Addicted: Origins of an Epidemic

SOUTHEASTERN NORTH CAROLINA (WECT) - Roughly two years have passed since what many consider to be the height of the nation’s opioid crisis.

In 2017, more deaths in the United States were attributed to opioid abuse in that one year than the entire casualty count during the Vietnam War — and the nation is still grappling with who should be held responsible.

“People are looking for who to blame, and there’s lots of blame to pass around in this crisis," said Kenny House, Vice-President of Clinical Services for Coastal Horizons.

While the assignment of blame may ultimately rest with the courts, a clearer picture of exactly what transpired in the mid-to-late 2000s is finally materializing.

The Washington Post, in tandem with HD Media, which publishes the Charleston Gazette-Mail in West Virginia, successfully sued the federal Drug Enforcement Administration for access to records detailing — down to the pill — how much oxycodone, hydrocodone and other opiates and opioids flooded communities around the country, including Southeastern North Carolina.

That data not only shows the total number of pills but catalogs which company manufactured the drugs, which distributor shipped them and what pharmacy dispensed them.

For the pharmacists and recovery experts, as well as those recovering from addiction, the data shows in numbers what they experienced first hand.

Of the 380 million transactions tracked by the DEA, Oxycodone and Hydrocodone were the most common opioid pills dispensed during the late 2000s and early 2010s, which is why The Washington Post said it focused on the patterns of those drugs, of which 76 billion pills were dispensed from 2006 to 2012, nationwide.

In that same time period, a total of more than 177.6 million pills were dispensed just from pharmacies in New Hanover, Brunswick, Pender, Columbus and Bladen counties. Region-wide, that translates to 29.6 million each year.

Drilling down even further, in Columbus County, that equated to 113 pills for every man, woman, and child in the county — per year.

Some of the pharmacies on the lists generated by the data are not unfamiliar to opioid-related headlines.

Anderson’s Drug Store, which was raided by the DEA in August 2018, had the fourth-highest dispense amount in Bladen County.

Those volumes didn’t go unnoticed by local prescription providers.

“It just got crazy,” said Hampstead pharmacist Beth Caveness.

Caveness owns and operates Village Pharmacy of Hampstead, which is located on U.S. 17 in Pender County and was burglarized twice in recent years, the crime attributed to the opioid crisis.

Village Pharmacy also had the third-highest 2006-2012 dispense rate in that county with 912,320 pills, though that amount was only about half as much as the second-highest, Kerr Drug in Burgaw, which dispensed 1,842,570 pills over that time.

The longtime business owner attributed her position on the list to pharmacy-shoppers targeting small, independent pharmacies — saying it may have been easier to avoid detection by visiting places like her’s than a string of chain stores that have more integrated records.

The Washington Post received statements from major pharmacy groups such as CVS and Walgreens, who are involved in lawsuits related to the opioid crisis, and who have defended their efforts to combat the crisis.

WECT talked with the local pharmacies on lists for each of the five counties.

“Obviously things have changed over the last decade,” said Kevin Sands, who owns Galloway-Sands Pharmacy in Supply, ranked fourth on the Brunswick County list.

Sands said during that time, the Supply pharmacy was surrounded by pain clinics, which may be part of the reason his pharmacy ranked so high.

In neighboring Bladen County, Bruce Dickerson of Dickerson’s Pharmacy in Elizabethtown said his store likely ranks at the top in dispense rates for all kinds of medications.

Still, he thinks things have come a long way from the late 2000s.

“I think everybody’s more aware than they were then,” he said.

Other pharmacists said the numbers should be taken with a grain of salt because they don’t take into account the timing of the prescriptions or the large pill counts that were admissible at that time.

Beyond the numbers, Caveness said she and her staff noticed their own unusual patterns when it came to people coming in with prescriptions for opioids.

She said customers from West Virginia would show up with prescriptions written by doctors in Florida, something she said she found extremely unusual and alarming.

“We couldn’t figure it out. It was so bizarre when it first started because it was just different from anything we’ve ever seen before,” Caveness said.

At Coastal Horizons, House said they saw a similar trend — but with people.

“It hit us, I would say, more like a tidal wave during that time period that you’re talking about, because we didn’t see the sheer volume coming, of the number of people that were going to entering the care system who were already going to be dependent on those opioid medications,” House explained.

Volume wasn’t the only trend House said they began to recognize.

House said at the time, many in the industry assumed those addicted to prescription pain killers were either doctor-shoppers or getting them through drug dealers or the internet.

“Somewhere around 80 percent of people with their non-medical use of these very powerful and addictive pain killers, that they really didn’t get it from the sources we thought they were getting it from," House said, explaining addicts were getting pills from their primary care physician or stealing it from a family member or friend.

“Those kind of trusted sources were actually contributing to this once these medications had been prescribed," he said.

For one former Wilmington resident, that was precisely the case.

Brent Botros, 27, had what many would call the American Dream of a childhood.

“Childhood was as good as it could have been,” he said. “I grew up in a nice house, great parents, older brother.”

His father, a doctor, immigrated to the United States from Egypt, before marrying his mother, a nurse. He played lacrosse when he attended high school at a local private school and said his goals included getting accepted into Eastern Carolina University’s mechanical engineering program.

When he was 14 or 15, he said he started “partying,” but that he only would drink alcohol.

“Before that, my dad had always put it, ingrained it in my head, ‘You can drink occasionally, but don’t do anything else.’ I always honored that, always respected that. I never thought that I would even smoke weed," Botros said. “That was never really a part of my expectations.”

After a while, though, he said that changed, and the partying eventually morphed into something darker.

He said his mother had suffered from arthritis and severe pain for much of her life.

“I found out that she was prescribed Oxycontin, oxycodone. I did my research on what that was and what it did psycho-actively. I found out I could get high from it, so I started stealing those from her," Botros explained.

By the time he was 18, he said he was regularly using prescription drugs, cocaine, and other substances.

Around age 21, he started using heroin.

“Once I felt that rush, I knew that this was going to be cheaper. This was going to give me a better high, and it was also going to help me feel better too," he said. "I began using that consistently, just about every day, sometimes two to three times a day.”

That transition is something House said he’s seen repeated over and over, and that it goes against what he thinks many people understand as the origin of the opioid crisis.

“Some people look at it as, well they were using Vicodin, that was relatively safe but it produced dependence, and now they’ve switched to heroin and now they’re at risk for overdose,” House said. “Really, that wasn’t what happened. It was that they transitioned to heroin because they could either no longer afford or access the prescription pain relievers.”

And once fentanyl began leeching into the market, House said that is when the crisis really took off.

Really, when you look at the overdose crisis that’s been created over the more immediate last few years, that was much more driven, not so much by heroin, but by the fentanyl.

Fast-forward to 2019, and Caveness said she is starting to see some of the same trends she remembers from the late 2000s — but this time, it’s with the medications designed to help fight addiction.

At the height of the opioid crisis, Caveness said she would get phone calls asking if her pharmacy carried “IP312s.”

“People would call and say, ‘Do you have the IP312s?’ What? ‘Do you have IP312s?’” she said, describing the calls. “And what they were doing was, they were reading me the imprint on the Percocet that they were interested in getting, and when you do that, that’s a red flag to me.”

Now, she said, the same calls are starting to come in about Suboxone, the brand name of buprenorphine, which is prescribed both for pain and as a step-down for those with substance abuse disorders involving opioids.

“I’m really getting to have a new level of concern that the drug that we are supposed to be using to help stop addiction, or help get people off of the opiates, is now being abused,” she said.

Despite legislation aimed at stopping the over-prescribing of opioids, House said he too is still seeing concerning trends.

“I still hear, even after the STOP act was put into play to limit the prescribing, I am still hearing stories about people who receive 60 pills in a prescription for Oxycontin or Vicodin, and they only needed 4 or 5 pills. So that’s still going on,” House said.

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