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FILE - This Monday, June 17, 2019, file photo, shows 5-mg pills of Oxycodone. Two Ohio counties are asking a judge to find that drugmakers and distributors were not allowed to ship suspicious orders of controlled substances to pharmacies. If a judge sides with the request from Cuyahoga and Summit counties, it would clear the way for the governments to assert that drug companies ignored the regulations as a nationwide opioid crisis continued to grow. (AP Photo/Keith Srakocic)

CHARLESTON - In Point Pleasant, West Virginia, population 4,350 in 2010, pharmacists at Fruth Pharmacy gave out 7.3 million painkillers between 2006 and 2012.

Less than a block away, across Jackson Avenue, a Rite Aid dispensed more than 3.9 million pills in the same seven-year window.

Those numbers come from recently released U.S. Drug Enforcement Administration data, which shows how chain drug stores around West Virginia put hundreds of millions of powerful painkillers into the hands of West Virginians while overdose death rates surged.

Chain drug stores' individual locations reported lower pill dispensing totals than many of the smaller, family-owned pharmacies that topped the DEA's list for opioid disbursements. Two West Virginia pharmacists who were indicted earlier this month on federal charges of conspiring to distribute controlled substances ran two of these smaller "pill-mills" - Tug Valley Pharmacy in Williamson, where pharmacists dispensed the fourth highest number of pain pills in the state; and Westside Pharmacy in Oceana, which was 13th on the list.

An analysis of DEA data, however, shows the outsize role corporations played at the end of the pharmaceutical supply line.

According to the DEA data, in West Virginia between 2006 and 2012:

n Rite Aid pharmacies dispensed 140 million painkillers at 108 locations

n CVS pharmacies dispensed 96.7 million painkillers at 50 locations

n Walmart pharmacies dispensed 67.4 million painkillers at 41 locations

n Kroger pharmacies dispensed 58 million painkillers at 43 locations

n Fruth pharmacies dispensed 35.2 million painkillers at 14 locations

n Walgreens pharmacies dispensed 17.1 million painkillers at 16 locations

This data was submitted in federal court as part of litigation brought against a wide range of pharmaceutical companies from hundreds of towns, cities and counties affected by the opioid epidemic. The companies are accused of conspiring to saturate the country with opioids. The data was not available to the public until attorneys for HD Media, which owns The Herald-Dispatch and Charleston Gazette-Mail, and The Washington Post successfully fought for its release.

While a total of 67 pharmacies were operating and dispersing pain pills in Charleston over this time, six Rite Aid locations alone provided nearly 8.8 million doses to the city - nearly 30% of all the opioid prescriptions filled in the state's capital over those seven years.

In Belle, an eastern Kanawha County town where 1,260 residents lived in 2010, two Rite Aids were the only pharmacies in town, according to DEA data. There, the stores provided nearly 2.8 million doses of pain pills between 2006 and 2012.

Concurrently, the age-adjusted rate of drug overdose deaths tripled between 1999 and 2016 across the country, federal data shows. Between 2005 and 2015, heroin use doubled in adults aged 18 to 25. About 45% of people who used heroin were also addicted to painkillers.

In the Brooke County seat of Wellsburg, population 2,805 in 2010, Rite Aid and Kroger pharmacies provided 2.4 million pain pills to residents.

Brooke County has the second highest rate of opioid-related hospitalizations in the state, behind only McDowell County, according to data from the federal Department of Health and Human Services.

Walgreens, Walmart, CVS Health, Rite Aid and Kroger are among the pharmacies named in federal lawsuits accusing them of flooding the country with billions of opioids and flouting requirements that they notify the DEA of suspicious orders.

Attorneys for the plaintiffs say an official at CVS who was listed as the company's DEA compliance coordinator admitted it was not her real job, and that other drug store chains did almost nothing to report suspicious orders, according to The New York Times.

Michael DeAngelis, senior director of communications at CVS Health, said in a statement that pharmacists at the company evaluate all prescriptions they receive for controlled substances, like opioids, before filling them.

"While we have taken numerous actions to strengthen our existing safeguards to help address the nation's opioid epidemic, it is important to keep in mind that doctors have the primary responsibility to make sure the opioid prescriptions they write are for a legitimate purpose," DeAngelis said. "Opioid medications are only a small percentage of the overall prescriptions our pharmacies dispensed."

He noted that no individual CVS pharmacy topped the DEA's database for the highest number of pain pills dispersed.

Unlike the other chain pharmacies, Fruth Pharmacy is a West Virginia-based company, operating about 30 pharmacies in West Virginia, Ohio and Kentucky.

Fruth Pharmacy President Lynne Fruth said she would not comment on data "she has not been given a chance to see." Invited to view the numbers, she said she wouldn't have time to look.

Chris Krese, a spokesman for the National Association of Chain Drug Stores - an industry group - warned that people should "take care" in drawing conclusions from the data released by the federal court.

"It does not lend itself to clear interpretations, and it is leading to some incorrect conclusions that are harmful to entire communities," Krese said.

Krese would not elaborate on what conclusions were incorrect, or how communities were being harmed.

Walgreens spokesman Phil Caruso said the company's pharmacists are highly trained and committed to dispensing legitimate prescriptions.

"Walgreens has not distributed prescription controlled substances since 2014 and before that time only distributed to our chain of pharmacies," he said. "Walgreens has been an industry leader in combating this crisis in the communities where our pharmacists live and work."

None of the representatives speaking for the pharmacy chains would discuss whether the companies' prescription-filling practices played a role in the opioid epidemic that has taken thousands of lives in West Virginia alone.

Representatives from Rite Aid, Kroger and Walmart did not respond to requests for comment.

'The pills don't just go out'

Dr. Rahul Gupta, West Virginia's former state health officer, said the data indicates the pharmacies didn't seem to be reporting suspicious orders to the federal government.

"Clearly, the retail pharmacies were not looking to actually look at these orders with a suspicious eye. They were dispensing; they saw their role as being dispensers," said Gupta, currently chief medical officer for the March of Dimes.

However, he said there was a culture of "complicitness" up and down the supply chain, including doctors writing prescriptions, distributors delivering the pills, and pharmacies giving them to patients, that ultimately cost human lives.

"Everyone that touched these pills ... is responsible ultimately for the end results that happened and continues to happen," he said.

Mike Goff, executive director of West Virginia's controlled substance monitoring program, declined to comment on the chain drug stores' role in the opioid epidemic.

However, Goff said some blame lies with the doctors who wrote the prescriptions, not just the pharmacies that filled them.

"The pills don't just go out," he said. "The pharmacies filled them and the numbers are big, but there are also doctors out there who wrote those prescriptions to be filled. So there's another piece to this."

Dr. Michael Brumage, former director for the West Virginia Office of Drug Control Policy, said that while it's easy to point fingers and shift blame, no one involved in these practices - executives, distributors, doctors or pharmacists - is innocent.

"They all have plausible deniability by blaming everybody else, but in truth, everybody was culpable in this," Brumage said. "Anybody who made a lot of money off the opioid crisis, at some point or another, conveniently looked the other way."

Brumage, who currently works as the medical director for Cabin Creek Health Systems and as a program director at West Virginia University's School of Public Health, characterized the opioid epidemic as one of the "biggest catastrophes" in the history of public health. He called it "a Vietnam (War) happening practically every year" because of the number of lives lost.

This epidemic, though, is one that was in the works for years before it was noticed, Brumage said, and while the numbers can be shocking at first glance, at this point they should be expected.

"This is something that is easy, I think in many respects, to externalize and look for the bad guy," Brumage said. "But this is a monster that we invited into our homes. This is not something that beat down the door. This is something we invited in."

Those responsible for negligent prescription practices here, Brumage said, are all concerned with the same thing: making a profit. It's not a lack of information or understanding that has distributors sending pills to the area, doctors writing prescriptions for them and pharmacists filling those prescriptions, he said.

"It's indifference. It's indifference to the harm you're causing by focusing on the bottom line," Brumage said. "That's sort of the lesson here: Big pharma and these pharmacy chains and the distributors, they don't care about the common person. I think they knew damn well what they were doing, but they were blinded by the inflow of cash."

Money, Gupta agreed, is what's at the center of it all.

"Everyone that monetized it has to be held responsible," he said. "It's a monetary thing at the end of the day."

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