Health Care

What fueled opioid crisis in Florida? Billions of pills, millions in campaign cash.

In a seven-year span that saw an opioid epidemic reach crisis levels, 5,556,553,071 hydrocodone and oxycodone pills flooded into Florida.

They poured across the state through shady clinics that became known as “pill mills.” But hundreds of millions streamed through grocery stores and chain pharmacies like CVS and Walgreens, according to newly released data provided by the Drug Enforcement Agency to The Washington Post and analyzed by the Herald/Times.

One Walgreens in Port Richey alone received an average 74,706 pills per month. The city’s population is 2,831.

Overall, the number of opioids that moved through Florida was second only to California. It amounted to an average of 42 pills per Floridian per year from 2006 through 2012.

While the figures may be new, the takeaway is not: Florida’s lax regulations on pain clinics lured addicts across state lines and helped fuel the national crisis.

State leaders were “asleep at the wheel for a decade,” said Dave Aronberg, a former Democratic state senator who was brought in by then-Attorney General Pam Bondi to tackle the deadly problem. “We became the pill suppliers for the rest of the country.”

In 2010, an estimated seven people a day in Florida died from prescription drug overdoses. Some reports have put that number higher.

Cracking down on clinics

Florida cracked down on rogue pain clinics starting in 2009. Within a couple of years, it banned one-stop clinics from distributing drugs, barred ex-felons from owning clinics and established a state database of controlled substance prescriptions to track potential “doctor shoppers” as well as doctors who repeatedly over-prescribed.

The measures caused many of the pill mills to shut their doors. The number of pain management clinics in the state dropped from 921 in 2009 to 371 in 2013, according to University of Central Florida researchers.

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But the powerful companies that manufactured and distributed the painkillers under brand names like OxyContin have yet to face major criminal penalties.

Information about the role the manufacturers and major pharmacies played is still emerging as civil lawsuits against them work their way through the courts. Cities, counties and towns plagued by their populations’ addiction problems have argued in recent court filings that pharmacy giants like Walgreens wholly neglected their legal duties to block suspicious orders and alert federal authorities.

Walgreens said in a statement that the chain stopped distributing prescription controlled substances in 2014 and that it “has been an industry leader in combating this crisis.”

Campaign contributions

Even while the lawsuits continue, Florida’s elected leaders have continued to accept millions in campaign contributions from the corporations that played key roles in the epidemic.

According to the pill data, 90 percent of the opioid painkillers prescribed in Florida were manufactured by four corporations: Actavis Pharma Inc.; SpecGx LLC; Par Pharmaceutical; and Amneal Pharmaceuticals LLC. Eleven companies distributed 90 percent of the pills, including Walgreens, CVS, Walmart and Publix.

Those 15 corporations, and key people associated with them, have given at least $22.6 million in campaign contributions to candidates and committees in Florida since 1993, a Herald/Times analysis found. (OxyContin, a controlled-release version of oxycodone, was approved by the U.S. Food & Drug Administration in December 1995.) That includes $8.4 million from 2006 to 2012 and another $12.1 million since 2013.

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Mike Fasano, who’s now the Pasco County tax collector but was a longtime Republican state lawmaker in the House and Senate, said the donations kept the Legislature from addressing the issue sooner.

“Money was talking in Tallahassee, unfortunately as people were dying,” he said.

Mike Fasano, then a state representative from New Port Richey, urges a yes vote on the floor of the House, Feb. 5, 2002, in Tallahassee. PHIL COALE AP

Fasano received $10,250 from the companies. Half came from Publix. Aronberg, the state attorney, received about $5,000.

The companies donated to candidates for the highest statewide offices, including former Agriculture Commissioner Adam Putnam and state legislative leaders like Sen. Wilton Simpson and House Speaker José Oliva of Miami Lakes, as well as about $180,000 to former Gov. Rick Scott, who’s now in the U.S. Senate.

Both Oliva and Simpson, who joined the Legislature in 2011 and 2012, respectively, pointed to the progress that the Legislature has made in recent years by funding programs for addiction treatment drugs like Vivitrol, upgrades to the prescription monitoring database, and a new law passed this year that will allow Attorney General Ashley Moody to use the information in that database against drug companies in Florida’s lawsuit against these companies, which is in state court.

“We’ve been trying to get our constituents the help they need, whether it’s mental health or families getting treatments,” Simpson said.

Oliva noted that the Florida House since 2015 has passed 17 bills related to opioids. “No contribution has ever or will ever change my principles or my vote,” he said.

Scott, in his first budget after taking office in 2011, proposed to scrap the state’s prescription monitoring database — an affront to lawmakers like Fasano who argued it hadn’t even been given a chance to get up and running, let alone prevent people from “doctor shopping.” Scott later reversed course, which was cheered far away in Kentucky, whose state leaders had pleaded with Florida to stiffen regulations on its pain clinics so their residents would stop driving across state lines and coming back with pills.

Scott also eliminated the Governor’s Office of Drug Control, leaving Florida without a centralized place to coordinate ways to combat the opioid epidemic.

Rick Scott’s explanation

In response to questions about donations from companies in the drug data, Chris Hartline, Scott’s spokesman in the U.S. Senate, said: “Describing companies like Walmart and Publix as ‘opioid distributors’ is one of the craziest things I’ve ever heard.”

Walmart distributed more than 289 million prescription opioid pills in Florida, the analysis found. Publix distributed about 194 million.

Hartline added that as governor, Scott “passed the most sweeping opioids legislation in state history,” and secured more than $1 billion for mental health and substance abuse services.

Bondi filed a lawsuit in 2018 against several drugmakers and pharmacies, accusing them of racketeering in their “relentless campaign” to supply Floridians with opioids.

But even Bondi accepted $54,000 from Walmart, $6,500 from Publix, $3,000 from Walgreens and $1,000 from the pharmaceutical company McKesson.

She did not respond to requests for comment.

At least $355,000 came from the drugmakers (Actavis, SpecGx and Par) themselves. The opioid manufacturers donated the vast majority to Florida’s Republican Party. They also gave more than $2,500 each to Scott, former Attorney General Bill McCollum, former state Rep. Jason Brodeur, former state Sens. Denise Grimsley and Dana Young, and former Senate President Joe Negron.

Brodeur, a Sanford Republican now running for state Senate, said that “not once” did any of the manufacturing or pharmacy companies that donated to him ever speak to him about the opioid crisis or related legislation.

“I’m proud of the bill we passed in 2018 putting severe restrictions on opioids,” he said, referencing legislation that required doctors and pharmacists to use the drug monitoring program. “Was it too late? In hindsight, absolutely.”

The companies defend their actions

The companies identified in the analysis said they have come a long way since 2012.

A Walmart spokeswoman pointed to a fact sheet that says Walmart and Sam’s Club “are the first national pharmacy chains to restrict initial acute opioid prescriptions to no more than a seven-day supply.”

A spokesman for CVS said the chain had only ever distributed hydrocodone, not oxycodone, and ended its distribution of even those drugs in 2014.

“While we have taken numerous actions to strengthen our existing safeguards ... doctors have the primary responsibility to make sure the opioid prescriptions they write are for a legitimate purpose,” the spokesman said.

Publix declined to comment on questions related to opioids, but a spokesman said the company’s “political activity does not correspond with any legislation.”

Dave Aronberg, state attorney for Palm Beach County, joined Sen. Bill Nelson during a press conference at St. Mary’s Medical Center in West Palm Beach, March 27, 2018. Nelson witnessed the affects of Palm Beach County’s opioid crisis during his visit to the neonatal intensive care unit. John McCall South Florida Sun Sentinel

McKesson, a distributor, said it will invest in a “national system” to alert pharmacists and doctors of patients at risk for opioid overuse. AmerisourceBergen and Cardinal Health both said the pill data collected by the Drug Enforcement Agency was only recently made public and therefore had not been available as a tool for distributors to monitor pharmacies’ total pill intake.

Amneal, a manufacturer, said it has a “rigorous compliance program.”

Aronberg said the corporate giants responsible for the opioid epidemic have not yet faced adequate legal consequences. But he’s hopeful the ongoing lawsuits will at least impose financial punishments.

“This epidemic was man-made and years in the making,” he said. “It was a combination of corporate malfeasance, professional greed, political apathy and regulatory failure.”