How Opioid Painkillers Became Big Business in a Philadelphia Neighborhood Already Ravaged by Drugs

August 2, 2019by Aubrey Whelan and Nathaniel Lash
The corner of D Street and Indiana Avenue in Philadelphia, PA on July 21, 2017. (David Maialetti/The Philadelphia Inquirer/TNS)

PHILADELPHIA — For years, Philadelphia’s Kensington neighborhood has been the epicenter of a huge open-air drug market where illicit drugs were bought and used in plain sight. But more than a decade ago, in the earliest days of what would become a nationwide opioid epidemic, the neighborhood quietly began to play host to another booming market — for pharmaceutical painkillers.

From 2006 and 2012, as such prescriptions accelerated, more opioid painkillers were sold to pharmacies in and around Kensington than nearly anywhere else in Pennsylvania, according to a Philadelphia Inquirer analysis of sales collected in a Drug Enforcement Administration database.

Olde Philly Pharmacy, a tiny storefront in Port Richmond, became a major opioid retailer, purchasing more than 4.6 million oxycodone and hydrocodone pills from drug manufacturers in that seven-year period, more than any other pharmacy in the 19134 ZIP code.

But Olde Philly — which in June agreed to pay $350,000 to settle claims it failed to keep complete and accurate records of its opioid sales — was just one among a handful of high-volume stores. All told, more than 26 million pills were sent to pharmacies in the 19134 ZIP code, which includes Kensington, Port Richmond and Harrowgate.

To be certain, pills alone — and any addictions they fueled — can’t account fully for the drug crisis in Kensington, where more people have died of overdoses than anywhere else in the city since at least 2007, hitting a high of 209 deaths in 2017.

But the DEA data — part of a federal lawsuit against pain pill manufacturers and distributors released after The Washington Post and the parent company of the Charleston (W.Va.) Gazette-Mail sued to make them public — show how prescription pills added to the pressure on neighborhoods already primed for a drug crisis.

“Without that increase in prescribing, we’d still be in the midst of a crisis,” said Kendra Viner, the manager of the city’s opioid surveillance program. “It might not be at the level it’s currently at.”

Across the eight-county Philadelphia metropolitan area, pharmacies ordered more than 1.3 billion oxycodone and hydrocodone pills from 2006 to 2012, the DEA records show. (More recent data remain under court seal.) The Inquirer analyzed a cleaned database released by The Post that only covers shipments of oxycodone and hydrocodone pills, the most commonly ordered opioids.

Camden County had more pills per person than any other in New Jersey over that seven-year period, nearly 300 pills for every man, woman and child who lived there. Delaware County led the Philadelphia suburbs with about 290 pills per person. Chester County had the fewest, 146 pills per person, well below the state average of about 240 pills per person.

In Philadelphia as a whole, fewer pills were sold per person — about 250 pills per person — than in many other parts of Pennsylvania. Rural Cambria County, in the middle of the state, saw sales of about 450 pills per person. Kensington’s rate in the 19134 ZIP code: 448.

The two Pennsylvania ZIP codes that received the most opioid pills are in Delaware County and Pittsburgh; but sales there were borne almost entirely by mail-order pharmacies that shipped pills around the country.

The retail landscape is very different in Philadelphia. In Port Richmond and Kensington, independent pharmacies ordered over 80% of the pills in the 19134 ZIP code.

Kensington’s ZIP code received the third-highest number of opioid pills in Pennsylvania, followed by South Philadelphia’s 19148 ZIP code, where pharmacies ordered nearly 26 million pills. The overdose death toll in South Philadelphia is second only to Kensington’s. According to city health department surveys, about 50% of people in addiction in Kensington got started on opioid pain pills; South Philadelphians have not been similarly surveyed.

Nor is it clear how many of the pills sold at neighborhood pharmacies stayed in the community, and how many were purchased by customers from elsewhere, some of whom may have been “doctor shopping” to obtain multiple prescriptions.

For a time, it was often impossible to track who was getting all those pills. It was only in 2014 that lawmakers in Pennsylvania instituted a prescription-drug monitoring program that allows pharmacists and doctors to check which drugs a patient is taking before writing or filling another prescription.

Before the monitoring program was instituted, Kensington pharmacist Richard Ost often refused to fill opioid prescriptions paid for in cash. Or he asked insured patients who wanted to pay with cash if they could go through insurers instead. Paying cash, he said, could mean someone was trying to get more drugs without tipping off their doctors or insurers.

But patients with cash mean more profit for a pharmacy, said Ost, who’s run Philadelphia Pharmacy on Lehigh Avenue for 37 years. Pharmacy benefit managers, which handle prescription drug plans for Medicare Part D and many private insurers, will often reimburse pharmacies at lower rates than they can get by accepting cash.

“So pharmacists are looking for other ways to support the profit structure,” Ost said. “Is it illegal? No. Is it unethical? I think you’re crossing a line.”

His pharmacy ordered only a third of the average volume of opioids bought by other retail pharmacies in the neighborhood between 2006 and 2012. Lately, he has been advocating for more pharmacists to dispense Narcan, the overdose-reversing drug.

From 2006 to 2012, Olde Philly Pharmacy bought nearly 1.4 million more pills than any other pharmacy in its ZIP code. In 2010 alone, the pharmacy ordered over 930,000 of the pills.

Not all of the pharmacy’s pills made it to legitimate patients. A federal warrant described how shortly after a scheduled inspection in 2014, Olde Philly Pharmacy reported an enormous loss: over 50,000 oxycodone pills, stolen by an unnamed employee. It had never been reported to the police, according to the warrant.

In June, owner James Cirillo agreed to pay $350,000 to settle allegations that his business violated the Controlled Substances Act. The settlement came almost five years after federal investigators executed the warrant where they found he had failed to keep records of nearly a hundred hydrocodone and oxycodone prescriptions the pharmacy had filled.

His lawyer, Joseph Mancano, said pharmacists like Cirillo are simply filling prescriptions from doctors.

“The settlement involved failure to maintain complete and accurate records. It’s essentially a record-keeping matter that we resolved — no allegations or charges of diversion of drugs, no criminal involvement, no illegal dispensing,” Mancano said. “In the scheme of things, it’s not that significant a case.”

As for why more pills had been sold in Kensington than in any other community in the city: “Are you surprised?” he asked.

An addiction expert in South Philadelphia said it made sense that opioid painkiller prescriptions were being filled in neighborhoods where people have physically demanding jobs and are coping with the chronic pain that can come with them.

“These are construction workers, a lot of manual laborers — they were trying to be functional,” said Priya Mammen, a public health advocate and emergency medicine physician from South Philadelphia based at the Lindy Institute of Urban Innovation at Drexel University. “They were buying Percocets off the street so they could go to work. And then, around 2011, the cost of buying a Percocet became more expensive than the cost of buying heroin.”

People with addiction in South Philadelphia are generally from the neighborhood, Mammen said, and many still have jobs and family support, which help prevent overdose deaths. “Being housed, being clothed, being fed, having jobs — these are protective things,” she said. All those reasons, she said, could account for why South Philly has nearly as many pills but far fewer deaths than Kensington, where people in addiction often don’t have such support.

And while the rate of opioid painkiller sales in Philadelphia as a whole is a mere fraction of the nation’s most pill-ravaged counties in Appalachia, the city is home to the worst urban opioid crisis in the country. To this day, Philadelphia overdose deaths cluster in places where pill retailing was heaviest from 2006 to 2012.

Drug addictions — and people — are complicated, said Michael Lynch, the medical director of the Pittsburgh Poison Center. “There are no straight lines here, and at the root of all this are the conditions that put people at risk for substance abuse,” like trauma, socioeconomic status, and mental illness, he said. “The nuance is hard.”

But, he said, tens of millions of pills pouring into communities dealing with long histories of substance abuse “should have popped up on multiple radars.”

And the numbers of pills sold across the country between 2006 and 2012? “They’re just mind-boggling,” he said.

———

©2019 The Philadelphia Inquirer

Visit The Philadelphia Inquirer at www.inquirer.com

Distributed by Tribune Content Agency, LLC.

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