CHARLESTON – On the second day of a trial accusing opioid manufacturers of causing an drug epidemic in West Virginia, plaintiff attorneys sought to undercut a central defense contention – that prescription drugs are safe and effective in dealing with pain.
“Can a person get addicted even if they take a drug as prescribed?” Elizabeth Smith, one of the attorneys for the state, asked during April 5 testimony.
“Yes,” answered Dr. R. Corey Waller, an expert witness for the plaintiffs. “You don’t have to have a risk of biology or family history. You can be prescribed for the first time for shoulder pain and become addicted to these substances.”
Williams
Waller is an addiction and pain management specialist with Health Management Associates based in Lansing, Michigan.
The trial began April 4 in Kanawha Circuit Court. It is being streamed live courtesy of Courtroom View Network. West Virginia Attorney General Patrick Morrisey filed the lawsuits in late 2019 in Boone Circuit Court. They now are being heard by the state's Mass Litigation Panel and Judge Derek Swope. It's a bench trial, which means there is no jury. Swope will decide the outcome.
West Virginia’s is among the latest of several state-conducted lawsuits including in Washington State and Florida in which opioid distributors and manufacturers are accused of irresponsibly oversupplying pills and deceiving the public about the dangers. The Centers for Disease Control (CDC) estimated 1,417 overdose deaths in West Virginia in 2021.
Studies have stated West Virginia’s high rate is due in part to its having an older population on average than other states, and lower-income residents, some living in remote rural areas far from a doctor’s office.
Also originally included as a defendant was Endo, but Morrisey announced last week that company settled with West Virginia for $26 million.
The complaints filed separately in 2019 in the Boone Circuit Court alleging the companies deliberately promoted a misinformation campaign to deceive the public. The charges include the creation of a public nuisance and violations of the state's Consumer Credit & Protection Act.
The case is seen as potentially important because West Virginia has the highest national rate of overdose, three times the national average. Native American reservations also have high rates of addiction. The final verdict in West Virginia could impact future litigations.
Plaintiff attorneys are seeking to show the companies ignored the addictive dangers of the drugs so they could profit by irresponsibly promoting them, while maintaining ineffective anti-drug diversion programs. They will seek millions in damages to fund addiction-treatment programs.
As they have in other trials, defense attorneys will argue that societal misuse of illegal drugs such as heroin caused the epidemic, not suppliers going about their normal business of providing legally prescribed opioids to treat chronic pain.
On Tuesday, Waller explained the nature of opioid drugs and how they influence the brain. He said opioids are able to bind themselves to brain receptors altering and cutting the transmission signals of pain from the production of pain-killing endorphins. But they can also change mood.
“It changes the way pain is felt,” Waller said.
Waller said opioid drugs such as heroine, Oxycodone and Hydrocodone are semi-synthetic drugs, whereas natural drugs include morphine and codeine. A fully synthetic drug is fentanyl, the most potent, 100 times more powerful than the others.
Waller said addiction is about behavior. He said using a drug can modify behavior.
“It (drug) becomes the most important thing in a person’s life, more than work or health,” he said. ‘The behavior becomes compulsive.”
“Can the behavior be explained?” Smith asked.
“Yes, it’s a fundamental disruption in part of the brain," Waller replied. "Dopamine levels (produces intense feeling of reward) the first time using are the highest. But it lowers again and again afterward.”
To get continued pleasure from a drug, Waller said the user has to take larger amounts as tolerance for the drug grows. The body attempts to return to the lower level, to get back to normal. This produces a craving for the drug. Once taken off a drug, symptoms include nausea, vomiting and sweating.
He said the addict becomes unable to fill their roles in work, home and school. And even though experiencing a persistent desire to cut use, an addict spends more time obtaining the drug.
Waller said blocking drugs such as methadone are able to cut opioid addiction which can reduce mortality by 65 percent.
“It is treatable but not without considerable effort,” he noted.
Under cross examination, Marc Williams of Nelson Mullins' Huntington office representing Janssen questioned Waller about his fitness to serve as a witness.
“You testified in West Virginia last May in Cabell County and the City of Huntington (a federal lawsuit against distributors McKesson, Cardinal Health and AmerisourceBergen),” Williams said. “You have limited connections in West Virginia, fair?”
“I have not practiced (in West Virginia),” Waller said.
“You did not talk to West Virginia physicians?”
Waller answered that he had gathered information for a report in the Cabell County trial, but did not repeat the same steps for this trial.
“Heroin is illegal, right?” Williams asked.
“Yes.”
“When you compare heroin with prescription opioids, those are approved.”
“Yes.”
“The FDA (Food & Drug Administration) has an arduous process to analyze the risks. A trained physician selects what’s best for a patient.”
Waller agreed but noted there are multiple considerations to make a judgement on the best form of treatment.
“Fentanyl is 100 times more potent than morphine.”
“Correct.”
"The dose makes the poison, right?”
“Yes,” Waller said.
“The longer and the more you take. There are lots of criteria including environment, and past trauma?”
“Yes,” Waller agreed.
“Chronic pain can change personality and the ability to perform a job, right?”
“Yes.”
“The job of a physician is to try and treat that pain,” Williams said.
“It’s an important function I agree,” Waller responded.
“You are normally retained by plaintiffs suing, correct?”
“Yes sir.”
“Do you believe the (opioid) manufacturers are responsible for creating the epidemic?” Williams asked.
Waller indicated it was a step in a system in which drugs became “over-exposed.”
Williams asked Waller about his appearance as a keynote speaker on the drug epidemic at Washington University in St. Louis. The program discussed the causes of the epidemic under the title, “How Did We Get Here?”
“I make a lot of academic talks,” Waller said.
Williams played for the court a segment of the speech, in which Waller told the audience “We did this! (create epidemic). Heroin has been here a long time, prescription opioids have not.”
Waller later indicated the filmed segment was taken out of context.
During the viewing of a previously taped film deposition, Dr. Rahul Gupta, former West Virginia State Health Officer (today director of National Drug Control Policy for President Biden) said 780 million opioid pills had been imported into the state during a several-year period after 2006. He said even as the numbers of opioid prescriptions leveled off, users who found opioids too expensive or difficult to get acquired heroin on the street to continue getting the pleasurable effects. He was asked if the numbers of opioid prescriptions caused the epidemic.
"The opinion I formed was that the misuse and abuse (opioids) was at the core," he said.
The trial is expected to last up to two months.
