As the nation’s opioid epidemic spiraled out of control at the turn of the decade, parts of rural America seemed awash in prescription drugs. But the extent to which drug distributors and manufacturers pumped opioids into those communities was unknown to the public—until now.
The 10 most prolific drug distributors together shoveled around 62.3 billion opioid pills into American pharmacies between 2006 and 2012, at the height of an addiction crisis that caused nearly 100,000 overdose deaths in that span, according to previously sealed data compiled by the U.S. Drug Enforcement Agency (DEA). Meanwhile, three drugmakers produced 85% of the supply.
The government’s database, known as ARCOS, was previously held under federal seal as part of a Multi-District Litigation (MDL) in Cleveland, which pits some 2,000 towns, cities and counties against about 20 drugmakers and distributors.
According to the Washington Post, which sued to gain access to the database, McKesson led the way among distributors, sending out 14.1 billion pills in a six-year span—or roughly 18.4% of the opioid supply. Rounding out the top five on the distributor list were Walgreens, Cardinal Health, AmerisourceBergen and CVS.
All told, those five distributors controlled around 75% of the opioid supply during that time, although consolidated distribution among a small group of companies is not unusual in the drug industry.
On the manufacturing side, three companies—SpecGx, a subsidiary of what is now Mallinckrodt; Actavis Pharma, the former generics giant now owned by Teva; and Par Pharmaceutical, a then-independent company now owned by Endo—turned out 85% of the opioid pills that made their way into U.S. pharmacies.
Purdue Pharma, the developer of the most notorious opioid brand, OxyContin, came in fourth place with 3% of the market. Generic versions of the med, from Teva and Endo, were first approved in 2004.
A Mallinckrodt spokesman told the Washington Post in a statement that the company's opioid production was government-controlled and that the company only sold to DEA-approved distributors. Teva, which acquired Actavis in 2016, did not comment on Actavis' activity. Endo declined to comment to the Post.
The behemoth Cleveland MDL is the only consolidated litigation attempting to hold the top of the drug industry’s supply chain accountable for its alleged role in creating and fueling the opioid epidemic. While individual cases have netted settlements from companies like Purdue Pharma and Teva, the MDL has prosecutors and the bench judge searching for novel ways to wrap up the litigation.
In early June, prosecutors proposed a “global peace” process that would rope all 2,000 or so plaintiffs into a single “negotiation class”—with an opt-out clause—in an attempt to net a single large settlement in the litigation.
The proposal could be a win-win for both sides: Cities and counties would receive a settlement proportionate to the number of opioids distributed there and the number of overdose deaths, and drugmakers could settle a case that “legally forecloses” any future litigation.
In the event the MDL does go to trial, a verdict in a case involving Johnson & Johnson and the state of Oklahoma could have major implications for how the trial will take shape.
On Monday, both parties presented closing arguments in a bench trial in which J&J was described as the “kingpin” of drugmakers responsible for the state’s opioid crisis. The state’s argument revolves around J&J’s aggressive marketing of its own opioid products as well as its role in providing other drugmakers with a cheap “mutant poppy” to boost production.
J&J has denied its role in the epidemic, saying the facts of the case “simply don’t align with what the state is claiming,” according to CFO Joe Wolk.
J&J’s case is unique in that it is the first time a drugmaker has actually gone to trial on charges it helped spur a public health crisis. The state of Oklahoma previously secured a combined $355 million in settlements from Purdue and Teva, which kept them out of the courtroom.
Purdue and its billionaire founding family, the Sacklers, have been the focus of hundreds of lawsuits for their marketing of OxyContin. After the Sacklers and Purdue settled with the state of Oklahoma for $270 million, analysts said future settlements could run into the billions and potentially require Purdue to file for bankruptcy to cover the expense.