- The Washington Times - Monday, May 7, 2018

Opioids distributors will admit they didn’t act swiftly enough, or outline efforts to do better in the future, as they’re hauled before Congress Tuesday to explain why tiny towns in West Virginia were flooded with millions of opioid bills, fueling the addiction crisis.

But they won’t accept full blame for the problem, saying as “middlemen” it was hard for them to second-guess doctors who overprescribed opioids or the federal government, which collects data on all suppliers.

The former chief of Cardinal Health plans to say he is sorry for not cutting the flow of oxycodone and hydrocodone to West Virginia pharmacies sooner, according to testimony submitted to the House Energy and Commerce Committee.

“With the benefit of hindsight, I wish we had moved faster and asked a different set of questions. I am deeply sorry we did not,” George S. Barrett, who served as Cardinal Health’s chairman and CEO from 2009 to 2017, says in his prepared remarks.

The Energy and Commerce panel is probing why small towns in West Virginia, which suffers from the highest overdose death rate in the nation, received far more pills their populations could justify.

Rep. Gregg Harper, Mississippi Republican and chairman of the panel’s oversight subcommittee, said he invited the five distributors at the “heart” of the probe. The panel previously grilled the Drug Enforcement Administration on why it didn’t do more to monitor the flow the pills, though it wants an accounting from the private sector, too.

“Through their testimony, we hope to gain a more complete picture of the crisis that unfolded in West Virginia and across our nation,” Mr. Harper said. “As we work to develop solutions to combat the opioid crisis, we must fully understand the root causes of it, and this investigation is an important part of that process.”

Mr. Barrett will be joined at the witness table by executives from McKesson Corporation, Miami-Luken, Inc., AmeriSourceBergen Corporation and H.D. Smith Wholesale Drug Company, which AmeriSourceBergen recently acquired.

Opioid overdoses are killing tens of thousands of Americans per year. Legions of Americans got hooked on prescription opioids over the past two decades, experts say, and many of them turned to heroin that is being laced with deadly synthetic fentanyl.

The problem is especially bad in the foothills of Appalachia, where the Family Discount Pharmacy in Mount Gay-Shamrock, West Virginia, received 16.5 million doses of hydrocodone and oxycodone between 2006 and 2016 from a number of distributors, including McKesson, Cardinal Health, and AmerisourceBergen.

In testimony, the distributors say they strive to fulfill legitimate orders and that part of the problem is they do not know if other companies are shipping pills to the same people.

The companies say the Drug Enforcement Administration could aid them by granting access to the electronic database, known as ARCOS, that sheds light on the bigger picture of shipments, they say.

“No single distributor knows the total volume of any drug distributed in a particular state or region, let alone to a particular pharmacy. That information is known to DEA, however,” McKesson President and CEO John Hammergren says in written testimony. “Finding a way to give all distributors access to that data, so that we can track how orders we receive relate to the total volume of controlled substances ordered by particular pharmacies or in particular geographic regions, is an important step that Congress and the states can take to help distributors conduct effective monitoring.”

McKesson will also try to put the eye-popping West Virginia numbers into context.

It said the state pharmacies have been high-volume consumers for prescription drugs generally — not just opioids —that amounts measured over multi-year periods of time will appear high, that raw numbers of opioids should be compared against the baseline of legitimate need in a given area and that pharmacies in rural places often serve a wide area, not just specific towns or counties.

Mr. Hammergren said the company cut off the Mount Gay-Shamrock pharmacy in 2014, though wishes they’d acted sooner and “have learned lessons from that experience.”

Dr. Joseph Mastandrea, chairman of the Miami-Luken board, plans to testify the company has reduced the sale of oxycodone by 61 percent and hydrocodone by 50 percent since 2014. The committee is scrutinizing why it did the bulk of its business in Mingo County, West Virginia, which has only 27,000 people, from 2007 to 2012.

“Miami-Luken has taken aggressive actions going back several years to strengthen its compliance efforts and suspicious order monitoring system. And as I sit here now, I can assure you that our company employs a compliance program that is second to none,” Mr. Mastrandrea says in prepared testimony.

In their defense, the companies plan to say opioids make up a small portion of their portfolios, and their logistical role between drug manufacturers and the health professionals makes it difficult for them to tell which shipments might be shady.

“As a wholesale distributor, H.D. Smith could not second-guess physicians’ prescribing decisions, and could not itself assess the medical needs of the patients of those prescribing physicians,” former President and CEO James Christopher Smith says in his prepared remarks. “There are difficult policy and medical decisions that are needed to balance access against diversion and we did the very best we could with the limited information to which we had access.”

Companies said they safeguard their supply in a number of ways. Security is tight at their facilities, they employ teams of investigators and they’re updating their computer system. They also said they’re willing to cut pharmacies off when they need to.

“AmerisourceBergen Drug Corporation has refused to service and has terminated service to hundreds of pharmacies that it identified as problematic, including some of the pharmacies in West Virginia that news reports have claimed were diverting opioids,” company President and CEO Steven Collis says in his written testimony.

• Tom Howell Jr. can be reached at thowell@washingtontimes.com.

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