CHARLESTON – An analytics analyst in a trial accusing suppliers of causing an opioid epidemic said the amount of prescriptions for pills in West Virginia increased dramatically between 1997 and 2017, with 2011 being the peak year.
“West Virginia ranked number one in opioid prescribing per capita (every man, woman and child),” Lacey Keller said.
The presented data said West Virginia had fewer drug prescribers than other states, but they prescribed a higher rate of opioids than other states.
The trial in the Kanawha Circuit Court is being streamed live courtesy of Courtroom View Network. Opioid suppliers Teva, Cephalon and Allergen are accused of recklessly flooding West Virginia with pills causing an epidemic.
Janssen, the drug subsidiary of Johnson & Johnson, settled with the state on April 18, agreeing to pay $99 million although company officials denied any wrongdoing. An additional defendant Endo also settled with the state in late March for $26 million.
In 2019, West Virginia Attorney General Patrick Morrisey filed lawsuits against the drug manufacturers in in the Boone Circuit Court. The case is being heard by a state Mass Litigation Panel in a bench trial with no jury. Judge Derek Swope will decide the verdict.
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 21 session, Keller, an data analyst with MK Analytics, was called as an expert witness by the state. She presented a number of charts showing the breakdown of opioid distribution in West Virginia.
Between the years 1997 and 2017, the dosage units of opioids went from 35.9 million to 2.5 billion (2017) with the peak year 2011. This represented 90 annual doses for every man, woman and child in the state.
In the years after 2011, the rates appeared to lower, but they remained far higher than 1997 and above the national average.
“Did usage increase year after year until 2011?” Keller was asked by the state’s attorney.
“Correct,” Keller answered. “By 2011 four times (more than in 1997).”
Teva, one of the defendants, went from providing 660,000 doses in 1997 to 1.2 billion by 2017.
Keller’s figures said the cumulative milligram annual dosages in 1997 were 248 million, in 2017 38 billion. By the peak year of 2011 the state stood at 90 opioids per capita (for each person) while the national rate was 40 per capita.
“West Virginia is above the national average,” Keller said.
In the numbers of drug prescribers however, West Virginia ranked 25th in the country.
West Virginia was displayed on a map colored in red denoting a high opioid prescribing rate along with Tennessee and Kentucky, which also had high rates.
The top three West Virginia counties per capita for drug prescriptions were Cabell, Logan and Mason counties. Those counties had double the statewide average and triple the national rate.
Keller’s information said there were 36 million opioid pills provided in 1997, 105 million in 2017.
Of the defendants, Teva had the biggest market share at 21 percent and 11.2 million prescriptions in the years 1997 to 2017. The defendant Allergan had 122,446 prescriptions or .3 percent of market share.
The drug OxyContin was dispensed along with Kadian, a morphine-based drug, and Norco containing hydrocodone.
“Kadian is one of the stronger opioid pills on the market,” Keller said. "It can have a stronger dose than the OxyContin 80 milligram.”
A chart said that 51 prescribers in West Virginia were responsible for providing 511 million dose units of drugs between 1997 and 2017, while 240 prescribers provided over 1.1 billion units, over half the statewide total. It was three times the level of the average prescriptions, Keller said.
Cabell County had 24 prescribers in the top 1 percent, while 40 percent of counties in the U.S. didn’t have a single prescriber in the top 1 percent.
Queens, New York, had a similar high rate of prescriptions to Cabell County, but Queens had a population of 2.3 million while Cabell had under 100,000 people.
“What conclusions did you draw?”
“There were 182 million doses (opioids provided) by 69 individuals (in West Virginia),” Keller said.
Keller said that in 2012 it amounted to 30 pills for every man, woman and child in the state. She said it was more doses and stronger doses of the drugs.
Keller said one doctor in Wood County a pain specialist had prescribed 29 million units of drugs between 1997 and 2017, or more than 1 million doses per year.
"That's two pills per every person in the state from this doctor alone," she said.
Keller said the defendants could have obtained sufficient information to understand the overall (negative) prescribing and purchasing trends in West Virginia.
