Opioid Control and Gun Control

It's nearly universally stated in the 2A community that gun control isn't about guns; it's about control.  It's looking like the same thing can be said about opioid control, and the governments' responses to the "opioid epidemic".  It doesn't matter if their policies are getting the right results, it only matters as a means to the end of more control over more people.

Background:  I've written on the topic a few times, a simple search in the search bar in the upper left corner of the screen returns the three most relevant posts.  Around the same time I did mine, Aesop at Raconteur Report wrote about opioids in Northern California and I always link to him.  (Parts 1, 2, 3, Final)  Let me share a short version of where I stand from a piece I posted last October.

I think there's a deliberate attempt to conflate prescription opioid problems with illegal heroin overdose.  We don't have a prescription drug problem, we have a "junkies shooting adulterated heroin problem".  So why the public ruse?  The old advise to "follow the money" leads me to the company that makes naloxone, the anti-narcotic drug administered to people in overdose.  It was being pushed that virtually everyone should carry it everywhere as a lifesaver; it was even pushed on librarians to have it available for the library junkies who OD while watching internet porn in the library (do you have that where you live?).  The price of naloxone had gone up 17x.  Going down that rabbit hole led directly to Hillary Clinton and the Obama administration.

A few weeks after I posted that, conservative commentator Eric Bolling lost his son to an overdose.  I truly feel sorry for Eric and his family for the incredible pain they've been subjected to.  On the other hand, Eric has fallen right into the "painkillers = heroin" trap and argues that we use too many opioid pain killers.  His awful emotional pain does not give him the right to inflict physical pain on others.

The problem is that the effort to restrict opioid prescriptions is fueling a black market while leaving people in agonizing pain.  According to Maia Szalavitz, an expert reporter on this subject writing in the NY Times: 

As many as 18 million patients rely on opioids to treat long-term pain that is intractable but not necessarily associated with terminal illness. In 2016, seeking to curb opioid misuse, the Centers for Disease Control and Prevention introduced guidelines outlining a maximum safe dosage and strongly urging doctors to avoid prescribing for chronic pain unless death is imminent. The guidelines were supposed to be voluntary and apply only to chronic pain patients seeing general practitioners. Instead, they have been widely seen by doctors as mandatory.

As a result, thousands of pain medication recipients have had their doses reduced or eliminated. But this attempt to save people from addiction is leaving many patients in perpetual pain — and thus inadvertently ruining, or even ending, lives.

The problem, as usual, is that the Government regulators are starting from a bad assumption.  They assumed today's junkie shooting contaminated fentanyl is yesterday's patient who started out on prescription drugs and got addicted that way.  Only about 8% of people who receive prescription opioids develop addictions.  80% of addicts get started in other, less legal, ways.

As the Journal of Pain Research points out, the government’s campaign is based on a false premise: “Today’s non-medical opioid users are not yesterday’s patients.” Medical users usually do not become addicts.

Wrong assumptions lead to wrong law, and doctors are being threatened with their livelihoods by new regulations.

Prescribing outside the C.D.C. guidelines can lead to scrutiny by medical boards and even the Drug Enforcement Administration — and the result has been that many doctors have either quit prescribing entirely or tapered patients’ doses to fit the guidelines. According to a 2017 Boston Globe survey, nearly 70 percent of family and internal medicine doctors nationwide reported having reduced their prescribing in the previous two years — and nearly 10 percent reported stopping prescribing pain medication entirely. 

The problem with these blanket policies from the CDC or other Big Government agencies is that people are individuals and vary in their response to the pain killers.  Some people can't get by without them.  The VA recently did a study that showed alarming rates of suicidal acts “following discontinuation of opioid therapy.”

Jay Lawrence, a former truck driver, is a case in point. When his doctor refused to continue his medication in early 2017 — even though he had severe pain from spinal cord injuries and was not addicted — he told his wife that he’d had enough. In a park where they’d recently renewed their wedding vows, he fatally shot himself in the chest while she held his hand.

Writing in the Orange County Register, Dr. Jeffrey Singer notes that attacking doctors for prescribing opioids to patients for essential pain relief does nothing to prevent black-market use of opioids or deaths among non-medical users:

A recent report reveals California’s “Death Certificate Project,” is terrorizing doctors into under-prescribing or even abruptly terminating medication for acute and chronic pain patients. The project investigates doctors who have treated patients identified as overdoses on death certificates and considers rescinding their licenses or charging them with homicide.

It is scandalous that we doctors and our patients are the latest victims of America’s war on drugs, while deaths from nonmedical use of licit and illicit drugs continue their exponential and perpetual climb — with no end in sight.

The U.S Centers for Disease Control and Prevention recently released the latest results of the current strategy: opioid-related overdose deaths in 2017 continued their steady climb, increasing 13 percent over 2016 totals. This happened despite the fact that per capita high-dose opioid prescriptions fell 58 percent from 2008 to 2017, while the number of all opioids dispensed fell 29 percent from 2010 to 2017.

Perhaps most damning is this assessment from the CATO Institute.  A study by Harvard’s Jeffrey Miron and others shows the government’s anti-opioid crusade has backfired and actually increased opioid addiction and overdose deaths:

Opioid overdose deaths have risen dramatically in the United States over the past two decades.… The opioid epidemic has resulted from too many restrictions on prescribing, not too few. Rather than decreasing opioid overdose deaths, restrictions push users from prescription opioids toward diverted or illicit opioids, which increase the risk of overdose because consumers cannot easily assess drug potency or quality in underground markets. The implication of this “more restrictions, more deaths” explanation is that the United States should scale back restrictions on opioid prescribing, perhaps to the point of legalization.

Last words not to Cato's Jeffery Miron, but to Maia Szalavitz who started down this road:

Paradoxically, there is a growing medical consensus that patients who are addicted to their pain pills shouldn’t be forced to taper their dosages. The safest treatment for opioid addiction is maintenance with an appropriate opioid: For addiction, the opioids methadone and buprenorphine are the only treatments proved to cut the death rate from overdose by 50 percent or more.

“We have less mercy for people who have chronic pain and are on chronic opioids than we do for somebody who’s using heroin in the streets right now,” said Dr. Kertesz.

Both groups deserve more compassion, including a safe legal harbor for high-dose prescribing for patients who truly need it — as well as for their doctors. Attempting to reduce overdose risk by raising the odds of suicide is both cruel and senseless.

Trying to Make Sense of The Opioid "Epidemic"

A couple of days ago, I sat down to collect my thoughts on the so-called "Opioid Epidemic" in the US.  I found it a lot harder to make sense of it than I would have thought. 

Let me backup for a minute and tell you where I'm starting from.  Borepatch had a great article on the big picture; as has Bayou Renaissance Man.  One of the aspects frequently talked about is how high the addiction and death numbers are in places like Ohio and West Virginia.  The Charleston (WV) Gazette-Mail wrote (last December) writes:

In six years, drug wholesalers showered the state with 780 million hydrocodone and oxycodone pills, while 1,728 West Virginians fatally overdosed on those two painkillers, a Sunday Gazette-Mail investigation found.

The unfettered shipments amount to 433 pain pills for every man, woman and child in West Virginia.

This doesn't begin to tally up the damages, not to mention the lives of the addicts that OD.  What about the crime committed trying to steal drugs?  What about armed robbery of medical clinics, drugstores, veterinarians and even robbery of people followed home from those places?  Exactly who the villains are depends on who's telling the story.  To the writers at the Charleston Gazette-Mail, it appears to be that the drug companies are the villain.  Liberal media sure hates them some big business!  To the determined libertarians, it's the government and the War on Drugs - and there's tons of collateral damage there.  To the CDC and some doctors I've read online, it's the doctors and especially "pill mills" writing the prescriptions.

That summary started to bother me.  When the Gazette-Mail said the drug companies shipped in "433 pain pills for every man, woman and child", it sure sounds like too many, but when you think about it, well, what does that mean?  That number was obtained by dividing the number of pills sent into the state by the number of residents over six years.  Looked at as pills/person in 2191 days (six years), that's less than 0.2 pills/person per day.  Now nobody takes 1/5 of a pill per day, so you're talking 1 person in 5 is taking one pill a day.  Only opioids aren't typically one pill once a day.  If those are prescription pills, the person is probably going to get four or five a day for a week or two.  That also cuts the number of people.  Now you have one person in 20 or 25 taking pills every day.  You're talking that statewide, 5% of the people may be recovering from an injury or surgery or something.  Some of the people are getting those strong pain pills daily, and they skew the numbers even more.  Maybe it's 4% or less of the population getting those pills.

I think "less than 4% of the population being treated for an injury or recovering from surgery" on any given day sounds pretty normal.  It sounds rather different than "433 pain pills for every man, woman and child", doesn't it?

What's a normal rate for the prescription of these drugs?  There have been heroin overdoses and deaths for as long as I can remember - and centuries before that, too.  So what's new here?  How do I know if something is really going on and it's not just the media being pushed by the people who hate "big pharma" or it's not just a push to get this covered by what certainly seems like the coming single-payer, socialized medicine fuster cluck we're heading for?  Are we really seeing something different? 

I can't answer what's normal, but if you can trust the Centers for Disease Control, they present data that appears to show that after a long period of low, but steady number of overdose deaths, starting in 2013 or '14, the rate began to really climb.  (looking at the blue numbers in this graph, 2012 is up less over 2011 than 2013 is over 2012).  This plot goes back to 1999, but I saw an extension to 1990 and it didn't look very different than the first few years of this plot. 

So if there's really a problem, and it really seems to be bad in West Virginia and Ohio, what's really going on?  

I got a new perspective from a seemingly unrelated article I read last week.  I get the Ammo.com weekly newsletter/ad, and they linked to this long but haunting piece on the Bitter Southerner.  I'm absolutely a Southerner, but bitter isn't in my makeup.  Still, the phrase that hooked me into reading was something like, "how do you have a dialog with people who automatically add the word 'trash' whenever they hear the word 'trailer'?"  While I've never lived in a trailer, I've visited many, had family that lived in one, and partied in a few more.  The expression they refer to, though, seems to be a stereotypical elitist phrase - a disparaging term the "northern and coastal elites" use against the southerners in flyover country.

After describing a world more like the one I grew up in than not, author David Joy threw in this paragraph.   

I get the same kind of questions about addiction. People don’t understand what would push someone to drugs like methamphetamine or heroin. They don’t understand what would make a man drink like my grandfather. The reason they can’t understand it is because they’ve never been that low. When all you’ve got is a twenty-dollar bill, twenty dollars doesn’t ward off eviction notices. Twenty dollars doesn’t get you health insurance. Twenty dollars doesn’t make a car payment. Twenty dollars doesn’t even keep the lights on. But twenty dollars can take you right out of this world for just a little while. Just a minute. Just long enough to breathe. That’s what every single addict I’ve ever known really wanted: just a second to breathe.

I have never reached that level of desperation in life, and for that I'm incredibly thankful.  And it is true that some of the worst death rates in West Virginia come from coal mining counties where EPA policies caused shutdowns of various mines.  The thing is, I don't think that sort of reaction to desperation - doing meth or heroin - is or could be widespread in a population. 

Red Kool-Aid in an old pickle jar (note to coastal elites: the jar is recycled!) - pure southern.  From Bitter Southerner.

The problem with this explanation is that the "epidemic" isn't just among the trailer population in the rural south.  The death rate is the same ballpark in New Hampshire, Massachusetts, Rhode Island and nine other states as it is in Ohio and West Virginia.  The epidemic affects bored kids from "good backgrounds" with not enough to keep them occupied and all sorts of "good kids", not just unemployed rural southerners with no economic future.   Yes, some people get prescribed narcotics for chronic pain and get addicted, too.

On the other hand, I believe there's evidence that there are such things as addictive personalities and some people are more inclined to those behaviors than the majority.  Not everyone can go the route that Bitter Southerner describes.  I know that's not a "politically correct" view, but I often wonder if our modern, "everyone can get addicted to something" mindset is just a way to get addiction treatment added to the "universal health care roster" that everyone pays for - just like getting retired widowers to pay for maternity coverage they'd never buy. 

(source: HHS Opioid Factsheet - pdf warning)

Ultimately, though, the soul-searching and navel-gazing does nothing about the problem.  The War on Drugs is no solution.  First off, if it was doing anything worthwhile the price of those drugs would be too high for the desperate people who only have $20.  Condemning the pharmaceutical companies doesn't do any good, either.  The couple of groups in the few companies that sold their pain pills as not being addictive when they're really very addictive should be investigated for fraud or improper practices and charged where appropriate (whatever the charges should be).  Locking up doctors for prescribing pain medication for patients doesn't help doctors and it doesn't help patients.  Shutting down pill mills dispensing "narcotics by the bag" has been blamed for forcing users to heroin (these guys make my head hurt).  Living in pain is bad for your health, too.  All of medicine is a compromise, just like all of engineering. 

Although it's painful to say it and I'm sure there will be objections, the people responsible for the opioid addicts are the opioid addicts.  If the libertarian creed is "don't hurt people and don't take their stuff", the opioid addicts are the ones violating that.  They're the ones raiding our wallets.  With the WoD, we pay in money and loss of freedoms.  In the case of doing a Portugal and going full legalization, we pay in money.  In both cases, we pay any other social costs. Without the WoD, perhaps we recoup some of the billions poured into that bottomless pit. 

Wait.  If we go full legalization it still costs us?  Who do you think pays for those detox programs we hear about working in Portugal?  Likewise, I really doubt that there are no health care costs at all for drug addicts even if it is legal.  Will it be cheaper than the WoD?  More than likely.  Even if we do the most heartless stuff you can read online and either just let the addicts die or do like the Fed.gov did during prohibition and actively try to kill them, it's still going to cost us.  If nothing else, someone has to pay to bury or otherwise handle the bodies.   

I don't see any way to handle the opioid problem that's a Good Solution.  The best we seem to be able to find is coming up with the least awful option: minimizing bad, not maximizing good.  More freedom is always better, but there's still a Shop Vac attached to your wallet even if there is no WoD. 

The desire to get high seems to be a fundamental human drive.  Judging by the cats' reactions to catnip, it's not limited to humans.  There will always be some percentage that become addicts.  Given that, it seems like the least awful solution is full legalization.  I don't have an estimate for what all the other costs of that will really be. I am, however, opposed to the "legalize it and tax it" mantra.  Ask Eric Garner how that "just tax it" thing worked out on cigarettes, which have been legalized but taxed forever. 

And none of this is going to happen.  If we have a senate that can't get rid of clearly unconstitutional meddling by the Fed.gov hydra taking over 1/5 of the economy, the entrenched deep state will never allow legalization.  The law enforcement industry, the civil asset forfeiture industry and all the other pieces of gravy train that keeps them sucking on our wallets is simply incapable of thinking they should give it up.

The title of this piece, "Trying to Make Sense of the Opioid Epidemic" is what this is all about.  I don't pretend to have any answers.  I'm just simply trying to make sense of it.

Noted in Passing: the Opioid “Crisis” is Not Due to Prescription Drugs

I've written on the so-called opioid crisis several times in the last few years and have come to the conclusion that the narrative we're being fed simply isn't true; that the stories are manufactured for reasons that aren't necessarily clear, but that could track back to some well known politicians (hint - one of the names is associated with Arkancide).  For example a couple of years ago, Mylan, the company that makes Epinephrine injector pens - the kind used to stop anaphylactic shock in people with allergies to things like bee stings - raised the price a factor of 4x and the media howled like banshees.  The company that makes Naloxone, the drug used to stop people from dying of opioid overdose from dying, raised their price 17x and the media didn't say a word. 

Back on November 20th, the CATO institute put up an article derived from a study published November 1st in The Annals of Emergency Medicine (full text).  The study demonstrates what I've reported here from the start, the numbers of people who become addicted to prescription opioids is too small to match the overdose numbers being seen.

This prospective cohort study by researchers in the Department of Emergency Medicine at Albert Einstein College of Medicine followed 484 “opioid naïve” patients prescribed opioids for acute pain upon release from the emergency department during a six month period. The statewide prescription drug monitoring program was employed in addition to regular follow up telephone interviews. One percent (five patients) met the criteria for persistent opioid use by the end of the follow up period. Four of the five patients still had moderate or severe pain in the affected body part six months after release from the emergency department.

I'm a little surprised to find that it's as much as 1% of the group that were using the opioids persistently, but 484 patients isn't a big number and sometimes small groups give strange results.  The CATO article also talks about a much larger study with a smaller number of misusers in the British Medical Journal.  

The study comes after a much larger retrospective cohort study reported in the BMJ of more than 568,000 opioid naïve patients prescribed opioids for acute postoperative pain between 2008 and 2016. Investigators found a total misuse rate of 0.6 percent. The researchers defined “misuse” as follows:

The primary outcome was an ICD-9 (international classification of diseases, ninth revision) diagnosis code of opioid dependence, abuse, or overdose…Opioid misuse was defined as the presence of at least one of these ICD codes after discharge and encompasses a composite of a wide range of forms of misuse. We included only diagnosis codes related specifically to prescription opioids.

There is simply no correlation between opioid prescription volume and non-medical use or opioid use disorder among people age 12 and over.  Meanwhile, the restrictions on drugs that some patients need are still being withheld as policymakers and law enforcement continue to pressure health care practitioners into undertreating patients in pain. At a recent international breast cancer conference experts stated the under-prescribing of opioids to breast cancer patients in the U.S. is now comparable to treatment in third world countries.

This despite the CDC coming out this April ('19) and saying (my editing), “you guys making drug policy and passing laws got us all wrong.  Those 2016 opioid prescription guidelines we issued were supposed to be just that: guidelines.   We always figured the doctors know best what their patients need.  You doctors should treat the patients who need it for pain.”

Closing words to CATO:

Meanwhile, as prescription volume precipitously drops, the overdose rate continues apace, with fentanyl and heroin now making up the overwhelming majority of overdose deaths. And now methamphetamine is making a comeback as a major cause of drug deaths—15 years after Congress addressed the “meth crisis’ with the Combat Methamphetamine Epidemic Act.

A clear case of, “it didn't work, so let's try it again only harder.”

Today's opioid or fentanyl addicts are not yesterday's patients.  That lie has to die.

Trying to Make Sense of The Opioid "Epidemic" - Part II

I spent a really long time writing the first part of this, first intending to put it up Saturday, but giving up after a little over two hours.  Yesterday I spent more time, perhaps another four hours.

Why?  After a while researching, I started feeling like I was being played.  Like the whole thing was a scam designed by someone for some unknown purpose (but that probably involved getting lots of government money).  It wasn't until I found that graph from the CDC data that I started to think maybe something really is there and there really is an increase in overdose deaths.

I find that getting away from the computer, picking up a guitar and playing some scales and mindless exercises will allow my mind to wander in more productive ways than sitting here.  Blogging isn't exactly a high-stress life, but I find that my brain will follow more idea trails when I'm not trying to put together a post.  It wasn't until after I posted it and sat down to play that the realization occurred to me that just because there really may be more heroin overdose deaths, that doesn't mean we're not being played.  Someone could be taking advantage of a situation that developed on its own. 

Cui bono?  Who benefits?  As always, start by asking that.

Thankfully, while I was playing guitar, Mrs. Graybeard (who can be a much better search engine weenie than me) started asking some questions.  It starts with a simple observation: have you noticed the push for every cop, every paramedic and every rescue group in the country to carry naloxone?  There was even a story about librarians administering it to addicts to save their lives.  Have you heard that the price of naloxone has gone up at least 17 fold in the last few years?  And isn't it interesting how everyone has heard the complaints that the makers of (epinephrine) epi pens, Mylan, hiked their prices 4x but no one seems to complain that naloxone has gone up 17x?

Going down that rabbit hole leads directly to Hillary Clinton and the Obama administration.  This is according to the Wikileaks emails found here.  You should read the whole thing.  Someone sleuthing around in the Wikileaks archive posted this (there are grammatical and other errors in here, but I've left the author's words as found):

There seems to be money flowing into the Clinton Foundation from big pharma. The CEOs are donating to Hillary's campaign. On the campaign trail I've seen Bill Clinton name drop the drug naloxone. The recent emails on wikileaks confirms that the one of the goals of the Clinton Foundation is to make this drug be everywhere. One of the manufactures of this drug is Hospira, a company recently bought by Pfizer. 
...
There seems to be serious conflicts on interest. been the campaign and the companies. For example Clinton wants to give these campaigns 7.5 billion dollars through federal programs. This is an OP-Ed from Hillary from last year:

Today I’m releasing a strategy to confront the drug and alcohol addiction crisis. My plan sets five goals: empower communities to prevent drug use among teenagers; ensure every person suffering from addiction can obtain comprehensive treatment; ensure that all first responders carry naloxone, which can stop overdoses from becoming fatal; require health care providers to receive training in recognizing substance use disorders and to consult a prescription drug monitoring program before prescribing controlled substances; and prioritize treatment over prison for low-level and nonviolent drug offenders, so we can end the era of mass incarceration.

The call for Naloxone by name was echoed by Tim Kaine - before he became her running mate in the last election - and by John Podesta.  Call it crony capitalism or crony socialism, either way it's corrupt to the core.

The drug isn't under patent, so there can be generics.  Hospira/Pfizer is one of only a few manufacturers and they've all jacked their prices up.  The defense seems to be "but we don't charge as much as the other guys".  Are the prices a function of supply and demand or "get it while the gettin's good"?

The states are jumping on the bandwagon, too - along with first aid instructors and even gun bloggers.  Everybody is trying to get first responders to carry naloxone or the narcan nasal spray.

Conspicuous in its absence is that none of the governments seem to be pushing anti-addiction treatments and therapies, just the drugs.  Admittedly when someone is comatose and ready to die from their OD, they don't benefit from counseling, but without breaking the addiction cycle they're probably going to need more of the drug someday.

It could be that the cartels are supplying heroin more cheaply than before and usage patterns are shifting to the cheaper heroin.  When the cartels cut their heroin with cheaper fentanyl, it's easier for addicts to overdose and die.  But the heroin overdose problem is not the myth that it's prescription drugs and it's entirely possible that a bump in heroin deaths is being exploited all the way around.

Invoking the specter of prescription drugs being used improperly appears to be an attempt to lump heroin and prescription drugs together as one massive problem which makes people who are taking prescription drugs for post-surgery pain afraid of becoming addicts or overdosing.  They're different problems.  There was a National Survey on Drug Use and Health (NSDUH)  run by the department of Health and Human Services (HHS) that said: 

According to NSDUH, only a quarter of people who take opioids for nonmedical reasons get them by obtaining a doctor's prescription. Hence the sequence that many people imagine -- a patient takes narcotics for pain, gets hooked, and eventually dies of an overdose -- is far from typical of opioid-related deaths.

According to that linked article, opioid-related deaths are rare even for patients who take narcotics every day for years. The CDC cites "a recent study of patients aged 15-64 years receiving opioids for chronic noncancer pain" who were followed for up to 13 years. The researchers found that "one in 550 patients died from opioid-related overdose," which is a risk of less than 0.2 percent. (I would assume from how that's worded that the study was not just on 550 patients, but on a bigger number.  A study of 550 people would be too small). 

So what do I think is going on?  First the disclaimer: bear in mind that I'm a paranoid old man (although not as paranoid as some of y'all!).   Conclusion, we are being played.  We're being played by the makers of naloxone, and those few drugs used to treat addicts and ODs.  We're also being played by the "addiction treatment industry" and recreational drug lobby that want to normalize heroin (like these folks, I think).  They're  scaremongering.  If they can convince Soccer Mom Suzy that heroin from the Mexican cartels is like the pain pills that she gets when she gets a wisdom tooth pulled, they can scare her.  They can use a death from a heroin overdose to get Suzy to advocate more money for addiction and overdose treatments.  I wouldn't hesitate too much to say we're being played by the CDC, as part of the general thing we see in every Fed.gov agency, loosely translated as "Don't cut us! We're valuable!"

That entire paragraph seems to describe byproducts of the WoD, so completely tossing our WoD and all its infrastructure would profoundly change all of it.  But like I said yesterday, that's just not gonna happen.  Far too many cronies and Deep State swamp creatures make a living off the WoD.  They will protect that turf and I don't see much chance that the WoD goes away.  If the country economically collapses and has to reset, maybe it will be too low priority to worry about the WoD.  For a while.  

Another way of visualizing what all the noise is about, again from the CDC.  Between 2006 and 2014, deaths from "opioid analgesics" went from 4 to 6 people per 100,000.  That's .0006 %.  Are we making mountains out of statistical molehills?

The Latest Meaningless Drivel on the "Opioid Epidemic"

This weekend saw a story about Clay County, Tennessee, with the hook to reel in readers being that  pharmacists bought, “270 pain pills for every man, woman, and child” in the county.  You're supposed to say, "oh my God, that's terrible!" or "those poor people!" or perhaps just cluck like a chicken.  Personally, I say, "what would a normal number be?"

I think it ought to be obvious that in one year, “every man, woman, and child”didn't take 270 pain pills.  That would be almost 3/4 of one pill for the year.  Clearly, some people needed to take some regularly while the vast majority didn't.  I can speculate: if someone has an acute pain crisis, surgery or an injury, say, they may take four pills a day for a couple of weeks, call it 60 pills.  That reduces the 270 pills for the entire population to a smaller number.  If the entire population took that one course of pain pills (they wouldn't have), you're down to 210 per person.  The story offers no such details, nor does the DEA provide them. 

Clay County doesn't have much in the way of population.  According to the news story linked above, about 7800 people, and its one city of any size, Celina, has four pharmacies.  The owner of one of those pharmacies, Tara Anderson, says, “I haven’t done anything I’m trying to hide.”

She says there's a need for pain medication in Clay County because of an aging workforce of manual laborers, who are now feeling the physical effects of their jobs.

Sound familiar?  Isn't this what Aesop at Raconteur Report wrote about opioids in Northern California last year?   (Parts 1, 2, 3, Final)

Bouncing back to the original news report:

It's that high volume of opioids for such a small population that caught the attention of federal agents.

Again, no information on exactly what the "high volume" is.  Is this 2.0 standard deviations higher than other cities with similar populations?  (I doubt it, but for illustration).  Three standard deviations?  Is it twice the normal amount?  10x?  20x?  We simply have nothing to judge this with.  With no contextual information, the whole story is based on a meaningless number.

Instead of going through drug store records, the DEA might be better off looking at the Census records.  If the population is largely older manual laborers, as pharmacist Ms. Anderson says, it may be totally legit.

Short version of my conclusion: I think there's a deliberate attempt to conflate prescription opioid problems with illegal heroin overdose.  We don't have a prescription drug problem, we have a "junkies shooting adulterated heroin problem".  So why the public ruse?  The old advise to "follow the money" leads me to the company that makes naloxone, the anti-narcotic drug administered to people in overdose.  It was being pushed that virtually everyone should carry it everywhere as a lifesaver; it was even pushed on librarians to have it available for the library junkies who OD while watching internet porn in the library (do you have that where you live?).  The price of naloxone had gone up 17x.  Going down that rabbit hole led directly to Hillary Clinton and the Obama administration.

Going on a wider view, that led directly to the US government making deals with the Sinaloa drug cartel for purposes that aren't clear.