The sale and abuse of dangerous opioids in the United States has skyrocketed, and Hill County has been part of that dramatic increase.
“There is an opioid crisis in Montana,” wrote Montana Attorney General Tim Fox in a lawsuit against Purdue Pharma and its associated companies.
“The epidemic began not with an outbreak, but with a business plan,” the attorney general continued in the Purdue lawsuit.
According to figures compiled by the federal government, between 2006 and 2012, the most recent years available, 4,947,900 opioids were shipped to pharmacies in Hill County, or 43 painkillers per person per year, far higher than the rate in any other Hi-Line county and most Montana counties.
Experts in the fight against opioids say the number may have decreased in some areas, but the problem remains serious to critical in most of the state, with the Rocky Boy’s Indian Reservation at the epicenter of the crisis. At Rocky Boy, experts agreed, the problem has reached epidemic proportions, with countless addicts and ever-increasing prices for the drugs.
Federal Database Of Every Opioid Pill
The figures were obtained from a federal database that is being used in a lawsuit filed by 2,000 cities, towns, counties and Indian tribes against 22 producers and distributors of opioids. The municipalities allege that through negligence and greed, the companies caused the death of thousands of people, knowingly created countless addicts and tore apart communities.
The database has information on every opioid pill manufactured in the United States and what company shipped it to what state.
U.S. District Court Judge Dan Polster is hearing the case in Cleveland and allowed some of the parties in the case access to the database under severe restrictions, but he denied the public the right to access to the database.
The Washington Post and the Charleston (West Virginia) Gazette-Mail, which won the 2017 Pulitzer Prize for its coverage of how the opioid crisis has devastated its state, appealed the decision to a three-judge panel, which ordered the database be made public.
The database tracks the sale of each of the 76 billion opioid pills manufactured in the U.S., where they were shipped to and what pharmacy sold them.
The figures for the state and the Hi-Line show:
- Montana: 245,472,116 pills were supplied to the state. A total of 105,674,596 were distributed by McKesson Corp., the most of any company.
- A total of 115,476,360 were manufactured by Spec. Gx LLF, the No. 1 manufacturer for the state.
- Hill County: An average of 43.9 pills per person each year were supplied to Hill County during the years in question, for a total of 4,847,900 pills.
- Blaine County: An average of 13 pills annually for each resident of the county were shipped to Blaine County pharmacies. That’s a total of 815,760 pills.
- Chouteau County: An average of 20 pills were sold and shipped to the county each year. That’s a total of 804,060 pills shipped to pharmacies in Chouteau County.
- Liberty County: Eight pills were shipped on average each year to county residents. In all, 139,000 pills were shipped to the county.
The Hill County averages are substantially higher than most counties in the state.
Lincoln County, where Libby is located, had the highest, with 61.6 pills annually.
Some counties had annual pill shipments similar to Hill County. Cascade County averaged 43.2 pills, while Valley County, where Glasgow is located, had 44.5 pills shipped per person per year.
Most other counties were lower, sometimes considerably lower.
For the details of the number of pills in Hill County, where they came from and what pharmacies sold them, visit the Washington Post.
There was no indication that any of the Hi-Line pharmacies did anything improper in filling the prescriptions. In other states, most notably West Virginia, some pharmacies became virtual opioid mills.
Way More Pills Than Anticipated
The Post reported that experts were shocked by the large number of pills that had swamped the United States in that era. It far exceeded their fears, they said.
The problem began, said Stacy Zinn, agent in charge for the Drug Enforcement Agency offices in Billings and Missoula, after highly questionable clinical tests in the early 2000s revealed the drugs were good pain relievers and were safe to use.
Some of the tests into the opioids were financed by the pharmaceutical industry.
Thinking they had found a “miracle drug” that could cure pain, especially headaches, lower back pain and knee injuries, doctors began prescribing opioids and pharmacies gave it out liberally.
When the addictive dangers began to surface, some restrictions were put in place, but they were too little and too late, Zinn said.
Older doctors continued to prescribe the drug without limits and in a couple of cases in Montana doctors, none of them on the Hi-Line, made money by prescribing unneeded drugs until they were caught by federal authorities.
Pharmacies were lax in following the rules, she said.
At the top of the heap, drug companies were making lots of money by encouraging widespread use of their products that provided them with huge profit margins.
“The pharmaceutical industry isn’t in this because they are concerned about people’s health,” Zinn said. “They want to make money.”
To combat growing drug abuse, the Montana DEA hopes next year to open offices in Bozeman and Great Falls.
The Post reported that the newspaper uncovered numerous incidents of drug company executives pushing through excessive orders of drugs that had been red-flagged by the company’s compliance officers.
Sometimes salesmen would joke about the addicted people who would end up paying high sums of money for the drugs, the Post reported.
Street pushers are also making considerable sums from addicted customers, Zinn said.
Pushers sell a hit of opioids for $15 in Los Vegas.
“By the time it gets to Billings, it’s $35,” Zinn said. “And when it gets to Wolf Point, it’s $65.”
The Rocky Boy Plague
At its worst, the same drugs would cost $100 in Rocky Boy, Zinn said.
The price got so high at Rocky Boy that West Coast gangs began bringing heroin to Rocky Boy and offering it to addicts at “discount” rates. That brought the price of opioids down, and soon heroin prices started to go up.
Most of the illegal opioid distribution in north-central Montana happens on Rocky Boy, said CJ Reichelt, supervisor of the regional Safe Trails Task Force, the anti-drug agency.
“Demand is still high on Rocky Boy,” Reichelt said during an interview with the Herald.
Most of the illegal opioids such as Oxycontin and Oxycodone that land in the region come from California and Washington. They usually originate with a legal prescriber who sells their pill for a certain rate, perhaps $15 a pill. The person who buys from the legally prescribed although illegal distributor then targets an area of high distribution such as Rocky Boy, where lower-level local distributors are used to sell the drugs. An Oxy pill could sell for about $90, Reichelt said.
For as long as he remembers, Reichelt says, opioids have been a problem.
“It hasn’t seemed to go downhill.”
Outside the Rocky Boy boundaries, Reichelt says it’s a different story. There are instances where people with legitimate prescriptions will sell some of the pills to someone on the street, but they are few.
And it’s not exclusively a reservation problem. Reichelt says opioids are almost nonexistent on Fort Belknap.
As the situation has gotten worse, efforts have been made to improve services to drug victims and potential suicide victims, both by the state of Montana and the tribal government at Rocky Boy.
At the neighboring Fort Belknap Reservation, where the problem is largely meth, the tribal government declared a state of emergency in hopes of securing more financial help from outside agencies.
Zinn said drug companies sell opioids to people with little or no oversight, The people genuinely in pain often cut their drugs in two and sell their remaining drugs at large profits. Some are successful in getting prescriptions filled even though they are not needed. This makes earning big profits even easier, she said.
The Fox Lawsuit
The suit filed by Montana Attorney General Tim Fox is separate from one filed by the 2,000 municipalities and tribes, but it has the same goal.
And it is hardly the only one.
A total of 1,600 lawsuits have been filed against Purdue Pharma and the three generations of the Sackler family who control the company, the largest of the opioid companies and the one that sold the most to Montanans.
The newsletter BioSpace reported that the company had taken in $4 billion in profits from the sales of opioids.
The Sackler family had been a patron of the arts for many years, but recently CNBC reported that two major art museums, Metropolitan Museum of Arts and the Guggenheim Museum in New York, have turned down contributions from the family.
CNBC said bankruptcy might be looming for the company.
In the state of Montana’s brief, filed in 2017, Fox said Purdue made a corporate decision to “promote opioids deceptively and illegally in order to significantly increase sales and generate billions of dollars in revenue for Purdue’s private owners, the Sackler family.”
The sales effort was aimed at over-prescription of opioids for lower back pain, arthritis and headaches.
“As a direct consequence,” Fox said, “the rampant use, overuse, and abuse of opioids is devastating Montana and its families.”
Write to John Kelleher at firstname.lastname@example.org
Paul Dragu contributed to this report.