IU study finds supply chain regulatory gaps exacerbated opioid crisis

The U.S. Supreme Court blocked Purdue Pharma’s bankruptcy settlement last month. The company’s owners, the Sackler family, will not have immunity for misleading marketing of OxyContin.

Indiana’s drug overdose panel reported that 930 people died from prescription opioid painkillers in 2018. More than 1,500 died last year.

Research from IU Kelley School of Business has found that another significant factor driving the opioid epidemic is how prescription opioids are monitored.

The Department of Drug Enforcement Administration monitors the supply of prescription opioids using shipment data from distributors and manufacturers.

IU doctoral student Kelley Iman Attari and professor Jonathan Helm said the complexity of the supply chain allows large quantities of opioids to be distributed without the risk of being flagged as suspicious.

Pharmacies ordered smaller shipments from multiple suppliers, Attari said, making it difficult for the DEA to track supplies and distribution.

He added that pharmacies that increase the number of their suppliers by one will subsequently see about a 4 percent increase in the total number of medicines dispensed.

The DEA also divides its monitoring into 23 geographic areas. So a suspicious order in one region is not always reported to other regions.

Attari said the facility’s opioid distribution increased by about 13% when it placed an order in one additional geographic region.

Helm and Attari added that public attention to the opioid crisis has focused on white, rural communities. But their research found that the increased complexity of the supply chain was felt more acutely in areas with larger nonwhite populations.

Attari said the way resources are distributed and addiction treatment is not equitable.

“When we focus on white communities, there’s less monitoring, less resources in nonwhite communities,” he said. “And then they can be exploited through supply chains.”

In a predominantly white area, adding one unit of complexity to the supply chain resulted in a 16 percent increase in opioid dispensing, Attari said.

In a county with a 10% larger nonwhite population, the same one-unit increase in complexity results in a 17% to 19% increase in pharmacy order fulfillment.

Attari and Helm said a holistic understanding of the prescription opioid supply chain could help the government improve monitoring.