It wasn’t difficult for Garry Adam’s Baltimore-area pharmacy customers to get their oxycodone order limits increased in the early 2010s.

Over one seven-month period, Adam, a sales representative for the drug distributor McKesson, helped a pharmacy in Parkville request six threshold increases totaling an additional 35,000 oxycodone pills per month.

In just over a month, Adam helped another major customer, the Dundalk pharmacy Drug City, request an additional 60,000 oxycodone pills per month. The business was already selling 200,000 doses of the drug each month — though less than a year earlier, Drug City’s head pharmacist had told McKesson he would usually dispense 60,000 per month.

Adam testified Wednesday in Baltimore City Circuit Court as part of the city’s trial against the drug distributors McKesson and AmerisourceBergen. The city alleges that the companies ignored their obligation to investigate and halt suspiciously large orders of opioids to Baltimore pharmacies, flooding the community with addictive painkillers and contributing to one of the deadliest opioid epidemics in the nation.

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The city is including some Baltimore County pharmacies in its case because, it argues, patients from the city often went to county pharmacies to get their prescriptions filled.

Testifying under subpoena, Adam defended his actions while he was a McKesson sales rep. He retired from the job in 2019.

“If I saw something, I reported it,” he said.

Big pharmacies like Drug City ordered large quantities of opioids, he agreed, but they also bought large quantities of other drugs, such as blood pressure medication. (Drug City was McKesson’s top buyer of oxycodone nationwide among independent pharmacies, according to evidence presented at the trial, purchasing 11.6 million opioids in less than six years before McKesson terminated the pharmacy as a customer in 2012.)

Under questioning from the city’s lead attorney, Bill Carmody, Adam acknowledged that he helped request oxycodone threshold increases for Joppa Road Pharmacy in Parkville time and again, emailing his colleagues at McKesson that more opioids were needed because of “increased business.”

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Adam also argued that he did not have access to all of the pharmacies’ dispensing data or the broader picture of how many opioids were going to each customer. In testimony that was at times testy and meandering — Adam referred to Carmody as “Mr. Lawyer” during one exchange and referred to illicit drug users as “druggies” — Adam repeatedly said the questions would be better aimed at McKesson’s regulatory staff.

His claim echoed what a former AmerisourceBergen sales rep, Kevin Dowling, testified last week.

Dowling acknowledged advising pharmacy customers to place smaller orders of certain medications to avoid hitting their thresholds, but denied “coaching” the businesses under questioning from a city attorney.

“I don’t like the word coaching,” Dowling said on the stand. “We educated customers on the new policies and procedures … and how to stay away from patient interruption.”

Dowling’s bonuses were based in part on the revenue earned from his pharmacy customers, though he said opioids made up only a small fraction of his business. But he also testified that he did not have all of the information necessary to understand the scope of opioid sales in Baltimore or potential problems at his pharmacies.

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“I was instructed to look for red flags, but did not have access to all the red flags,” he said.

The city’s argument, however, is that the drug companies’ regulatory teams had all of the information they needed to detect red flags at pharmacies in Baltimore city and county and cut them off sooner.

The companies had data showing the ever-growing demand for opioids at these pharmacies, the large numbers of prescriptions coming from just a few doctors at area pain clinics, and the unusually high volume of cash transactions at some stores, according to the city’s evidence.

McKesson did cut off Drug City as a customer in 2012, shortly after Adam reported seeing suspicious activity in the pharmacy’s parking lot, according to his testimony. That was a few months after the Drug Enforcement Administration had requested the pharmacy’s sales records from McKesson, according to previous testimony.

Drug City and its former owner reached a $900,000 settlement with the DEA in 2016 for dispensing controlled substances to people that the business “should have known were diverting the drugs.”

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McKesson also terminated Joppa Road Pharmacy as a customer after Adam saw several vehicles with out-of-state license plates in the parking lot and observed patients follow a delivery driver into the store to buy controlled substances, he testified. He had been trained to identify these red flags for opioid diversion.

“I didn’t like what I saw,” he said.

Baltimore’s opioid trial began last month and is scheduled to continue until at least early November. The city is expected to continue presenting witnesses through next week, though the trial is not in session every day due to scheduling conflicts. Testimony will resume next week.

On Tuesday, the city called William Padula, a professor of pharmaceutical and health economics at the University of Southern California, to provide an estimate for how much money the city has spent on responding to and preventing opioid use disorder and overdoses caused by misuse of prescription opioids.

In all, Padula testified, the city will likely spend a total of $260.2 million by 2029, an estimate that he said was conservative and based on an analysis of policing, health and homeless services costs. Baltimore spent about $193.8 million between 2011 and 2021, he said, and is expected to spend another $66.4 million in the next five years.