Nearly 15 million prescription pain pills were shipped to pharmacies in Cheshire County from 2006 to 2012, according to newly released federal data — a rate of about 27½ pills per person per year.
The companies that manufactured and distributed those drugs now face an onslaught of lawsuits from thousands of local and state governments, including Keene and Cheshire County.
The plaintiffs allege the drug companies aggressively marketed prescription opioids while misleading the public about their dangers, propelling an opioid epidemic that kills tens of thousands per year. The companies have denied wrongdoing.
“It was really saddening to look at those numbers,” County Administrator Christopher C. Coates said Friday.
The statistics come from a U.S. Drug Enforcement Administration database that tracks every prescription opioid pill shipped in the country. The database, filed under seal as part of the sprawling opioid litigation, was released after The Washington Post and the Charleston (W.Va.) Gazette-Mail fought a lengthy court battle for access to it and other records.
The Washington Post published and analyzed nationwide and county-level data this past week.
The rate of pill distribution in Cheshire County was below the national average, which was 36 pills per person per year between 2006 and 2012, according to The Post.
New Hampshire pharmacies received 281 million hydrocodone and oxycodone pills in that time, as 76 billion such pills were shipped to locations nationwide.
Jake White, now a recovery coach at the Keene Serenity Center, said he was using opioids in the Keene area around that time. He said prescription opioids were easy to get.
“There were people cruising around,” he said. “They would find out that somebody had cancer, and they would go up and talk to them,” hoping to buy their excess pills.
White said pills didn’t seem as dangerous as heroin, which was being cut with other substances. “At least I knew what I was getting every time,” he said. “It was regulated, it was consistent.”
Overdose deaths from prescription opioids began rising around 1999, according to the U.S. Centers for Disease Control and Prevention. Around 2010, heroin deaths began climbing — the so-called “second wave” of the epidemic.
A few years later, deaths from more potent synthetic opioids like fentanyl — often mixed into or marketed as heroin — began to spike.
Nationwide, almost 400,000 people died from opioid overdoses between 1999 and 2017, according to the CDC.
A 2014 study in the journal JAMA Psychiatry, drawing on a survey of about 2,800 heroin users, found that most of those who began using opioids in the 1960s overwhelmingly started with heroin. By contrast, those who first used in the 2000s mostly began with prescription drugs before switching to heroin, though the trend started to reverse itself again around 2010.
New Hampshire has been hit particularly hard by the drug epidemic, with 471 confirmed overdose deaths in 2018, according to the state medical examiner’s office. The vast majority involved fentanyl or other opioids.
In Keene, according to numbers kept by the police department, annual drug-overdose deaths numbered in the low single digits throughout the first decade of the 2000s before increasing around 2013. The death toll has hit double digits each of the past two years.
Daniel Ciccarone, a professor at the University of California San Francisco School of Medicine who studies opioid use, said a mix of supply and demand factors have shaped the epidemic, and the availability of pills was just one. He argues it’s also important to look at the “social determinants” that may be driving demand, such as chronic pain, mental health and economic hardship.
“My hypothesis is that’s it’s complicated,” he said. “That you would not have gotten an epidemic this big, this huge, this historic, one that’s driven life expectancy down three years in a row for the first time in 100 years, without both.”
White struck a similar note.
“You take down one dealer, and three more pop up,” he said. “You take away one source of release for these people, and they find another. It’s sad, and until we deal with the reasons … people use, they’re just gonna find another way.”