For the first time ever, the public can see details of who manufactured pain pills and which pharmacies stocked them, revealing exactly what drug companies knew as they flooded communities with opioids that fueled a national epidemic.

After a yearlong court battle, The Washington Post and HD Media, which owns the Charleston Gazette-Mail, recently won public access to a key Drug Enforcement Administration database. The government and drug industry opposed its release and won the initial court case, but the news organizations recently prevailed on appeal. The groups also convinced the court to unseal depositions and internal documents, such as emails, that show companies' internal push to increase sales even while opioid-related deaths soared.

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The database, which The Washington Post released publicly last week, details 380 million times manufacturers sold opioids to pharmacies, physicians or other distributors from 2006 to 2012.

The Washington Post narrowed the data to oxycodone and hydrocodone pills because research has shown those common prescriptions were the painkillers most often diverted into the black market.

In Texas there were a total of 5,432,109,644 pills prescribed during the years between 2006 to 2012. The state average number of pills per person was 31.3. Texas ranked 36th in the country for opioid usage.

Oklahoma ranked 9th. In Oklahoma the number of pills were 1,403,265,597 or 53.8 pills per person.

Nationwide from 2006 to 2012, states received an average of 37 pain pills per person each year. But some states were shipped almost twice that. Many of those pills ended up on the black market instead of being used for medical reasons.

How it affects Grayson County

Back in May, former pain management doctor Howard Greg Diamond was sentenced to 20 years in federal prison for conspiract with intent to distribute and distribution of a controlled substance charges. He also received 10 years for health care fraud aiding and abetting.

Diamond's court case began just over two years ago after the DEA executed a search warrant at Diamondback Pain and Wellness Center in Sherman. Less than two months later, Diamond was arrested

An indictment that was returned on July 6, 2017 says that the seven people, who are not named in the indictment, filled prescriptions obtained from Diamond and then overdosed on those medications in the days and weeks that followed. Some of the patients died within a couple of days of filling the prescriptions and others were within a month of getting the medication.

The drugs prescribed by Diamond that are linked in the indictment to overdoses include Fentanyl, Hydromorphone, alprazolam, methadone, morphine, oxycodone, zolpidem and oxymorphone.

But Grayson County's issue with opioids did not begin or end with Diamond.

Frank Hotchkiss is a veteran living in Grayson County who has gone from being addicted to methemphatmine and using opioids to now interning to become a licensed chemical dependceny therapist.

Hotchkiss said the biggest reason the drugs are rampant in this area is because of how easy they have become to obtain. He said at the Department for Veteran's Affairs, doctors hand out pills like candy.

“The availability is the most pressing problem right now,” Hotchkiss said. “Right in this area it is so rampant. I've been working a lot with people in Gainesville who are having a big problem with veteran's getting hooked on drugs. Substance abuse explodes into other problems. I will never run out of work, especially in this area.”

The bigger numbers

Nationally, about 144,000 people died from opioid overdoses 2006-12. Another 211,000 deaths were tallied 2013-17, although some places have started to see a slowdown. Lawsuits related to drug companies' role in those deaths already are the largest in Amerian history with settlements surpassing those made with tobacco companies in the 1980s.

Some of the largest drug companies already have paid more than $1 billion in federal fines and even more to states and counties who sued. Exact deals remain to be reached with most filers.

The Post reported that oxycodone and hydrocodone pills accounted for three-quarters of all opioid shipments to pharmacies over the seven years of tracking. The newspaper released the original data, as well as an easy-to-use search tool, writing that they want “to help the public understand the impact of years of prescription pill shipments on their communities.”

Communities have long known the tally of resulting overdose deaths. But until now, Americans could not know how many pain killers had been sent to their communities because public officials and drug company attorneys sought to keep the information secret.

The deaths came in three waves.

Manufacturers saturated towns with more painkillers than reasonably could be used for medical purposes and so the pills were diverted to the black market and abused. When access to medical-grade opioids was cut off amid crackdowns and public pressure, people had to switch to street opioids, like heroin, to prevent debilitating withdrawal.

People died.

Overdoses spiked even more as Mexican cartels began mixing often-tainted Chinese fentanyl into heroin and then began selling that powerful opioid on its own.

Court documents show that companies ran marketing campaigns with distorted facts about painkillers' effectiveness and aggressively pushed for increased sales even when they knew more pills were being sold than could legally be used. At least one executive was criminally convicted for trying to bribe doctors to increase pain killer sales.

The Healthcare Distribution Alliance, the national trade association representing pharmaceutical distributors, emailed GateHouse Media to “correct some misperceptions about the origins of the country's prescription opioid abuse epidemic.” Senior Vice President John Parker, emphasized that their members followed rules requiring them to report sales to federal officials.

“The DEA has been the only entity to have all of this data at their fingertips, and it could have used the information to consistently monitor the supply of opioids and when appropriate, proactively identify bad actors,” he said in the statement. “Unlike the DEA, distributors have no authority to stop physicians from writing prescriptions, nor can they take unilateral action to halt pharmacies' ability to dispense medication.”

Internal documents freed as part of the Washington Post's legal case and shared with the public by the newspaper show that many high-level company officials focused on following the letter of reporting laws but did not see themselves as having a broader duty to halt suspicious sales even as overdose deaths grew.

One of the nation's largest distributors said as much in an August 2018 court deposition.

“Cardinal Health does not have an obligation to the general public,” said Vice President Jennifer Norris when asked about the opioid epidemic. “Cardinal Health has an obligation to perform its duties in accordance with the law, the statute, regulations, and guidance.”

An email exchange a decade earlier illustrates the sales-at-any-cost attitude prevalent throughout the documents newly unsealed by the court.

In January 2009, a national account manager for Mallinckrodt told a vice president of KeySource Medical that he had just shipped the company 1,200 bottles of 30mg oxycodone tablets. That particular dosage is widely preferred by illicit users and drug traffickers.

“Keep 'em comin'!” said Steve Cochran of KeySource. “Flyin' out of there. It's like people are addicted to these things or something. Oh, wait, people are…”

Victor Borelli, from Mallinckrodt, replied: “Just like Doritos keep eating, we'll make more.

Reporter Richard A. Todd contributed to this report.