That's... over an 8 year period? So about 10 million a year, or ~111 per person per year; i.e. less than one per day per person. Literally everyone in the town wouldn't be on prescription painkillers, obviously, but it'd only take like a 3rd of that population (or less, plus however many folks were driving into town for their meds) on prescription painkillers to make that... not actually that unreasonable? 1 per day per relevant person, likely to be 2 or more in practice since even opioids don't tend to last 24 hours, etc. Not all of the folks on painkillers would be on opioid painkillers, but... still. It wouldn't take that many people on a daily painkiller prescription to hit those kind of numbers over nearly a decade.
That's definitely a number reported like that to be scary more than informative, and by a rough eyeball suggests a lot like the pharma folks involved are likely to avoid legal censure, blech.
E: Though looking a little more, it looks like the national average is ~10% on painkillers, roughly half that on opioids. End up being about 2k pills a year per likely person in a population that size, so about 6/day per likely person, which... is a bit much. I'd expect 2-4 to be more likely, from what I've seen of opioid prescriptions.
That said, you only need that population of prescribers again, or about half it, to be driving into town for pickup for it to start just looking like folks with a daily painkiller prescription.
10 million a year for a town of 91,000 is fucking nuts. Opiates for acute pain should by NHS guidelines not exceed 7 days supply per person, so shipping enough to give
everyone an annual prescription is unprecedented. Even assuming all 91,000 residents are terminally ill palliative care patients, it would be an aberration to give all of them opiates, as there are strict inclusion and exclusion criteria which must be satisfied before the long term effects of pain management by opiates is deemed worth the side effects (e.g. 5%-10% of people lack the liver enzyme that turns codeine into morphine, producing no pain relief but still retaining side effects. A smaller population overproduces the enzyme, resulting in a proneness to toxicity). Needless to say having 1 in 10 people addicted to opiates and 6.5% of the population dead from overdoses is a clear smoking gun for malpractice, but some brief maths show just how obviously fucked up this scale of oversupply would seem to a pharmaceutical supplier (it may not seem obvious at first, but if my pharmacist ordered these many pills I would be fucking concerned lmao, because the police would be kicking down the door and asking questions with no obvious answers short of running a hospice or a drug smuggling operation).
For starters, it's hard to gauge just how atrocious the oversupply of opiates was, because not all opiates are equal in strength or addictiveness per pill. The number of pills NPR gives is sourced from totals deriving from AmerisourceBergen, Cardinal Health and McKesson, which all have a broad portfolio of various opiates.
A typical codeine prescription might see someone seriously in pain be prescribed 60mg tablet of codeine q4h, or 8 pills per day.
Doing some rough tablecloth maths,
using the per capita surgeries for high income North America, from the town of 91,000 people you'd expect this town to have about 4228 operations per year. Using codeine and the
unreasonable assumption that every operation required a 7 day course of opiates (which is ridiculous) you'd expect 240,128 codeine pills delivered for this cohort per year.
It just gets even more unjustifiable if the quantity of pills included stronger opiates like hydromorphone.
E.g. a 32mg hydromorphone pill is roughly equal to 160mg of oral morphine, whereas the total 480mg daily cap for codeine is roughly equal to 48mg of oral morphine. If the opiates they were using were more potent, long-lasting ones like hydromorphone, you would expect even fewer opiates prescribed.
I had to double check and make sure Huntingdon wasn't some unusal cluster of hospices providing end of term chronic pain management for terminally ill patients (it's not that uncommon, so I checked and Huntingdon does have a hospice)
which has seen 15,000 patients in the last 41 years, or about 365 people a year. Assuming all of those patients are taking a codeine prescription (which again is not a reasonable assumption, not every hospice patient is on palliative care, and a patient on palliative care could last years or just days), the absolute maximum you'd expect Huntingdon hospice to produce is a prescription of around 1,065,800 pills a year - assuming all patients are on palliative care, with none passing away.
I haven't been able to find an exact breakdown of what drugs in what dosages per pill, but even using the most generous and liberal estimate of prescriptions, assuming all possible patients are responsive to opiates, there is an unexplainable black hole of 8.7 million pills per year - consistent with having 1 in 10 addicted to opioids instead of some anomalous medical event in Huntingdon requiring 1 in 10 to be on an end of term opioid prescription.
A brief look into criminal investigations of another pharmaceutical company Purdue shows they were well aware they were acting as the suppliers to deliberate overprescription:
As part of today’s guilty plea, Purdue admitted that from May 2007 through at least March 2017, it conspired to defraud the United States by impeding the lawful function of the Drug Enforcement Administration (DEA). Purdue represented to the DEA that it maintained an effective anti-diversion program when, in fact, Purdue continued to market its opioid products to more than 100 health care providers whom the company had good reason to believe were diverting opioids. Purdue also reported misleading information to the DEA to boost Purdue’s manufacturing quotas. The misleading information comprised prescription data that included prescriptions written by doctors that Purdue had good reason to believe were engaged in diversion. The conspiracy also involved aiding and abetting violations of the Food, Drug, and Cosmetic Act by facilitating the dispensing of its opioid products, including OxyContin, without a legitimate medical purpose, and thus without lawful prescriptions.
Every hospital and pharmacy has its own procedures in place to ensure proper drugs accountability, both to make sure patients don't take too much or too little, and to ensure no staff members are pilfering and distributing their own stash. There is no way the pharmaceutical suppliers, phamacies, doctors did not know what they were doing for profit. Fortunately this was also the conclusion of the DEA and the US justice system, so my faith in humanity is at least somewhat restored. But the scale was unprecedented, and not localised to just one town.
In two years, the town of Kermit in West Virginia received almost nine million opioid pills, according to a congressional committee.
Just 400 people live in Kermit.
For a village of 400 people, you would expect anywhere between 1,000 and 0 opioid pills a year...
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