A recently released Drug Enforcement Administration-owned and managed database with detailed information on manufacturing, distribution and dispensing of Food and Drug Administration-approved opioid medications showed that 76 billion opioid pills were distributed across the United States from 2006 to 2012.
Media outlets covering the story have highlighted a narrative pushed by lawyers suing industry — specifically that pharmaceutical wholesale companies should have stopped the flow of these medications, in turn preventing the crisis of opioid misuse facing the nation today.
Missing from much of the coverage is the fact that the number of pills is far less sensational when looked at through the lens of prescribing. Specifically — during that period, the Centers for Disease Control’s own data show that doctors and health care providers wrote nearly 1.7 billion prescriptions for opioid medications. Prescribing rates peaked in 2012, when more than 255 million prescriptions were written with an average prescribing rate of 81.3 scripts per every 100 people living in the United States.
Some simple math shows that this accounts for around 45 pills per script — a number that likely seems familiar to the millions of citizens who have received an opioid prescription over the past 15 years.
The DEA has a responsibility to set production quotas to limit the supply of controlled substances with the stated goal of preventing diversion and abuse of these drugs while ensuring an adequate and uninterrupted supply. But the former head of the Office of Diversion Control, who has pointed the finger at pharmaceutical wholesale distributors for the crisis, said, “The DEA cannot just cut quotas by 20 percent to 30 percent to ‘see what happens.’ This ultimately involves patient care, and nobody at the DEA wants to see any patient or family suffer because of a quota-related shortage.”
Unfortunately, pharmaceutical distributors are in the same position. Wholesalers, like my company AmerisourceBergen, fill aggregate orders from health care institutions like retail pharmacies, hospitals, long-term-care facilities and even hospices. We don’t have access to specific patient information or prescriptions. Instead, we get an order for a quantity of medication that can be used to fill multiple prescriptions from a DEA-registered pharmacy that then dispenses medications to patients with valid prescriptions from their state-licensed and DEA- registered healthcare providers. All of these shipments are then reported directly to the DEA, which holds that information in the database that was just released.
Unsurprisingly, former DEA bureaucrats who now work with plaintiff firms and lawyers looking for billions of dollars in paydays want to make the issue seem simple. But a narrow look at the issue that considers 76 billion pills without looking at the nearly 2 billion prescriptions that accounted for them creates a one-sided and skewed narrative.
That lens means that corporations like mine, who don’t know you and have no line of sight into your relationship with a doctor, may be deciding what medications you can access. That’s not a good outcome for anyone.