West Virginia has been devastated by the opioid epidemic, and suffers from the highest rate of prescription opioid overdose deaths in the U.S. A fatal contributor to this epidemic has been the flooding of prescription pain pills into the market by drug wholesalers. For years, the exact number of opioids flooding the area remained unknown, but concerns grew as the number of overdose deaths continued to skyrocket.

After an initial tip that West Virginia’s Attorney General had deep ties to pharmaceutical companies, Pulitzer-winning journalist Eric Eyre led an investigation into the actions of drug wholesalers. He discovered that millions of pills were being shipped into quaint southern West Virginia towns. Much of the attention has been focused on Kermit, a small town home to just 392 people with shipments upwards of nine million pills over the course of two years.

Eyre’s investigation has been celebrated as a wake-up call regarding the influx of prescription pills to the area and has inspired numerous small towns in the state adversely impacted by opioid overdose deaths to take arms against drug wholesalers through court proceedings.

The Politic: What peaked your interest to investigate the influx of prescription drugs into WV?

It started in 2013 when we got a tip that our attorney general was involved in a lawsuit against drug wholesalers and they had paid for his inauguration ceremony as well as largely funding his campaign. His wife worked for one of the largest drug wholesalers in the nation, called Cardinal Health.

We wrote a story about that, saying that he had recused himself from the case at the beginning of the year when it started in January 2013. We found documents that showed otherwise. That dispute lasted 2-3 years. We had a lot of coverage and a lot of back and forth.

The next step was early 2016. We got wind there was a lawsuit complaint in a case that was updated. The revised lawsuit was actually filed under seal at the request of both the Attorney General’s Office and the drug wholesalers. So, you have this complaint that has the state’s allegations against the drug companies filed under seal and we were like: “Why were there be a reason to seal a state’s complaint if you [the Attorney General’s Office] are filing a complaint on behalf of the state?”

You would think it would be open to public inspection but it was filed under seal. In March of 2016, we filed a motion to intervene in the case. Basically, the idea was to unseal all the complaints. We had multiple hearings. Each wholesaler had a local counsel, a corporate counsel, and then another outside counsel.

We had two lawyers against 30 lawyers, back and forth. Their position was that the information contained in the complaint were trade secrets and that contained information gave competitors an unfair competitive advantage.

We argued the data was something the public had the right to see and that we had a public health crisis with the opioid epidemic and we needed to say what the role was of the drug companies in this epidemic. There were around 200 pages of legal filings. I had to do a lot of proofreading.

The guys that were working for us were pro-bono, so they were working for free. Of course, the big lawyers from the drug companies don’t work for free. We had multiple hearings. To file stuff, we had to meet multiple deadlines. I had to literally get in the car a couple of times and drive the motions and response to motions that we had down to the court.

I remember one time on a Friday I had to get something in and made it by the skin of my teeth. One thing we thought was pretty interesting was one of their responses, saying the Gazette-Mail was trying to “stick its intrusive journalistic nose into a case where it didn’t have any standing.” At the end of the day, the judge sided with us except for one condition: If a company was settled or in the process of settling their case with the state, that their information contained in the complaint would still be under seal.

So I think we got six or seven out of a dozen companies unsealed. What that showed were specific allegations about unusual shipments to pharmacies in southern West Virginia and the doctors that had been disciplined and indicted. You had cases where 10,000 Oxycodone pills had been shipped to a particular pharmacy one day, and then like 30,000 oxycodone pills three days later, and 50,000 oxycodone the day after that. It was just really unusual large amounts of in particular Oxycodone or Oxycontin and Hydrocodone shipped to these individual pharmacies.

Amid all that, there were references to DEA data which tracked all shipments of controlled substances to pharmacies. The next step was to file a FOIA with the Attorney General. Basically, we asked for all data referenced in the complaints provided by the DEA to the Attorney General’s Office. They released a huge amount of DEA data that showed every shipment from each wholesaler to every county in West Virginia and the number of pills sent to every pharmacy in West Virginia. That data was what nobody else had.

As far as we know, that was the first time in history any newspaper had gotten ahold of sales like that. The only gap was the DEA data didn’t show which wholesaler shipped to which pharmacy, but we’re trying to figure that information through other means.

The Pulitzer website referred to your work as “courageous reporting performed in the face of powerful opposition.” Who were some of the most powerful opponents to your reporting?

Well, these companies are huge. Mckesson is the 5th-largest on the Fortune 500 list based on revenue. They have what’s called the “Big 3”, that’s Mckesson, Cardinal Health, and Amerisource-Bergen. Amerisource-Bergen also ranks number 12 on that list, and Cardinal ranks 21st on the Fortune 500. If you look at the Fortune 500 companies, at companies like Walmart and Exxon, you recognize them. But then you get to companies like Mckesson.

A couple years ago, you or I would have no idea what Mckesson is. They put up a tremendous fight to block us. We actually went to back to court, but they tried to keep their drug sales data secret.

Did you ever feel constrained by your resources at a small-town newspaper?

Our biggest constraint as a small newspaper is the small number of reporters. We don’t have 300-400 reporters like the New York Times. So everybody has to put in a story or two a day in order to fill the newspaper holes so readers have something to read. That puts a great demand on your time, making it harder to do investigative projects. If you are at the NYT or the Washington Post as part of the investigative team, you don’t have any requirements for daily stories, so you could spend a year, or two, on one thing. I try to chip away early in the morning or after turning my story in the late afternoon or evening.

It’s a constant pressure that every day you have to “feed the beast” and rightfully so. People who buy the paper deserve to get fresh news every day, but it’s really hard when you’re trying to work on a project. It’s difficult when you’re looking at a spreadsheet or scheduling interviews with recovering addicts and get a call from your editor asking you to cover a press conference or press release. It’s frustrating and takes the bigger momentum away from your project. The biggest restraint is finding the time to put into these projects.

How did people react when the numbers came out? Were they surprised or had a suspicion that something like this was happening?

When Bernie Sanders picked it up and put it on Facebook, it went absolutely through the roof. And then, I started getting calls from Jake Tapper at CNN and MSNBC; even Fox News wanted to pick it up. There were emails from people who lost loved ones who wrote to say thank-you and shining light on this issue.

We had written previously about bad doctors and pill-mill pharmacies, and the coverage of Purdue Pharma and Oxycontin has received a lot of attention. However, the role of the actual wholesaler hadn’t really been told in great detail.

Is there a link between the opioid crisis and the heroin epidemic we are facing today?

CDC has come out with many studies stating that once people were hooked on opioids, and then losing those opioids because of the crackdown on pill mills, the transition to needles was not difficult at all. The other factor is now they are putting fentanyl and I believe heroine too into a pill form. So, people do not know what they are taking. At least with Oxycontin, people knew the milligram strength. You knew what you were getting into.

Now, people are pressing Fentanyl into pill form and you don’t know what you are getting into. From what I understand, Fentanyl comes into Mexico, and if it is not cut properly, you can have a few grains, like salt, and put it on your tongue and then you are dead.

It is a hazard for law enforcement too. When somebody [in law enforcement] goes into a house after somebody dies of an overdose, if they get it on them and accidentally wipe it on their mouth and inhale it, they put themselves in jeopardy. The problem with fentanyl is that it is so much stronger than what the pills were.

How will the American Health Care Act affect access to substance abuse treatment for addicts in WV?

I have seen different numbers on how many people would be losing treatment. I have seen, on the low end, that about 30,000 people won’t get substance abuse treatment in West Virginia. On the high end, I’ve seen upwards of 50,000 Medicaid recipients won’t get substance abuse treatment. I think that bodes negatively for people out of substance abuse treatment, and most of that is going to be opioid treatment. That’s certainly not a good thing.

And it is not just here, I get calls from reporters in New Hampshire, Maine, Pennsylvania, Ohio, Tennessee, Kentucky, Virginia. New Hampshire is a special example because they didn’t have much of a drug overdose problem five-six years ago, and now they are number two, with West Virginia being number one, in drug overdose rates.

How have has your reporting contributed to the efforts in WV to combat the epidemic?

There’s something called suspicious order reporting. It occurs when a pharmacy orders an excessive number of drugs from a wholesaler. The wholesaler is supposed to report the order as suspicious. However, there were only two companies doing that and the Board of Pharmacy was not enforcing that rule.

My second piece was about suspicious order reporting. Even before I finished the piece, I asked the Board of Pharmacy for suspicious order reports. They decided a week or two later to start enforcing the rule and began forwarding those reports to the Attorney General and the State Police.

Whenever I asked to see the suspicious orders, they showed me two boxes. Then I asked,” What do you do with these reports?” and they responded, “We don’t do anything with them, we haven’t enforced that law since it’s been on the books. We just keep them in a box and shelf them.” Nobody investigates them. They don’t send anybody out to call the pharmacy, nor call the wholesaler. Now at least they are doing something with them.

The other big fallout from my reporting was all these lawsuits from cities and town and counties in WV. There were probably two dozen counties or more who have either filed suit or announced their intention to file suit. A lot of these small towns that were flooded with opioids are now filing their own lawsuits. They have a huge uphill battle because the drug companies are hiring all the best lawyers. It’s going to be a dogfight.

Eric Eyre’s winning pieces can be viewed on the Pulitzer website: http://www.pulitzer.org/winners/eric-eyre

This interview has been edited for clarity and concision and is the first segment of a four-part series examining different ways the media, government officials, and concerned citizens are working to combat the opioid epidemic.