Nearly 55 million legal opioid pills flooded St. Louis County from 2006-12, and newly obtained data shows what entities are behind them.

The Washington Post obtained a Drug Enforcement Administration data set that details nearly 380 million transactions during that period — showing exactly who’s behind the manufacturing, distribution and pharmaceutical sales of oxycodone and hydrocodone pills.

Although prescription painkillers aren’t the sole cause of the crisis, it reveals that some northern Minnesota communities saw more pills compared to the rest of the state.

The DEA’s data set was composed of shipments of oxycodone and hydrocodone pills, which make up three-quarters of total opioid pill shipments to pharmacies, according to the Post.

Painkillers can push people to street drugs, as they seek stronger opioids, said Cody Wiberg, executive director of the Minnesota’s Board of Pharmacy.

"The issue with opioids ... is that the longer you're on them, the more likely it is that you're going to need to increase the dose (because) you become tolerant to the effects," Wiberg said. "People become addicted to prescription opioids, whether they ... are intentionally abusing it or not ... they have to keep increasing the dose."

On average, 130 people die daily from an opioid overdose, according to the Centers for Disease Control and Prevention.

The pharmacies supplying opioid pills to U.S. communities that were hit hardest by the epidemic are the same ones supplying Northland communities.

Despite serving the state’s fourth most populous city, two pharmacies in Duluth are among those that sold the highest number of opioid pills in Minnesota during the seven-year span.

Companies that created a majority of the opioid pills purchased in northern Minnesota are also currently entangled in nationally watched lawsuits.

After a legal battle with the government, the Washington Post gained access to a database maintained by the DEA. Its staff analyzed the data, and then provided it for public use. The data used throughout the story is courtesy of the Post's work and analysis.

Duluth Walgreens stores among top 5

Two Walgreens stores in Duluth rank among the top-five pharmaceutical sellers of opioid pills in Minnesota. The DEA's data only identifies the two stores by buyer number and does not give specific location beyond the city.

Combined, the two pharmacies sold more than 11 million pills in the seven-year span.

Only Brooklyn Center's Omnicare, Fridley's PharMerica and the Hennepin County Medical Center P-1 Pharmacy in Minneapolis sold more. Together, the three pharmacies sold nearly 26 million pills.

Numerous factors may have influenced the standings of the Duluth pharmacies, said Heather Blue, an assistant professor at the University of Minnesota Duluth’s College of Pharmacy and an emergency medicine pharmacist at St. Luke's.

Blue called criticisms of the local pharmacies “misplaced."

“I don't want people to use the data set and come down hard on the pharmacies,” she said. “I think (people need to take) one more step back and (think) about the prescribers. But it's still information."

The local Walgreens stores see many customers, as Duluth is home to two major hospitals that see patients for surgeries, Blue said.

There may also be more pharmacies per capita in the state’s metro areas, resulting in lower numbers of pills being sold at each as people have more options, she said.

Wiberg, of the Board of Pharmacy, also pointed out Walgreens' size: It's one of the biggest pharmacy chains in the U.S. and has a large customer base, so it ends up filling more prescriptions.

Walgreens declined an interview request to discuss the two Duluth pharmacies. Instead, company spokesman Phil Caruso issued a statement.

“Walgreens pharmacists are highly trained professionals committed to dispensing legitimate prescriptions that meet the needs of our patients. Walgreens has not distributed prescription controlled substances since 2014 and before that time only distributed to our chain of pharmacies. Walgreens has been an industry leader in (combating) this crisis in the communities where our pharmacists live and work.”

There are mechanisms in place to identify and monitor the amount of pills being prescribed to an individual, Blue said. In Minnesota, health care professionals use the Minnesota Prescription Monitoring Program — software that tracks controlled-substance prescriptions.

And physicians or pharmacies can deny a prescription to anyone if they feel the prescription isn’t valid, Blue said.

They also deny prescriptions when they "double check" if the medication would harm a patient, Wiberg said.

But, the prescription legally belongs to the patient, so they may get it filled elsewhere.

“Pharmacists want to take care of their patients," she said. "And (they) want to do that with (the patient’s) prescriber. And so it's going to be a conversation with the prescriber."

Millions of opioid pills

Over 841 million pills entered Minnesota from 2006-12.

An analysis of northern Minnesota counties show there was a higher-than-average amount of pills distributed to these communities.

About 39 pills were distributed per person each year in St. Louis County — about 16 pills higher than the state average, according to the database.

Nearby counties reflect similar trends.

Carlton County had more than 40 pills per person distributed annually, and Cook County had 33 pills per person. That state average is about 22 pills per person, which Lake County fell below with about 20 pills per person.

“It's shocking to see … the crisis has hit Minnesota. And we knew this,” Blue said. But there are still states with higher rates than Minnesota's, she added.

Who are the companies making and selling the pills?

The manufacturers and distributors supplying pills to the local area are also doing so in other communities.

In Minnesota, the top three companies made 86 percent of the pills, according to the Post's analysis of DEA data. The companies — SpecGx LLC., Actavis Pharma, Inc. and Par Pharmaceutical — are also the top manufacturers for the rest of the nation.

The Post's analysis shows the three companies made about 88 percent of opioid pills nationwide.

These manufacturers, along with others, are involved in the more than 2,000 drug industry lawsuits filed by state, local and tribal governments, according to reporting from the Associated Press.

They make up the beginning of the process that a pill goes through before reaching the consumer.

Pills start at manufacturers, Blue said. Then, distributors purchase them from manufacturers and sell to pharmacies. Pharmacies opt to purchase from distributors as it’s simpler, and many use just one distributor for their needs.

Pharmacies are "indirectly" responsible for pills entering communities, Wiberg said.

Pharmacists and prescription writers have a "corresponding responsibility" to ensure the prescriptions they write or fulfill are for legitimate medical reasons, he said.

"If you have if you have a pharmacy that is doing things appropriately and is appropriately refusing to fill illegitimate prescriptions, they're going to order less opiates and control substances to come in," he said. "If you have a pharmacy or a number of pharmacies that are kind of (relaxed) about that, and they're letting prescriptions slide, and some of these should not be filled — you're going to see more opiates coming into that community."