An expert witness called by opioid manufacturers in West Virginia’s trial against the companies testified Thursday that there was “no evidence to show” their marketing campaigns led to an increase in opioid prescribing in the state.
Margaret Kyle, an economics professor who serves as chairwoman of Intellectual Property and Markets for Technology at French university MINES ParisTech, reviewed marketing materials and prescription trends for opioids manufactured by companies acquired by Teva Pharmaceutical Industries Ltd. and a group of companies owned by Allergan Finance LLC. Those are the two remaining defendants in the ongoing opioid trial.
In her analysis, Kyle asserted that marketing efforts for specific drugs were often sparse in West Virginia. Only 87 prescribers, she said, were visited by sales representatives pushing education on the opioid drug Kadian.
“The vast majority of those doctors didn’t change their prescribing habits for the drug or they had declines in [prescriptions] for Kadian after the visits,” Kyle said. “[Sales representative visits] didn’t expand the prescribing of even Kadian, so there’s no evidence they led to the increased prescribing of other opioids.”
Throughout the first few weeks of the trial, attorneys for West Virginia argued that the companies’ marketing efforts for specific drugs, and for opioids in general, contributed to the state’s continuing addiction and overdose epidemic.
On Thursday, Kyle testified that she saw no evidence in the documents provided to her that the companies produced or disseminated any unbranded marketing materials — those meant to educate prescribers generally on new types of treatments, but not name-brand or specific drugs — for opioids in West Virginia.
Attorneys for the state pushed back, presenting numerous pamphlets and articles signed off or sponsored by the companies — or their subsidiaries — advocating opioid use for pain management. In previous testimony, witnesses from the companies said such materials were widely produced, but it’s unclear how many made their way to doctors’ offices in West Virginia.
While Kyle testified that there was no statistically significant increase in opioid prescriptions tied to marketing, attorneys for the state disagreed.
In 1997 — the year marketing efforts for Norco, another opioid medication, began — there were only 92 prescriptions written for it in West Virginia. By 2002, there were 9,233 — a near-1,000% increase.
Kyle acknowledged that there was a bump in prescriptions, but she noted that it was “an increase off a very small starting number.” She said many of the patients prescribed Norco and Kadian weren’t receiving opioid medications for the first time, and instead were using those medications to replace other opioids.
The court also heard a prerecorded video deposition Thursday from Mark Spangler, executive director of the West Virginia Board of Medicine. Spangler walked attorneys through how the Board of Medicine functions, and what policies are in place for physicians suspected of overprescribing opioid drugs. Physicians themselves, he said, are responsible for setting standard of care guidelines.
He said he believes physicians have “an important role to play” in ensuring the appropriate prescribing of any drug, including opioids. Spangler said that, today, fewer doctors prescribe opioids than at any time before, likely because of the fallout from the opioid crisis.
The ongoing trial began April 4 and is expected to continue until at least May 27. The case is a bench trial, so Mercer Circuit Judge Derek Swope is the only person who will consider the evidence and decide the case.
The state alleges the pharmaceutical companies created a public nuisance and violated the West Virginia Consumer Credit and Protection Act by mischaracterizing and failing to disclose the serious risk of addiction from prescription opioid medication.
West Virginia also alleges the companies overstated the benefits of chronic opioid therapy and promoted the idea that doctors should prescribe higher dosage amounts without disclosing the greater risk involved.
Attorney General Patrick Morrisey originally filed the lawsuit in Boone County Circuit Court. It later was moved to West Virginia’s Mass Litigation Panel, where Swope became the presiding judge.
Attorneys for Teva and a group of companies owned by Allergan Finance LLC have argued that their sales representatives appropriately and legally marketed their opioid medications.
They’ve also argued that their respective opioid medications took up so little of West Virginia’s overall opioid market share, with nearly every relevant medication taking up less than 1% of the total, that they couldn’t be declared a public nuisance.
The state is seeking an injunction to require the companies to accurately disclose the “significant risk and limited benefits” of opioid drugs and not to market opioid medications as front-line treatment for chronic pain.
The government additionally is asking Swope to assess civil and other financial penalties against the companies.
The trial will continue at 8:30 a.m. Friday.