Baltimore’s lawsuit against opioid distributors is “the biggest and most important case in the history of this city,” offering a chance to hold drug companies accountable for the hundreds of millions of painkillers they shipped into the metro area and the addiction and overdose crisis that followed, a city attorney told jurors Wednesday.
The arguments from attorney Bill Carmody were part of opening statements Wednesday, setting the stage for how the city and opioid companies will approach the planned eight-week trial.
“They devastated the public health and safety of this city,” Carmody said during his nearly two-hour opening statement. “They took advantage of this town.”
Drug distributors McKesson and AmerisourceBergen — which are among the largest companies in the nation — say they’re being wrongly blamed for a crisis caused by illegal street drugs such as heroin and fentanyl.
“We are going to defend ourselves hard, because we did not cause the opioid epidemic in Baltimore and we are not going to let the plaintiffs put all of these societal harms at our feet,” said Robert Nicholas, one of the lawyers for AmerisourceBergen.
Baltimore’s overdose death rate is nearly double that of any other major American city, The Baltimore Banner and New York Times reported earlier this year in an investigation that the city highlighted in its opening statement.
Here are some of the most staggering claims from the city’s opening statement, along with the drug companies’ responses:
At its peak, opioid companies shipped 320 million painkillers to the Baltimore area
Together, AmerisourceBergen and McKesson supplied about 60% of the half a billion opioids that flooded Baltimore city and county during the prescription pill crisis.
The 320 million pills they sold here would be enough to give an opioid to every person at a packed Camden Yards — 7,000 times over.
The pills kept flowing even as the prescription opioid crisis became a heroin crisis and then a fentanyl crisis in the mid-2010s. Experts say that 80% of people who use heroin started with prescription opioids.
The distributors say that opioids make up only a fraction of their business. They act as middlemen between drug manufacturers and the hospitals and pharmacies that need all sorts of medications.
What’s more, the companies’ attorneys said, the demand for opioids was driven by doctors’ prescriptions, not by distributors. When the medical community embraced opioids as a solution for chronic pain in the 1990s and early 2000s — a movement that was encouraged by drug manufacturing companies like Purdue Pharma — doctors began prescribing more opioids and the federal Drug Enforcement Administration raised annual production limits to meet the demand.
“We should not second guess the medical decisions of these doctors,” Nicholas said.
It’s true that the push to use more opioids was pervasive during that period. In Maryland, for example, lawmakers established a State Advisory Council on Pain Management that recommended removing barriers to pain treatment in 2004.
Drug distributors ignored their responsibility to watch for suspicious orders
Prescribers, pharmacies, drug manufacturers and distributors must register with the DEA to sell controlled substances. As part of the deal, they are also required to keep an eye out for suspicious orders or signs that the drugs they sell are being diverted for illegal use. That “closed loop” system is supposed to ensure controlled substances like opioids stay out of the wrong hands and off the streets.
The city claims that McKesson and AmerisourceBergen ignored their obligations in the quest for higher sales numbers. Both companies went years without reporting a single suspicious order in Baltimore, even as their sales here skyrocketed.
In an email that Carmody called a “smoking gun,” a member of McKesson’s regulatory staff told other employees to avoid putting the word “suspicious” in writing. The companies also told their customers their thresholds for certain drugs, making it possible for pharmacies to easily evade limits on opioid orders.
The distributors, however, say they followed their regulatory requirements and reported all orders of controlled substances to the DEA in real time. It was up to the DEA to investigate further. AmerisourceBergen’s suspicious order monitoring system was praised as an industry leader in 2007, Nicholas said.
“Nobody was hiding anything,” said Andrew Stanner, an attorney for McKesson.
A Dundalk pharmacy was one of McKesson’s largest oxycodone buyers
The city is focusing on distributors’ sales to pharmacies during this trial because that’s where most opioid diversion happened, Carmody told jurors.
Drug City was McKesson’s No. 1 buyer of oxycodone nationwide among independent pharmacies, he said. The Dundalk pharmacy received 3 million opioid pills in a single year, despite operating in a community of about 65,000 people.
“Of course they knew what was going on,” Carmody said.
McKesson knew of reports that drug dealers sold pills in the pharmacy’s parking lot, he said. But the company did not halt sales there; instead, it congratulated the pharmacy’s owner.
Stanner told jurors that Drug City is a typical community pharmacy that sells balloons and greeting cards. That’s what McKesson’s salespeople saw when they visited the store, he said, not the chaotic drug market that the city claims.
Drug City and its former owner reached a $900,000 settlement with the DEA in 2016 for dispensing controlled substances to people that the company “should have known were diverting the drugs.”
Company officials joked about the opioid crisis in internal emails
Internally, regulatory staff at Amerisource Bergen were sharing parody song lyrics about the opioid crisis that referred to oxycodone as “hillbilly heroin.” Another, set to the tune of Jimmy Buffett’s “Margaritaville,” mocked how easy it was to obtain opioids in Florida.
In one email, an AmerisourceBergen corporate investigator shared a joking mock-up of a Kellogg’s cereal box under the subject “Oxycontin for kids.”
Nicholas told jurors that these were “a few embarrassing emails from many years ago” that city attorneys pulled out of hundreds of thousands of pages of documents turned over during the lawsuit.
Fentanyl filled Baltimore’s opioid void, driving the nation’s highest overdose death rate
As The Baltimore Banner reported in May, the overdose death rate in Baltimore is staggering. It is the highest of any major American city.
City lawyers say that the situation spiraled out of control when easily accessible opioids pills disappeared amid a DEA crackdown in 2012. Without prescription opioids, people who had become dependent on the drugs turned to cheaper street drugs, like heroin. Eventually, the potent synthetic opioid fentanyl overtook the drug market, causing overdose deaths to spike.
Though Baltimore had a well-known heroin problem for decades before opioids became more popular, the city had successfully “beaten back” the problem and reduced opioid deaths in the early 2000s, Carmody said. The influx of prescription opioids brought the problem back to an unprecedented level.
The lawyers for McKesson and AmerisourceBergen did not dispute that there is a severe opioid crisis in Baltimore. But they pointed to other sources, like drug cartels and street gangs, and the “medicine cabinet” diversion that occurred when prescription opioids were plentiful.
“What they’re really saying is that we should be responsible for diversion that occurred after the opioids were out of our possession,” Nicholas said.
Testimony in the trial will begin Thursday morning.
Correction: This article was updated to correct attribution of an email that mocked opioid use.
