CHARLESTON – While defendants at an opioid trial in Charleston showed an email Friday in which an HD doctor said, “We created a monster,” they referred to prescribing loose opioids. Plaintiffs countered with a Cardinal Health salesman who they said had ignored the red flags in a West Huntington’s disease pharmacy.
The study addresses Huntington and Cabell County’s allegations that AmerisourceBergen Drug Corp., Cardinal Health and McKesson, collectively known as the “Big Three,” helped fuel the opioid crisis by creating 127, 9 million doses of opiate sent to the county before being reduced in the pills sent, users turned to illegal drugs.
The defendants blame the lack of communication with the Drug Enforcement Administration, its regulatory agency, high prescribing rate from doctors and poor health of Western Virgins for the increase in pills shipped to the state.
Friday’s testimony was shared with Dr. Joseph Werthammer, a pediatric neonatologist at Cabell Huntington Hospital, who spoke about newborn abstinence syndrome (NAS), a condition that occurs in newborns as a result of the baby’s sudden cessation of exposure in the womb to substances made by him used, it was found mother.
Babies born with NAS can experience tremors, seizures, overactive reflexes, and tight muscle tone. This leads to excitement, excessive crying and poor feeding, as well as slow weight gain. It can have long-term effects, and babies require special care and environments in order to heal.
A 2016 report by the Centers for Disease Control and Prevention found that there was a 300% increase in babies born with NAS in the US between 2000 and 2012. In 2016, nearly 5% of babies born in West Virginia were born addicted to drugs. Of 1,000 live births in the state, 49.9 were born with NAS. In 2014 it was 32.1 and in 2015 34.4.
Werthammer said in 2010 that Cabell Huntington Hospital has around 50 to 60 patients, but by 2015 it will be 250 a year. He estimates that approximately 2,500 children born with NAS live in Cabell County.
A defense attorney said half of the babies Werthammer referred to don’t reach the threshold of needing medication to help with symptoms.
“The other half,” said Werthammer.
NAS can be caused by at least 15 drugs, some prescription-only, a defense attorney said. Werthammer said about 85% of cases nationally and locally involve opiates, but Cabell now faces the problem of babies being born with multiple drugs in their system.
The opioid pills that the dealers were sending were prescribed for prescription doctors, another defense attorney said, to show the doctors were to blame.
In a 2017 email chain between Werthammer and others, he wrote: âUnfortunately, it wasn’t the big pharmaceutical industry that wrote prescriptions. It was me and my colleagues. “
On another chain of emails, he published a 2017 article pointing out how quickly a person can become addicted. Werthammer replied to someone’s response to the new information: “We created a monster.”
While defendants said the doctors were to blame for the opioid epidemic, plaintiffs called a former Cardinal Health sales representative to the booth located The Medicine Shoppe on Adams Ave. 2402 where there was a sharp increase in opioid sales following the closure of the SafeScript pharmacy.
SafeScript, an ABDC customer, was shut down in the spring of 2012 after its owner was arrested when he was found in a truck with a woman, a possible drug book, and other items that would indicate an illegal drug diversion. According to information from the DEA drug database, from 2006 until it closed, the HD pharmacy averaged 35,551 oxycodone dosage units per month.
One trader’s misfortune was another, the plaintiffs argue, because SafeScript customers haven’t stopped using opioids – they simply switched to The Medicine Shoppe, a customer of Cardinal Health.
DEA data showed The Medicine Shoppe received an average of 18,600 unit doses of opioids per month from 2006 to 2014, 3.9 million tablets, about 3.7 times the national average and more than 2.5 times the state average.
When asked if he knew The Medicine Shoppe received nearly 3.7 million oxycodone pills from Cardinal Health from 2006 to 2014, Jesse Kave, a salesman for Cardinal Health, said he did not know.
Kave said while he had access to see what a company was buying through trending reports, it wasn’t something he checked often, nor was it part of his job.
Cabell County’s attorney Mike Fuller pointed to Kave’s 2020 filing in which he said The Medicine Shoppe had a “ton” of suspicious orders. Kave said he didn’t remember saying that.
Fuller showed an email in 2011 in which Kave told his superiors that doctors are changing their prescribing standards from OxyContin to oxymorphone. Fuller then turned to a July 2012 investigative report on the pharmacy conducted following an influx of opioids due to SafeScript’s closure.
A pharmacist in charge of The Medicine Shoppe said doctors had prescribed high rates of Oxy 15s and 30s, high doses of opioids, for pain management. In fact, 71% of the oxycodone released were 15 and 30 years old, showing disproportionate growth.
Fuller said a high rate of prescriptions for a drug known to be abused should have been a red flag when Kave said prescriptions for the drug fell.
Scott Lemley, the current director of innovation for Huntington, who previously served as a criminal intelligence analyst with the police force and the Mayor’s Office of Drug Control Policy, predicted that the Huntington’s Crisis, due to pharmacies like SafeScript and The Medicine Shoppe, the lawyers the plaintiff said would be imminent.
The Huntington Police Department’s 2011 annual report, which Lemley oversaw, said the most widespread threat to the community was illegal diversion of strong pain relievers like oxycodone and oxymorphone.
The beginning of the crisis could be seen in the seizures of the K-9 unit from 2012 to 2013. In 2012 the unit seized 699 grams of heroin and increased to 1,865 grams in 2013. Prescription pill seizures increased from 3,300 dosage units to 11,000.
He testified Friday that prescription opioid abuse had increased but was overtaken by heroin around 2014.
While working with the mayor’s drug control policy bureau, Lemley said the team went to the community and used their data analysis to build relationships with residents. This gave them a better understanding of the problem.
The drug incidents in 2004 were very limited, but by 2014/16 they had permeated the entire community. He also collected data on opioid overdose, which showed that opioid abuse did not discriminate based on race, age, or gender. Everyone was affected.
“It exploded,” he said. “We have found that we cannot stop ourselves.”
He said they went to state delegates, the Cabell-Huntington Health Department, and other organizations to develop programs like the harm reduction program or naloxone delivery to help those in need.
Huntington’s attorney Temitope Leyimu referred to a strategic plan released by the ODCP that recorded thousands of hours of interaction among law enforcement officers, health professionals, social service administrators, educators and others to combat the crisis.
Steve Ruby, an attorney for Cardinal Health, said illegal drug traffickers working in an open drug market in the Fairfield West neighborhood were caused by Huntington’s drug problem.
The root of the problem preceded it, he said. Huntington’s decline began in the 1980s when many of the manufacturing facilities began dismantling and closing. By 2000, most high-paying manufacturing facilities were gone, a Lemley report said.
The loss of revenue cut the city’s services, like the police focus and drug department, and left the city in a vulnerable position, Lemley had written, and the drug dealers‘ attention was drawn to it.
The turning point came when four teenagers were killed near Charleston Avenue in Huntington in 2005. From then on, the City of Huntington could no longer ignore that there was a problem with drugs and violent crime.
Ruby said nowhere in the report did he blame traders.
The defense said Lemley’s data did not track what type of drug caused the overdose, and there is no way of telling how many were legally from prescription opioids. They also said it consisted of multiple sources across HD, which could lead to more errors in the bottom line.