What Opioid Crisis? Pharmacies Thrive Selling Painkillers in Small Kentucky Town

Medicaid expansion is a double-edged sword

Manchester, Kentucky, is an economically depressed city in the foothills of the Appalachian Mountains. But one type of business is thriving: pharmacies. Eleven drug stores, mostly independents, are scattered around a tiny city of 1,500 people. And prescription pain drugs are one of their best-selling items, according to Kaiser Health News.

Most pharmacies in Manchester and in surrounding Clay County (population 21,000) lack the convenience-store trappings of national chains, such as CVS or Walgreen’s. They sell few items over the counter, focusing on prescriptions.

Clay’s residents filled prescriptions for 2.2 million doses of hydrocodone and approximately 617,000 doses of oxycodone in the 12-month period ending last September—the equivalent of approximately150 doses for every man, woman, and child.

Painkillers became more accessible through legal channels in Kentucky after eligibility for Medicaid was expanded under the Patient Protection and Affordable Care Act (PPACA) in 2014. Free medications, including addictive opioid painkillers, became available to nearly 440,000 more residents who joined the Medicaid rolls. That occurred amid an epidemic of fatal overdoses involving prescription opioids in Kentucky and nationwide during the past decade.

To combat drug abuse, Kentucky in 2012 passed a law to manage the sales of pain drugs. It required doctors and pharmacists to use a state database to find out if their patients were recently prescribed narcotics. Its purpose was to prevent patients from obtaining multiple prescriptions from different doctors. The law also mandated that all pain clinics be licensed and gave law enforcement easier access to the drug-monitoring database.

But doctors and pharmacists are ill-equipped to be enforcers. They say it’s difficult to distinguish immediately between use and abuse and to overcome social forces beyond their control.

“We see a lot of overdoses and have a tremendous drug problem in the area,” said Dr. Jeffrey Newswanger, an emergency physician at Manchester Memorial Hospital. “Whether there is any correlation between ODs and the Medicaid expansion is hard to say. I think in general most abusers are getting their drugs from the street, not from prescriptions.”

Manchester’s closest inpatient drug treatment facility has a waiting list of 100 people––an increase of more than 50% in recent years, said Tim Cesario, director of substance abuse services at the Cumberland River Comprehensive Care Center in Corbin. The facility—with 41 beds for men and 15 for women—has been at capacity for several years, he said.

Cesario attributed the trend to the increased availability of pain pills, particularly from drug dealers, and has concluded that the state’s Medicaid expansion was both good and bad for those fighting the opioid epidemic.

“It did enable people to get pain pills for free if they can get someone to prescribe them, but it also increased their ability to get treatment because they now had a way to pay for it,” he said. “So on one hand it’s worked against us, and on another, it has worked with us.”

Source: Kaiser Health News; February 8, 2017.