SEATTLE (Legal Newsline) - Attorneys for the State of Washington argue that an overdose epidemic of opioids called the worst in the state’s history was a result of reckless distribution of the drugs by three accused companies, while their defense attorneys maintain it was societal over-pain-medicating by doctors and illegal use of heroin in the 1990s that fueled it.
“What is the consequence of not getting treatment?” Laura Singer the attorney for Washington State asked.
“Death,” Dr. Caleb Banta-Green, a University of Washington Addiction, Drug and Alcohol Institute director answered. Green studies drug substance abuse impacts and interventions.
Prescription drug distributors McKesson, Cardinal Health and AmerisourceBergen Corp. are accused of irresponsibly over-promoting and distributing opioid drugs to pharmacies and doctor’s offices that led to multiple overdose deaths in the state. The Washington State Department of Health estimated 1,200 in 2020.
The trial is being streamed live courtesy of Courtroom View Network.
The distributors take the pills from the manufacturers and supply them to hospitals, doctor’s offices and pharmacies. The most commonly shipped opioid drugs include OxyContin, Hydrocodone, methadone and fentanyl.
During Wednesday’s session, Singer indicated that fentanyl is the newer drug to threaten lives and Banta-Green agreed. A chart was exhibited that showed a dramatic increase from the drug and other synthetic compounds beginning in 2018 through 2021.
Banta-Green called the situation very rare that had not been seen before and intervention and treatments had not been adequate.
“Is there an epidemic in Washington?” Singer asked.
“Yes,” Banta-Green said.
Banta-Green said the epidemic was having a major impact on mortality, hospitalizations and the damaging of lives, parents who could not perform their roles because of addiction, workers who could not perform their jobs, increased incarceration in prisons.
“It’s broad across society,” he said.
“In 20 years have you seen an epidemic of this magnitude?”
“No.”
Banta-Green said indigenous native American people had a three-fold higher rate of death and addiction than non-native groups.
“Have you been frustrated in the response to the epidemic,” Singer asked.
“Yes,” Banta-Green said. “We try to support recovery and lower mortality.”
He added that the anti-opioid drug Naloxone is urgently needed in the community and said there is a stigma with the opioid addicted. Some medical practitioners do not want to treat them.
“There is a substantial need for services for folks to rebuild their lives.” Banta-Green said.
“It (addiction) is not a lack of will power it is a neuro chemical condition,” he noted. “Building robust care and compassion are important.”
During cross examination, Enu Mainigi, the defense attorney for Cardinal Health, sought to establish that prior illegal drug abuse had paved the way for the epidemic.
“Is it fair to say that heroin use in the 1990s was responsible for most of the deaths?”
Plaintiff attorneys objected to the question, concerned an earlier time was out of the scope of the questioning. The objection was sustained.
“Heroin was considered the dominant opioid during the 1990s responsible for most deaths, not opioids, do you agree?” Mainigi asked.
“Correct,” Banta-Green said.
“Opioid proscribing peaked in 2010?”
“Yes, give or take a year.”
“Is it fair to say that heroin was the primary (epidemic) driver?” Mainigi asked.
“No,” Banta-Green said. “I wouldn’t call it the driver. It preceeded the prescription opioids.”
Banta-Green agreed that illegal fentanyl was made to look like proscription opioids.
“Is it fair to say that any pill not from a pharmacy is likely to be fentanyl and not Oxycodone?”
“That’s my understanding.”
“Many people are on opioids who used illicit fentanyl?”
“Yes.”
“Methamphetamine is not an opioid?”
“Correct.”
“Is Washington facing a methamphetamine epidemic?”
“Yes.”
“Is it fair to say that up to the mid 1990s opioids were not provided for non-cancer pain?” Mainigi asked.
“That’s my understanding,” Banta-Green said.
Mainigi played a clip recording of a 2017 broadcast over station KCBS FM interview in which Banta-Green was asked how the use of opioids rose.
“In the mid 1990s it was said (medical community, government) we’re under-treating chronic pain,” Banta-Green said. “There was more treating of pain with opioids.”
He also indicated that during the same time period the length that opioid drugs were taken increased from a matter of weeks to months.
A document exhibited said opioids had been used historically for patients with cancer and end-of-life patients, but in the mid-1980s care information suggested they could be used more liberally. It was also believed they could be taken for longer periods of time.
Under the slogan “Pain is the 5th Vital Sign,” and that pain was undertreated became a kind of movement, Mainigi said.
“For a time in the 1990s the prescribing of opioids increased 300%,” she said.
“That sounds about right,” Banta-Green agreed.
Banta-Green agreed there was a later push (after 1990s) through policy and educational shifts to be more careful proscribing doses of the drugs and to whom they were proscribed.