West Virginia communities moved forcefully Tuesday to show that prescription opioids have been a “gateway” leading Americans on deadly paths to heroin and illicit fentanyl, escalating a crucial and controversial debate in multidistrict opioid litigation’s leadoff trial.
Cabell County and its largest city, Huntington — two plaintiffs in the bellwether trial that started Monday against the nation’s three biggest drug distributors — underscored the issue’s importance by making their first expert witness an addiction specialist who extensively discussed links between prescription and illicit opioids.
Roughly 500,000 Americans have died since the early days of the opioid crisis in the late 1990s. Fatal overdoses at first tended to involve prescription narcotics, such as oxycodone and hydrocodone. In 2010, deaths from heroin began spiking, and more recently, there’s been a surge of fatal fentanyl overdoses.
The gateway concept is significant because it could dramatically expand the legal liability of the three drug distributors: AmerisourceBergen Corp., Cardinal Health Inc. and McKesson Corp. They fought unsuccessfully to limit testimony on the gateway effect during briefing before the trial.
The wholesale distributors are accused of ignoring obvious signs that pharmacies were ordering opioids in huge amounts that clearly exceeded legitimate medical needs. They have countered that allegation by contending that pain management standards have evolved over the years, at times widening acceptance of opioids, and have suggested that people who use prescription and illicit opioids are usually just heavy consumers of many drugs, not patients who get a short-term opioid prescription and suddenly become full-fledged opioid addicts.
Nearly 12,000 deaths in 2019 involved natural and semisynthetic prescription opioids, about 14,000 involved heroin and more than 36,000 involved synthetic opioids, such as fentanyl, according to the Centers for Disease Control and Prevention. Some deaths involve multiple opioids, and fentanyl is available in both prescription and illicit forms, the latter of which is viewed as far more dangerous.
Cabell and Huntington are accusing the distributors of creating a “public nuisance” in the form of the opioid crisis and are seeking $2.6 billion to address the problem. The trial’s outcome, which will be decided by U.S. District Judge David A. Faber, could have major repercussions for the broader resolution of the MDL, which contains 3,000 cases that also target drugmakers and pharmacies. The distributors have floated a $21 billion global settlement, but it hasn’t been finalized, and many state and local governments could opt out.
The trial will continue May 5th and is scheduled to last for up to 12 weeks.