As the nation's opioid crisis grew, the pills got stronger

WASHINGTON (AP) — In 2012, as the death toll from the nation's opioid crisis mounted, drug companies shipped out enough of the powerful and addictive painkillers for every man, woman and child in the U.S. to have nearly a 20-day supply.

In some counties, mostly in Appalachia, it was well over 100 days.

An Associated Press analysis of drug-distribution data released as a result of lawsuits against the industry also found that the amount of opioids as measured by total potency continued to rise early this decade even as the number of pills distributed began to dip.

The reason: Doctors were prescribing – and the industry was supplying – stronger pills.

"It shows it wasn't just the number of pills being shipped that increased. The actual amount of opioids being prescribed and consumed went up," said Anna Lembke, a Stanford University professor who researches opioids and is serving as a paid expert witness for plaintiffs in the litigation.

"We know that the higher the dose of prescribed opioids, and the longer patients are on them, even for a legitimate pain condition, the more likely they are to get addicted."

The AP found that the overall amount of opioid medication shipped to pharmacies, medical providers and hospitals increased 55 percent from 2006 through 2012. The number of pills rose significantly over that period, too — but that increase was lower, about 44 percent. (The amount of medication was calculated using a standard measure of potency known as a morphine milligram equivalent, or MME.)

In 2006 and 2007, the counties at the very top of the list of those receiving the most opioids were scattered about the eastern half of the U.S. By 2012, they were all in the Appalachian region. And the numbers were up dramatically.

For instance, in 2006, Tennessee's Hamblen County received the most opioid medication per person in the country – about 70 days' worth of a typical prescription for every man, woman and child. By 2012, the top county was Norton, Virginia, and the number of days' worth of opioids was a staggering 134.

In calculating days of medication, the AP used 50 MMEs as a daily dosage. That is the upper limit beyond which the Centers for Disease Control and Prevention urges doctors to use caution.

The data comes from the federal Drug Enforcement Administration's collection of information from pharmaceutical companies about how controlled substances were distributed down to pharmacies, doctors and hospitals. It's a key part of the case for some 2,000 state, local and tribal governments suing the industry over the opioid crisis.

The first of the federal trials, involving claims from Ohio's Cuyahoga and Summit counties, is scheduled to start in October.