The city of 3,000 people taken by a tsunami of 20 million pills of opioids in the USA


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This small pharmacy in Williamson delivered more than 10 million opioid pills between 2006 and 2016

Williamson is a city of 3 thousand inhabitants in the American state of West Virginia. In spite of the small size, the municipality consumed a tsunami of opioid pills between 2006 and 2016: according to a report of the US Congress, 20 million units of the drug that causes an epidemic of national proportions and that became a health problem public in the USA.

The latest episode of this crisis came on March 26, when drug giant Purdue woke up – in one of many lawsuits around the issue – to pay $ 270 million to the State of Oklahoma, which accuses opiate maker OxyContin of having, through aggressive marketing of its product, helped fuel the wave of overdoses that have left thousands dead in the state.

In all, officials estimate that 218,000 Americans died of overdose of prescription opioids between 1999 and 2017, and little Williamson has become a symbol of the problem.

But how could an inner city have been flooded with medicines? How has the health crisis taken its present dimension, putting a pharmaceutical giant in the spotlight?

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West Virginia Tourism Board

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A small mining town in West Virginia has become a symbol of the public health crisis caused by opioids in the United States.

Millions of medical prescriptions

The influx of pills to Williamson results in an average of more than 6,500 units of medication per inhabitant of the city.

Opioids are a class of drugs naturally found in poppy, the same used to produce heroin. They are prescribed to treat different degrees of pain, because they act faster, stronger and longer lasting than ordinary painkillers.

But these are the same features that make opioids not only potentially addictive but also relatively easy to cause overdose. Despite this, they have been widely prescribed to patients around the US in the past two decades. In the boom year, 2012, the number of revenues rose from 225 million, or 81.3 for every 100 Americans.

Williamson is one of hundreds of cities, counties or states that have opened lawsuits against the pharmaceutical industry.

And Purdue's OxyContin has become the prescribed opioid linked to the greatest number of overuse, according to the government agency National Center for Biotechnology Information.


"Williamson earned the nickname 'Pilliamson' because of this unbelievable amount of pills," Eric Eyre, a journalist based in West Virginia, tells the BBC.

Eyre won the investigative reporting Pulitzer Prize in 2017 by producing a series of news reports about over-the-counter pain relievers in West Virginia, one of the poorest states in the US.

Data from CDC, the leading US health agency, point out that West Virginia has the highest rate of overdose deaths in the country: 57.3 deaths per 100,000 people in 2017, more than double the national average (21.7) .

Mingo County, where Williamson is located, has the fourth highest national rate of overdose deaths.

"An escape"

"High rates of drug deaths are concentrated in shifting, mining-focused communities, or those dependent on jobs in the service sector," says Shannon Monnat, assistant professor at Syracuse University, who studied the impact of the opioid crisis on American rural area.

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Rural communities, such as the impoverished West Virginia State, are some of the worst affected by the epidemic.

"For many people, work and family institutions have disintegrated over the past 30 years, and this has left some people with little meaning in life. Drugs are a way to escape emotional pain or the reality of a lack of connection or purpose in life. "

In 2017, a news report from NBC interviewed Williamson's emergency service, which at the time said it had an average of 50 overdose cases a month.

"It is fair to say that everyone in Williamson must know someone affected by drug abuse," Roger May, a city-born photographer, told the BBC.

"It began with mining workers, who need the medicine to control their pain, but we quickly began to hear stories of family members also using drugs (opioids), including teenagers, who stole the pills to take to parties. So, a few years later, we saw people posting on Facebook that someone had overdose or died. "

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Williamson City Council

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Williamson's location helped make it a destination for people from other states looking to buy opioids

Tip of the iceberg

The numbers Eric Eyre revealed in his reports for the Charleston Gazette-Mail newspaper showed that the Williamson crisis was just the tip of the iceberg.

Papers obtained by the National Drug Enforcement Agency (DEA) show that pharmaceutical distributors shipped 780 million oxycodone and hydrocodone tablets, the most common opioid analgesics, to West Virginia pharmacies between 2007 and 2012.

"There's the case of Kermit, a town of 400 residents in West Virginia, who also received millions of pills, but Williamson became more symbolic because of the volume of medication and the fact that people traveled hundreds of miles to buy medicine there, "adds Eyre.

Williamson is near the border of West Virginia with the states of Kentucky and Tennessee.

This geographic location, coupled with regulation at the time of the influx of drugs, made the city a perfect destination for the so-called 'pain-management clinics' – and a surge of medical opioid prescriptions.

People started lining up at 6 o'clock in the morning at the drugstore door to get medicine.

A single doctor, Katherine Hoover, opened an office in Williamson in 2002, and by 2010 – when police performed an intervention at her clinic – she had already prescribed opioid 333,000 times.

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Miner statue in West Virginia; economic decline of mining and chronic pain caused by years of manual labor contributed to excesses in the use of strong analgesics

'Business plan'

Frankie Tack, a University of West Virginia drug addiction expert, is part of a group of scholars who believe that rural communities have turned into good opportunities for business expansion for drug giants.

"I do not think companies have accidentally dumped all these pills in cities like Williamson. It was part of a business model, targeting communities that would be at greater risk," Tack told the BBC.

"In West Virginia, there are so many cities with people involved in manual labor (which causes pain in the body) and with less access to medical services.

He says he interviewed patients who ingested opioids "without knowing what they were, let alone being addictive."

"If you look at this epidemic, you see that the victims were initially middle-aged people, people most likely to need pain medication."

But drug manufacturers and distributors have consistently denied these allegations.

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A single doctor has prescribed 330,000 opioid pills in Williamson between 2002 and 2010

Chronic pain

But to understand how the epidemic has reached its present point, we need to go back two decades in time.

By the mid-1990s, about 100 million Americans were estimated to be affected by chronic pain, prompting health authorities to call for less regulation in the use of more powerful analgesics.

The main argument in favor of this was that patients with chronic pain – from the elderly to workers who carried back years of manual labor – would have a better quality of life if they had access to stronger drugs.

The discussion evolved to the point where the level of pain was declared a "fifth vital sign" of patients – meaning that their measurement and management came to be seen as as important as monitoring of temperature, blood pressure, respiratory rate, and heart rate .

Soon, prescription drugs with opioids began to be distributed all over the country – and pharmacists started a race for their market share.

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OxyContin is estimated to have generated $ 35 billion in sales for Purdue Pharma


One such company is Purdue Pharma. In 1996, the company began selling its flagship, OxyContin. By 2001, it had already generated $ 1 billion in sales of opioid.

Rapidly, however, reports of opioid – related deaths began to rise, pulling a surge in the overall rate of overdose deaths in the U.S. – from 16,849 in 1999 to 36,000 in 2007.

In the same year, Purdue was fined more than $ 600 million, after admitting guilty for misleading the public about the risk of addiction present in OxyContin. It was one of the highest fines ever applied to a pharmaceutical company in US history.

Health information firm IQVIA estimates that OxyContin has generated Purdue $ 35 billion in sales. Research shows that the drug accounted for 82% of the company's sales in 2017.

Earlier this month, Purdue announced it was considering filing bankruptcy, restraining legal proceedings against it and negotiating settlements out of court.

The settlement in Oklahoma would be the first in which the company would respond to a popular jury regarding the liability of pharmaceutical companies in the American opioid crisis. The case was settled by out-of-court settlement, but the drug company is a defendant in hundreds of other lawsuits.

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Protest of relatives of overdose victims in the USA; deaths continue to grow in the country

Overdose deaths continue to rise – there were more than 70,000 cases in 2017. Authorities have contained medical prescriptions, but they are still high – 58.7 prescriptions for every 100 Americans.

At the same time, opioid addicts have resorted to counterfeit drugs or illicit drugs, such as heroin.

Research in Congress

Overdoses are now the largest cause of death among adults under 55 and kill as much as firearms and traffic accidents combined.

"There have been drug outbreaks before in the US, but they tended to be concentrated in 'pockets.' This is different: many people get addicted, even when they use opioid properly," says Frankie Tack.

Williamson's "tsunami" of pills was one of the highlights of a congressional investigation – made public last December – about the opioid crisis in West Virginia.

The investigation has drawn harsh criticism not only of pharmaceutical companies but also of the DEA's anti-drug agency.

"Our finding revealed systemic failures by both distributors and the DEA that contributed – and failed to contain – the opioid crisis in the state," House Energy and Commerce Committee leader Greg Walden said in a statement.

Experts predict that the mountain of legal proceedings against pharmaceuticals will result in massive out-of-court settlements, such as those involving the American tobacco industry in the late 1990s – one of the deals surpassed $ 200 billion.

"Cities, counties and states have filed lawsuits seeking redress against public expenditures related to the opioid epidemic," said Nora Engstrom, a law professor at Stanford University. "Some economists estimated that by 2015 the economic cost of this crisis was $ 504 billion, or 2.8 percent of US GDP."

At the local level, these costs are felt more strongly. In Mingo County, where Williamson is located, a survey estimated that the opioid crisis cost nearly $ 7,000 per capita – whose per capita income is just over $ 20,000.

"Opioids have devastated entire communities in West Virginia and other parts of the United States," says Roger May. "The feeling is that they have taken advantage of some people."

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