During a five-year period, just three pharmaceutical distributors shipped enough opioids into Missouri for each resident to have 160 pills.
The top three wholesalers - McKesson, AmerisourceBergen and Cardinal Health - brought 1.6 billion dosages of prescription opioids to Missouri between 2012-17. Sen. Claire McCaskill's, D-Missouri, latest report on the development of the opioid abuse epidemic is that statistic's source. Released in July, it suggests that distributors may not be doing enough to stem the tide.
Distributors have certain responsibilities under the Controlled Substances Act, and one of them is reporting suspicious orders of substances like opioids to the drug enforcement administration, the report stated.
"Opioid orders of unusual size or frequency can be telltale signs that bad actors might be taking pills and putting them on the black market," McCaskill said in a Monday statement. "The Missouri counties with some of the largest numbers of suspicious order reports also had high rates of hospitalization and death due to opioid overdose. That's not a coincidence."
In Callaway County, distributors reported 1.2-2.8 suspicious orders per 1,000 - much lower than some counties like Buchanan and Iron, which had more than eight suspicious orders per 1,000. Callaway County also had 0.7-0.9 ER visits, due to opioid use, per 1,000 visits.
Pharmacy employees have been caught ordering extra doses of opioids for shady reasons. The report pointed to a 2015 incident in Buffalo where a pharmacy was disciplined for diverting nearly 22,000 units of hydrocodone for a pharmacist's personal use.
That's the kind of suspicious activity wholesalers may be able to detect and report to the DEA. McCaskill and the Senate Homeland Security and Governmental Affairs Committee found discrepancies in the numbers of suspicious orders reported by various companies.
"Despite the highly sophisticated methods and significant resources the three major distributors have deployed, their suspicious order reporting between 2012 and 2017 varied widely," the report stated.
Additionally, McKesson and AmerisourceBergen each brought 650 million dosage units to Missouri from 2012-17. McKessen reported 16,714 suspicious orders to the DEA while AmerisourceBergen reported 224. Cardinal Health, which shipped about half as many dosage units as AmerisourceBergen, reported 5,125.
The report points out these differences in numbers don't indicate violations of the Controlled Substances Act. McCaskill said they might, however, indicate DEA isn't doing enough to enforce the CSA.
"I've already introduced a bill to strengthen this enforcement, so the agency can do more to prevent opioids from getting on the black market," she added.
What is undeniable, she said, opioid addiction is taking a massive toll in Missouri. Between 2012-16, more than 3,400 Missourians died from opioid-related overdoses.