Recently released data shows how many opioid pills flowed into pharmacies across the United States in the peak years of the opioid epidemic — illustrating how practices such as overprescribing and doctor-shopping helped launch the nation into a public health crisis that led to the deaths of thousands of Americans.
According to the data, which was shared by The Washington Post, which obtained it from federal sources via lawsuit, vendors in the towns of Southampton and East Hampton together received more than 14 million hydrocodone and oxycodone pills from manufacturers over six years, from 2006 to 2012. That would be enough for each resident of the two towns to take about 31 pills per year — a number similar to the rates in both Suffolk County and New York State as a whole.
Several individual pharmacies in East Hampton and Southampton approached or exceeded 1 million pills received, to be delivered to patients via prescription, over the six-year period. B&B Hampton Drugs Inc. of Hampton Bays led the way with 1,543,280 pills, followed by Barth’s Pharmacy Inc. of Westhampton Beach, 1,119,340, and CVS Pharmacy in East Hampton, 1,091,900. Other top providers were in Southampton, Eastport, Montauk and Sag Harbor.
The totals were only for the two most popular forms of opioid painkiller pills, which often carry the brand names Vicodin and OxyContin, respectively.
Dr. Juan Gargiulo, a pain management specialist in Southampton, said part of the reason doctors were prescribing so many opiates during that span was that they were not fully aware of their effects. He said pharmaceutical companies marketed opioids in such a way that doctors didn’t know they would be addictive among patients who had not previously shown signs of addiction.
According to the National Institutes of Health, deaths from prescription opioids rose from 3,442 in 1999 to 17,029 in 2017.
While data detailing the numbers of pills distributed in more recent years wasn’t available, fewer pills may have been distributed, as both the health care industry and various levels of government put stopgaps in place to address the opioid crisis.
To curb abuse, lawmakers started limiting how doctors could prescribe opioids. In New York, initial opioid prescriptions for acute pain were reduced from a 30-day supply to a week’s supply in 2016.
New York also introduced the I-STOP program in 2013 to create a database for all Schedule II, III and IV substances — allowing doctors and pharmacists to better monitor medications prescribed to individuals — to stop patients from doctor-shopping or pharmacy shopping.
“Now, a lot of the patients, I don’t think are abusing the pain medications like they were before at all,” Dr. Gargiulo said.
But while the influx of pills was reduced, the number of people who were already addicted was not. Pill prices quickly shot up, and people turned to street drugs like heroin, because it was cheaper, according to Dr. Shawn Cannon, Stony Brook Southampton Hospital’s chief academic officer of the Residency Program in Social Medicine.
Dr. Cannon warned against looking at the number of pills shipped to pharmacies during those years in a “vacuum,” because some people on the South Fork spend just a few months here, and some come with chronic pain or incurable diseases, seeking to relax.
“It doesn’t necessarily 100 percent reflect our community,” he said of the data, adding that areas with more outlying numbers compared to the surrounding counties may be more indicative of a deeper problem.
The two Long Island towns had similar pills-per-person counts as Suffolk County as a whole (33) and Nassau County (28) over the six-year period, but lower than neighboring Riverhead Town (56). Both Queens and Kings counties in New York City were at 11 pills per person annually. Other areas of the United States were much higher — such as Mingo, West Virginia, which vended at a rate of 203 pills per person annually.
Most of the pills that came into Southampton and East Hampton went to pharmacies, with smaller numbers going to veterinarians, doctors and dentists.
The Post also collected data on pill manufacturers and distributors. In Suffolk County, the top distributor was Cardinal Health, the top manufacturer was SpecGx LLC, and the top pharmacy, which received 7,072,610 pills in the six-year period, was Rupal Enterprise Inc. in Selden.
Pharmacist Andrew Poster works at the White’s Apothecary in Sag Harbor, one of three pharmacies under White’s Pharmacy Inc. ownership, which opened earlier this year. He said that, based on observation, both I-STOP and electronic prescriptions have decreased the number of opioids that pharmacies have dispensed. Glancing at the number of pills sent to White’s Pharmacy in East Hampton in the six years, 938,060, he pulled out his calculator from behind the counter.
“That’s roughly 430 pills a day,” Mr. Poster said, adding that some patients take three pills a day, every day, which totals to more than 1,000 per year. In his estimation, 430 pills per day isn’t that high: Mr. Poster has worked in pharmacies across the island and in Florida. In Florida, he said, the epidemic is much worse.
Southrifty Drug in Southampton was the fourth-highest receiver of pills in the two towns, at 994,700 in six years. Bob Grisnik, the pharmacist and owner of Southrifty, was part of Southampton’s Opioid Addiction Task Force. He was also the first pharmacist in the country to have his license amended to become a “take-back pharmacy” — where patients safely can return unused or expired pills.
Mr. Grisnik said he typically fills prescriptions without knowing why they are prescribed, what ailment led to the prescription. But he said he’s careful to check to see if anything seems inconsistent.
“I’m very, very aware of the prescriptions I take in,” he said. “We look at them with a fine-toothed comb, and if there’s anything I don’t like, I make a phone call to the doctor.”
He looks for anything that appears suspicious, such as receiving prescriptions from out-of-area doctors looking to have them filled in Southampton. Mr. Grisnik said that a few years ago, doctors in Brooklyn were sending prescriptions to pharmacies on the East End.
“When I saw that, it concerned me, and I called the DEA about it,” he said, explaining that the head of the Long Island office of the federal Drug Enforcement Agency was a friend of his.
“I told him about it, and that I was very hesitant about filling these prescriptions,” Mr. Grisnik said. He also called the Village Police. He said he worked with the DEA and police department on filling the prescriptions until they had collected enough evidence against a few doctors to arrest them.
He said he hasn’t noticed an increase or decrease in the number of opioid prescriptions filled at Southrifty since 2012, since many prescriptions that come to the pharmacy are from doctors who specialize in pain management. But he has noticed a change from how doctors used to prescribe opiates years ago: He used to see dentists giving patients a prescription for 30 or 40 painkillers, but now laws have become stricter about how many they are allowed to give patients.
“We’re still seeing a lot of opioids, because the doctors are writing them,” he said, but most of the opioids provided by Southrifty go to the same patients every month, often patients with chronic pain.
Pharmacist James Constantine has worked at Hampton Liggett Drugs in Hampton Bays for 13 years. Liggett Drugs had the most hydrocodone and oxycodone shipped to it than any other pharmacy in either Southampton or East Hampton. Mr. Constantine attributes it to the high number of customers the pharmacy has — he said it’s busier than even the chain pharmacies in the area.
He also pointed out that Suffolk County has a high number of worker’s compensation claims, which may skew the numbers. He added that he sees a lot of day laborers coming into the pharmacy who may require stronger medications.
Between him and the owner, Mark Hertz, he said they know almost everyone to whom they provide prescriptions in the store. “That’s why it’s easy for us to tell people ‘no,’” he said. “And I’m honest with people. If I don’t want to fill their prescription, we just tell them.”
Mr. Constantine said the number of opioid pills coming into pharmacies in the area is “definitely down,” also pointing to I-STOP, electronic prescriptions and increased awareness about opioids as possible reasons.
At East End Pain Management, where he practices, Dr. Gargiulo said he takes preventative steps to make sure patients are using their prescription pills in the correct way, and even before the opioid epidemic, he was careful with how he prescribed the pills.
Now, he has guidelines for patients who use narcotics, such as keeping a safe box in their home to keep pills away from children, and he educates them about the drugs they’re taking. He monitors patients who take narcotics, including conducting urine tests.
“We are very, very strict with that,” he said. “If we give you pain medications and you don’t have them in your system, you will not get any more pain medications. Period.” This helps avoid patients diverting them to others.
Additionally, he estimated that 40 percent of his patients don’t use pain medication at all. “We’re always pushing for that,” he said. Because of his strict rules, he said, patients who are looking to abuse pills do not usually come to him.
There are patients who need to take opioids for pain, though, he noted, and opioid abuse has made it more difficult for people who use their pills as directed. Dr. Gargiulo also said insurance companies are becoming more critical of opioid prescriptions.
“I feel that narcotics play a role in pain management,” Dr. Gargiulo said. “I think it’s important, because there are people who don’t have any other option — people who have cancer … But you also have to discuss, every time they come, how they feel, how much they can do, if they can do better with or without the narcotics.”
But Dr. Cannon said he’s turning his focus away from prescription pill abuse and more on fighting deaths, which are attributed to drugs laced with fentanyl and carfentanil.
“There are many people now in addiction who really want to start calling this the fentanyl and carfentanil crisis,” he said. “To me, it’s not about the amount of pills being sent out — it’s about saving lives. Those things may not be as related as we think.”
About The Data:
The data came from federal sources via The Washington Post, which fought a yearlong legal battle to make a part of the database maintained by the federal Drug Enforcement Administration available to the public. Though records indicate the number of pills shipped to providers in each county, they could have gone to people living in different areas, according to The Post.
Other opioids were shipped in lower quantities and diverted at lower rates, which is why only data from hydrocodone and oxycodone were consolidated.