Several factors contributed to pharmacies in Van Buren and Fort Smith receiving more opioids in a six-year period than any others in Arkansas, officials say.

A recent report published by The Washington Post shows Walmart Pharmacy 10-0016 in Van Buren and National Family Pharmacy and Anderson’s Discount Pharmacy in Fort Smith from 2006-12 each received more opioids from distributors than any other pharmacy in Arkansas. Local officials in the medical and pharmaceutical fields say requirements from the Joint Commission on the Accreditation of Healthcare Organizations and a lack of prescription oversight combined with pill mills and drug addiction present in the area at the time contributed to the number of opioids the three pharmacies received.

“At the end of the day, it’s a reflection of what has been happening in the greater Fort Smith community,” said District 77 state Rep. Justin Boyd, R-Fort Smith, who is a pharmacist. “There have been a significant number of prescriptions for large quantities of opioids written.”

National Family Pharmacy in Fort Smith received nearly 9.6 million opioids in the six-year period, while Anderson’s received more than 7.9 million. Walmart Pharmacy 10-0016 received nearly 5.1 million pills during that time, according to DEA records obtained by The Post.

Arkansas in that time received more than 894 million oxycodone and hydrocodone pills, records show.

The Joint Commission during this time listed pain as the fifth vital sign for medical treatment. If patients weren’t satisfied with how their pain was treated, they could fill out a form listing the hospital that the Joint Commission would review, said Dr. Don Phillips of the Arkansas Medical Board and Mercy Clinic in Fort Smith. The opioid prescribing rate in the county climbed consistently from 171.72 prescriptions per 100 people in 2006 to 229.4 per 100 in 2012, according to Centers for Disease Control and Prevention.

“We were told by the hospitals, ‘You have to give adequate pain relief,’ and that led to higher prescriptions than what we wanted,” Phillips said.

“Nationally, there was a push to treat pain. Part of how I was trained as a pharmacist was, if people tell you they’re in pain, you have to believe them,” said Boyd, adding that what happens in a pharmacy “is a reflection of what’s happening in the doctor’s office.”

Phillips also pointed out that the Prescription Drug Monitoring Program, which allows doctors to check their patients’ prescription histories, was not mandated for doctors to check until 2015. This created a difficult situation in Fort Smith, which has a high population of people addicted to other narcotics, Phillips said.

“We had a drug problem because we didn’t know that people were getting multiple prescriptions and masquerading as chronic pain patients. Now, all that has come to light,” he said.

Another factor Phillips pointed out was the presence of “pill mills” — clinics run by doctors who unethically write prescriptions — in eastern Oklahoma. St. Madron Pain Clinic in Roland from January 2013 through June 2014 prescribed 5.6 million opioids, the majority of which were filled in Fort Smith, according to the Oklahoma Bureau of Narcotics. The clinic was operating years before then.

Phillips pointed out that both National Family Pharmacy and Anderson’s are close to the Arkansas-Oklahoma border.

“For various reasons, Fort Smith was hit harder than the other places,” Boyd said.

While they acknowledged the Fort Smith region’s difficult past with opioid prescriptions, Phillips and Boyd both said they are happy with the direction the region is moving. The county painkiller prescribing rate dipped from 169 prescriptions per 100 people in 2016 to 153.1 per 100 in 2017, according to CDC

And with the improvement of technology, available information and education, Phillips expects for opioid prescribing practices and addiction to improve in the region.

“We have to look in the rear view mirror and say, ‘This is what happened, these are the things that led to it, and we have to do everything we can to treat pain, but go about it differently,’” Boyd said.