Drug companies supplied Tuolumne County with more prescription pain pills per person than almost anywhere else in California from 2006 through 2012, according to an investigation by The Washington Post.

The revelation comes from a database maintained by the federal Drug Enforcement Administration that tracked every pain pill sold in the United States over the seven-year period, which The Post obtained as the result of a court order and published last week.

Tuolumne County received more than 33 million pain pills from 2006 through 2012, which comes out to about 84 pills per person each year, the third highest rate of all 58 counties in the state.

Lake County had the highest rate of pills per person at about 97, followed by Shasta County with about 94.

“This highlights what we have known locally and has become apparent nationally — that there were a lot of opioids being prescribed,” said Paul Marum, who works for AmeriCorps VISTA and helps coordinate the Tuolumne County Opioid Safety Coalition.

The pharmacy at Save Mart in the Timberhills Shopping Center on Mono Way received the most pain pills at about 5.3 million, according to the database published by The Post.

AmerisourceBergen Drug was the top distributor of pain pills in the county during that time at more than 15.6 million, while Actavis Pharma Inc. was the top manufacturer at more than 14 million.

Separate data from the California Department of Public Health, or CDPH, showed that Tuolumne County’s opioid-related death rate was consistently among the 10 highest in the state during the seven-year period, with the exception of 2012 when the county ranked 11th.

Marum said that such rates can be deceiving, however, due to the county’s relatively small population.

“One overdose will massively change our rate because we have such a relatively small population,” he said.

There were 60 deaths in Tuolumne County from 2006 through 2012 reportedly due to opioid overdose, according to the CDPH data, while the number throughout the state over the same period was 12,391.

Tuolumne County ranked 33rd of all 58 counties in the actual number of deaths from opioids from 2006 through 2012.

The total number of deaths in the county due to opioid overdoses from 2013 through 2017, the latest year of data available from the CDPH, was reportedly 40.

Marum said it’s difficult to compare the county’s opioid-related death rates with other areas because the types of overdoses are typically different.

“The typical opioid overdose is not what you are expecting from somewhere like the Bay Area or valley,” he said. “Here, it’s people who are 55 or older and might have taken a few too many pills they were legitimately prescribed by a doctor.

“That’s a problem, and it’s hurting our community, but it’s not the heroin overdoses that people think of when they imagine an opioid overdose.”

Doctors in the county have also been writing fewer prescriptions for pain pills since a high of 81,534 in 2012. According to the CDPH, the total number of prescriptions dropped to 61,842 in 2017 and 42,816 during the first three quarters of last year.

Marum attributed part of the decline to changes in prescribing practices since 2012.

“When someone goes to pharmacy now and picks up a prescription, they are getting less pills,” he said. “You might have gotten a 30-day supply of pain medication if you got your wisdom teeth removed, but now you might get a three-day supply.”

Tuolumne County’s rate of prescriptions per capita was nearly double the average for the state as a whole, which Marum said was likely due to the older population who have a legitimate need for medication to manage pain.

The U.S. Census Bureau reported the median age in the county as 48, compared to 36 for the state as a whole.

Marum also attributed part of the decline in prescriptions written for pain pills to the work of the Tuolumne County Opioid Safety Coalition, which consists of representatives from public health, social services, schools, law enforcement, behavioral health, doctors, and pharmacists.

“A lot of it has been medical education with providers,” he said.

The level of risk from pain medications and how much people were misusing them was not properly understood in the past, according to Marum.

Drug manufacturers previously told doctors that the medications were safe, but Marum said information coming out of recent lawsuits show they knew that wasn’t the truth and hid the dangers.

“Manufacturers said they had new formulations where they were safe and you can’t overdose,” he said. “That wasn’t true, but that’s how they were sold to the public and doctors.”

The coalition recently helped the Tuolumne County Social Services Department with obtaining a $1 million grant from the state for a program called “Road to Resilience,” which aims to curb drug abuse among pregnant mothers and those with infants up to 1 year old.

Cori Allen, deputy director of the Social Services Department, said the goal of the grant is to build a team of three “navigators” who will help the mothers obtain the necessary services from the various agencies that provide them.

Partners include the coalition, Tuolumne Band of Me-Wuk Indians, Adventist Health Sonora, county Behavioral Health, and Infant Child Enrichment Services.

“When we put the partnership together, the Tuolumne County Opioid Safety Coalition was first in line,” Allen said. “They will remain an active partner and continue to work with us as we develop our charter.”

The county has also cracked down on some doctors who were caught overprescribing opioids.

In 2016, former Sonora doctor Lori Sostock was sentenced to 90 days in jail after pleading to guilty to four felony counts related to unlawfully prescribing the powerful and addictive opioid oxycodone. She voluntarily surrendered her license to practice medicine in March 2016.

Sostock’s wife and former office manager, Vanessa Sostock, also pleaded guilty to one count of conspiracy to commit a crime and was sentenced to 60 days in jail.

Some doctors believe that not all of the blame for the opioid crisis should be cast on the drug manufacturers.

Dr. Ralph Retherford, who practiced family medicine in Soulsbyville from 2000 to 2016, said he believes that doctors themselves are at least 90 percent at fault.

“Any doctor worth his salt does not believe drug reps that come into his office,” he said. “They’re trying to sell you something.”

Retherford said doctors prescribed fewer pain pills in the 1970s out of fear of losing their license or getting in trouble with the DEA, but there was a major shift that started in the late 1980s regarding how doctors prescribed the drugs.

As a result, Retherford said there’s a whole generation of doctors led to believe their patients wouldn’t be able to get hooked on opioids if they had truly had pain.

“When hospice came along, the argument was put forth that these people are at the end of life and we don’t need to worry about them getting addicted,” he said. “I agree with that, but that thinking was moved over to the young guy with a backache from getting hurt at work.”

Since retiring in 2016, Retherford has worked at an Adventist Health clinic on Forest Road where he solely prescribes the drug buprenorphine.

The drug is sold under the brand name Subutex and used to treat opioid addiction and chronic pain. Retherford said he started working at the clinic because he couldn’t find a provider for about 30 patients on Medi-Cal when he shut down his office.

Retherford is at the clinic every Tuesday and Friday. He saw 18 patients on Tuesday.

“It’s sort of miraculous,” he said of buprenorphine. “It relieves cravings and withdrawals, but you can’t overdose on it. You also can’t overdose on heroin while on it.”

Retherford also questioned some of the numbers presented in The Post’s database, which don’t seem to be consistent with others that have been previously reported.

A local pharmacy told Retherford in 2013 that they were dispensing an average of 110,000 pain pills per week. The state’s drug monitoring program, CURES, also reported in 2013 that Tuolumne County residents were prescribed equivalent of 437 Vicodin pills per person per year.

“There’s some discrepancy, but what we do know is that there are way too many,” he said.

Contact Alex MacLean at amaclean@uniondemocrat.com or (209) 588-4530.




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