SEATTLE (Legal Newsline) - Trial resumed Monday in a lawsuit filed by the Washington State Attorney General’s Office against three of the country’s top opioid drug distributors, accusing them of causing an overdose epidemic by oversupplying drugs, and operating ineffective anti-diversion programs.
“More staffing and additional resources (order checking) were asked for and it wasn’t being provided,” Ruth Carter, a 30-year veteran with the U.S. Drug Enforcement Administration (DEA) told the courtroom. “It was impossible to review that amount of orders.”
Prescription drug distributors Cardinal Health, McKesson Corp. and AmerisourceBergen Corp. are accused of irresponsibly over-promoting and distributing opioid drugs to pharmacies and doctor’s offices for profit.
The distributors take the pills from the manufacturers and supply them to hospitals, doctor’s offices and pharmacies. Three of the most commonly shipped opioid drugs include OxyContin, Hydrocodone and methadone.
The state is asking for damages of $32.8 billion initially to fund treatment and related programs, but with more coming from penalties and surrendered profits the total could reach $95 billion.
According to the Washington State Department of Health, 1,200 people died of opioid overdose in the state in 2020.
The bench trial began in mid-November and is expected to last through February. It is being streamed live courtesy of Courtroom View Network.
Carter retired from the DEA in June of 2019 and is today an expert witness who testifies on behalf of plaintiffs and states suing the drug companies. She told Elizabeth Smith, the attorney for the state, the anti-diversion programs enacted by the distributing companies were not sufficiently investigative of their pharmacy customers.
One anti-diversion manager with Cardinal Health, Stephen Rearden; the evidence stated had only three employees to review orders, and prior witnesses testified that the number of suspicious orders could number 150 per day. A request for more staffers to check suspicious drug orders was rebuffed by company officials.
Carter maintained the three companies did not practice “due diligence” in investigating and red-flagging drug orders from customers that were suspiciously high in volume or more than in the past.
The state claims that abuse of the drugs took a big jump in 2008 due in part to a rise in internet pharmacies (not brick and mortar businesses), pain clinics and the over-prescribing of drugs by doctors in what are called “pill mills.”
In the case of Amerisource Bergen Corp., Carter said an exhibited spread sheet showed the company’s anti-diversion activities coming up short.
“It does not provide due diligence,” she said of the spread sheet. “You do not know your customers.”
Another exhibited document showed that City Center Drug in Aberdeen, Washington in 2008 had 10.7-times more shipments of the drug OxyContin than the average pharmacy.
“Is this a concerning percent?” Smith asked.
“Yes,” Carter said.
Carter added the “Know Your Customer” checking procedure recommended by the DEA included having customers provide answers on questionnaires and company officials making site visits to pharmacies when suspicious orders were red-flagged.
Carter said the companies needed to know the details of their customers' ordering habits.
“Have any of the documents you were shown changed your opinion of Cardinal’s due diligence?” Smith asked.
“No,” Carter answered.
Pharmacies mentioned in the questioning included Jim’s Pharmacy serving the Port Angeles area, Tick Klock Drug (Colfax), Mercury Pharmacy Services (Mountlake Terrace), Swanson Owl (Aberdeen), Virginia Mason Medical Center (Seattle) and Rite Aid (Mount Vernon, Kent).
Carter said dosages of the drugs had also increased in the years after 2008, with lower doses more common prior to the opioid epidemic.
“The drug abusers prefer the higher doses,” Carter said.
A document stated that one of the pharmacies had asked for an increase of 1,000 doses and attributed the need to “business growth.”
Carter was asked if this was appropriate.
“No,” she said. “These are dangerous controlled substances. Just because a filler is low is not a reason to give out a controlled substance. An order should not be shipped until suspicion is dispelled.”
Carter also disagreed that a pharmacy that is physically close to the Idaho border because of its location should get an elevated supply.
“It’s not a very populated area of the state,” she said.
Carter indicated that more needed to be done to make certain that pills going to pain clinics were getting into the hands of actual medical practitioners at the facilities. She added that in some cases only a cursory internet search had been done by company officials to verify if some doctors worked at the clinics.
Later in the day Monday, Paul Schmidt, defense attorney for McKesson, sought to undercut Carter’s testimony by playing prior recorded videos with company witnesses testifying they had supplied the DEA with daily and monthly reports of suspicious orders.
Carter said reporting the orders that were then shipped did not relieve the companies of the responsibility for the shipments.
Schmidt displayed reports on pharmacies that had no history of disciplinary action from the DEA, or had been inspected and everything was found to be in order.
Carter told Schmidt she had looked at documents reviewing 400 pharmacies across the state.
“There are hundreds of pharmacies you did not review,” Schmidt said.
“More than 100, sure,” Carter responded.