Anonymous Coward]

Most of this came about because of the War on Drugs, not in spite of it. If you let the government be the gatekeeper of what people put in their bodies, then the government had better be damn good at it. People will clearly abdicate personal responsibility to authority (of the government and their doctor). However, I happen to think a wiser course of action would be to legalize all drugs and sell them in a controlled fashion to anyone who wants them. You want to buy hydrocodone? You got it. You want to buy heroin? You got it. You want to buy cocaine? You got it. We can use taxes to steer people towards safer drugs by making them cheaper than the more dangerous drugs (it would be much better if every heroin addict had access to a safer opiate like suboxone or even hydrocodone which is much safer). We take all the money saved from enforcement, incarceration and the courts system and invest in educational and treatment programs. Oh and as a side effect we neuter a good many gangs that are supported through the drug trade. Criminalizing drug addiction might feel good to all those authoritarians out there (on both sides of the isle), but it simply doesn't make much sense. We've got almost 100 years of proof in this country alone.

Re:Almost Heaven, West Virginia

[ThurstonMoore]

Speaking as a somewhat local, I wish you were correct, but majority of those pills were abused.

Re:Almost Heaven, West Virginia

[gtall]

Nothing Marsha Blackburn supports has a bright side.

Re:Almost Heaven, West Virginia

[pr0fessor]

I'm not local to West Virginia but I do live in a small town that has the only hospital in the county and even for some small towns in neighboring counties it's still the closest hospital. It makes our hospital busy all the time.

Re:Almost Heaven, West Virginia

[Anonymous Coward]

A) Having access to the medications I'm legit prescribed by my surgeon or doctor, while abusers of the same drugs also have easy access to them
and
B) Not having access to the medications I'm legit prescribed and living in agony, while abusers of those drugs still maintain easy access to them

Rather false dichotomy. You can have stricter controls and making it slightly more difficult for doctors to prescribe. That does mean some people might have more trouble getting it, but you may also end up with a bunch of people who are better off when unnecessarily prescribed something they didn't actually need.

I'm reminded of legislation that dealt with over-fertilization of farms along a river I grew up on. The farmers yelled about how they needed that fertilizer to keep up yields, while the fishing industry was almost completely dead. After some careful research and well justified limits were established, the yield didn't change, the farmers got the revenue while spending less on fertilizer, and fish started coming back. Turns out they were using as much fertilizer as they could manage in the hopes it would help when it didn't. Maybe likewise we should be carefully studying how much painkillers make a difference (there are already studies that heavy opioids don't make a difference in many situations), and use them more carefully instead of spray and pray.

A very small part of me almost wishes for people who support these laws, and people tasked with enforcing them such as those at the DEA, would get to experience some major surgery that involves their body sliced open and bones sawed apart and sent home with no pain relief, just so they are personally connected to and aware of exactly what they are doing to other human beings.

I've had three surgeries in the last decade, including one from a car accident, and in all cases I was prescribed opioid painkillers. I only used them for two days before being sent home after one surgery, and in the other two cases i denied them. That didn't mean "no pain relief," as I was still given strong versions of OTC pain killers, and I still had the option of changing my mind. I would not describe my pain tolerance as above average either. But without much regard for the severity of surgery, I potentially given a two week supply of heavy duty stuff and told to use as long as I needed over those two weeks without consultation on what is "need" vs. when to switch to a different painkiller.

Re:Almost Heaven, West Virginia

[Solandri]

According to your link, that bill didn't become law until 2016. Opioid overdose deaths began to skyrocket in 2013, long before the bill was even written.

Based on your link, the more likely culprit was lobbying by pharmaceutical companies getting the bigwigs at the DEA to change enforcement policies.

In 2011, more than 17,000 Americans died from opioid prescription overdoses. That same year Cardinal Health, the second largest distributor, started pushing back at Joe Rannazzisi. The companies' attorneys went over his head and called his bosses at the Justice Department, who called in Rannazzisi to have him explain his tactics.

JOE RANNAZZISI: And it in-- infuriated me that I was over there, trying to explain what my motives were or why I was going after these corporations? And when I went back to the office, and I sat down with my staff, I basically said, "You know, I just got questioned on why we're doing-- why we're doing what we're doing. This is-- this-- this is-- now this is war. We're going after these people and we're not going to stop.
[...]
Rannazzisi says the drug industry used that money and influence to pressure top lawyers at the DEA to take a softer approach. Former DEA attorney Jonathan Novak said it divided the litigation office. He said in 2013, he noticed a sea change in the way prosecutions of big distributors were handled. Cases his supervisors once would have easily approved, now weren't good enough.

Re:Almost Heaven, West Virginia

[Anonymous Coward]

--Whoosh!
select * from lame_ass_slashdot_comments
where user_id = 'anonymous'
and comment_title like '%Almost Heaven%'
and comment_snark_level = 'high'
and commenter_is_a_pompous_ass is not null
;

Re:Almost Heaven, West Virginia

[DavidHumus]

> If I ordered 5000 ampules would anyone notice?

Well, yeah, now they would. Thanks a lot, West Virginia.

Re:Almost Heaven, West Virginia

[j33px0r]

A little quick magic math with 26,000 people, I'm sure I'll overlook something:

75% of population roughly being adults: Down to 19,500 people
2 million pills a year over 10 years.
If a person on a prescription was taking 1 pill a day you'd have enough for roughly 5000 people a year or two a day for 2,500, the remainder for general hospital use. Of course, I'm sure that's not how it played out but it seems rather high...harr...

Re:Almost Heaven, West Virginia

[rahvin112]

Nothing like a quote from the jack booted thugs in the DEA for how to ruin America.

You know how you actually ruin America? You put law enforcement in charge of a medical issue. Then they do things like threaten people with jail which cuts the pharmaceutical supplies of a drug with physical addiction issues so the users have to immediately turn to street drugs to reduce withdrawl side effects.

Then on top of that you stigmatize drug treatment so that seeking help makes you a looser, then add in a little random drug screening at employers so the person gets fired as well.

Our war on drugs is the most fucked up thing you could EVER do to this country.

Re:Almost Heaven, West Virginia

[hey!]

They were shipped to two pharmacies in the small town but is also county seat and has the only hospital in the county.

208 million divided by a population of 26839 is 7750 pills per person.. Over the course of ten years that's two oxycodone doses per day for every man, woman, child and infant in the county, and that's assuming everyone in the county went to the county seat rather than closer pharmacies in adjacent counties, which include several Walmarts.

There's really no way to make this even close to reasonable. West Virginia has the highest opioid death rate in the country, 52 deaths per 100,0000, but even so there probably aren't even enough opioid addicts in the vicinity of these pharmacies to absorb all those pills. They must have been funneled into the black market.

Re:Almost Heaven, West Virginia

[pr0fessor]

It depend on the dose. Low dose hydrocodone 5/325 used for pain management after injury is 1 to 2 pills every 4-6 hours max of 8 a day and would be the most commonly prescribed.

Re:Almost Heaven, West Virginia

[swb]

I think you have to look at the down side of extremely restrictive prescriptions in terms of what it does in the illegal drug market.

Tightening of prescription opiates started happening BEFORE the current overdose crisis and I think drove a lot of more casual pill users to heroin as street prices for pills creeped up. A surge in heroin users and the short-term supply inelasticity of heroin means the market adapts -- hard-to-interdict synthetics from China get turned loose, either on its own or to pump up overly diluted heroin.

So now you have not only a lot of inexperienced heroin users, you have a lot of bad heroin as a result of mostly just tightening down the prescription pill supply.

My sense was that the DEA probably needed to clamp down on the high-dosage pill supply (Oxycontin 30 mg and larger, for example) while mostly tolerating a certain level of abuse and diversion in the low-dosage pill market (your extremely common 5 mg oxycodone and hydrocodones, like Percocet and Vicodin).

While you certainly will have some problems with this -- those with addictive tendences will probably escalate. That being said, the recreational abusers and the overprescribed will be inclined to stick with reliable, relatively low doses, and many will not develop addiction at all let alone overdose. The history of opium has demonstrated that a lot of addicts wind up being maintenance addicts, people who are addicted but maintain their consumption at levels that are long-term sustainable.

The counter to this (existing policy) just seems to cause a lot of problems. Way more black market opiates of unknown quantities, much higher overdose rates, and policy makers making patient care for people with legitimate uses of opiates much more difficult.

Re:Almost Heaven, West Virginia

[phoenix_rizzen]

It's not 208 million pills. It's 20.8 million pills.

For a population of 2900 people, across 10 years, it works out to 1.9 pills per day per person.

If you spread it across the whole county, it drops to a lot less.

20,800,000 / 26,839 / 10 / 365 = 0.2 pills per person per day.

Re:Almost Heaven, West Virginia

[plopez]

There are 7 pharmacies in that town.

Re:Almost Heaven, West Virginia

[plopez]

Now factor in there are 7 pharmacies in the town itself.

Re:Almost Heaven, West Virginia

[hey!]

In 2016. opioid overdoses claimed 64,000 lives. That's like a 9/11 attack every 17 days. It's like terrorists wiping out a city the size of Topeka KS every two years. It's amazing to me that anything else is news while something this big is going on, and our politicians are literally doing nothing about it.

Oh, last year Congress allocated a billion dollars in block grants to be spent over two years, but I have seen what dropping these kinds of hot potato money bombs on state public health agencies does: it just ends up lining the pockets of politically connected contractors. Give a state agency currently operating on a shoestring ten million dollars it has to spend by the end of the year and it won't even have the manpower to oversee that much spending while doing the other things it has to do.

In one case I know of a state public health agency spent a million dollars on a public reporting website that the state's own internal IT people told me they'd have charged back $10,000 for. But they had to spend the money immediately, and so they turned to one of the very few contractors capable of absorbing that much federally encumbered money on such short notice. And because those contractors maintain substantial Washington lobbying presence they were probably ready to take the hot potato off the agency's hand before the agency knew it was coming.

A serious effort to spend 20 million dollars in a state on this problem would give them that money over ten years to be spent at whatever pace they could manage effectively. That would do far more for the people working closest to the problem. Hot potato funding is just a gift to the congressens' political cronies.

In any case a billion dollars is peanuts. We spent trillions in response to 9/11, and even reorganized the Executive Branch, all for what is in comparison a minor event.

Re:Almost Heaven, West Virginia

[hey!]

I stand corrected. But one of those pharmacies got 9 million pills in two years. Given that there are larger pharmacies just across the river from it, it's still pretty damned ridiculous.

Re:Almost Heaven, West Virginia

[Anonymous Coward]

Her B.S is in home economics, bitch better get back in that kitchen, my sandwich isn't gonna make itself!

Re:Almost Heaven, West Virginia

[Anonymous Coward]

Nothing Marsha Blackburn supports has a bright side.

Marsha Blackburn supports incandescent light bulbs. Idiotic? Maybe. But you can't claim it doesn't have a bright side.

Re:Almost Heaven, West Virginia

[fafalone]

Youre assuming people in surrounding areas have pharmacies and doctors that will treat pain. Many pain patients have to drive hours to find a doctor who will help them, then fill scripts right there. I lived it every month for years. They almost certainly served the entire state, maybe others.

Re: Almost Heaven, West Virginia

[edtice1559]

But they only give you medication while you're in the hospital. So if you come in with a trauma, they will load you up with morphine. But at some point you get sent home with a prescription. After I had my wisdom teeth out, my dentist told me to get the script filled immediately and take one right away rather than waiting until I felt discomfort (presumably because the medicine takes time to work). So if you have a lot of people leaving the hospital with a long drive home, they could be filling their scripts on the way. Although I'm guessing that there was also a lot of abuse here.

Re:Almost Heaven, West Virginia

[pr0fessor]

Until they investigate the prescriptions and where the people come from there really isn't anything we can say other than having the only hospital in the area makes it the center of medical care.

Re:Almost Heaven, West Virginia

[Darinbob]

I got a prescription for hydrocodone after some dental work, plus an antibiotic. I headed to the drugstore, which I wasn't familiar with since I normally go to my medical foundation's pharmacy. Didn't have an "insurance card" and I wasn't in their system. So they looked at me suspiciously.

However, the hydrocodone they were fine with, but I had to wait around a couple hours (in pain) while they phoned back and forth to see if I was allowed to get the antibiotic.

Re: Almost Heaven, West Virginia

[Darinbob]

Yes, for in house use, or your first prescription while being discharged. The majority of refills will happen at an outside pharmacy.

Re: Almost Heaven, West Virginia

[jittles]

After I had my wisdom teeth out, my dentist told me to get the script filled immediately and take one right away rather than waiting until I felt discomfort (presumably because the medicine takes time to work).

They recommend that you take all pain meds (opiod or otherwise) prior to actually needing the dose. They say that they're more effective if you take them before the pain gets to its worst.

Re:Almost Heaven, West Virginia

[Trailer Trash]

Most of this came abut due to the Congress neutering the Law enforcement (DEA) on behest of the Drug Companies that product the opioids.

Good. Why on earth do you think law enforcement officers should be making decisions about drugs instead of doctors and pharmacists? That's simply absurd.

Re: Almost Heaven, West Virginia

[M0j0_j0j0]

Yes, and now with support of bigint for these special high value cases

Re:Almost Heaven, West Virginia

[cnaumann]

And alcohol probably claimed 88,000 lives. That is not news either.

Re:Almost Heaven, West Virginia

[hey!]

Yes, and a half million people will die from cancer.

The issues isn't deaths, the issue is preventable deaths.

Re:Almost Heaven, West Virginia

[gfxguy]

I actually don't believe in requiring prescriptions for any drugs - they should all be legalized. I get that some people have no self control and will end up killing themselves, but history, w.r.t. other drugs and other countries has shown using government resources on education and drug treatment programs is more effective.

I had two shoulder surgeries. I knew the problems with the the hydrocodone I was prescribed. I stretched out my prescription from 1 week to 2 by only taking it at night so that I could sleep and still drive to work the next day without being a danger to people around me. When I asked for more, after two weeks, the doctor looked at me like I just grew horns on my head and was the devil himself. The issue was I was still in a great deal of pain. I used all my allotted physical therapy sessions and still wasn't better. So I didn't get the other shoulder done for years because I asked what the point was if it was still just going to hurt.

Then I found out from a new orthopedist that the first one didn't remove enough bone. The pain wasn't in my head.

On a different note, my son had to take inhaler using a pediatric inhaler tube. My dog found it one night and chewed it up - the tube, yes, the TUBE, requires a prescription. We were on vacation, and it was a nightmare.

Then when had a bout of conjunctivitis, we KNEW EXACTLY what we needed, but still had to go to the doctor, wasting their time, our time, money, just to get a prescription for what we already knew we needed. I'm not suggesting people always diagnose themselves, but sometimes it's really obvious and really annoying to wait hours or days to see a doctor when you could just go buy something at the pharmacy immediately and start treating your problem. I'm not suggesting people not see their doctors, I'm saying sometimes you really don't need them.

It's not "deregulation," I think the FDA should still evaluate drugs and the claims of the companies, but a prescription is to tell you what the doctor thinks you be taking, it shouldn't be REQUIRED to take something.

I mean, WTF? They look at you like a criminal just for buying cold medication with Pseudoephedrine.

I'm sorry that other people would be idiots and kill themselves, but natural selection is important to the survival of humankind.

Re:Almost Heaven, West Virginia

[JesseMcDonald]

Yes, and a half million people will die from cancer.

The issues isn't deaths, the issue is preventable deaths.

Are you trying to say that deaths due to alcohol aren't preventable, while deaths due to opiods are? For that matter, even many deaths from cancer are preventable (or at least deferrable... which amounts to the same thing in the end if you can defer it long enough) with early enough detection and proper treatment.

Re:Almost Heaven, West Virginia

[hey!]

I'm saying that a substantial fraction of opioid deaths could be stopped by monitoring situations like the one we're discussing, where a ridiculous number of doses are shipped to a couple tiny pharmacies. One pharmacy got nine million doses of Oxycontin in just two years.

It's easy to check if that's even possibly reasonable. If that same pharmacy also got 150 million doses of statin (a class of blood pressure medication taken by 60% of Americans) then it's just a popular pharmacy. But if its ordering more Oxycontin than statin, it's a virtual certainty that nearly all of those nine million doses went to junkies.

And if that's the case, simply auditing pharmacies with unusual volumes of opioid orders would take a huge chunk out of the black market trade. Show me something that simple which would save cancer or alcohol patients and I'm all ears.

Re:Almost Heaven, West Virginia

[sjames]

But before the DEA was neutered (somewhat), we had B. Ideally, we would legislate that the DEA behave more reasonably, but you can't legislate that.

It's great when a person can do OK with less opoids. Some can, some cant. Some surgeries leave more post-op pain than others. What we DON'T need though is cops that practice medicine without a license and decide who needs what without even seeing the patient first. Before the DEA was curbed, they didn't even demonstrate an understanding that it's natural for an oncologist or a pain specialist to prescribe more opoids than a pediatrician.

I have no idea what your pain tolerance is nor what surgeries you had. You probably have no idea how much GP's surgery hurts or what his pain tolerance is.

If you can figure out how to do option C, everyone with actual need gets what they need and recreational users get none, I'd love to see your proposal. But absent that, people who need painkillers getting what the need is VASTLY more important than cutting off people who abuse drugs.

Re:Almost Heaven, West Virginia

[sjames]

A real question though is how many of those opoid overdoses happened because users resorted to street drugs of unknown and poorly controlled strength rather than well regulated pharmaceuticals?

Re:Almost Heaven, West Virginia

[sjames]

Note that statins are for cholesterol, not high blood pressure.

Also, you have to consider the pharmacy. For example, it it's right next to a cancer clinic, it will probably fill a LOT of perfectly legit opoid prescriptions.

Re:Almost Heaven, West Virginia

[sad_]

Does anybody actually LOOK at those forms. If I ordered 5000 ampules would anyone notice?

as with 99.9% of paperwork & reports, nobody looks at them. it is there for a 'cover your ass' reason. in case anything would happen, people can reach to the paperwork/report and say - here is the proof.

Re:Almost Heaven, West Virginia

[Agripa]

The DEA leaving patients with a legitimate need for narcotic painkillers without them and persecuting doctors who were proscribing them to these patients did not help.

Ultimately this is the fault of Congress and the people who voted for them.

Re: Almost Heaven, West Virginia

[edtice1559]

Yeah so it seems reasonable that people leaving the hospital went right to the pharmacy to fill their medications.

Re:Almost Heaven, West Virginia

[Harvey Manfrenjenson]

It's a fair question, but there is one important difference between deaths-from-alcohol and deaths-from-opiates: The latter figure has absolutely exploded in the past 17 years, going from 10,000/year in 1990 to 59-65,000 in 2016.* Alcohol-related deaths have also been rising, but at a much more modest pace (37% since 2002, according to one source).

So it would appear that something big is happening that is specifically affecting opiate-related deaths, and if we can identify what that is, we might be able to prevent a lot of them.

Re:Almost Heaven, West Virginia

[Harvey Manfrenjenson]

Sorry about that asterisk-- I was trying to include a citation, but for some reason this caused Slashdot to scramble my post into an unreadable mess. Here's the citation: https://www.nytimes.com/intera...

Re:Almost Heaven, West Virginia

[JesseMcDonald]

That sounds much more reasonable. Still, the issue isn't "preventable deaths" since "preventable" is a binary attribute, not a continuum, and in the end most deaths would qualify. Situations where literally nothing could have been done to prevent the death are extremely rare. The real issue is cost vs. benefit—some preventable deaths are more costly to prevent than others. Included in that analysis are other factors beyond the mere number of deaths, many of which have no easy answers; for example, how ought the life of one individual be weighed against the general well-being of many? Is it right to condemn one person, or more likely many, to a life of pain in order to prevent someone else from dying of an overdose? It is a more complex situation than most seem to assume, and I for one remain highly skeptical of any "simple" political solution.

Re:Almost Heaven, West Virginia

[dcw3]

In 2016. opioid overdoses claimed 64,000 lives.

No, that was the total for all drugs. Opioids did just, but up to 14,550, from 12,727 in 2015.
https://www.vox.com/policy-and...

Re: Almost Heaven, West Virginia

[dcw3]

What he (parent) said.

I was in a trauma unit last spring, and given morphine, even though I wasn't in much pain initially due to severe numbness...it was a prophylactic (no, not that kind). My nose was nearly severed from my face. I was sent home the next day (thanks to a great surgeon) with a script for Percocet, and told not to wait for pain to take it. For me, it didn't end up mattering because the nerves are still damaged, leaving me feeling as though the area was injected with Novocain...all the time.

Re: They probably weren't all for just that one to

[Anonymous Coward]

Thank you, captain obvious!

Shit now I need some OxyContin after reading your earnest attempt to say something insightful

Re:Fake news

[Lab Rat Jason]

Spoken like a true drug addict.

Blockchain will fix that.

[xxxJonBoyxxx]

Blockchain in the supply chain will fix that. My IBM commercial told me so.

Re: Blockchain will fix that.

[xxxJonBoyxxx]

I know. I was there for AS2-based drug pedigrees. How's that working?

It's the American way of life

[Anonymous Coward]

Everyone has their diagnosis, their pills and their prescriptions. If something doesn't feel right, then you pop a few pills. Maybe you call the lawyer, there's always a chance you can sue someone. Meanwhile, you slowly eat yourself to a premature death. It's the American way of life.

Re:It's the American way of life

[Anonymous Coward]

That and shooting one another... preferably someone you know/are supposed to love

Re:It's the American way of life

[gtall]

No, everyone does not, and no it isn't the American way of life. Please do get a sense of proportion.

Re:It's the American way of life

[blindseer]

No, the American way of life is shooting yourself. Shooting each other is the national pastime of Venezuela.

The number of intentional deaths by firearm in the USA is about 10 per 100,000, and the murder rate in the USA is about 5 per 100,000. These numbers do not match unless suicides are being counted as deaths by firearm. About 2/3rds of deaths in the USA by firearm are suicides.

Venezuela on the other hand see 57 murders per 100,000, and 59 intentional deaths by firearm per 100,000. That only makes sense if a lot of people are shot to death by others.

Oh, and in America there are enough firearms for every man, woman, child, and household pet to be armed. In Venezuela there's 1 firearm for every 10 people. So, tell me how gun ownership is a problem in the USA again? Pretty sure that it's not the guns killing people in America, it's untreated mental conditions.

Re:It's the American way of life

[blindseer]

You mean like London, England?
http://www.telegraph.co.uk/new...

Or Paris, France?
https://crimeresearch.org/2017...

Pretty sure the problem is not the guns. France has a gun ownership rate of about 30 per 100, and England is about 6 per 100.

I'm still safer in Austin, Texas than Glasgow, Scotland.

Re:It's the American way of life

[blindseer]

If you want to compare countries then compare countries. Why limit the comparison to "first world Western democratic" nations? Can you define "first world", "Western", and "democratic"? Then explain why we are discussing only those nations as opposed to the rest of the world.

Can you even define "nation"? The USA is a federation of states, each with different laws on gun ownership, different styles of law enforcement, different drug laws, different cultures, different economies. Texas, California, and New York, are very large states separated by great distances. Each state is in many ways are as different or similar to each other as the UK is to Australia or Canada.

Does "first world Western democracy" define Mexico? Cuba? If not then why not? If so then it sure would be nice if they weren't our neighbors and the federal government wasn't letting the criminals just walk over the borders.

This will work it's way out in time. I see European "Western democracies" are seeing their own immigrant troubles now. I expect the crime rates to even out in time. Or Europe nations will cease to be "Western" ,or "democratic", or "first world", or perhaps even nations. Whatever problems the USA has it's not the guns. It might be the drugs. It might be the immigrants. Highly likely the immigrants with the drugs. You all in Europe there will see the same, if you don't do something about the immigrants, and the drugs they inevitably bring.

Re:Ironically

[Anonymous Coward]

Yes, and it was the republicans who passed medicare part B, which forbade the government from negotiating prices for pharmaceuticals...

So yes, on top of everything else, they made sure that we would pay top dollar to get addicted, which then increases Heroin usage when the addicts can no longer afford these overpriced drugs

So lets do some Math.

[jellomizer]

Meds Per Person: 22800000.0/2900.0 = 7862.07
Meds Per Person/Year: 7862.07/10.0 = 786.21
Meds Per Person/Day: 786.21/365 = 2.15

Now it is unlikely that the Town is all on these Meds and 2 of these meds a day is very high. I have family suffering from constant pain, and they only use these once a week, in case of extreme pain (And unlike the media, these meds do work), to bring the pain to a manageable level.

However my main point is the news shoving people with big scary numbers, to really prove a point, but while there is still a problem, the real numbers are not as obvious as the article is lead to believe, as this is over 10 years. Not one big shipment.

Re:So lets do some Math.

[Anonymous Coward]

You are waaayyy off that 2 a day being very high. True chronic pain sufferers are not prescribed PRN, they are prescribed a fix amount and told to take the full amount every day. (This helps prevent both diversion and abuse, IE; oh today is "bad" I need to take more. No, you get the same amount every day.) Standard dosing for mild chronic suffers is between between 40mg and 60mg per day. The pills have a useful life of around 6 hours each, and most commonly sold in 7.5mg and 10mg doses. That equates to 4 to 10 pills per day for an average chronic pain suffer on a therapeutic dose. Longer acting time released version exist which greatly cut down the number of pills consumed, while still delivering the same dose of medication, however they are more expensive and many insurance companies won't pay for them.

Re:So lets do some Math.

[jellomizer]

"True chronic pain sufferers are not prescribed PRN"
That is bit of a generalization (a Very DANGEROUS generalization)

True chronic pain suffers have different types of pains, and different pain regimes. Being that these are controlled substances, doctors would like to give patients safer alternatives for "normal" pain days. These drugs do not cure Chronic Pain, but makes its bearable for that day. However Chronic Pain isn't a one size fits all diagnosis it is very different for people.

Re:So lets do some Math.

[jruschme]

That was the same conclusion I came to. The big numbers make it look like a drug oversight crisis. If anything, it is a public health crisis and the real question is why are so many people in one area in such amounts of pain.

Re:So lets do some Math.

[Goetterdaemmerung]

However my main point is the news shoving people with big scary numbers, to really prove a point, but while there is still a problem, the real numbers are not as obvious as the article is lead to believe, as this is over 10 years. Not one big shipment.

You are right. Without any comparison with other areas' usage it is impossible to draw any legitimate conclusion. If this rural area has the same drug usage as NYC that would mean one thing, however if all rural areas have statistically similar usage that means quite another.

Re:So lets do some Math.

[SlaveToTheGrind]

And as I pointed out in more detail further down, Williamson is the only town of any size and thus has some of the only pharmacies in that part of the state, so they're serving a lot more people than just the ~3k inside the technical city limits. I'd guess you're looking at more like a pill or two per person per week once you factor that in. Back of the envelope, you probably can get to numbers like that with a fairly small population of heavy users on top of your normal, legitimate baseline volume.

Re:So lets do some Math.

[Archangel Michael]

And nobody is looking at OTHER nearby towns that may not have pharmacies, or being this is the only town with a Hospital in that county.

The problem with big numbers, is they can be misleading. Big Numbers over a Long Time look horrible, until you do the math, and then it doesn't look so bad. In fact, it actually starts to look more and more reasonable.

But hey, lets kneejerk reaction based on large misleading numbers!

Re:So lets do some Math.

[gweihir]

There is also the possibility that the town is just 2600 numbers, but that this is the place to go to a pharmacy for significantly more people. The given numbers are dishonest.

Re:So lets do some Math.

[Mashiki]

You're way off. My mom has the nerves in her feet destroyed from diabetes, she takes 50mg 3/daily of long-acting hydromorphone. On top of that she takes 325/5mg acet/oxy upto 5/day for breakthrough pain. This isn't uncommon for people who have severe nerve damage, that's even less then what most cancer patients at stage 2 or 3 take for pain control. Even in my case, I take 50-100mg of tramadol, up to 600mg/daily to control pain from when I broke my back. 600mg is where they switch you to long-acting, and then you take *more* pain meds for when the pain breaks through. If people in your family are only taking something once/week for extreme pain, then they're not really in a constant state of pain, or they're having problems paying for the medication and aren't telling you.

The whole premise of pain management is to have you at a level of pain medication where it will get you through the day at a bearable level. When you get to more specialized treatments like with pain clinics, then you move onto things like nerve blocks, localized site injections, implant pumps for constant release and so on. The amount of pain meds could be even higher then what you were originally taking, or lower. For instance, one of the other medications that I use for pain management is baclofen(muscle relaxant), the option I can have is for a line placed directly into my spine and have a steady stream of it all the time, instead of taking 20mg/2-3 daily.

I haven't even gotten to the pain medication resistance, and the requirement to switch pain medications every 5-7 years because they become less effective over time.

Re:So lets do some Math.

[ThurstonMoore]

You are assuming that the oxy's were Percocet which would be available in 7.5 and 10mg dosages. A good bit of them were likely Oxycontin which would be anywhere from 10mg to 160mg per pill. They quit making the 160's early on because that's a stupid amount of drug to put in one pill so a lot of them were most likely the 80mg variety until the non crushable version was released, which lead to the intro of and popularity of Opana for a few years until they were also forced to make non crushable, which lead to the intro of heroin to WV.

Re:So lets do some Math.

[ThurstonMoore]

The problem is two fold. One the coal industry dominates this area of WV and results in a lot of painful injuries. Second those injuries lead to addiction which the drug industry knowingly feeds. Once they get you addicted to the pain pills they keep you addicted under the guise of treatment with Suboxone.

Re:So lets do some Math.

[houghi]

Without telling us what the standard average is, it is still meaningless. That 2.14 is how much of a deviation for these specific drugs?

Re:So lets do some Math.

[rahvin112]

Meds Per Person: 22800000.0/2900.0 = 7862.07
Meds Per Person/Year: 7862.07/10.0 = 786.21
Meds Per Person/Day: 786.21/365 = 2.15

Now it is unlikely that the Town is all on these Meds and 2 of these meds a day is very high. I have family suffering from constant pain, and they only use these once a week, in case of extreme pain (And unlike the media, these meds do work), to bring the pain to a manageable level.

It always amazes me how many experts there are in how much pain people are in and how much they should be able to tolerate.

You're wrong.

Re:So lets do some Math.

[spacepimp]

Are you deliberately ignoring the overdose rate in West Virginia vs the rest of the country? These numbers indicate widespread abuse, not a small town where every single person in the town takes two pills daily and there is nothing to write about.

Re:So lets do some Math.

[plopez]

I removed 50% of the population due to being children, pregnant, etc. I then divided that number by 3 as the national average for pain med Rx. I got about 8.

But that did *not* factor in having 7 pharmaceis in town.

Re:So lets do some Math.

[CronoCloud]

And nobody is looking at OTHER nearby towns that may not have pharmacies, or being this is the only town with a Hospital in that county.

I live in the county seat of a small county in Illinois, it has the only hospital in this county. The population of the county seat is a bit under 12000 and the county population of around 36000 .... and there are only 3 pharmacies.

You are also ignoring WV's high opiate overdose rate.

Re:So lets do some Math.

[ortholattice]

Another post says this town has the only hospital that serves a community of 26000+ people. So it is really like 0.24 med per person/day, or about 1 pill per day for every 4 people, assuming the town also has most of the pharmacies.

Although it's been a while, I vaguely recall the dosage for oxycodone for severe pain as being 1 pill every 6 hours, or 4 per day. So that would be 4 pills per day for every 16 people, or about 6% of the population.

While your "family" suffers from "constant pain", I haven't heard of people in severe pain needing only 1 pill per week. Maybe they really need more but tough it out until it's unbearable, because they can't find doctors willing to prescribe what they need? If so, that isn't a great quality of life.

That isn't to say there isn't abuse, but the numbers don't exactly sound outrageous to me.

Even crazier, all 2,900 people are a single family

[JoeyRox]

Because it's all relative in West Virginia.

Two pills a day, per person.

[BenJeremy]

If you break down the numbers, it's far less outrageous, but hey, why bother with the math? 20.8 million sounds like a crazy, impossible number, right? 20.8 million over 3650 days and 2900 people is less than 2 pills per person per day. Some people may be taking 4~6 pills a day on a regular basis (not saying that is good, but it is in line with a typical prescription), while others won't have any at all. It doesn't seem that unreasonable, given how opioids are prescribed these days.

Re:Two pills a day, per person.

[SlaveToTheGrind]

Yeah, hard math tends to hurt splashy headlines (as well as Congressional investigations looking for a silver bullet/whipping boy).

On top of that, this part of WV is very sparsely populated and they don't have a pharmacy in every small town. Those pharmacies in Williamson are just about the only ones in that part of WV, so they're serving a much larger regional population than just those in the city limits. Total population in surrounding Mingo County in 2010 was nearly 27k. The numbers start getting really small really fast when you take into account how that part of the country actually operates.

Re:Two pills a day, per person.

[Archangel Michael]

when you take into account how that part of the country actually operates.

But why do that, when we elitists in big cities know how to run things better than stupid hicks in WV? That's just a fact!

(Please note, sarcasm)

Re:Two pills a day, per person.

[bluefoxlucid]

I tend to be adversarial and will try to break things. A supportive approach when problem-solving tends to just create more problems. Therefor, I would like to hear more about the dynamics of pharmaceutical services in this area of WV, and pursue the hypothesis that this investigation is founded on bullshit.

Should that line of argument prove indefensible, then we are left with stronger evidence of drug supplier, pharmacist, and prescriber reckless neglect, if not collusion. I'm certain we can deliberately build a case for collusion if we simply ignore the facts and don't ask important questions about alternative theories; there are already enough people interested in that conclusion, so they should be able to provide an anchor against mishandling the opposing investigation.

Re:Two pills a day, per person.

[ThurstonMoore]

I'm in a much smaller town than Williamson and I can think of 3 pharmacies within 5 miles of my current location. If I expand that to 15 miles I can think of 10 off the top of my head and I'm on the outskirts of pill territory.

Re:Two pills a day, per person.

[SlaveToTheGrind]

Look closer. Most of them are in South Williamson, across the border in Kentucky. Even if it's possible to fill controlled substance prescriptions across the state line, dollars to donuts most docs will write them and most people will fill them in their state.

Re:Two pills a day, per person.

[SlaveToTheGrind]

I'm in a much smaller town than Williamson and I can think of 3 pharmacies within 5 miles of my current location. If I expand that to 15 miles I can think of 10 off the top of my head and I'm on the outskirts of pill territory.

Right, just like a bunch of small towns are within 10-20 miles of Williamson and its pharmacies, which is exactly my point. And it's not clear what your unverifiable anecdote has to do with the issue at hand. If you know of any pharmacies in Mingo County other than the three in Williamson, feel free to point them out.

Re:Two pills a day, per person.

[squiggleslash]

Given your interpretation of those figures, between 1/3 and half of all people in that county, including the children, are on prescription painkillers.

That is completely unreasonable, and the story is absolutely right to suggest it's newsworthy.

Yes, opiods are over prescribed. But not to extent almost half the population is on them.

Re:Two pills a day, per person.

[dunkelfalke]

So you are saying that you consider it normal that every
single person in town takes opiates daily? Must be seriously painful living there. I mean, this is the kind of numbers pallative care facilities would have.

Re:Two pills a day, per person.

[plopez]

WHen adjusted for pregnant women, children, etc. and using the national average of 1 in 3 Americans are on narcotics I worked it out to 8 per person per day.

This did *not* include the fact there are 7 pharmacies in the town.

That seems excessive to me.

Re:Two pills a day, per person.

[plopez]

Most states allow Rx to cross borders. If someone comes in and says "I live just across the border and you are the closest and/or the only one my insurance will pay for" then not too many questions would be asked.

Re:Two pills a day, per person.

[SlaveToTheGrind]

Most states allow Rx to cross borders.

Ok, and I said that even if that's permissible, I don't think it would move the needle too terribly much given the general tendency of smaller communities to keep dollars in their community whenever possible.

If someone comes in and says "I live just across the border and you are the closest and/or the only one my insurance will pay for"

Look at the map of Williamson. It's physically impossible to live in WV and be closer to a KY pharmacy than one on the WV side. And I'd be surprised if you saw much variation in network coverage. An awful lot of people abusing pills are going to be on SSI Disability/Medicaid anyway, and there's no rational way a pharmacy in that sort of community wouldn't accept that.

Re:Two pills a day, per person.

[ThurstonMoore]

8 in Williamson. Trust me this is not about a sensational headline the pill problem was huge in southern WV, now its a heroin problem. Instead of trying to be an internet know it all why don't you listen to people who are intimately familiar with the situation and learn something. There is a reason people around here say the Mingo(insert your southern WV county of choice) mating call is the sound of someone shaking a pill bottle, its because people around here will do anything for dope.

Re:Two pills a day, per person.

[ThurstonMoore]

What are you trying to prove with with your posts? Are you arguing that there is not a huge opiate problem in southern WV? If you are then you could not be any more wrong. It is obscene that 20M opiate pills were sold through 2 of the 8 pharmacies in a tiny town in Bumfuck middle of nowhere WV. Get your head out of your ass and stop arguing for the sake of arguing.

Re:Two pills a day, per person.

[jittles]

Given your interpretation of those figures, between 1/3 and half of all people in that county, including the children, are on prescription painkillers.

That is completely unreasonable, and the story is absolutely right to suggest it's newsworthy.

Yes, opiods are over prescribed. But not to extent almost half the population is on them.

There are over 26,000 people in that county, with only one hospital. That hospital is in the town in question.

Re:Two pills a day, per person.

[Trailer Trash]

Sure, but how many counties and people does the hospital serve? It doesn't matter how many people are in the county if it's the only hospital in 50 miles.

Re:Two pills a day, per person.

[SlaveToTheGrind]

Get your head out of your ass and stop arguing for the sake of arguing.

Says the person who continues to overstate numbers to try to make the problem sound more dramatic than it is, which is the issue I've quite openly expressed concern over from the beginning. There are not 8 pharmacies in the town of Williamson in the state of West Virginia. If you disagree, please post their names and addresses.

And try to chill out a bit. I'm intimately acquainted with this general area of the country, and I understand well the challenges it has had for decades. But overwrought stories like this that play statistical tricks to try to make the numbers look as ridiculous as possible are simply going to look... well, ridiculous.

At the end of the day, it doesn't matter where the pills are being dispensed, and likewise the fact that a lot of people in a geographical area all have to go to the same handful of places matters not a whit. The bottom line issue, as I know you understand, is the doctors that are overprescribing the pills, not the pharmacies that are simply carrying out the doctors' orders. And those doctors are, as they have for decades, trying to help their patients in their own twisted way. Just like they try to help by getting huge percentages of the population signed up for SSDI. If the pills dry up, the symptoms will shift to something else just like they shifted to the pills in the first place. To the extent you're trying to fight a war on drugs, you'll miserably fail just as all past efforts have. You have to address the underlying problem that's driving the behavior. And that's a lot harder than picking a meaningless scapegoat to publicly flog. Happy trails, friend.

Re:Two pills a day, per person.

[fafalone]

It could absolutely move the needle. Finding a doctor that adequately treats pain isn't like finding some GP to look at your rash, nor is finding a pharmacy that keeps lots of pain meds in stock so you're not waiting days. Driving several hours to whole other states is very common. It's appalling how many people in this thread don't know the first thing about pain management yet comment like they're experts stating obvious facts. The media and politicians have done an excellent job whipping the population into a hysteria rivaling the crack panic of the 80s. Meanwhile dead silence about the mountains of dead bodies that lay right at the feet of those who didn't listen about what would happen when hundreds of thousands of people were kicked off quality controlled meds obtained from medical professionals; the OD epidemic surprised no one who had even the smallest inkling of knowledge about the drug war.

Re: Fake news

[Anonymous Coward]

If your boss can't handle the idea that getting wisdom teeth pulled out of your face is justification for missing work, then your boss is a cunt

Re: Spread over 10 years

[NeoMorphy]

1.96 is close enough to be counted as 2/day. If there are any children in that town, and assuming it's only the adults talking them, it's even more.

Where are they getting the money to buy it?

[jfdavis668]

This is not a hotbed of economic progress. How are they affording to pay for it?

Re:Where are they getting the money to buy it?

[93 Escort Wagon]

This is not a hotbed of economic progress. How are they affording to pay for it?

They’re selling drugs on the streets.

Re:Where are they getting the money to buy it?

[AvitarX]

Getting over perscriber and selling half is SOP in my city.

Re:Where are they getting the money to buy it?

[ThurstonMoore]

Work, steal or suck. How do junkies anywhere else pay for drugs?

Re:Where are they getting the money to buy it?

[plopez]

or sell

Online drug sales

[aglider]

Is it that difficult to guess?
Try check with delivery and parcel services and you'll get the confirmation.

Re:almost arrested

[Anonymous Coward]

"the cops are poking over your facebook feed as we speak"

Please, this is West Virginia. The FBI is busy getting fisted by the White House and the local cops are busy ticketing black people and/or shooting black people, or stealing money from the towns of inbred hookwormed lumps of mashed potatoes that the census calls "inhabitants". Hell, while I was typing this, another West Virginia resident probably drank 12 shots of bourbon, got in their 90s Ford Fiesta, and drove down to the local pharmacy to pick up more oxy that his brother in law wrote the script for.

Fake news!

[OzPeter]

This is all the work of criminal latino gangs. These gangs forced the poor people of the great state of West Virginia into the offices of innocent Doctors and coerced those brave and hardworking Doctors into writing prescriptions for the drugs.

It is only by building a great and yuge wall (the best wall, the most beautiful wall) that we can stop the spread of drugs affecting the little babies all over the country. And today great American companies like Purdue Pharma (real heroes of the economy I tell you) have come out a stated that a wall is the best thing we can do for our country.

Re:Fake news!

[gtall]

Since many of the illicit drugs are shipped from China, we'll be needing a wall there as well. Oh look, they have a nice yuge wall already there across the north. All we need to do is get our lovely construction companies to repair it...we'll charge...err...Mexico for the repair....now where's that fellow Ping's phone number. President Kelly, could you ping Ping for me?

They call it....

[Jfetjunky]

Hillbilly heroine (for a reason). My father has been addicted for a good portion of his later life.

This is part of the reason I can't take people sheltered people seriously when they go off tangents about illicit drugs when people are likely addicted to synthetic opiates all around them. But that's totally fine because it came from a doctor. The older I've gotten, the more the line seems quite arbitrary, which makes it hard to believe in a system of enforcement of any kind.

Re:They call it....

[Gilgaron]

It does make me wonder if legalizing weed (since it is cheap and you can grow it yourself) would alleviate the opiate crisis... people may still bomb themselves out of their minds but at least they won't be supporting whatever this prison pharma complex has become. Whether we pay to support these guys on welfare, or rehab, or prison it is on the public's dime right now any way you slice it.

Re:They call it....

[CronoCloud]

It does make me wonder if legalizing weed

Yeah, I've been wondering that too and have been edging more towards the legalize with controls mindset.

People shouldn't smoke the stuff though, that's the WORST way to imbibe it. They ought to put THC into patches or gum or powder you can mix with stuff.

As an aside they really ought to have a prescription Ensure supplement with a touch of THC for seniors/disabled folks with appetite/nutritional issues.

Re:Technically, is it that many?

[bobbied]

Your math is correct but the article is wrong. The population of the town is 3,100+ as of 2010. Also, this town is the largest city in the county which has a total of 27,000 people, surely some of those used those pills too.

My guess is the authors of the article where trying to make a point by skewing the population numbers lower. This is misleading to the max as for the county the pills/person works out to about 1/5th a pill per day per person.

The population isn't 2,900!

[bobbied]

The town's population is 3,100. This city is the largest city in the county which has a population of about 30,000.

Surely these pills didn't get distributed only to those living in the city.... So Why do we discuss the size of the town only and not the county which the pharmacies obviously serve too? I'm pretty sure more than just city folks get their prescriptions filled in town.

Somebody is being misleading here....Very misleading. I think on purpose.

Re:The population isn't 2,900!

[thegarbz]

Oh thank god. For a moment I thought the entire population was popping 2 pills a day rather than the entire population popping a pill every 5 days. I'm glad you cleared that up.

Re:The population isn't 2,900!

[bobbied]

ONE hydrocodone every 5 days is a serious problem?

The typical prescription is 1 every 4 hours, sometimes 2 so you get 6-12 pills per day. When I've gotten these, I usually get 3 days worth which works out to 18-36 pills per RX..... That means they are passing out 1 RX for hydrocodone every 90 - 180 days per person (or about ~2 RX per year if my math is right).

Getting two RX scripts for pain each year doesn't sound too bad for an average, especially if the demographics favor older people. I got three pain med scripts last year myself though I only filled one. My daughter got about 5 scripts, but she was in a car accident that broke her arm and had it re-set once before they gave up and did surgery so there's good reason for this.

Re:The population isn't 2,900!

[thegarbz]

ONE hydrocodone every 5 days is a serious problem?/quote

For one person no. For an entire population it shows a horrific substance dependency problem.

Re:The population isn't 2,900!

[bobbied]

I'm not so sure it does. 2 RX scripts per year per person doesn't seem crazy. We've averaged more than that as a family of 4 for a couple of years. But to really know, we need to look at average RX rates for similar social economic and age groups nation wide and compare it to the local RX rate. This discussion of how many pills are being shipped to a location is useless information without some serious context.

Re:The population isn't 2,900!

[thegarbz]

I'm not so sure it does. 2 RX scripts per year per person doesn't seem crazy. We've averaged more than that as a family of 4 for a couple of years.

American right? I wasn't even given an opiates subscription last time I recovered from surgery abdominal surgery. Last time I took some basic 30mg codeine was 2 years ago after a tooth extraction (and that wasn't even the most recent one).

A lot of the drugs Americans seem to depend heavily on are carefully controlled or outright not available in other countries, and I'm not talking about 3rd world we can't afford it you're gonna die unavailable, but rather the 1st world why the heck would you want that take a cup of cement a vitamin and harden up kind of way.

An opiate every 5 days doesn't seem crazy? Wow. Just Wow.

Re:The population isn't 2,900!

[bobbied]

No, I'm saying that a script or two per year/per person doesn't seem crazy for some populations depending on the age mix.

I'm also saying that the authors of the article used inappropriate numbers and do so on purpose. I'm guessing they are trying to make a point, but when you make a point using misleading facts, I'm inclined not to trust your conclusions and question pretty much everything you say. They needed to do a bit of basic investigation here and actually establish how those pills where distributed. I have a feeling they all didn't end up in a town of 2,900 or even the county of 30,000.

Re:The population isn't 2,900!

[bobbied]

https://slate.com/technology/2018/01/20-8-million-pain-pills-shipped-to-one-town-over-10-years-might-not-be-that-bad.html

The above discusses the issues that I have with this story...

Re:Technically, is it that many?

[nevermindme]

Looks like someone did not pay attention in history class or never has been to West Virginia to throw an unqualified southern state label around. Could WV be a sotherns state? YES....BUT. West Virginia was the part of Virginia that the secessionists either did not or cared not to control during the civil war. See: https://en.wikipedia.org/wiki/... Most of the state's politics are focused today towards re-establishing a diverse manufacturing economy well situated to be part of the manufacturing process for the remarkable number of industries along the Ohio River.

The real puzzle

[Tablizer]

Even more outrageous is why the crooks were not smart enough to spread the contraband across cities so it doesn't stand out. They must have been users.

Community size

[Dan East]

WV is a neighboring state, and I happen to know a good bit about its demographics. WV has extremely rural areas - one county has a few dozen zip codes and some only have a hundred people in them, and the entire county only has around 10k people (and it is not a huge county geographically). The fact that the exact town the pharmacy is in only has 2,900 people does not mean those are the only people served by that pharmacy. It may serve the entire county and portions of the adjoining counties as well. The number is very, very deceiving if intended to represent the total customer base of those pharmacies.

Re:Community size

[DavidHumus]

Interesting how many of the comments here are fighting the numbers. It's not like West Virginia leads the nation in drug-related deaths - oh, wait, they do:

In 2016, the five states with the highest rates of death due to drug overdose were West Virginia (52.0 per 100,000), Ohio (39.1 per 100,000), New Hampshire (39.0 per 100,000), Pennsylvania (37.9 per 100,000) and (Kentucky (33.5 per 100,000).

[https://www.cdc.gov/drugoverdose/data/statedeaths.html]

But that's probably a big coincidence.

If it is laxative...

[grumpyman]

It's only good for 20 years for all residents. Not enough.

Re:Technically, is it that many?

[cayenne8]

Calculation looks correct. I guess it's the pain that comes with living in a southern state.

Another fucking yankee that doesn't know his history....

Re:Mingo County, WV went 83% for Trump

[Archangel Michael]

Makes sense that stupid liberals can't do math, or account for small towns in rural counties with only one hospital in that county, which happens to be in that town.

Hillary's "Deplorables" comment helped her win the election!

Re:Technically, is it that many?

[Rockoon]

My guess is the authors of the article where trying to make a point by skewing the population numbers lower.

Thats not called a point. Its called a deception. A fucking lie.

coal miners are in pain and work rules say no pot

[Joe_Dragon]

coal miners are in pain and work rules say no to Medical Marijuana

Re:They probably weren't all for just that one tow

[Immerman]

1.9 pills per day, per person. Better lay off the pills when you're doing math.

Re: Spread over 10 years

[plopez]

My estimate was 8 after adjusting for national averages (I know, national), children, pregnant women etc.

Re:almost arrested

[Onymous Hero]

The Ford Fiesta wasn't sold in the USA until 2010 or so...

More troubling: Wholesalers looking the other way

[CheckeredFlag]

It was two drug wholesalers that knowingly shipped all those pills and looked the other way. There is no way they would not have seen this as suspicious, but why question a huge revenue stream?

Ohio-based Miami-Luken drug wholesaler reportedly sold 6.4 million hydrocodone and oxycodone pills to Tug Valley Pharmacy between 2008 and 2015, the company told the panel, according to the outlet. In 2008, the company’s shipments to the town tripled compared to the previous year.

Some executive(s) needs to go to prison and become a warning to other wholesalers.

Re:Technically, is it that many?

[ThurstonMoore]

WV was created during the Civil War. The state split from VA and joined the North.

Re:Technically, is it that many?

[bobbied]

I'm with you on this.. They will claim to not be technically lying because what they said is actually true, but they sure messed with the numbers to make a story out of something that wasn't a story..

Figures never lie, but liars figure...

AND

There are lies, damnable lies and statistics..

Re:Technically, is it that many?

[ThurstonMoore]

Both.

Re:Spread over 10 years

[ThurstonMoore]

The local industry (coal mining, nothing else) does produce a lot of long term injuries, but they don't employ a lot of people. This is very much a problem of the drug manufactures pumping pills into the state.

Re:almost arrested

[djbckr]

The Ford Fiesta wasn't sold in the USA until 2010 or so...

Not really sure what that has to do with this thread, but I remember the Ford Fiesta my father bought in the 1980's here in the states.

Re:Back of the envelope calc

[ThurstonMoore]

"Now I don't take any opioids so I dunno how many pill an addict needs per day, but I'd say at least two,likely more, but at least two."

The answer is how many do you have?

Re:almost arrested

[Onymous Hero]

Yes, the first version sold for three years from 1978 to 1980. It was never sold in the 90s, and only made a reappearance in 2010.

Re:almost arrested

[Onymous Hero]

It was available for 3 years in the late 70s. There was no 90's Fiesta in the USA.

I did the math

[JustAnotherOldGuy]

I did the math...that's 7,172 pain pills per person, if every single resident was gobbling them down at ~20 pills a day.

But there's nothing to see here, no siree, just move along. And whatever you do, don't say anything bad about the Sackler family, who almost single-handedly created this problem by deceptively marketing these opioids as being safe and manageable.

Re:I did the math

[plopez]

Many people will probably not be perscribed (prenant women, children, anyone with a CDL etc.) the overall Rx rate being 1/3 and I worked it out to 8 per day. Now factor in I counted 7 pharmacies in the town.

Not good.

Re: Fake news

[HiThere]

I think it varies a lot between people. I don't get much benefit from it either, OTOH I get *NO* benefit from acetaminophen, and alway use either aspirin or ibuprofen instead. Or sometimes alcohol, even though it doesn't reduce inflammation.

That's only 2 pills per person per day

[phoenix_rizzen]

What's the big deal? ;)

Update, town has 7 pharmacies

[plopez]

Yep 7. No numbers on number of narcotics sent to the other 5.

Re:They probably weren't all for just that one tow

[plopez]

factor in there are 7 pharmacies in the town. I estimated 8 pills per person per day when I factored in children, nursing moms etc. *without* adjusting for those 7 pharmacies.

Re:almost arrested

[amicusNYCL]

This is definitely a Slashdot thread. We're talking about the prescription opioid epidemic but the history of Ford Fiesta sales in the US do not go unnoticed. You should start those comments with "ackchyually" though to really drive the point home.

Re:Fake news

[amicusNYCL]

so they can't have any opioid effects.

Other than overdose and death.

Do you understand that there is basically an 8 or 9 figure industry in the US based only around providing medication for opioid overdose? If the mass market opioid drugs are not to blame for this because they don't produce any opioid effects like you claim, then why does the anti-overdose industry exist?

If you want a hint, look at the historical price of naloxone from its market debut in 1971 until today, and compare the price changes with sales of prescription opioids. Look at stats from the CDC like saying that in 2014 over 47,000 people died in the US from drug overdoses, a new high number, and 60% of those deaths were from opioids. If pills like this have no opioid effects, which by the way completely ignores the experiences of so many people who have abused them, then are you suggesting that all of these people are dying from injecting heroin? Why do you think people end up abusing oxy and hydrocodone? Do they just like the taste?

Re:It's a symptom of the welfare state

[fredrated]

As opposed to the Republican party showing a stick up everybody's ass.

Meanwhile in the rest of the world...

[stooo]

https://www.nytimes.com/2018/0...

The Case for Cannabis

[Eldaar]

It's really unfortunate that science and research into cannabis and hemp extracts has been hampered for so long, since the more we analyze these plants, the more we understand just how beneficial some of their cannabinoids are.

I bring this up because an increasing number of patients and doctors are discovering the ability of CBD (cannabidiol, non-psychoactive) to relieve pain. Take the case of long-time professional baseball pitcher, David Wells: https://www.youtube.com/watch?.... There is plenty of additional evidence to the efficacy of CBD - just search online. But here's an additional example: https://www.forbes.com/sites/d...

My hope is that more people will become aware that CBD can be a very effective alternative to opioids for pain relief, since CBD has very few negative side effects and is not habit-forming the way opioids are. And in fact, while CBD extracted from cannabis is only legal in some states, CBD extracted from hemp is legal in all 50 states. For those curious, the only real difference between marijuana and hemp is that the former has more than 0.3% THC content, whereas the latter has less than 0.3% THC content. THC is the psychoactive cannabinoid - the one that makes you feel high.

Mingo and destiny?

[istartedi]

It seems like that place is destined to be at the epicenter of the USA's social issues. Unionization of coal mines there sparked a massive civil conflict back in the 1920s.

Re: Fake news

[h4ck7h3p14n37]

Isn't acetaminophen an antipyretic (fever reducer) and aspirin and ibuprofen anti-inflammatories (NSAID's)? I wouldn't call any of them pain killers. In my experience even the hydrocodone and oxycodone formulations don't work that well to kill pain. I have to take at least 15mg to notice any relief and that might just be the opiate buzz.

The best actual pain killer I've taken is Propoxyphene, but it was withdrawn from market due to causing electrical problems with the heart. I had a torn ligament and it worked great to take away the sharp pain while not affecting me mentally.

Re:Mingo County, WV went 83% for Trump

[CronoCloud]

This "stupid liberal" lives in a small town in a rural county with only one hospital, in Illinois. The population of this town is a bit under 12000 and the county population of around 36000 .... and there are only 3 pharmacies.

We also have strict rules on opiate prescriptions to prevent the kind of shit going down in WV. We are dealing with the problem with poor blue collar people and opiates...but addiction treatment is a covered service here. So it is nowhere near as bad as WV.

Re:Technically, is it that many?

[CronoCloud]

Yes but Migration patterns AFTER the war have now "southernized" West Virginia (and Kentucky).

Kentucky, a state that NEVER seceded and sent far more men to fight for the Union than the Confederacy has more Confederate monuments than Union. If you ask Kentuckians if they are Southerners, they now answer yes. But back during the war they would have said, No, having more in common with Indiana and Illnois. Now Kentucky is basically North Tennesse rather than "South Indiana"

Hell now Indiana is basically North Kentucky because of migration patterns.

Re:almost arrested

[Onymous Hero]

If you don't get the minutest details correct then how can one trust the rest of your arguments? :P

I'm sure they'll get to the bottom of this...

[qeveren]

Any day now...

Re:More troubling: Wholesalers looking the other w

[qeveren]

The DEA was investigating this whole mess, but then Congress mysteriously shut that down...go figure.

Other communities nearby

[superdave80]

Williamson is by far the largest city in the county. In fact, looking at the wikipedia page, there are only four towns listed, plus about twenty or so unincorporated areas. The total county population is about 29,000 (10x Williamson), so it is entirely possible that a lot of these surrounding communities go to Williamson for their prescriptions since they are too small to each have their own pharmacy.

Re:Fake news

[Lab Rat Jason]

^^^ check the username. I'm familiar with pharmacogenetics and biosythetic pathways. Occam's razor: Which is more likely? Pharmacogenetics or bog standard drug abuse? GGP's post certainly sounds more like drug tourism than genuine inability to get relief. Everybody on this damned planet thinks they are a special snowflake that deserves some special consideration, due to their circumstances... GGP isn't special, he/she just wants others to think they are.

Some history here....

[hamster_nz]

Just had to see what this place looked like - "a pharmacy in an a shack" wouldn't be too far from the mark.

Also saw this on the search query:

n the recent case of Tug Valley Pharmacy et al v All Plaintiffs (2015 W.Va. LEXIS 673 [May 13, 2015]), the West Virginia Supreme Court weighed in on public policy concerning the diversion of controlled substances. The ruling allowed substance abusers to sue the prescribers and pharmacists who supplied the medications, even though the patients acknowledged engaging in an array of illegal activities including criminally acquiring narcotics by misleading physicians and pharmacists, doctor shopping, and ingesting the medications in amounts greater than prescribed.

http://www.pharmacytimes.com/p...

Opiates are the religion of the masses

[Tenebrousedge]

n/t

Re: Fake news

[dcw3]

It does. I have DNA test results (Medimap...hopefully the price will come down, it was ~$600) showing which meds work best, and which don't, in a sort of stoplight chart, along with verbal descriptions. The results were enlightening, and explained why a couple meds weren't doing much for me.