Inter-office memos in 2012 issued by officials of AmerisourceBergen, one of three distributors of opioid pills accused of irresponsibly flooding the drug market for profit and causing an overdose epidemic, used humor that some have described as cruel.
An employee of the company called the humor memo “unprofessional.”
“But we were extremely dedicated and took our job very seriously,” David Breitmayer, a former controlled substances (drug diversion control) investigator for AmerisourceBergen, told a courtroom.
Breitmayer’s taped testimony taken in 2020 was played on Wednesday during trial in the King County Superior Court.
The Washington State Attorney General’s Office filed suit against AmerisourceBergen, McKesson Corp. and Cardinal Health accusing them of not properly monitoring suspicious orders which resulted in illicit diversions of drugs falling into the wrong hands, and causing an opioid epidemic.
The companies are accused of violating regulations of the U.S. Drug Enforcement Administration (DEA) and the Controlled Substances Act (CSA), a federal law passed in 1970.
Both sides of attorneys are presenting their case without a jury in a trial expected to last for three months.
Distributors take opioid pills from manufacturers and supply them to pharmacies, clinics and doctor’s offices.
State attorneys displayed the inter-office AmerisourceBergen memo received by Breitmayer and other company employees in 2012 in which the memo parodied a song made famous in the popular 1960’s TV show, The Beverly Hillbillies.
A memo referred to them as "Pillbillies."
“Come and listen to my story about a man named Jed, a poor mountaineer who barely kept his (drug) habit fed,” the memo read. The original song had said, “Kept his ‘family’ fed.”
The memo rhymed.
“Jed, head south (Florida), don’t put too much (pills) in your mouth, have a heapin’ helpin’ (pills).”
The original song had said, “Have a heapin’ helpin’ of ‘hospitality.’”
An article in the Daily Mail said the passage is ironic since the companies have supplied millions of opioid pills to the Appalachian Mountain area where the fictional Jed Clampet of the Beverly Hillbillies came from. The memo also joked that Jed travels to Florida to buy “hillbilly heroin,” slang for OxyContin. The Daily Mail article said Florida has been known for its lax regulation of opiates and pain clinics where large amounts of the drugs were dispensed.
In addition the joke memo thanked Florida Sen. Rick Scott for inviting the Pillbillies in to that state. Scott, a Republican former Governor, has served as a U.S. Senator since 2018.
Another memo called Eastern Kentucky, a low-income and rural area of the state “OxyContinville,” because of its high use of drugs, the article said.
Yet another memo shown as evidence in the courtroom portrayed a children’s cereal box based on Kellogg’s cereals, with a frog holding a syringe. The title on the box said “Sugar Smacks.”
In 2015 the U.S. Food and Drug Administration (FDA) approved the use of OxyContin for children suffering from pain ages 11 to 16.
“The word ‘smack’ is for heroin?” a state’s attorney asked. “This is OxyContin for kids with smack or heroin. Do you have a recollection of receiving this (memo)?”
“Vaguely,” Breitmayer answered.
Breitmayer said AmerisourceBergen had established a “Suspicious Order Monitoring” program designed to prevent diversions of drugs into the wrong hands. However, he said he had not been tested for his knowledge about the purchases of high-risk products, or had been certified for his knowledge of federal regulations.
Breitmayer said the system at the company used software to red-flag suspicious drug orders that exceeded threshold limits (number of pills), and would forward the information to the DEA. He added that sources of information used to evaluate an order included dollar volume of the order and class of drug. Frequency of ordering was also used.
“We had a wealth of information,” Brietmayer said. “We would identify trends, erratic ordering or drops or increases in purchasing.”
“Do you agree that opioids are potentially lethal?” the state’s attorney asked.
“Yes,” Breitmayer responded.
State attorneys exhibited an inter-office letter from the company’s Corporate Security and Regulatory Affairs Dept. (CSRA) that said, “It’s amazing how few people recognize red flags (spot suspicious orders).”
Brietmayer was asked who the statement referred to.
“I can’t speculate,” he answered.
“You don’t have any basis to disagree with that?”
Breitmayer agreed.
Breitmayer was shown another document.
“Here is a document where the CSRA is recommending that customers (pills) not be cut off (cancel the order),” the attorney said.
“Correct,” Breitmayer said.
An average pharmacy during the early 2000s could dispense 69,000 units (pills) of the drug OxyContin in a year, evidence stated.
Jenifer Norris, a legal attorney for Cardinal Health, appeared as a witness later in the day. She was asked if she understood that opioid drugs could be patently dangerous.
“Perhaps, yes,” she said.
“Does Cardinal agree that it has a reporting requirement to identify and report suspicious (drug) orders?”
“Yes, that is Cardinal’s obligation,” Norris said.
She agreed there were two choices to distributors, decline to ship an order or if the customer was found unlikely to divert drugs, ship the order.
“Was Cardinal shipping suspicious orders?” the state’s attorney asked.
“We were making reports to the DEA,” Norris answered. “We were shipping in accordance with the DEA.”
Norris was asked if she agreed a distributor must be vigilant in shipping pills, or it can have a detrimental effect on the public.
“That’s a key component in the distribution chain?”
“Yes,” Norris responded.