WV: Problematic pharmacies, highly addictive pills discussed in Week 3 of opioid trial

Herald-Dispatch News –

CHARLESTON — A despairing story told through emails, investigation reports and pill data during testimony in the third week of a federal opioid trial showed how, after a problematic Huntington pharmacy was shut down by the Drug Enforcement Administration, another swooped in quickly to fill the void.

Huntington and Cabell County’s lawsuits allege that AmerisourceBergen Drug Corp., Cardinal Health and McKesson, known collectively as the “Big Three” drug distributors, helped fuel the opioid crisis by sending 127.9 million opiate doses into the region from 2006-14 before a reduction in shipments made users turn to illicit drugs.

The defendants blame the lack of communication with the Drug Enforcement Administration, their regulator; a high rate of prescriptions written by doctors; and West Virginians’ poor health for the uptick in pills shipped to the state.

Much of the testimony in week three surrounded SafeScript, a downtown Huntington pharmacy, and its relationship with AmerisourceBergen. SafeScript was closed in spring 2012 after its owner was arrested when he was found in a truck with a woman, possible drug ledger and other items that would indicate illegal drug diversion was occurring. Information from the DEA drug database said the pharmacy averaged 35,551 oxycodone dosage units a month from 2006 until its closure.

AmerisourceBergen said its system of checks and balances to prevent diversion of opioids into the illicit market goes beyond what regulation calls for. Testimony showed, however, the firm could change its monthly pill shipment thresholds fluidly so it did not have to report a large order to its regulator.

While they set pill order thresholds for the amount of pills that could be ordered, the threshold could be raised if the pharmacy could justify it.

A 2009 memo on policy showed a small pharmacy could order 350,000 hydrocodone or oxycodone pills a year; a medium pharmacy, 760,000; and a large pharmacy, more than 1 million without triggering a suspicious-order alert.

Steve Mays, vice president of regulatory affairs for AmerisourceBergen, said regulation only identifies a suspicious order as one of unusual quantity, one that deviates from the usual pattern or one that is frequent. Even today, there is no further guidance from the DEA on what is suspicious, Mays said. It does not come down to a certain number of pills shipped. In turning the spotlight from AmerisourceBergen to its competitor, Cardinal Health, Cabell County attorney Mike Fuller accused them of doing the same.

Fuller said the closure of SafeScript by the DEA and the end of its relationship with AmerisourceBergen did not mitigate opioid abuse — it just made its customers find a new pharmacy with a different distributor.

That pharmacy was T and J Enterprises, doing business as The Medicine Shoppe at 2402 Adams Ave. in Huntington, a Cardinal Health customer, which saw an uptick in opioid sales after the closure of SafeScript.

Internal documents from Cardinal Health said the pharmacy had seen an influx of opioid sales, 71% of which were Oxy 15s and 30s, a highly addictive high dose of opioids. The sales showed a disproportionate growth of opioids to other products.

A company email prior to those documents from Jesse Kave, a Cardinal Health salesman who also testified last week, had said OxyContin sales were down at other pharmacies because doctors were switching to oxymorphone.

Michael A. Mone, who worked in Cardinal Health’s anti-diversion branch, said that company’s system worked like AmerisourceBergen’s. The number of suspicious orders triggered by the computer and those found actually to be suspicious after review varies drastically, however. There were more than 1,000 in August, September and October combined, but none were reported.

Mone said the DEA never complained about its shipments to Cabell County, nor did they alert them of any wrongdoings by pharmacies there.

Fuller pointed to Kave’s 2020 deposition in which he said The Medicine Shoppe had a “ton” of suspicious orders. Kave said he did not remember saying that.

In returning to testimony from local witnesses, Dr. Joseph Werthammer, a pediatric neonatologist at Cabell Huntington Hospital, discussed neonatal abstinence syndrome (NAS) at trial Friday.

Werthammer said in 2010, Cabell Huntington Hospital had about 50 to 60 patients, but by 2015 it was 250 a year. He estimates about 2,500 children who were born with NAS live in Cabell County, which requires a lot of resources and funds from the county.

The defense said not all of those cases involved opioids. Werthammer agreed, saying about 85% of cases do. The defense shared an email from Werthammer in which he shared with his colleagues a 2017 article that referenced how quickly a person can become addicted. Werthammer replied to someone’s response to the new information: “We have created a monster.”

The week of testimony concluded with Scott Lemley, current director of innovations for Huntington and who previously worked as the criminal intelligence analyst for the police department and the Mayor’s Office of Drug Control Policy, who predicted the crisis Huntington was about to face.

The Huntington Police Department’s 2011 annual report, which he oversaw, said the most prevalent emerging threat to the community was the illegal diversion of powerful pain medications, like oxycodone and oxymorphone.

Drug incidents in 2004 were very confined, he said, but by 2014-16, they had permeated the entire community. He also collected opioid overdose data, which showed opioid abuse did not discriminate by race, age or gender. Everyone was affected.

During his work with the Mayor’s Office of Drug Control Policy, Lemley said the team went to the community and used his data analysis to build relationships with residents and learn so they could get funding to build the programs they needed to help.

The defense said the root of Huntington’s problems goes back to the decline of manufacturing plants in the 1980s and a loss of revenue in taxpayer dollars. That loss in revenue resulted in a cutback of city services, like the police force and drug unit, which left the city in a vulnerable position. Illegal drug dealers took notice.

The defense said Lemley’s data was unfinished and consisted of several sources, which could cause more errors. Lemley’s analytics never mentioned distributors, they said.

The fourth week of trial will start at 10 a.m. Monday at the Robert C. Byrd U.S. Courthouse in Charleston.

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Tags: Law Opioid Epidemic" >Drug Enforcement Agency
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