Three major U.S. drug distributors should be held responsible for sending a "tsunami" of prescription pain pills that caused a health crisis in one corner of West Virginia, an attorney for local governments said in closing arguments Tuesday in a landmark federal lawsuit.
Distributors AmerisourceBergen Drug Co., Cardinal Health Inc. and McKesson Corp. distributed 81 million pills into Cabell County and the city of Huntington over eight years.
The lawsuit by the city and the county accused the companies of creating a "public nuisance" with the onslaught and ignoring the signs that the community of about 100,000 people along the Ohio River was being ravaged by addiction.
The plaintiffs are seeking more than $2.5 billion that would go toward abatement efforts.
"I don't know of anywhere else in the country that can show this tsunami of pills," Cabell County attorney Paul Farrell said.
The companies, in turn, say poor communication and pill quotas set by federal agents were to blame, along with a rise in prescriptions written by doctors.
Farrell tried to show that the defendants' conduct was unreasonable, reckless and disregarded the public's health and safety.
"The defendants saw everything, they overlooked a great deal and they corrected very little," Farrell said. "The massive volume of prescription opioids distributed by the defendants demonstrates a failure to maintain effective control."
Farrell referred to testimony from Dr. Rahul Gupta, West Virginia's former health officer and now President Joe Biden's pick as the director of the Office of National Drug Control Policy. In 2016, Gupta conducted contact tracing of all 830 drug overdoses in the state and found that a significant percentage of those who died had opioids in their system but did not have a valid prescription for them, Farrell said.
AmerisourceBergen attorney Bob Nicholas argued that the plaintiffs failed to show that the companies committed unreasonable conduct.
"Licensed pharmacies dispensed the medicines that these doctors prescribed," Nicholas said. "The only thing to be said about the distributors is that they did not second guess these medical judgments. They did not subvert the standard of care. They did not countermand medical decisions and withhold medicines. They weren't qualified to do that. It wasn't their place to do that. And medicine would not have gone where it needed to go."
Opioid overdoses have been linked to the deaths of nearly 500,000 Americans since 2000 and reached a record of nearly 50,000 in 2019. West Virginia has had the nation's highest fatal opioid overdose rate.
Farrell pointed to witness and expert testimony showing that from 2015 to 2020, there were nearly 6,500 overdoses in Huntington and Cabell County, 1,151 drug-related deaths, 2,500 babies born exposed to drugs and 8,252 people suffering from opioid use disorder — or about 10% of the current population.
Anne Kearse, an attorney for the city of Huntington, displayed photos of expert witnesses and quote boxes with their testimony to show how opioids have caused widespread community harm. In one quote box, former Huntington Police Chief William Holbrook said the addiction crisis "has affected me profoundly." And Jan Rader, the city's fire chief, said the overdose carnage "cuts across every socioeconomic line. So there is no typical person that overdoses."
The federal bench trial began May 3. It had been scheduled to last through mid-August, but company attorneys rested their case earlier this month after just five days of witness testimony. Plaintiff attorneys conducted more than six weeks of testimony.
Similar lawsuits have resulted in multimillion-dollar settlements, but this is the first time allegations have wound up at federal trial. The result could have huge effects on other similar lawsuits that have been filed across the country.
Last week, lawyers for state and local governments announced a potential $26 billion settlement over the toll of opioids with AmerisourceBergen, Cardinal Health and McKesson, and the drugmaker Johnson & Johnson. After full details are shared, each state would have 30 days to decide whether to join. And local governments will have five months after that to decide. If governments don't opt in, the settlement total would go down.
In separate, similar lawsuits, the state of West Virginia reached a $37 million settlement with McKesson in 2019 and $20 million with Cardinal Health and $16 million with AmerisourceBergen in 2017.