CHARLESTON — The fourth week of Huntington and Cabell County’s opioid trial against three drug distributors was highlighted by an email showing McKesson Corp. employees cheering Appalachian trends shifting away from pills to illicit drugs in 2012.
The email was shared among McKesson employees, first by Tracey Jonas, director of regulatory processes, who shared a February 2012 article which said the DEA was seeing a sharp drop in Florida oxycodone.
Dave Gustin, a director of regulatory affairs, said pill users in Ohio and Kentucky were shifting to illicit drug use, such as heroin and meth. Jonas responded “Good ... let them move to heroin and meth ...we don’t have to monitor that.”
The issue surrounds the governments’ accusations the “Big Three” drug wholesalers — AmerisourceBergen, Cardinal Health and McKesson — fueled the opioid crisis by sending excessive shipments of opioids into the area for eight years, before a reduction in the number of pills shipped made users turn to illicit drugs.
The defendants point to the Drug Enforcement Administration, doctors and West Virginians’ poor health as the culprits.
In the fourth week, the plaintiffs attempted to show McKesson’s guilt by bringing to the stand Michael Oriente, director of regulatory affairs for McKesson, whose emails painted overwhelmed employees who said they could not do their job due to the workload.
McKesson paid to the DEA $13.25 million in 2008 and $150 million in 2017 to settle claims it violated the Controlled Substance Act by failing to report suspicious orders or prescription medications. After the 2008 settlement, McKesson leadership was told more than 4,600 suspicious order violations were found at “multiple” of its 39 distribution centers.
Testimony showed one director of regulatory affairs had warned his coworkers via email in 2008 that thresholds were being set too high and there were large gaps between the amount being shipped and what pharmacies needed.
In June 2009, another director of regulatory affairs had said it was not possible to be truly diligent in vetting the threshold increase requests. They started adding higher thresholds than companies requested to take down the workload.
Tim Ashworth, a McKesson salesperson, said its sales force is the company’s “eyes and ears” against illegal drug diversion, all while giving them a chance to double their salaries for making sales. McKesson would anticipate a pharmacy’s needs before it hit the threshold, and raise it without questioning, he said.
Cabell County attorney Eric Kennedy said, according to McKesson protocol, reviews were supposed to be handled by management, but it was Ashworth and other sales members who would be the ones to help pharmacies fill out those questionnaires.
On Wednesday, James “Ralf” Rafalski, a retired diversion investigator at the DEA, took the stand to testify no matter which of the six suspicious order monitoring systems you input the defendant’s shipment data, anywhere from 20% to 99.8% (with most categories showing more than 50%) of their shipments amounting to millions of pills should have been flagged and reported to the DEA.
But combined the companies reported only 415 of 189.1k transactions.
The defendants said Rafalski’s findings were based on the analysis of another person, which left room for human error. His report was incomplete and only focused on what the plaintiffs had asked him to find. He left out how doctors, pharmacies and manufactures had contributed to the opioid crisis, they said.
McKesson attorney Paul Schmidt asked his testimony to be tossed as a result. Faber has not yet ruled on that request.
Testimony Thursday turned back to Huntington community leaders, like Cabell County Sheriff Chuck Zerkle, who said he fears for what is to come for the county while detailing the strain the opioid crisis placed on government resources.
With pills, Zerkle said there was not a large number of overdoses because people were taking pills they could trust. But as heroin abuse raged, dealers started cutting it with stronger drugs like fentanyl, which caused overdoses and the opioid crisis.
Now law enforcement officers are overwhelmed and see death every day. Cabell County saw a jail bill deficit of about $3.3 million, which left Zerkle no choice but to double the amount of inmates he would take in his home confinement program.
Ten percent of Zerkle’s deputies are assigned to schools to help children cope better with what they see at home. As the sole entity tasked with excusing mental hygiene warrants, Zerkle is overwhelmed with serving about 700 a year.
People are leaving the county as a result, which leads to fewer taxes being paid and more abandoned houses, he said.
Defense attorneys said the county has a surplus of $500,000 right now they could allocate to the sheriff’s department.
Dr. Lyn O’Connell, associate director of addiction sciences at Marshall Health, testified Friday to the “The Resiliency Plan,” a $2.6 billion plan that outlines what dozens of community leaders believe is the pathway to the end of the substance use epidemic. The plan runs over decades and also focuses on economic recovery and homelessness, as well.
Steve Ruby, a former U.S. attorney for the Southern District of West Virginia who now represents Cardinal Health, questioned if the wide-spreading resilience plan calling for millions of dollars to abate the opioid crisis was just an over exaggeration to use at trial. Paul Farrell Jr., the lead attorney for Cabell County, was present at the first meeting that led to its creation, Ruby said.
The trial will resume Monday, June 7.