With the rest of the country taking a chance to catch its breath after the announcement of a $26 billion settlement with some opioid firms, Huntington and Cabell County are standing firm as they prepare for closing arguments with opioid distributors this week.
The trial surrounds Cabell County and Huntington’s allegations that AmerisourceBergen Drug Corp., McKesson and Cardinal Health helped to create and fuel the opioid crisis in the area by pumping a copious amount of pills into the county. The “Big Three” — which were three of the four companies to settle nationally — have blamed West Virginians’ poor health, doctors and the federal Drug Enforcement Administration for the amount of pills.
Closing arguments in the case will take place Tuesday and Wednesday at the Charleston federal courthouse. Each side is expected to receive six hours, with the defense splitting its time equally.
Plaintiffs presented their case in 32 days, from May to the end of June, with the defendants needing five more to fill in holes they hope will prove their case.
At the midway point, when the defendants argued for dismissal, U.S. District Court Judge David A. Faber — the case’s decider — asked if the public nuisance law was broad enough to address the plaintiffs’ cause of action, which seeks $2.54 billion to abate the opioid crisis over a 15-year period.
To recap the defendants’ case, two statements were made in the final moments of defense witness testimony. First, a witness said that in order to abate the epidemic, it would take medical assisted treatment.
The final question posed by Cabell County attorney Paul T. Farrell Jr. asked if the oversupply of opioids was a causal factor for the crisis, to which Stephenie Colston, a defense witness, replied that it was one of the contributing factors — seemingly answering the question Faber asked.
The defendants called several doctors to the stand, who testified they had to weigh the risks and benefits of opioid prescribing, while trying to satisfy the ever-changing policies of their regulators and medical boards that set prescribing standards.
Some of the testimony strengthened the plaintiffs’ case of there being a gateway between prescription opioid abuse and the move to heroin.
John “Tri” MacDonald, an expert in data analytics related to the pharmaceutical supply chain, testified that West Virginia had a history of having a higher drug volume per capita compared to the rest of the United States. Even though it was receiving three times the opioids than the national average, MacDonald said it was not out of line.
MacDonald said testimony from plaintiff witnesses — who said anywhere from 20% to 99.8% of opioid shipments should have been blocked — was unreliable.
But Cabell County attorneys pointed to documents regarding a congressional hearing that said the crisis began in West Virginia and devastated the community. They also pointed to the vast number of pills West Virginia received compared to other states.
From 2006-14, Cardinal Health shipped 131 million pills to West Virginia, which has a population of 1.8 million people. Comparatively, Texas received 79.3 million pills for its population of 25.2 million.
Before the defense rested its case last week, health economist and defense witness Kevin Murphy said the people who were getting the pills were not the ones dying from them later. Farrell said it also could be true that the people receiving the pills were diverting them to others, who later moved them to the illicit drug market.
The trial will be the first major trial regarding opioids to conclude in the country and is part of a vast opioid litigation network.
It is not clear how long Faber will take to make his decision.