A larger failure

The Washington Post had an investigation, it had been published months ago (at https://www.washingtonpost.com/investigations/the-opioid-crisis-15-percent-of-the-pharmacies-handled-nearly-half-of-the-pills/2019/08/12/b24bd4ee-b3c7-11e9-8f6c-7828e68cb15f_story.html) and I did look at a few sides of what was happening, yet the larger failure was never looked at. The fact that the DEA has failed its nation to this degree is almost too weird for words.

The headline might give us: ‘As overdoses soared, nearly 35 billion opioids — half of distributed pills — handled by 15 percent of pharmacies‘, there was a clear need to investigate the pharmacies and the FDA who had been a failing regulator in all this, yet the Washington Post gives us that there is enough blame to go around. When we see: “The DEA has maintained this database for roughly two decades but did not regularly mine the records to identify pharmacies buying unusual quantities of opioid pills, according to current and former DEA officials. The agency relies on drug companies and pharmacies to monitor and report suspicious purchases“, we see more than mere stupidity and laziness, the DEA shows that there is a systemic failure in America. The mere mention of ‘The agency relies on drug companies and pharmacies to monitor and report suspicious purchases‘, shows just how stupid the DEA has been, a stage where a commercially driven enterprise will monitor itself has in all of history never ever worked. Looking at the top 15, the three pharmacies in Kentucky sold enough opioids to hand every citizen in Kentucky 3 tablets each, that is merely the three pharmacies in that list, and there are close to 300 (as far as I have been able to count them). The simplest stage that I could have shown the DEA using IBM modeller/IBM statistics in less than one hour (providing the data was transferred).

The DEA and the FDA failed to this degree. A stage that could have been addressed half a decade ago, it was never mined; that is the size if what I will plainly call incompetence. Even as the New York Times gave us Yesterday: ‘Judge Orders Pause in Opioid Litigation Against Purdue Pharma and Sacklers‘, we see (at https://www.nytimes.com/2019/10/11/health/purdue-bankruptcy-opioids.html) that there is another stage, it is not about the “mounting costs of litigation”, I see that there is a larger systemic failure and whilst we accept that the people can go after Purdue Pharma and its owners, the Sacklers. There is a clear stage where the FDA and the DEA should have stepped in half a decade ago, they did not!

Even as politicians and law makers are giving rise to the option “They would also give up ownership of Purdue, which would be restructured into a new company, overseen by public administrators. The new company would continue to sell its signature opioid, OxyContin, as well as other medications, but all profits would go to pay the cities, counties and states for the costs of the opioid epidemic“, that sounds nice, but in the end the problem is larger than one company and the failure of the DEA is out in the open and left alone, untapped and not really investigated, the same can be said for the FDA in all this. Large companies had too much hold on these institutions and now that the dam is build, this can all happen again. Sanitation of the DEA and FDA will be essential in all this.

Even as there is in the most extreme some validity to the claim by B. Douglas Hoey, chief executive of the National Community Pharmacists Association when he gives us “There are legitimate reasons small pharmacies can have outsize volumes” so far his words do not sound true. The fact that three in Kentucky and the list of 15 pharmacies where the smallest transgressor prescribed 65 pills per person with a total of 1,294,890 pills (in Oklahoma of all places), we see a large failure and the rods by Hoey come across as hollow. In this the National Community Pharmacists Association should have mined its data as well, that was seemingly never done to any degree. I would have needed less than an hour to see initial top line results and raise red flags all over America. The idea that someone in West Virginia prescribed 70 pills per person and in total prescribed 13,168,350 pills should be out in limelight, none of the three ever gave this, none of them decided to arrest the people in Strosnider in Mingo County and prosecute them (after investigations) regarding the prescriptions of opioids.

When we get the results where over 6 years 15% of the pharmacies received 48% of pain pills is a metric that is too unacceptable and Hoey hiding behind “The numbers don’t always tell the whole story” clearly implies that he needs replacement, in addition the entire facilitation towards pharmaceutical companies must change. In addition, when the Post gives us “Many of the high-volume pharmacies had annual double-digit growth in pain pills and bought far more opioids than competitors in the same counties. The analysis also considered proximity to urban centers“, I feel certain that there is a lot more in those numbers and beyond the need for greed there is no valid explanation forthcoming any day soon. A systemic failure that is now the driver behind an addiction pandemic. The disbelieve merely grows when we are confronted with: “A judge recently ordered the release of seven years of database records, which expose the paths of more than 70 billion pain pills distributed to about 83,000 pharmacies“, this gives us an average of a little over 843,000 pain pills per pharmacy over 7 years, making it 120,000 pills per pharmacy per year. A simple search via:

SPLIT FILE PER YEAR pharmacy.
FREQUENCIES
/NOTABLE
/STATISTICS=mean.

It would have given us the results of something that would have knocked over any junior analyst making that person push every red alert that this person could lay their hands on. One hundred and twenty thousand pain pills per pharmacy per year is a massive result! The fact that the DEA and the FDA fell short of something I typed in 14 seconds shows just how large the failure is (processing that amount of data takes additional time). I reckon that if I started this in 2013, with a monthly dashboard, I feel 99.5% certain that the phones of the top brass of the FDA and the DEA would be red hot from every politician that saw those results.

If I had changed it towards:

SPLIT FILE PER YEAR STATE pharmacy.
FREQUENCIES
/NOTABLE
/STATISTICS=mean MIN MAX STDDEV.

I would get a lot more to work with, in addition as those who do not prescribe pain pills would not be part of the numbers, the results would be rather interesting to read and this is merely top line results, when we start digging into the numbers and start looking into the specifics like Kroger Pharmacies (KY) and Walmart Pharmacies (KY) and look at them per state (merely examples) we will get an even more descriptive stage of the data involved, so when B. Douglas Hoey stated: “The numbers don’t always tell the whole story” he ended up being more wrong than you could ever imagine, it is not merely the numbers, it is about asking the right questions, but he did not offer that point of view, did he?

The failure of the DEA becomes a larger issue when we see: “A DEA spokesman said he could not provide a complete list of all enforcement actions by the agency against pharmacies nationwide for violations of the Controlled Substances Act“, this shows a failure in logistics and organisation, In all this the National Community Pharmacists Association has a larger role to play, if the quality of a pharmacy is everything, any association would need to remain aware of any legal and prosecution issues playing, not merely because it is a prosecution or an action, but it is up to the association to make sure its members are aware of issues that play in the legal and enforcement field in all this, so there is a carpet hiding a truckload of trash, even as we point at the DEA, the failure is actually larger and involves pharmaceutical corporations, the FDA, the DEA, the Pharmacy association, as well as optionally accounting, bought and sold pills should be in the audit, something this big would have had to show up, unless the books were designed to keep such numbers out of view, yet when one player (Strosnider, Mingo County, WV) sells 13,168,350 pills whilst prescriptions are set to $6 per pill, that one place has to book $13 million dollar per year on pain pills only, and that was NOT noticed?

Go cry me a river!

The failure is large, the stage that the Washington Post gives us is merely one side, the NY Times gives another part, but the overall failure where the US government collects all data and does nothing is the real largest failure. As the NY Times gives us: “the eight individual Sacklers who are typically named in the litigation argue that because they have been sued for their roles with Purdue, Purdue’s protection in bankruptcy court should cover them too“, yet the US government (specifically FDA and DEA) had the data and for the longest time they apparently did nothing, in a stage of such a systemic failure, will anything ever get resolved?

 

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