KY: How was this Kentucky county flooded with pain pills? Federal case helps explain.

Lexington Herald Leader News –

A drug-company officer has admitted not reporting large, suspicious orders of pain pills by a Clay County pharmacy that played a role in helping flood the community with pills.

David B. Gustin pleaded guilty Monday in federal court in London to a misdemeanor charge of knowingly failing to tell the U.S. Drug Enforcement Administration about suspicious orders by Community Drug, a Manchester pharmacy.

Gustin, a compliance officer at drug wholesaler McKesson, approved shipping more pain pills to Community Drug in 2011 and 2012 despite red flags that the pharmacy was a source of supply for addicts and drug dealers, according to a court document.

The owner of the pharmacy, Charles Terry Tenhet, pleaded guilty in December 2012 to conspiring to distribute pain pills and is serving a 10-year sentence.

Pills involved in that conspiracy came from McKesson.

From July 2011 to April 2012, Gustin approved providing a total of more than 300,000 oxycodone pills to Community Drug, according to his plea agreement.

Gustin was first charged in March 2019 with being part of a conspiracy to illegally distribute pain pills and Xanax, a crime punishable by up to 20 years, but pleaded guilty to the lesser charge.

It is unusual to have drug-company officials charged in distribution conspiracy cases. After Gustin was originally charged, his attorney, Brian Butler, said in a court document that the case could be the first federal prosecution of its kind in the country.

Community Drug at one time was a go-to pharmacy for drug organizations that allegedly distributed hundreds of thousands of pills in southeastern Kentucky, court records indicate.

The business filled out-of-state prescriptions for cash, raising its prices when other local pharmacies wouldn’t fill orders they saw as suspicious, according to court documents.

One witness told investigators that Tenhet charged as much as $1,300 for 400 pain pills.

The pharmacy filled prescriptions despite obvious signs that the pills were headed for the black market, including groups of customers coming in together and sharing money to pay for out-of-state prescriptions, and customers with identical orders for pain pills despite their age or ailment.

While that was going on, Gustin was director of regulatory affairs for McKesson.

His job included approving sales to pharmacies in 15 states, deciding how many pills they would be allowed to buy and whether to increase those caps, and reviewing dispensing data to try to spot orders that were suspicious because of their size or pattern.

Community Drug became a McKesson customer in June 2011, estimating that it would dispense 5,000 oxycodone pills a month.

However, McKesson shipped 21,900 pills to the pharmacy the next month, and Gustin approved several increases in the amount the pharmacy could receive.

Gustin knew the pharmacy was ordering “an unusual and suspiciously high” number of 30-milligram oxycodone pills, which were in demand for illegal sales, according to his plea deal.

Gustin told Community Drug in May 2012 that it could only keep getting pills from McKesson if it stopped filling prescriptions from doctors outside the immediate vicinity, including doctors in other states.

But Community Drug kept getting drugs from McKesson and using them to fill prescriptions from out-of-state doctors, and Gustin didn’t report the orders as suspicious.

McKesson kept shipping pills to Community Drug after getting a subpoena from the DEA about the pharmacy and after DEA agents interviewed Gustin about the sales, according to his plea agreement.

Gustin faces up to a year in prison and a fine of $100,000. U.S. District Judge Robert E. Wier scheduled sentencing in October.

McKesson agreed in January 2017 to pay a civil penalty of $150 million to settle allegations that it didn’t properly report suspicious drug orders by pharmacies in Kentucky and other states.

Federal authorities said at the time that because the company was not telling the DEA about the orders, it was more likely that pills were diverted to illegal sales, helping fuel opioid abuse.

Then-Attorney General Andy Beshear sued McKesson in January 2018, alleging the company took part in unfair and deceptive practices to distribute millions of pain pills to Kentucky between 2010 and 2016 even as overdose deaths rose.

“McKesson knowingly and intentionally distributed enormous quantities of prescription opioids throughout Kentucky with total disregard for our health and safety,” Beshear said at the time.

The company said the allegations were unfounded.

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