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More than 94 million opioid pills flowed into Jackson County

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Drug manufacturers and distributors poured more than 94 million opioid pain pills into Jackson County during a seven-year span — enough to provide every man, woman and child with 67 pills every year.

Five pharmacy locations accounted for almost 25.5 million of those opioid pills.

The Washington Post released a trove of information this month on the path of opioid pills through America from 2006 to 2012 after fighting a years-long battle against the drug industry and federal Drug Enforcement Administration to win access to the information.

The newspaper is making the data available to local journalists and the public on its website.

“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 Washington Post said in explaining its decision to share the data.

While Appalachia and parts of the South were saturated with the most pills, maps produced by the Washington Post show Southwest Oregon and Northern California saw large numbers of pills flow into the region.

Located at the busy intersection of Highway 62 and Antelope Road in White City, Cascade Pharmacy filled prescriptions for more than 6.6 million opioid pills during those seven years — putting it at the top of the list in Jackson County.

The pharmacy serves walk-in customers, has a bustling drive-through and delivers medication throughout the Rogue Valley.

Cascade Pharmacy beat out second-place Costco in Central Point, which gave out more than 4.9 million pills.

Third place went to West Main Pharmacy in Medford at almost 4.9 million pills.

Like Cascade Pharmacy, West Main Pharmacy is an independent store — not part of a chain of big box stores with pharmacies.

Fred Meyer was fourth with more than 4 million pills, and Walgreens in Medford rounded out the Top 5 list with nearly 4 million pills, according to the data.

Steven Miller, a staff pharmacist at Cascade Pharmacy, said the mom-and-pop style independent store does triple the prescription volume of big box pharmacies.

Miller said he used to work at a big box pharmacy and believes Cascade Pharmacy doesn’t have an unusually high ratio of opioid prescriptions.

“I think that Cascade was likely the pharmacy with the highest volume of opioid prescriptions during that time period because we were the pharmacy with the highest total overall volume of prescriptions during that time. So if you do more prescriptions, you’re going to have more pain meds,” Miller said.

Drug manufacturers and distributors were the first to be hit with massive lawsuits related to opioids. Local, state and federal governments have successfully argued companies downplayed the risk of addiction and failed to flag suspiciously large orders.

Chain pharmacies are now facing lawsuits, prompting many to place restrictions on opioid prescriptions.

Walmart was the first national chain to place a seven-day supply limit on new opioid prescriptions for acute pain, according to the company.

In medical terms, acute pain is considered to be temporary, such as pain that results from an injury that later heals.

Amid growing national awareness about opioid addiction and overdose risk, Miller said Cascade Pharmacy is working to improve safety for its patients.

He said the whole pharmacy team is involved with prescriptions, making sure there are no clerical errors from doctors’ offices and no dangerous interactions with other drugs patients are taking. They check to see that the dose is appropriate, both in terms of strength and how often patients are instructed to take a drug.

“If there are problems, the number one thing is communication. We talk to the doctors. We talk to the patients,” he said.

Oregon changed its laws to allow pharmacists to prescribe the overdose antidote naloxone, which can restore breathing in an overdose victim.

Miller said if pharmacists at Cascade Pharmacy are worried about a particular patient’s risk, they bring up the subject of naloxone and see if the person is willing to accept a prescription for the antidote.

When sold under the brand name Narcan, naloxone comes in a nasal spray that is as easy to use as a decongestant spray. People who administer Narcan are still urged to call 911 because the effects are temporary and the victim may fall back into an overdose state and die.

Cascade Pharmacy requires patients with narcotic prescriptions to fill all their prescriptions at the pharmacy. That way, pharmacists can check for harmful drug interactions.

The policy also stops “pharmacy shopping” among patients who misuse opioids and try to fill prescriptions at multiple pharmacies to avoid detection.

Nationwide, many doctors have grown more reluctant to prescribe opioids, and insurance companies are clamping down on coverage.

Miller said wariness about the dangers of opioids is appropriate, but restrictions are creating hardship for many of the chronic pain patients he sees.

He said most are in legitimate pain and just want relief so they can carry out their daily activities and remain functional. Patients on opioids now feel stigmatized.

“It’s honestly really sad because as a health care provider, that’s one of my favorite parts of the job is getting to interact with patients on a face-to-face basis every day,” Miller said. “You can see people that come from other pharmacies that have changed their policies that are now filling with us. People are ashamed that they even have to take pain medication.”

He said Cascade Pharmacy is trying to help chronic pain patients find alternatives to opioids.

Although addiction and deadly overdoses have gained the most public attention, Miller said opioids also have side effects that can make patients miserable.

“Constipation is a thing that nobody likes to talk about, but it just comes along with the territory of opioid prescriptions. Nauseousness is a really big issue,” he said.

After researching scientific studies on the hemp extract called cannabidiol, or CBD, Cascade Pharmacy pharmacists decided to start carrying CBD products.

Advocates tout the compound as a treatment for pain, anxiety, insomnia and other conditions. Unlike the THC found in marijuana, CBD doesn’t get users high.

Miller said he was skeptical at first about finding enough scientific research on CBD’s effects that would win him over.

“But we absolutely found some,” he said. “There are — for specific patients — benefits to natural products like that, that will help for pain, but without all the baggage that can come along with prescription medications like opioids.”

Miller said it's important for patients to have open communication with their pharmacists and to ask for help in dealing with medical problems, drug side effects and potential alternatives.

“Your neighborhood pharmacist is a member of your team. He or she is on your side and is really just there for your safety and well-being,” he said.

Reach Mail Tribune reporter Vickie Aldous at 541-776-4486 or valdous@rosebudmedia.com. Follow her on Twitter @VickieAldous.

Pharmacist Steven Miller prepares prescriptions at Cascade Pharmacy in White City Friday.{ }Andy Atkinson / Mail Tribune
Enough opioid pills flowed into Jackson County to provide every man, woman and child with 67 pills every year from 2006-2012.{ }Andy Atkinson / Mail Tribune