CHARLESTON – Janssen settled with West Virginia, but the state trial continues against opioid suppliers Teva, Cephalon and Allergen continues.
As the third week of the trial began April 18, an expert witness told Judge Derek Swope the drug crisis was caused by oversupplying the people of West Virginia with prescription opioids.
The trial accusing the companies of causing an opioid epidemic in West Virginia began April 4 in Kanawha Circuit Court. It is being streamed live courtesy of Courtroom View Network.
In 2019, West Virginia Attorney General Patrick Morrisey filed lawsuits against the drug manufacturers in in the Boone Circuit Court and the case was moved to its current venue in the Kanawha Circuit Court. The case is being heard by a state Mass Litigation Panel in a bench trial with no jury. Swope will decide the verdict after what is expected to be a two-month trial.
Other state-conducted lawsuits including in Washington State and Florida are being held against opioid distributors and manufacturers. Closing arguments in the Washington hearing have been put on hold until July officials said at the request of parties in the lawsuit.
Plaintiffs’ attorneys in West Virginia seek to prove the companies ignored the addictive dangers of the drugs for profits, endangering the public by creating a public nuisance and violating the West Virginia Consumer Protection and Control Act. They said the epidemic started in the 1990s when the medical community (doctors), misled by drug manufacturers and distributors, abandoned their former conservative policy of prescribing opioids used mostly for end-of-life and cancer treatments, and recklessly prescribed opioid drugs for a broader market such as back pain and arthritis.
Anti-drug diversion in-house programs required of the companies by the U.S. Drug Enforcement Administration were ineffective, the attorneys contended.
Defense attorneys argue the epidemic was caused by illegal drug abuse including heroin and fentanyl, and not by manufacturing companies legally supplying doctors and hospitals with the pain pills they prescribed.
During the April 18 session Dr. Andrew Kolodny, medical director of Opioid Policy Research at the Heller School (Brandeis University), continued a second day of testimony as an expert witness for the state. He told the court the drug crisis was caused by oversupplying the people of West Virginia with prescription opioids.
Kolodny described the epidemic caused by a collective marketing effort involving many players including manufacturers, distributors, key opinion leaders, pain organizations, patient groups and hospitals.
“It (pro-opioid marketing and messaging) was coming from every direction,” Kolodny said. “The defendants participated in a coordinated effort. The idea was to get comfortable with opioids.”
Minimizing the fear of addiction among doctors was a central goal of the effort, Kolodny said. Opioid proponents manufacturers and organizations used a variety of suggestive techniques in developing pro-opioid literature.
“Fear of addiction was presented as a barrier (to pain relief),” Kolodny said. “But fear of addiction is a reasonable concern.”
Organizations such as the American Academy of Pain and the American Pain Foundation were critical of guidelines from the Centers for Disease Control (CDC) that recommended a more cautious approach to using opioids. The groups targeted media reporters, doctors, pharmacies, patients and returning veterans for their pro-opioid messaging campaigns.
One promotional piece exhibited by the state called the idea that children could become addicted to opioids a “myth,” and that less than one percent of children treated with opioids could become addicted a true statement.
“That’s false,” Kolodny said. “The notion we can worry less is false.”
Kolodny said the campaigns to increase the use of opioids were successful because it was a concerted effort by many groups.
“If it was just sales reps it would not have been as successful,” he said.
Kolodny said payments made to pain organizations were received from the manufacturers, often under the guise of being educational grants. Teva was a large donor.
A chart exhibited showed that during one period Alpharma Inc., a New Jersey pharmaceutical company, gave a $100,000 grant to support the distribution of pro-opioid literature, Endo $100,000, Cephalon $50,000, and King Pharma $75,000.
Approximately 5,200 doctors in West Virginia received such literature, one titled “Responsible Opioid Prescribing.”
Kolodny agreed that hundreds of thousands of dollars had been spent promoting opioids during the 1990s.
“The payments were viewed as key marketing and policy-influencing tools,” Kolodny said. “In the case of opioids it contributed to sickness and death for many.”