GREENFIELD — Little about the appearance of the only CVS store in this picturesque old mill city of 17,000 suggests anything remarkable.
The cream-colored 24-hour pharmacy occupies a plaza wedged between a brick public elementary school and a storefront business that prepares tax returns.
But this CVS in the northern part of the state’s Pioneer Valley bears a dubious distinction: From 2006 to 2012, the pharmacy received the largest number of opioid painkillers of any neighborhood drugstore in Massachusetts, taking in 5.3 million hydrocodone and oxycodone pills from pharmaceutical distributors, according to recently released federal data.
The data, which The Washington Post and other media outlets recently obtained from the federal Drug Enforcement Administration, has stirred concerns about the painkillers that poured into this Western Massachusetts city.
“I can’t believe we’re in that much pain,” said Mayor William F. Martin, who wrote to CVS Wednesday asking for an explanation amid media reports on the data.
CVS attributes the high volume at the Greenfield store during that period to its location. It is the only 24-hour CVS within a 30-mile radius and is near a hospital and a large physicians’ practice. Only a third of the pharmacy’s customers live in Greenfield, said a spokesman for the corporation.
But the questions that the new data generated underscore the complexities and contradictions surrounding the opioid epidemic, which began with prescribed pain pills about 20 years ago but has since shifted to illegal drugs.
Today, the overdose crisis in Massachusetts is driven almost entirely by street drugs, particularly the deadly, illicit forms of fentanyl.
Indeed, the state has consistently had one of the nation’s lowest rates of opioid prescriptions, according to previously available federal data going back to 2006. In 2017, for example, Massachusetts physicians wrote 40.1 opioid prescriptions per 100 people, the sixth-lowest rate and well below the national average of 58.7.
The new DEA figures confirm this pattern, showing that the number of prescription pain pills that flowed into Massachusetts in 2006 through 2012 was lower, per person, than in many other states. And the pill count in Franklin County, where Greenfield is located, was lower than in most other counties in the state.
Even so, in 2017 Massachusetts had the seventh-highest rate of opioid-related overdoses in the nation, and Franklin County generally followed the statewide pattern.
Dr. Ruth A. Potee, a Greenfield family physician and addiction specialist, has an explanation for the seeming contradiction: “The way that the pills came to New England wasn’t from the local prescription pad,” Potee said.
Instead, starting in the late 1990s, a flood of painkillers came illegally from pill mills in Florida, driven up the “Oxy Highway,” as Potee and others familiar with the situation called Interstate 95.
After the pill mills were shuttered in 2010 and painkillers became scarcer and more expensive, many who became hooked turned to heroin. And in recent years, heroin has been contaminated with illicit, highly potent fentanyl, leading to the high death rate.
As for the Greenfield CVS, Potee said she has known for years that the pharmacy was the biggest dispenser of pain pills in the state. But she was not overly concerned because she knew the customers came from a wide area.
That CVS, she said, is the only 24-hour pharmacy in rural Franklin County, which covers 702 square miles and sits close to Vermont, where 24-hour pharmacies are also scarce.
In 2016, CVS, based in Woonsocket, R.I., reached a $3.5 million settlement with the federal government amid allegations that pharmacists in Massachusetts and New Hampshire filled hundreds of forged prescriptions for painkillers. Later that year, it paid a $795,000 state fine in a settlement over what the attorney general’s office called improperly dispensed opioids.
But CVS spokesman Michael J. DeAngelis said in an e-mail that over the past several years, the drugstore chain has taken “numerous actions to strengthen our existing safeguards,” resulting in a 30 percent reduction in the amount of controlled substances that its retail pharmacies dispense.
Still, the newly released data have sparked shock and dismay among some in Greenfield. In his letter to CVS, Mayor Martin asked how “such a large deployment of opioids to one single CVS Pharmacy” failed to raise red flags for the giant drugstore chain.
The data also troubled a Boston attorney who is helping to represent Greenfield and about 120 other Massachusetts cities and towns as part of a mammoth, multistate lawsuit against the makers and distributors of opioids. Greenfield was the first community in Massachusetts to sue the drug companies.
“This pharmacy in Greenfield is exactly what the lawsuit is all about,” said the attorney, Peter Merrigan, a Greenfield native. “There’s an unusually high number of opioids being sold in this pharmacy, and the distributors, under the [federal] Controlled Substances Act, had a duty to report any suspicious orders to the DEA.”
Merrigan said his cousin died in 2012 of opioid addiction at age 34.
The DEA data show that 1.28 billion oxycodone and hydrocodone pills poured into Massachusetts, and 76 billion nationwide, from 2006 to 2012.
The hot spots in Tennessee, Kentucky, West Virginia, and elsewhere received 150 to 250 pills per person per year. In Massachusetts, the per-person count ranged from 19.7 in Middlesex County to 38.5 in Dukes County, which encompasses Martha’s Vineyard. In Franklin County, the number was 26.6.
The highest number of pain pills received by any business in the state — 34.2 million — went to the Injured Workers Pharmacy in Andover. The company, now known as IWP, is a mail-order pharmacy that ships drugs nationwide, with only a small fraction going to Massachusetts patients. (Nevertheless, Attorney General Maura Healey’s office said Wednesday that it is investigating IWP’s opioid dispensing practices.)
The second- and third-ranking pharmacies on the list are part of national companies that serve nursing homes and other facilities. The Greenfield CVS received the fourth-highest number of pills statewide.
In Suffolk County, the largest number of pills went to Sullivan’s Pharmacy in Roslindale. The pharmacy did not return calls seeking comment, but its website says it provides home delivery to patients throughout Eastern Massachusetts.
Meanwhile, opioid prescriptions have declined nationwide since 2012. The trend is especially steep in Massachusetts, where opioid prescriptions fell by nearly 40 percent since the beginning of 2015.
In fact, instead of worrying about too many painkillers being dispensed, Potee, the Greenfield physician, started to worry that there were too few, leaving pain patients without relief.
In 2014, she said, she and other members of Franklin County’s opioid task force raised concerns about pharmacists’ new restrictions on dispensing opioids. The group met with representatives of CVS and several other drugstores to urge them not to withhold medication from people in pain but instead to stay alert to warning signs of misuse.
Meanwhile, powerful fentanyl has become almost ubiquitous within the illicit drug supply. As of 2018, nearly 90 percent of opioid-related deaths in Massachusetts involved fentanyl, and prescription drugs were found in the bodies of less than 20 percent of the victims, according to Department of Public Health data.
Like many poorer communities in Massachusetts, Greenfield, which once had a thriving tool-making industry, has had to combat opioid addiction.
Gene LaCoy, owner of The Music Store, which sells stereo equipment kitty-corner across from the CVS, has seen the effects.
When he sought to recoup $1,000 from a customer who stiffed him, he learned the man was in jail for burglaries to feed an opioid addiction. He said he fired an employee who stole small sums of cash from the register to pay for drugs. And the son of a motorcycle buddy of Lacoy’s died of an opioid overdose earlier this year, he said.
LaCoy, 55, has worked at the store for 34 years, and has seen the town change since he grew up there. These days, several storefronts on Federal and Main streets stand empty and the mini-golf courses and video game stores he enjoyed when he was young are gone.
“There’s not a lot of things for kids to do around here,” he said.