CHARLESTON – Plaintiff attorneys in a lawsuit accusing opioid manufacturers of causing a drug epidemic in West Virginia produced a witness who seemed to suggest that those who don’t learn from history are doomed to repeat it.
Dr. David T. Courtwright told state attorneys April 6 there have been four major drug epidemics in U.S. history. The current epidemic Courtwright attributed to the medical community abandoning a formerly conservative approach to dispensing pills.
“Prescribing practices changed," Courtwright testified. "There was more exposure (to pills) and more addiction.”
Courtwright, a health historian and professor emeritus with the University of North Florida, said there is nothing new about an opioid epidemic in the United States.
Janssen, the drug arm of Johnson & Johnson, and opioid suppliers Teva, Cephalon and Allergen are accused of causing an epidemic in West Virginia.
The trial in Kanawha Circuit Court is being streamed live courtesy of Courtroom View Network.
West Virginia Attorney General Patrick Morrisey filed lawsuits against the drug manufacturers in late 2019 in Boone Circuit Court. The case is being heard by the state's Mass Litigation Panel in a bench trial with no jury. Judge Derek Swope will decide the outcome after what is expected to be two months of testimony.
This is the latest of several state-conducted lawsuits – including Washington and Florida – against opioid distributors and manufacturers. Plaintiffs attorneys in West Virginia will seek to prove the companies ignored the addictive dangers of the drugs so they could profit. Accusing the defendants of creating a public nuisance and violating the West Virginia Consumer Protection and Control Act, state attorneys contend the companies recklessly promoted opioid drugs to sales reps and pro-drug advocates while instituting ineffective anti-drug diversion programs.
West Virginia will seek millions in damages from the defendants to fund addiction treatment programs.
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.
Originally included as a defendant was another company Endo, but Morrisey announced March 30 the company had settled with West Virginia for $26 million.
The current case is seen as 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.
The Centers for Disease Control estimated 1,417 overdose deaths in West Virginia in 2021.
Called as a witness by the state, Courtwright said there have been four major drug epidemics in U.S. history, in the late 19th century (heroin), in the mid-1950s, in the early 1970s (an era of experimentation with recreational drugs) and the current epidemic beginning in the 1990s.
“All of them (epidemics) saw increased exposure (to drugs),” Courtwright said. “The first (1890) and the fourth (1990) were medical in nature, drugs introduced by doctors.”
State attorneys displayed a chart that read, “We have been here (epidemic) before.”
Courtwright said the desire to alleviate pain goes back centuries, originally using the opium poppy imported from overseas. But he said a movement to curtail profligate use of narcotics because of the concern for the lives it was destroying grew in the period from 1890 to the 1920s. This was later labeled “Narcotic Conservatism.”
Laws were passed at the federal and state level, such as the Pure Food and Drug Act restricting the use of addictive drugs, requiring government registration for suppliers and increasing criminal prosecution for violators.
By the 1920s in West Virginia, the number of addicts had dropped and the state was described as the “cleanest state in the country.” During World War II, with the government controlling drug use for wartime needs, the availability of drugs to the general public at home dropped further.
“The number of new addicts was very small,” Courtwright said.
He noted that change came in the 1980s when medical advocates began to challenge the concept of narcotic conservatism.
“There were a small number of doctors that said it had gone too far,” Courtwright said. "That physicians were too conservative (prescribing drugs). This was a revolutionary break with tradition.”
Two such advocates Courtwright said were the doctors Kathleen Foley and Russell Portenoy. A 1980 letter authored by them challenged previous medical wisdom, claiming that addiction was rare among patients treated with narcotics.
Courtwright said the evidence to justify such a position was weak and flawed.
By 1984, he said the medical community was relaxing its vigil on opioid prescriptions. Purdue Pharma, the maker of the opioid drug OxyContin, instructed sales reps on how to sell the drugs and sponsored lectures on its benefits to doctors. In 2007 the company pled guilty to misleading the public about the dangers of the drug and agreed to pay $600 million in damages. Three top company officials were found guilty on criminal charges.
Courtwright said the pro-drug advocates played multiple roles, providing speakers to medical conventions, serving as literature editors, educating medical students and vising hospitals to promote the products. He called them “gate keepers.”
“Did the defendants fund advocacy organizations?” Courtright was asked.
“Yes,” he said, and gave the American Pain Association and American Association of Chronic Pain as two examples.
During cross examination Steve Brody the defense attorney with the firm of O’Melveny asked Courtwright, “You’re not qualified to treat patients?”
“No,” Courtwright said.
“You have not identified any manufacturers who misled?”
Courtwright agreed.
“You didn’t interview West Virginia patients?”
“I did not.”
Brody called attention to a meeting of the Inter-Agency Committee on Pain, Discomfort and Humanitarian Care held in 1979. A document noting the meeting had been attended by scientists and health professionals called for a focus on the treatment of pain. The document said 75 million Americans suffered from some kind of pain with a yearly loss of 700 million work days.
“It says there’s a critical need to expand research and training (pain treatment), correct?” Brody asked.
“It says we should do more,” Courtwright said.
“New drugs must be developed for pain control, correct?”
Courtwright agreed the document stated that.
“The FDA (Food & Drug Administration) approved the drugs manufactured by the defendants, correct?”
“Yes,” Courtwright said.
“When the FDA approved them it made the determination the benefits outweighed the risks.”
“Yes.”
Courtwright also agreed there was a crack cocaine epidemic in the country in the 1980s. A 1979 document said two-thirds of high school students surveyed said they had tried an illicit drug.
Brody played a tape with then-President George H.W. Bush saying the drug epidemic of the late 1980s was sapping the health of the country and called for stronger laws.
“Crack cocaine is part of this country’s long history isn’t it?” Brody asked.
“Yes.”
“Bush’s hardline approach did not stem the epidemic?”
“It did come down (abuse rate), but in general it did not eliminate crack and heroin in the U.S.,” Courtwright said.