Opioid ball rolling down hillMore than 430,000 people have died from opioid overdoses since2000, according to figures from the Centers for Disease Control.(Image: Shutterstock)

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It wasn't just Purdue Pharma that has been blamed for leadingthe nation into a spiraling opioid crisis; it had plenty of help, accordingto the Associated Press.

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Drug Enforcement Administration records indicate that most ofthe 76 billion oxycodone and hydrocodone pills that flooded U.S.pharmacies from 2006 to 2012 were generics, and the annual numberincreased by more than 50 percent during that period.

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Related: Opioid manufacturers: A publicnuisance?

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Purdue, for its part, ended up with a fine of $635 million formarketing claims that OxyContin wasn't as addictive as otheropioids. But overdoses pursued the pills wherever they went, totingup the highest body counts in areas where there were the most pillsper capita.

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Keith Humphreys, a Stanford University professor who researchesopioids, told the AP, “I think the scale of this is stunning. Itreally looks like wherever you spread the most gas, you get themost fires.”

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But which companies should get the most blame can be a challengeto figure out, even as more than 2,000 state, local and tribalgovernments have sued drugmakers. The suits make the issue bothhuge and complex. More than 430,000 people have died from overdosessince 2000, according to figures from the Centers for DiseaseControl, and from 2006–2012 they rose from less than 18,000 peryear to more than 23,000.

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According to the report, West Virginia, Kentucky, Tennessee andNevada received in excess of 50 pills for eachresident per year, while areas of the Appalachianregion saw more than 100 pills per person.

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Purdue accounted for just about 3 percent of opioids during thatperiod, while 90 percent came from three generic drug producers:SpecGX, Par Pharmaceutical and Activis Pharma. Those companiesclaim they were only meeting doctors' prescription demands, whileMcKesson Corp., Walgreens, Cardinal Health and AmerisourceBergeneach distributed more than 10 percent of the drugs sent on topharmacies. McKesson led the way, at more than 18 percent, duringthat time frame.

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Distribution details are currently playing into settlementnegotiations, but because the information had not previously beenmade public, lack of transparency around prescriptions likelycontributed to a slower federal response, according to Dr. JoshuaSharfstein of Johns Hopkins University. “To a certainextent, no agency really felt responsible and had access to thedata in real-time to see what was happening.”

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Marlene Satter

Marlene Y. Satter has worked in and written about the financial industry for decades.