This editorial originally appeared in The Washington Post.
The truth hurts. Also, the truth will set you free. Both old sayings receive validation in the The Post’s continuing investigative reporting series on the history of the prescription opioid industry and the addiction epidemic it helped to spawn.
It is indeed painful to find out that millions of oxycodone and hydrocodone pills flooded poor communities in Appalachia as pharmaceutical companies and the Drug Enforcement Administration failed to heed signs of large-scale inappropriate prescribing. Yet there is a certain liberation in finally being able to point to specific data, which might help assign responsibility for what may be U.S. health care’s most fateful systemic failure in recent history.
It is one thing to suspect, for example, that many doctors and pharmacies were little more than “pill mills” supplying untreated addicts rather than legitimate pain patients. It is quite another to know, as The Post reported last week, that nearly 35 billion opioids — about half of all distributed pills — were handled by just 15 percent of the nation’s pharmacies between 2006 and 2012.
The American people gain from knowing that, and knowing that a single drugstore in tiny Albany, Kentucky, purchased nearly 6.8 million hydrocodone and oxycodone pills during that period, equivalent to 96 a year for all 10,000 or so men, women and children in surrounding Clinton County. This was the most on a per capita, per county basis in the United States.
We needed someone to ask what, if anything, the store’s owner, Kent Shearer, has to say about that, and about the fact that he was a business partner of a nearby doctor who pleaded guilty in federal court to illegally prescribing opioids. Shearer declined to comment to The Post’s reporters, though other companies have commented.
The DEA has kept such data for years, off-limits to the press and public. The Justice Department, the DEA’s parent agency, maintained that publication could compromise ongoing investigations. Drug companies argued that to disclose them would risk legitimate trade secrets.
The Post and the Charleston Gazette-Mail in West Virginia sued for release of the database, which formed part of the record in the massive federal lawsuit against the drug companies that will go to trial in an Ohio courtroom Oct. 21. Noting an overriding public interest in disclosure, and invoking Justice Louis Brandeis’ maxim “sunlight is said to be the best of disinfectants,” a three-judge federal court ruled in favor of the newspapers, enabling some of the remarkable journalism now before the public.
There is always a tension between discretion and disclosure, between keeping the public informed about the workings of large systems and permitting the specialists who operate them to handle delicate matters in private. Nowhere is that tension more relevant than in health care, where medical expertise, proprietary information and patient privacy are all at a premium. Like all good things, however, those may be taken to an extreme or converted into excuses for unwarranted concealment.
Any ordinary person who knew that a single pharmacy in small-town Kentucky was handling millions of potentially addictive pills over a seven-year period might have rung an alarm, even if the bureaucracy, industry and doctors didn’t. The problem is that no ordinary person could know — until now.