Data shows distribution of pain pills in Montana

Recently released data from the Drug Enforcement Administration shows more than 245 million legally-prescribed hydrocodone and oxycodone were supplied to Montana from 2006 to 2012, with Lincoln County receiving the most pills per person per year statewide during that time stretch at 61 pills per person.

The database, supervised by the Administration, monitors the path of every legal pain pill in the nation and was made public as a result of a court order from The Washington Post and HD media. Data was released as part of the largest civil action in U.S. history. The robust data set was analyzed and then published by The Post. It shows where more than 76 billion oxycodone and hydrocodone pills were distributed and which companies manufactured them during a segment of the opioid crisis that claimed nearly 100,000 lives in the United States.

Jason Cohen, chief medical officer at North Valley Hospital and hospitalist with Kalispell Regional Healthcare in Flathead County, says there are multiple reasons why so many opioids were being pushed during that particular time period.

He said it can be traced back to the early 2000’s even when drug companies began campaigning for doctors to prescribe long-acting pain medication to their patients.

“You had a lot of people writing prescriptions for opioids partially because we were being told by these companies that we were undertreating pain,” Cohen said. “The message was very pervasive.”

It was also in the early 2000’s when pain was declared the fifth vital sign, which are defined as “measurements taken to help assess the general physical health of a person,” and more.

“One of the questions patients were being asked was ‘how effectively did we treat your pain?’ and their answers had a lot of weight,” said Cohen, who wrapped up his own residency in Oregon in 2006.

And the overprescribing of opioids and unabated manufacturing and distribution by the companies that pushed the movement continued until a crisis ensued.

With the exception of Yellowstone County, which was supplied the most pills total at nearly 39 million pills, or 38 pills per person per year during that time, the bulk of the legally-prescribed opioids in Montana were mostly confined to the Northwest corridor of the state.

Flathead County as a whole saw the second highest number of pills prescribed during the seven-year stretch at almost 32.1 million pills. That’s about 51 pills per person per year during that time. Other counties that saw a steady stream of opioids include Lake, Missoula and Cascade counties.

Lincoln County was supplied the 10th-most amount of total painkillers statewide at 8,351,810 pills. But when broken down by how many of those pills could have been distributed to each person in the county for each of the seven years, Lincoln County was number one in the state at 61 pills per person per year.

Cohen offers multiple possibilities as to the Northwest corner of the state amassed a large portion of the state’s opioid supply. He says one should look at the population of people who look to chronic pain killers, which can include people on disability, veterans and elders.

For example, Lincoln County has a historically high population of disabled individuals. According to U.S. census data that was compiled by the University of Montana, Lincoln County was one of six counties in Montana to have a disability rate between 19 and 36.9 percent from 2012 to 2017.

“There was a rise in disabled people which increased the chronic pain diagnosis,” Cohen said.

Flathead County is also one of the fastest aging counties in the states, with about a quarter of the current population being 60 years of age and older. Lincoln and Flathead counties also have some of the highest percentages of veteran populations, according to U.S. Census data.

The data from the administration also gives insight as to which companies manufactured and distributed the pills and which pharmacies filled the prescriptions.

Of the 245 million pills supplied to Montana, the Walgreens in Kalispell received the highest number of pills in the state by a sizeable margin at just over 4.1 million pills. The second highest pharmacy, Montana CVS in Butte, received nearly 3.1 million during the seven years, according to The Post’s county-level analysis.

In Lincoln County during that time, Franks 293 Drug, which is now Granite Pharmacy and is under different management, filled the most prescriptions by a wide margin.

According to Brian Saari, the pharmacy manager of one of Granite Pharmacy in Libby, the popular pharmacy serves patients all over Lincoln County. However, while the majority of providers who go through the pharmacy are local, such as Cabinet Peaks Medical Center, a good amount of prescriptions also come from Flathead County, where people in Lincoln County may travel for specific medical needs.

“For those [prescriptions] coming from the Kalispell area, many are part of a pain contract,” Saari explained. “So those patients are assigned a specific pain doctor and work with a specific pharmacy and can’t have their medications filled elsewhere.”

Saari said he couldn’t speak to the operations of Franks 293 Drugs, but said Granite Pharmacy “tightly controls and regulates the filling of opioid prescriptions at every level.”

While data from 2006 to 2012 shows Montana was no exception to the nationwide spike in opioid abuse, other data shows the epidemic began to subside in most parts of the nation soon after, following a nationwide outcry that pushed into the limelight.

“We started recognizing it as being something that crossed socioeconomic lines. This isn’t a problem that is just isolated to people who have addictive personalities, it was impacting your neighbor, the person at the gym, your friend’s son,” Cohen said. “It wasn’t affecting your preconceived notion of what a drug addict was.”

Maps compiled by the Centers for Disease Control and Prevention show, among other key findings, “the overall national opioid prescribing rate declined from 2012 to 2017, and in 2017, the prescribing rate had fallen to the lowest it had been in more than 10 years at 58.7 prescriptions per 100 persons.” This is down from 81.3 prescriptions per 100 persons at the peak of the crisis in 2012.

Cohen says he doesn’t know if there is one factor alone that can be credited with the start of the opioid crisis subsiding, but says the push for electronic health records and a standardization system such as the drug registry has played an instrumental part.

In 2011, Montana Legislature authorized the Montana Prescription Drug Registry as an online tool to “provide a list of controlled substance prescriptions to health-care providers to improve patient care and safety.” Up until the 2019 Legislative Session, use of the system was optional. But as of July 2021, physicians - with a few exceptions - will be required to observe their patient’s medical and prescription history in the system prior to writing prescriptions.

In addition to shifting towards a standardized electronic system and many other improvements, the Centers for Disease Control and Prevention recently rolled out a guideline for prescribing opioids and treating chronic pain. According to Cohen, many hospitals began adopting some of those practices.

Reporter Kianna Gardner can be reached at 758-4439 or kgardner@dailyinterlake.com