2006–2014

Where the pills went, who sent them, and who paid.

76Bpills shipped across the United States in nine years. This site follows the pill through the distribution system — and counts what came after.

US pharmaceutical shipments, 2006–2014

Total pills shipped0pills

Shipped from distributors to pharmacies nationwide

Act 1 — pills shipped per year
Year	Pills
2006	22,360,250
2007	23,722,510
2008	25,049,455
2009	26,373,764
2010	27,927,210
2011	29,215,117
2012	26,843,948
2013	24,585,023
2014	22,546,561

Act 1 — Scale

76 billion pills.

Between 2006 and 2014, pharmaceutical distributors reported 0 billion doses of oxycodone and hydrocodone to the DEA. The curve rises through 2010 and then turns.

Oxy + hydro market share, 2006 → 2014

Three distributors — McKesson, Cardinal Health, and AmerisourceBergen — shipped the bulk of opioid pain pills.

Act 2 — top distributors market share 2006 → 2014
Distributor	2006	2014
MCKESSON CORPORATION	38.9%	35.0%
CARDINAL HEALTH	25.5%	27.5%
AMERISOURCEBERGEN DRUG CORPORATION	20.1%	21.7%
H.D. SMITH WHOLESALE DRUG CO	10.1%	10.3%
MIAMI-LUKEN INC	5.4%	5.5%

Act 2 — Distributors

Three companies.

McKesson, Cardinal Health, and AmerisourceBergen together moved most of the pills. Their share shifted, but the trio stayed on top.

DEA enforcement actions per year

Federal enforcement scaled up through the early 2010s, with DEA actions clustering around 2012–2014.

Act 3 — DEA enforcement actions per year
Year	Actions	Notable
2006	250	DEA Diversion annual summary 2006 (synthetic)
2007	360	DEA Diversion annual summary 2007 (synthetic)
2008	520	DEA Diversion annual summary 2008 (synthetic)
2009	700	DEA Diversion annual summary 2009 (synthetic)
2010	880	DEA Diversion annual summary 2010 (synthetic)
2011	1,060	DEA Diversion annual summary 2011 (synthetic)
2012	1,245	United States v. Florida Pain Relief Centers; United States v. Tug Valley Pharmacy; Operation Pill Nation II was a multi
2013	1,380	DEA Diversion annual summary 2013 (synthetic)
2014	1,418	United States v. Appalachian Wholesale; United States v. Mingo Family Pharmacy; Operation Supply Chain targeted large distributor diversion

Act 3 — Enforcement

The regulators catch up.

Enforcement actions from the DEA Diversion Control Division climbed through 2012–2013 as the scale of the problem became impossible to ignore.

Act 4 — Aftermath

The counties left behind.

The pills came in waves; the deaths followed. These six counties carried some of the heaviest per-capita shipments — and some of the steepest casualties.