Santa Fe New Mexican
Española store pegged at center of New Mexico’s opioid epidemic
According to DEA data, Walgreens in city of 10,000 dispensed 6.1M prescription pain pills in 7-year period ending in 2012
ESPAÑOLA — On the outside, the only Walgreens in this small Northern New Mexico city mirrors the thousands of others scattered across the nation, with the drugstore’s familiar name plastered in red cursive across a hulking beige building.
Located on the corner of Fairview Lane and North Riverside Drive, one of the busiest corners of the city, this typically busy Walgreens — much like its counterparts in every state — offers customers everything from toothpaste and greeting cards to energy drinks and same-day photos. But this particular store has a dubious distinction. For a seven-year period, it was one of the most prolific dispensers of opioid medications in New Mexico, an especially
troubling fact for a city that has been in the throes of a harrowing, decadeslong battle against drug abuse and addiction that has claimed scores of lives and scarred hundreds, if not thousands, of families.
The Walgreens in Española, a city with a population of about 10,000 people, dispensed the third-highest number of pain pills in the state from 2006 to the end of 2012, according to an analysis by the Washington Post, which examined a never-before-released Drug Enforcement Administration database that “tracks the path of every single pain pill sold in the United States.”
“These records provide an unprecedented look at the surge of legal pain pills that fueled the prescription opioid epidemic, which resulted in nearly 100,000 deaths during the seven-year time frame ending in 2012,” the newspaper reported. “A county-level analysis of the cumulative data shows where the most oxycodone and hydrocodone pills were distributed across the country over that time: more than 76 billion in all.”
According to the newspaper, the Española Walgreens handed out more than 6.1 million pain pills during that period, behind Prime Therapeutics in Albuquerque and a Lovelace outpatient pharmacy, also in Albuquerque. The analysis tracked nearly 11.8 million pain pills back to Prime Therapeutics and just over 6.6 million to Lovelace’s outpatient pharmacy.
“Given the population base that Walgreens is supported by in this area, even if you include northern Santa Fe County, all of Rio Arriba County, there’s no way we should be third in the state,” said Lauren Reichelt, director of the Health and Human Services Department for Rio Arriba County, where Española is located.
“We don’t approach the population of Albuquerque or Santa Fe or Rio Rancho or Las Cruces,” she added in an interview Friday. “We don’t come close, so it is out of proportion to the population, and that’s for sure.”
A pharmacist at the Española Walgreens expressed shock at the numbers.
“That’s crazy. Yikes,” she said before referring inquiries to a store manager, who did not return a message seeking comment.
In a statement, a Walgreens spokesman said Walgreens pharmacists are highly trained professionals who are committed to dispensing legitimate prescriptions that meet the needs of their patients.
“Walgreens has been an industry leader in combating this crisis in the communities where our pharmacists live and work,” Phil Caruso wrote.
Caruso declined further comment, saying he didn’t have anything to add beyond the statement.
Walgreens has taken a number of steps to combat the opioid epidemic, including making naloxone, also known as Narcan, more accessible. Naloxone is a medication approved by the Food and Drug Administration to prevent overdose by such opioids as heroin, morphine and oxycodone, according to the Substance Abuse and Mental Health Services Administration.
Walgreens is allowed to dispense naloxone without a prescription in most states, including New Mexico, which, according to the state Department of Health, has had one of the highest drug overdose death rates in the country for most of the past two decades.
“Rio Arriba County had the highest total drug overdose death rate (85.5 deaths per 100,000) among all New Mexico counties during 2011-2015,” the Health Department reports. “However, the problem of drug overdose is by no means limited to Rio Arriba County. Bernalillo County had the largest number of drug overdose deaths and many New Mexico counties had total drug overdose death rates more than twice the U.S. rate.”
The Washington Post’s analysis did not include more recent data from the last several years, making it difficult to determine how many pills the Española Walgreens dispensed after 2012.
Española Mayor Javier Sanchez said he was horrified by the number of painkillers Walgreens dispensed.
“At the same time, it makes me recognize the reality in which we live,” he said. “It doesn’t surprise me, unfortunately.”
The problem takes root
Drugmakers could be held accountable.
Earlier this year, seven New Mexico counties filed near-identical lawsuits against more than two dozen manufacturers and distributors of opioid medications, alleging they used deceptive tactics in prescribing and marketing the highly addictive drugs.
“There are law firms within the state of New Mexico that are trying to open up those doors to Rio Arriba County and the state of New Mexico,” Sanchez said. “In fact, they came and gave a discussion to our City Council a few weeks ago.”
Reichelt suspects the problem with opioids in the area has improved since the latest available data from the DEA. She said the community has taken various steps to fight the opioid epidemic, including creating the state’s first county-run Health and Human Services Department.
“We did that specifically because we felt that the federal and state response [to the drug problem] was not the proper response for our community, and we needed to craft our own response,” she said. “Back in the late ’90s, early 2000s, this was really looked at as a heroin epidemic and a law enforcement issue, and the response was to beef up law enforcement to try and eliminate heroin, which we in this community didn’t think would work.”
Part of the reason Reichelt and others didn’t think a crackdown on heroin would be as effective is because Reichelt had previously conducted a study that showed many of the county’s overdoses could be linked to Librium and Valium.
“In 1997, there were four doctors who were running pill mills, and the state cracked down on them and took away their prescribing privileges,” she said. “That’s when we saw Librium and Valium be replaced by heroin as the drug of choice because that’s what was available at the time.
“So we knew that prescribing practices had something to do with the genesis of the epidemic back in 2002 in Rio Arriba County, and we were saying that. But at the time, that was a very radical thing to say, and nobody was listening.”
Asked why, Reichelt said ethnicity may have been a factor.
“The only community impacted in the entire country was a community of color, and the drug of choice people were seeing was heroin, so it got branded as a criminal problem. It was the height of the war on drugs, so what you saw happening was sort of a perfect storm of bad federal policy,” she said. “One was the war on drugs, which required counties to lock people up in jail for addiction. The other piece of that were prescribing practices where pharmaceutical companies were allowed to encourage doctors to overprescribe and to reward them for doing so.”
Reichelt credited Presbyterian Española Hospital with being a leader in the fight. The hospital, she said, changed its prescription policies around 2013 or 2014.
“What they did that was so innovative that really made a difference in this community was they tied hospital admitting privileges for physicians to checking with the [prescription drug monitoring program database, which tracks controlled substance prescriptions in the state] to make sure that they’re not issuing duplicate prescriptions.”
After the hospital and area clinics required all prescribers to check the socalled PDMP database, a requirement later mandated by state law, she said the number of overdoses in Rio Arriba County stemming from prescription painkillers fell.
“Nobody was monitoring prescriptions the way they should’ve been,” she said.
Rio Arriba County was the first in the country to be hit by the opioid epidemic, Reichelt said, citing a New York Times report that included a series of interactive maps showing how the addiction epidemic rippled across the country.
“In 1999, there is one dark red spot in the entire country, and that’s Rio Arriba County,” she said. “There’s another spot in West Virginia that I think is orange and then every year thereafter, you can see the dark red just rippling out from those two counties across the country.”
Sanchez, Española’s mayor, said his city and surrounding area “clearly have a problem with and struggle with dependency in many formats.”
“It pervades our community individually and as a whole, and one of the things that we have to do is not only try to find ways to perhaps curb it but find out what is causing it to begin with,” he said.
For Reichelt, the blame over the opioid epidemic lies squarely with the pharmaceutical companies.
“It was the Wild West of pain pills,” she said, referring to the 2006-12 time period examined by the Washington Post, which called the set of data “critically important” and made the information public and accessible to readers and other journalists.
“What was happening was the pharmaceutical companies faked their research, so they were telling doctors, ‘This stuff is not dangerous at all. It’s a miracle. You can prescribe as much as you want,’ ” Reichelt said. “They were doing the same stuff they did with tobacco. They were deliberately inducing addiction because it was profitable. If there are real bad guys in this, the real bad guys are the pharmaceutical companies.”