SEATTLE (Legal Newsline) - Attorneys for the State of Washington and those defending three of the country’s biggest opioid pill distributors sparred this week over figures showing that drug ordering took a big jump around the year 2006.
In testimony Tuesday through Thursday, Lacey Keller, a data analyst with MK Analytics, presented figures that showed ordering trends of opioids in Washington State from 2002 through 2018.
“In 2006, pharmacies began to exceed the average (orders),” Keller said.
Later in the day on Thursday, an Aberdeen Fire Department Fire Chief said Gray’s Harbor County was being overwhelmed by the opioid epidemic. Defense attorneys argued the situation was a result of illegal drugs like fentanyl and heroin being brought in by drug dealers, and commented that the fire department itself used opiates to treat patients in chronic pain.
Keller's evidence said the opioid drug OxyContin made up 41% of the orders during the time period (2006), Hydrocodone 33% and methadone 10.3%.
Among the top counties in Washington receiving shipments of opioids were Pend Oreille, Clallam and Garfield counties.
In addition, according to UW Medicine, King County, the state’s largest and most populous county (Seattle, Tacoma), set a new record in 2021 for fentanyl-related overdose deaths with 217 cases this year. Last year the previous record saw 172 deaths.
The three defendants at trial - McKesson, Cardinal Health and AmerisourceBergen - are accused of distributing opioid drugs without properly monitoring suspicious orders which resulted in illicit diversions into the wrong hands. A suspicious order is one that deviates from a normal pattern of size (number of pills) or frequency of order.
The distributors take the pills from the manufacturers and supply them to hospitals, doctor’s offices and pharmacies.
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.
The case is proceeding as a bench trial before Judge Michael Scott, in what is expected to be a three month trial at King County Superior Court.
Keller supplied statistics gleaned from a government Automated Reports and Consolidated Ordering System (ARCOS) that showed annual shipments of dosage units (pills) had jumped from 209.7 million in 2006 to 2.1 billion in 2018.
Of the three companies McKesson accounted for the biggest share, 34% of market volume.
Shipments of pills jumped during the period 2006-2018 from 664,694 shipments to 6,662,105.
McKesson was also tops in revenue from the distribution of opioids at $1.01 billion for the years 2006 to 2018, Cardinal at $89.1 million and AmerisourceBergen Corp. at $360 million.
Lawyers for the defense questioned the accuracy of the reports saying they were inconsistent, that the data did not present all the suspicious orders flagged and reported to the DEA by the defendants.
Robert Nichols with the law firm Reed Smith, representing AmerisourceBergen, told Keller she had not offered an opinion that the company had shipped too many opioids into Washington State.
“Correct,” Keller said, “I don’t offer a value judgment.”
“You can’t say a pill was diverted (into wrong hands)?” Nichols asked.
“Correct.”
Nichols indicated the number of pills shipped by AmerisourceBergen was smaller than the other two companies. He said Amerisource did not even appear on one tracking chart Keller had submitted.
Keller agreed.
“You can’t say an order was likely to be diverted?”
“Correct,” Keller said.
Paul Schmidt, the defense attorney representing McKesson Corp., asked Keller if rural communities in Washington ordered more pills because of the difficulty residents had getting to a doctor.
Keller said she could not comment on that, lacking data on the subject of rural ordering.
Schmidt said that Keller, in her presentations, had neglected to include reported suspicious orders from McKesson to the DEA on documents back in 2008 that were on dot matrix printed forms.
“I was not able to clearly extract this (dot matrix) information,” Keller said.
“Should you have disclosed that these existed?” Schmidt asked.
“No, it wasn’t necessary,” Keller said.
“You did not make value judgments, which orders should have been blocked?”
Keller agreed.
Under re-direct, attorney James Ledlie, for Washington State with the firm Motley & Rice, noted that the companies had signed memos of understanding (MOU’s), agreements to inform the DEA of suspicious drug orders.
“Did they have an obligation to report?” Ledlie asked.
“It says that very clearly,” Keller responded.
Keller said the data showed the provision of opioid drugs to chain pharmacies, retail outlets and individual orders, not to hospitals and treatment centers.
Called by the state as a live witness by virtual (computer) link, Aberdeen Fire Chief Tom Hubbard told Christopher Moriarty, the attorney for the state, that opioid overdoses in the community had risen dramatically in recent years.
“There’s been a steady increase since 2012,” Hubbard said. “We’re seeing up to 15 overdoses a month. Our use of Narcan (anti-opioid drug) has increased from 25 times a year in 2012, to 70 times a year.”
Hubbard said the epidemic has taken its toll on emergency responders and has been a drain on the fire department.
“It’s hard when you see this (overdose) day in and day out,” he said. “It’s seeing (narcotic) needles, loss of employment (from drugs), and deaths. It has a ripple effect. You see it in the streets and parks.
"We need help and resources,” Hubbard added. “Even combined (partnering with county agencies), it has overwhelmed us.”
Attorney Megan Rodgers, representing McKesson Corp., said Aberdeen Fire Department responders had the opiates fentanyl and morphine in their kits to treat chronic pain such as abdominal pain, heart attacks and amputations.
Hubbard agreed.
She asked the fire chief if illegal drugs like heroin and methamphetamine were being brought into Aberdeen by drug dealers.
“I don’t know that I’m not in law enforcement,” Hubbard responded.
“But those are not sold by wholesale distributors,” Rodgers said. “Heroin and meth are not prescription opioids, right?”
“Right,” Hubbard agreed.
Rodgers exhibited a letter from the Grey's Harbor County coroner's office expressing concern about the introduction of illegal counterfeit fentanyl pills.