By Jeannette Hinkle, The Arizona Republic.
KINGMAN — A small independent pharmacy called Uptown Drug dispensed 5.6 million hydrocodone and oxycodone pills in this northwest Arizona city from 2006 to 2012.
That’s almost 200 pills per resident.
But about four years ago, owner and pharmacist Chris Proffit stopped filling new opioid prescriptions.
“If anybody walked into my store now, it doesn’t matter where they’re from, even if they’re a physician around the corner, and they wanted to fill a monthly opiate prescription with us, we would not,” Proffit said.
“I limit the amount of opioids we purchase and the amount of opioids we dispense, and we will not increase that volume, no matter what.”
Proffit said he stopped accepting new opioid prescriptions after he got a call from one of Uptown Drug’s wholesalers, Cardinal Health, which distributed 250 million opioid pills in Arizona from 2006 to 2012, the third-highest number of any distributor.
Cardinal Health was getting pressure to sell fewer opioids, and after looking at Uptown Drug’s numbers, Proffit said the distributor suggested he buy fewer.
It was an easy decision, Proffit said.
“We were looking for a way to dispense less,” he said. “We’re always looking for a way to dispense less. In my mind, less out there is less of a problem.”
Millions of pills dispensed per store
Uptown Drug, an independent pharmacy in Kingman, dispensed millions of opioids over seven years. Its owner has stopped accepting new prescriptions.
The current policy at Uptown Drug is a sign that the prescription drug portion of the opioid crisis in Arizona might be waning as new regulations on prescribing practices take effect.
A CVS spokesman said the company has reduced the amount of controlled substances dispensed at its retail pharmacies by 30 percent in the past few years.
But there’s a lot of ground to make up.
Drug Enforcement Administration data recently obtained by the Washington Post shows just how many opioids were being doled out in Arizona during the height of the prescription boom.
More than 6 million prescription opioid pills were dispensed at one Walgreens in Casa Grande from 2006 to 2012.
Nearly 7 million opioid pills were dispensed at one Walgreens in Prescott in the same period.
And more than 14 million opioid pills were dispensed at one CVS in Bullhead City.
In the statement to The Arizona Republic, the CVS spokesman said the Bullhead City CVS served a large customer base in both Arizona and nearby Nevada, as well as patients visiting the area for emergency room treatment.
Statewide, Walgreens distributed 604 million pills from 2006 to 2012, according to Drug Enforcement Administration data newly obtained by the Washington Post.
In the Arizona list of locations that dispensed the most prescription hydrocodone and oxycodone pills from 2006 to 2012, lesser-known names are mixed in with the pharmacy giants.
Palace Health Mart, a pharmacy in Globe, population 7,346, dispensed 4.3 million opioid pills over seven years. It was sold to CVS in 2016.
In Springerville, population 1,982, Western Drug & General Store dispensed 3.1 million opioid pills in that time.
This volume of pills translates to a shocking number of powerful opioids distributed per resident.
In Gila County, enough pills were distributed from 2006 to 2012 to give each resident 56 pills every year. In Graham County, the number was 58 pills per resident per year.
In Mohave County, home to an estimated 209,550 people, enough pills were dispensed to give each person 74 opioid pills per year, the highest per capita rate in Arizona.
Most of the pills distributed in Mohave County came from CVS and Walgreens, but millions came from Uptown Drug, which operates three locations in the Kingman area.
“At the time, it was really not considered that abnormal,” said Proffit, who moved to Kingman from the Scottsdale area in 2008 to purchase Uptown Drug. Proffit began working at Uptown Drug to learn the business and officially purchased the company in 2017.
A vast majority of the prescriptions in the early years of the opioid prescription boom were written by pain management clinics around Kingman, Proffit said.
In 2009, near the beginning of the spike, Dr. Albert Szu Sun Yeh, who operated a small pain management clinic outside Kingman that was only open one day per week, was charged with improperly prescribing drugs, among other allegations.
According to law enforcement officials who conducted an undercover sting at the clinic, it took 58 seconds to get a prescription for pain pills from Yeh.
“Dr. Yeh did not practice medicine,” DEA Special Agent Elizabeth Kempshall said at the time. “He dealt drugs.”
While Proffit said prescribing practices at Kingman’s remaining pain management clinics seem to have gotten more responsible, many of the opioid prescriptions he fills now seem like they’re being given to patients to stave off the effects of withdrawal rather than to treat pain.
“My question would be, were they in pain when they started, or how much pain were they in when they started,” Proffit said.
Of course, pharmacists at CVS, Walgreens and independent retailers like Uptown Drug are still placing opioid pills in bottles, then in bags, and handing them across a counter.
In its statement to The Republic, the CVS spokesman said the company has taken “numerous actions to strengthen our existing safeguards to help address the nation’s opioid epidemic,” but it is doctors who are responsible for making sure the opioid prescriptions they write are for legitimate purposes.
Proffit echoed that sentiment, but said he does feel conflicted about filling bottles of pain pills for people he knows are addicted to them. But for patients who can’t access drug treatment, Proffit doesn’t see an alternative. Refusing to fill the prescription means inflicting pain, he said.
“You wish you could do more or something different for that patient. Absolutely, yeah,” Proffit said. “But I don’t have a better option for them right now and I don’t know that anybody does. ‘Curling up in a corner and dying,’ is some of the quotes that they use to me if they were not to be able to be on opioids.”
Drug deaths continue to climb
Getting the pills can mean death, too.
Since 2013, opioid-involved deaths have risen by 76 percent in Arizona, according to the National Institute on Drug Abuse. In 2012, 454 people died of an opioid-caused overdose.
Opioid-related deaths had soared to a suspected 1,375 people in 2018, although that number is preliminary and likely will decrease, according to the Arizona Department of Health Services.
Proffit said Uptown Drug pharmacists make it clear to all patients who fill an opioid prescription that they can purchase the opioid-overdose reversal drug naloxone there.
Each of Uptown Drug’s four pharmacists is trained to administer naloxone, known by its name brand Narcan, though none has had to revive someone in the store yet.
The pharmacy offers training to patients and caregivers in how to use it, too, Proffit said.
Assessing the damage done
The streets of Kingman, with slightly under 30,000 residents, are lined with tributes to its location along Route 66.
There are two 1950s-style diners, a themed motel that boasts “the longest map in the world,” and multiple roadside murals sporting the famous black-and-white road sign long associated with open-road freedom.
Kingman also is home to a newly revitalized downtown with a wine bar, multiple breweries, a trendy barbecue joint and an arts center.
On a recent Sunday, a yoga class was in full swing.
Less than a mile away, Susan Brace says the opioid crisis is still ravaging the community, even if it’s not apparent to the brewery crowd or the motorists passing through town.
Brace has managed the Arcadia Lodge in Kingman for 18 years. The motel has seen better days. Its pool is empty. Graffiti marks some of the doors to its rooms.
Leaning against a counter in the motel’s plant-filled office, which ticks with the sound of a collection of dashboard bobble toys, Brace said she runs a tight ship. She has a pit bull named Coco guarding the place and she keeps an automatic weapon on hand.
But opioids have permeated the lives of the Arcadia’s residents, most of whom pay $475 a month in rent to stay there.
“I’ve cleaned rooms where they’ve been busted or something and I find more pills now than anything,” Brace said. “A lot of oxycodone.”
Even if fewer patients are being given new opioid prescriptions, Brace says the damage is done.
“I’ve never seen anything like this before,” she said.
Recouping losses in Bullhead City
About 40 miles away, Bullhead City is working to hold manufacturers and distributors of opioids accountable for some of the pain they’ve wrought on the community.
At the end of June, Bullhead City filed a lawsuit in Mohave County Superior Court in Kingman seeking damages for “the societal and financial harm it has suffered at the hands of those responsible for the opioid crisis — the manufacturers and distributors of opioids,” according to a news release issued by the city.
Bullhead City Manager Toby Cotter said the crisis has strained budgets for schools, public safety and health services. Signs of the crisis are evident in the changing physical landscape of the community.
Catholic Charities is opening a new homeless shelter in Bullhead City, and an inpatient drug treatment center funded by grant money is also being built.
“These are things we’ve never had before,” Cotter said. “Let’s connect the dots.”
Cotter himself has fielded multiple calls from residents saying that prescriptions were stolen from their homes, claims Cotter doubts. He remembers one particularly disturbing call from an elderly woman who pleaded through tears for him to help her fill a prescription at Walmart. By the time she’d reached the pharmacy there, there were no more pills left, and she begged Cotter to help her find a way to fill the prescription.
“She said, ‘I can’t live without them,’” Cotter said. “Why is a city manager taking a call that someone can’t get a prescription filled at Walmart?”
The lawsuit, one of three the city is pursuing against opioid distributors and manufacturers, all of which are being brought by attorneys at no cost to taxpayers, names several companies that have produced the most pills for Arizona, including Cardinal Health and Actavis Pharma Inc.
Jeff Reeves, senior partner at Theodora Oringher PC, one of the firms bringing the lawsuit, estimated the trial will be set sometime in 2020.
Although communities nationwide are joining in a federal lawsuit filed in Ohio set to go to trial in October, Cotter said Bullhead City’s decision to file the lawsuit locally is an attempt to emphasize the local impact of the crisis.
Bullhead City isn’t going to put a dent in Big Pharma, Cotter said, but it can put distributors and manufacturers before an Arizona judge and jury.
“All we hope to do is do what’s best for Bullhead City,” Cotter said. “We’ve had a decade or more of damage, and it might take another decade to recover. You can’t fix the past, but moving forward with these lawsuits, if there are awards, those are the funds that will be used to repair damage and hopefully prevent future damage.”
“And in the meantime,” Cotter said, “we’ll keep educating.”