Missouri’s Struggle with Opioid Painkillers Revealed in Senate Report

Senate Report Cover

In July 2018, a U.S. Senate report revealed the massive overprescribing of opioid painkillers to Missourians that has been going on unabated for years. While the numbers in this report tell the story of unscrupulous doctors, pharmacists and pharmaceutical distribution corporations, they don’t tell the story of human suffering. For that, you have only to talk to mothers, fathers, siblings and others in the state who have lost someone to an addiction that resulted from this overprescribing.

But numbers do provide us with concrete evidence that distribution and prescribing practices for addictive substances must change. Perhaps you thought there were changes already in progress? This report will show you that there have not yet been nearly enough changes put into effect.

What Does the Report Document?

This report looks at the number of addictive painkillers shipped to Missouri pharmacies, focusing mostly on the years 2012 to 2017 and the major pharmaceutical distributors shipping pills to those pharmacies. The actions of some major pharmaceutical corporations manufacturing opioid painkillers are also included in this round-up.

These distributors are supposed to report any suspicious ordering patterns to the Drug Enforcement Administration (DEA). For example, if one pharmacy in a small town orders vastly more oxycodone pills than other pharmacies in town, diversion of these pills to the illicit market should be suspected and a report should be filed with the DEA. It turns out that one of these distributors filed a huge number of reports to the DEA and others did not. And even after these reports were filed, the situation did not improve.

Here’s a few of the highlights.

  • In six years, the three largest distributors shipped 1.6 BILLION doses of opioid painkillers into the state. This is enough for every person in the state to have received 260 pills.
  • The two largest distributors each shipped about 650 million doses into Missouri. One of them sent 16,714 reports of suspicious ordering to the DEA and the other only sent 224.
  • Manufacturers are also supposed to report suspicious ordering. The manufacturer Mallinckrodt Pharmaceuticals (oxycodone and hydrocodone products) made 905 of these reports about Missouri orders while Endo Pharmaceuticals (Opana extended release) made none.

Why the uneven levels of reporting? The report offers no logical explanations from the non-reporting corporations. Still, the thousands of reports that DID get made were not enough to stem the flood of opioids into the state.

Actions Taken by the DEA

The DEA is responsible for ensuring that pharmaceutical companies, distributors and pharmacists comply with the Controlled Substances Act. This 1970 Act establishes the controls that are supposed to keep drugs from being diverted to the illicit market. The DEA has the power to issue an immediate suspension order (ISO) to halt activities that they determine could indicate that drugs are being improperly ordered, shipped or prescribed. This Senate report notes that despite more than 21,000 alerts about suspicious orders in Missouri, the DEA issued zero ISOs to any distributors or manufacturers between 2012 and 2017.

Pharmacies and doctors must register with the DEA to get permission to distribute or prescribe opioid painkillers. The number of ISOs issued against all Missouri registrants fell from 58 in 2011 to eight in 2014. In 2015, there were only five, in 2016 there were nine and in 2017, only six.

Tens of Thousands of Pills Simply “Lost”

St. Louis, Missouri
St. Louis, Missouri

In addition to some doctors prescribing too many pills, in some cases, tens of thousands of pills are simply unaccounted for. And in other pharmacies, tens of thousands of pills were diverted into the wrong hands.

  • A pharmacy in Webb City could not account for more than 35,000 hydrocodone doses and nearly 20,000 oxycodone doses.
  • In a pharmacy in Buffalo, Missouri, the pharmacist diverted nearly 22,000 doses of hydrocodone to his personal use.
  • In St. Louis, pharmacy employees with the password to the ordering system managed to alter drug orders and obtain more than 3,000 doses for their own use.
  • At chain-affiliated pharmacies in Joplin, Independence, Chesterfield, and Kansas City, more than 54,000 doses went missing or were diverted.

The Takeaway

When suspicious ordering goes unchecked and when hundreds of thousands of doses are diverted to the illicit market, these activities generate more addiction among the state’s population. Some people addicted to opioids may have gotten started by using these drugs recreationally. Many others become dependent on these medications after using them just as their doctors recommended. If they didn’t get the help they needed as they became dependent, many then develop full-blown addictions. An uncontrolled market like this simply causes more suffering.

However, more than a decade of research into this field has also convinced me that changing the actions of government agencies and corporations is only part of the solution. If the supply of prescription opioids is cut off, those who are addicted to them will, in desperation, look for heroin or other black market substances.

Greater control of the market and effective drug rehabilitation for Missouri of those who are addicted must be carried out simultaneously for there to be improvement in our national situation. Otherwise, we condemn our citizens to desperation, illegal drug purchases and the very real possibility of overdose on heroin or fentanyl.

Clinical Review by Claire Pinelli, LADS, CCS, ICAADC, MCAP


Karen Hadley

For more than a decade, Karen has been researching and writing about drug trafficking, drug abuse, addiction and recovery. She has also studied and written about policy issues related to drug treatment.