The Kern River Valley has one of the most severe opioid problems in California. One particularly stricken burg in the area, Wofford Heights, has an opioid overdose rate five times the national average.
So, when a previously unreleased database maintained by the Drug Enforcement Administration showed that a busy rural pharmacy, The Drugstore in Kernville, has been buying and dispensing oxycodone and hydrocodone pills, two of the most abused and deadly opioids on the market, at what seemed an astounding rate, a phone call was in order.
Between 2006 and 2012, drug manufacturers shipped more than 6 million oxycodone and hydrocodone pills to the bustling little mountain pharmacy on Piute Drive — enough for 870 pills per year for each of the 995 people who live within 5 miles of its front door.
That confluence of data points prompted an obvious question: What, if anything, might connect the two?
The Washington Post obtained the DEA's national data on licensed pharmacies by court order on July 15, broke it down and on Sunday dropped some numbers. Among its findings: Over that seven-year period, 15 percent of U.S. pharmacies, about 1,000 of them, received 48 percent of pain pills, or about 100 million pills.
Some of the highest-volume dispensers of those two opioids are based in the same regions of the U.S. where opioid addiction and overdose are among the worst: West Virginia, Kentucky and southwestern Virginia.
The Kern River Valley is in their dismal company, led by Wofford Heights, which had 22.8 opioid overdoes per 100,000 residents in 2017, nearly five times the national figure.
Hold it right there, says Austin Horn, The Drugstore's pharmacist. His pharmacy, he maintains, is being stigmatized by the study's misleading parameters.
Pill-to-person ratios that establish a 5-mile radius as their basis — as the Post study does — might have some value in high-density areas where competition affords customers more choices, but The Drugstore fills prescriptions for customers for 50 miles around and has one solitary competitor 12 miles away, in another nearby town.
"We're a high-volume pharmacy," Horn said. "We service the whole area."
But not high volume for opioids — at least not based on percentage of all drugs dispensed, according to Horn. Just 18 percent of prescriptions filled by The Drugstore are controlled substances, he said.
"That puts us on the low end of the scale," Horn said. "So this study is a little bit skewed. It's very misleading."
He wouldn't speculate on the root of the Kern River Valley's opioid problem.
"I don't know," he said. "I'm not the one who chooses what to prescribe to people."
Neither can he track what happens to prescribed painkillers once they leave his store.
That's a trail worth following, though, and several states are doing so with billboard campaigns that warn parents about leaving their pain medication in accessible places such as bathroom medicine cabinets.
As a pharmacist, Horn knows this: State and federal regulatory agencies are looking over his shoulder with unprecedented scrutiny.
"They're all retired DEA agents, and they know their customers — us, the pharmacies — just like we know our customers," the patients, he said.
Another factor in the Kern River Valley's opioid overdose epidemic is its lack of a state-licensed narcotics treatment programs. As The Californian reported in 2017, none of the state's 21 ZIP codes with the highest overdose rates has such a program. Few had opioid treatment programs within 40 miles.
California is in the process of rolling out a program, modeled after one developed in Vermont, that allows physicians to dispense buprenorphine, an addiction-fighting narcotic, through rural clinics or physicians' offices working in collaboration with nearby opioid treatment programs.
Lake Isabella currently has none of those treatment options.
The opioid addiction crisis has several points of entry: Among them, pharmaceutical companies, treatment protocols, prescribing physicians, dispensing pharmacies, uncautious parents, the black market, and uneven treatment opportunities.
Kernville's pharmacist embraces regulatory scrutiny, but his message today is this: Nothing to see here.
Horn's initial reluctance to talk about the pharmacy business didn't stem so much from The Post's exploration of the DEA's data, he said, as this:
"We're a family business, and we're one of the only drugstores around; business is good," he said. "We don't need CVS knowing it's a great place to do business. They're ruthless."