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Holes in supply chain regulation heightened opioid crisis, IU research says

By Bente Bouthier

Posted July 9, 2024

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IU Kelley PhD student Iman Attari and Professor Jonathan Helm said supply chain complexity enabled large amounts of opioids to be distributed without being flagged as suspicious. (Overdose Lifeline)

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 its misleading marketing of OxyContin.

Indiana’s drug overdose dashboard reported that 930 people died from opioid prescription pain relievers in 2018. Last year, more than 1,500 people died.

IU Kelley School of Business research found another key piece that fueled the opioid epidemic is the way prescription opioids are tracked.

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

IU Kelley PhD student Iman Attari and Professor Jonathan Helm said supply chain complexity enabled large amounts of opioids to be distributed without being flagged as suspicious.

Pharmacies ordered smaller shipments from many suppliers, Attari said, making supply and distribution harder for the DEA to track.

He said pharmacies that increase their number of suppliers by one have an approximately 4 percent increase in their total dispensing after that.

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

Attari said a dispenser’s opioid distribution increased about 13 percent when it ordered from one additional geographic region.

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

Attari said that framing means allocation of resources and addiction treatment are not equitable.

“When the focus is on the white communities, there is like less monitoring, resources in the non-white communities,” he said. “And then these can be exploited by the supply chains.”

In a predominantly white area, a one-unit increase in supply chain complexity resulted in a 16 percent increase in opioid dispensing, according to Attari.

In a county with a 10 percent higher non-white population, the same one-unit increase in complexity leads to a 17 to 19 percent increase in dispensing for pharmacies.

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