ELLSWORTH — A Rite Aid Pharmacy in Machias distributed an average of more than 1,000 prescription painkillers per day in a town of roughly 2,220 people. Another pharmacy next door in Marshfield, a town of 500, sold nearly 700 pills per day. Hannaford in Ellsworth: an average of 1,650 pills per day, for a total of nearly 16 million over the course of seven years.
That’s according to information analyzed by The Washington Post and released last week. The database, compiled by the Drug Enforcement Administration, tracked the path of every pain pill sold in the United States for seven years between 2006 and 2012.
The Ellsworth American used The Post’s data, which looks at the two most common painkillers, oxycodone and hydrocodone, to dig deeper into the issue in Hancock and Washington counties.
Over those seven years, the Hannaford pharmacy in Ellsworth distributed a total of 4,216,710 pills — the second highest total for any pharmacy in the state, after Miller Drug in Bangor.
In Washington County, Rite Aid Pharmacy in Machias distributed 2.75 million pills, followed closely by Treworgy Rexall Pharmacy in Calais, with 2.35 million pills sold in a town of 1,600 residents.
Gordon Smith, the state’s recently appointed director of opioid response, said he’d seen the numbers and that although “they are very alarming,” the figures don’t illuminate much of anything new.
“They are kind of ancient history. To go back and rehash what was happening in 2010 and 2012 when Maine was a very high prescriber — we know that already and we’ve been working on it for a number of years.”
Smith added that since 2013, the percentage of opioid pain pills prescribed in the state has gone down 41.5 percent, what he said was the ninth-steepest drop in the country.
“We’ve almost cut in half the opioids prescribed for pain. Can we drive it down lower?” Smith said.
The director attributed the drop in part to a 2016 law that limits the number of milligrams a medical provider can prescribe per day and requires patients receiving more than 100 milligrams per day to be tapered off to that level or below. (There are exceptions, such as for patients with cancer.)
“It’s really the toughest law in the country in terms of all the things it does to limit prescribers,” Smith said.
Greater public awareness and provider education also have played a role in the decline, he said.
What about the earlier period covered by the database, when millions of pills were flowing into Maine counties?
“What were we doing between 2002 and 2016 when that law was passed?” Smith wondered. “I wish we were doing more.”
But as the epidemic shifted from involving primarily prescription opioid painkillers to other, more potent drugs, the country began to pay attention, said Smith.
“It wasn’t frankly until fentanyl and heroin got into the mix and thousands of people overdosed that the public and the media took such a strong interest in it.”
Drug overdose deaths in Maine began to fall this year after steadily rising since at least 2014, according to data from the Centers for Disease Control and Prevention.
Asked whether the newly released pill distribution data would result in any disciplinary action for those in charge of prescribing and distributing, Smith said there have already been a host of disciplinary actions taken by the Board of Licensure in Medicine and other state regulatory agencies.
“A significant percentage of the board’s disciplinary cases have involved this issue,” Smith said.
“There is an attempt to make [prescribers and pharmaceutical companies] accountable. So far I would say not so much the individual pharmacists or pharmacies, but that may well be because we did not have pill mills in Maine. In Maine, you can’t just set up a storefront in Millinocket without people noticing.”
There are a number of lawsuits aimed at pharmaceutical manufacturers and distributors, Smith pointed out.
Washington County, which had the highest death rate for opioid overdoses of any county in Maine in 2016, joined at least a dozen counties in the state in January in a suit naming 28 opioid manufacturers.
That lawsuit, brought by firms in Auburn and New York, argues that the companies, which include Purdue Pharma, CVS, Walgreens and Walmart, continued to market — and encourage doctors to prescribe — painkillers despite knowing the likelihood of addiction among patients.
There are still roughly 9,000 Mainers receiving a prescription for more than the legal limit of 100 milligrams per day of a controlled painkiller, said Smith, most of whom have been granted an exemption for cancer and other chronic diseases.
Before 2016, more than 18,000 Mainers were getting such a prescription, Smith said.
“You’re never gonna get that pendulum in that perfect spot where only people who are getting it need it,” Smith said.
“There are some people who became quite dependent on opioids for pain and have really had a difficult time tapering off high doses or finding people to prescribe at the level that they feel they need.”
Smith said he is also making greater use of the state’s Prescription Monitoring Program (PMP) to track prescriptions, all of which must now be filed electronically. The monitoring program has been around since 2003.
“This terrific resource has been around for a long time, but it has not always been used to help inform opioid policy in the state. Now is really the time when we’re beginning to become more strategic in our response.”
The Prescription Monitoring Program, Smith said, allows him to see “every controlled substance and who is prescribing it. The database is very rich.”
But, he said, “In the past it’s not always been transparent even in the aggregate information released. We intend to have a much more transparent and public process.”
Another piece of the puzzle, Smith said, is getting insurance companies to cover alternative pain treatments, such as acupuncture, osteopathic manipulation, “almost anything other than opioids.”
“I recently met with one carrier in the state and I’m now examining all the policies and all the carriers,” Smith said. “I come out of a background of working with providers, hospitals and insurance companies; it’s not our nature to be down there passing laws if I can sit down with those organizations.”
But going to the Legislature isn’t out of the question if he can’t get companies to provide coverage for alternatives, Smith said.
“The response is going to be aggressive and things are going to get better and people want to be a part of that effort.”
In a last comment before running off to a full day, Smith added that along with all of the prescriber limits and treatment alternatives, it is important to look at “the underlying problems of why. The drug use is just a symptom of what’s going on with that individual.”