Nine years ago, SafeScript, a small downtown Huntington pharmacy, was raided by federal agents and shut down after its owner was arrested on state drug trafficking charges when he was found in a parked pickup with a woman, prescription drugs, blank pharmacy labels and suspected drug ledgers.
The case went cold after his charges were dismissed, but an analytics expert testified at a trial against opioid wholesalers Monday that, prior to the pharmacy’s closure, AmerisourceBergen had been shipping it an average of 35,500 oxycodone doses a month, about seven times the national average.
The revelation, just part of an expert’s analysis of three datasets, suggests Huntington and Cabell County were bombarded and targeted by opioid distributors when they received 109.8 million doses of opiates over a nine-year period.
In pointing to data Monday, plaintiffs aimed to show the situation was not a complex maze of opiates being shipped from dozens of shipping facilities to pharmacies throughout the country. Nearly 90% of it was shipped from just three facilities, with half of it going to less than one-fourth of the pharmacies in the county and at a highly disproportionate rate to that of the rest of the United States.
Plaintiffs argued that, when the defendants reduced the number of pills shipped around 2012, it made users turn to illicit opiate drugs, such as heroin. The defendants said they did report suspicious orders to the U.S. Drug Enforcement Administration, but never heard back and did not know when a pharmacy was under investigation. They attribute the volume to DEA pill quotas and a rise in prescriptions written by doctors for a population with health issues.
Craig McCann, who holds a doctorate in economics and works for a consulting group based in Washington, D.C., served as an expert witness Monday at the Robert C. Byrd U.S. Courthouse, in Charleston. The testimony is part of a lawsuit in which the Huntington and Cabell County accuse drug distributors AmerisourceBergen Drug Co., Cardinal Health Inc. and McKesson Corp., of fueling the opioid epidemic.
At the questioning of plaintiff attorney Peter Mougey, McCann said sorting through 500 million records of ARCOS data was like sorting through about 20,000 banker boxes of paper and turning it into something they could work with.
“Ultimately, what we do is quite simple. It’s arithmetic. It’s nothing fancy,” he said. “It’s taking a subset of the data and then doing subtotals on elements of that data that might be interesting to the court.”
While previous Herald-Dispatch reporting said 81 million opioid pills were shipped to the county from 2006 to 2014, McCann said a more accurate way to judge the amount of opioids being shipped is by dose using the Morphine Milligram Equivalent, a formula the Centers for Disease Control and Prevention provides to compare drugs with varying potencies.
The data showed that, from 2006 to 2014, 109.8 million doses of hydro- and oxycodone units were shipped to Cabell County and Huntington — 89.9% of that coming from the defendants.
The average per capita shipped annually in the country during that time was 39.9 doses per person. In West Virginia, it was 72 per person and, in Cabell County and Huntington, it was an average of 122 doses per person — more than four times the national average.
The number did not include 12 other opiates, however. McCann said 135.6 billion dosage units of 14 opiates were sent across the country each year, with 1.37 billion being sent to West Virginia and 127.9 million to Cabell County.
Government data showed that, from 1997 to 2010, the number of pills being shipped to the county and city skyrocketed by 1,110%. In about 2010, the number dropped roughly in half, to numbers that last had been seen in 2005. At its height, Cabell and Huntington received about three times as much as national shipment rates, and about 66% more than the overall state, he said.
The “Big Three’’ distributors shipped 17.08 doses of hydro- and oxycodone per person per year throughout the United States, 37.04 to West Virginia and 63.48 to Cabell County. When asked to use a calculator to add the doses, McCann couldn’t.
“The calculator won’t take numbers that large,” he told the judge.
AmerisourceBergen distributed about eight times and Cardinal Health four times the number of doses per capita into Cabell County as it did into the rest of the country. Of McKesson’s shipments, about 76.1% (17 million doses) went to the local Veterans Affairs hospital.
McCann said over 99% of the pills coming into Cabell and Huntington came from three distribution centers, one for each defendant. Nine pharmacies — including CVS, McCloud Family, SafeScript and Fruth pharmacies — of the more than 40 in Cabell County received the majority of doses of hydro- and oxycodone, he said.
As the plaintiffs looked closer into the pharmacies to where opiates were shipped, the defendants again objected, stating that the data included pharmacies miles away from Huntington. The data was important to show Huntington was the “go to” place to get opioids, the plaintiffs said.
From 2006 to 2014, AmerisourceBergen shipped 4.67 billion doses of oxycodone to retail and chain pharmacies nationally, with an average of 5,036 doses a month. For West Virginia, the average was 8,229 and for Huntington, Cabell County, it was 10,743, about 220% the national average.
From January of 2006 to January 2010, the number for oxycodone doubled. By January 2010, 4,783 dose units were shipped on average nationally, 8,489 units were sent to West Virginia and 15,186 units were sent to Huntington and Cabell County, about 350% times the national average.
McCann said SafeScript, a small Huntington pharmacy, averaged 35,551 oxycodone dose units a month, about seven times the national rate. Average pharmacies receive 60,000 oxycodone doses a year. Safescript received 426,000 before it was shut down after it was raided in 2012.
Cardinal Health’s average shipments of oxycodone dose units nationally was 4,975. For West Virginia it was 5,460 and for Cabell County and Huntington, 6,989. The average sent to Cabell County and Huntington was 8,559 in January 2010, compared to 4,876 nationally.
The Medicine Shoppe, a small West Huntington pharmacy, received an average of 18,600 dose units per month, about 3.7 times the national average and more than 2.5 times the state average.
Family Discount Pharmacy, in Mingo County, went from 10,000 dose units in 2006 to a 100,000 dose monthly average of hydrocodone just three years later. The 2010 shipments were 35 times that of the national average, McCann said.
Then-Cardinal Health Executive Chairman George Barrett said during a congressional committee hearing in 2018 he regretted that the company didn’t do more to stop the high volume of shipments to the area.
McKesson’s average shipment of oxycodone was 4,294 dose units nationally during the time frame. In West Virginia, it was 4,500 and, in Huntington and Cabell County, it was 4,400. Crabbe Orchard Pharmacy, in Raleigh County, averaged 25,000 per month shipments of oxycodone dose units from the distributor, and it increased to as much as 45,000 in 2011.
McKesson’s average shipment of hydrocodone dose units per month nationally and in West Virginia was 4,000. In Huntington and Cabell County, it was 2,200. Family Discount Pharmacy averaged 116,000 dose units per month, about 55 times the Cabell County average.
McCann’s testimony is expected to continue Tuesday morning.