Thread by @HesslerHD

I’m back for day #36 of the opioid trial in Charleston, W.Va. Yesterday’s testimony showed politics has played a role in the prescribing of opioids in the state for decades. Catch up here:

herald-dispatch.com/news/politics-…

Today we will continue hearing testimony about insurance, which did not make the cut for yesterday’s story because of story length restrictions. Will get the fully testimony in today’s story later.

At the questioning of Anthony Majestro, Economist James Hughes, who has bene testifying about insurance in the state, said he did not review specific data regarding the amount of pills being shipped into Cabell County or documents related to the opioid crisis.

“I guess I’m wondering what relevance this witness has,” Majestro said. Majestro said payors are not part of the closed distribution system, nor are they registered by the DEA and did not break laws through their conduct.

He also said Hughes did not review any steps the payors could have taken to help prevent the opioid epidemic.

Pointing to Safescript, a problematic Huntington pharmacy, Majestro said most prescriptions were paid for by cash by the patient. A payor’s actions would have no impact on cash customers, he said.

Hughes is done and AmerisourceBergen has called Ted Martens, a retired PWC employee, to the stand.

Martens is a forensic accountant.

Ted Martens, a forensic accountant, said ABDC’s opioid sales were just a small fraction of its total distribution of prescription pills and medical supplies in Cabell County.

He said non-opioid medications, blood pressure and anti-depressant medication was sold at a high rate comparatively by ABDC.

Martens said the findings of Craig McCann, who testified about DEA pill shipment data in May, were incomplete because they only reflected retail pharmacies, not hospitals and other closed pharmacies.

He said looking at the three was a more complete picture to show the scope of ABDC’s business in Cabell County and Huntington.
Nonetheless, he said McCann’s analysis of the data he reviewed was reliable.

Martens is done with his testimony. We are taking a break. I like these speed witnesses.

Still thinking about how Hughes made about half of my yearly salary just by testifying for a few hours.

The Cabell County Commission at the last minute added an executive session for opioid litigation to its agenda today. They have these closed-door discussions often, but it’s weird it was just added.

https://twitter.com/mckennahorsley/status/1413136428444229641

Next up at the opioid trial is Dr. Kevin Murphy, another economist. Testifying for McKesson. Timothy Hester asking questions. chicagobooth.edu/faculty/direct…

FWIW: I have reached out to West Virginia AG Patrick Morrisey’s office to see where he/the state stands after this news came out overnight.

I *may* be spreading myself a little thin.

https://twitter.com/BrianMannADK/status/1413069540578271238

As of April, West Virginia was only set to receive 1% - about $80 million - from the bankruptcy settlement, despite being one of the areas most affected by the opioid crisis. herald-dispatch.com/news/plan-call…

Murphy said responsibility for the crisis lies with doctors because they control prescriptions. Distributors do not control the quantity of prescriptions needed to be filled.
“In order to sell a legitimate pills in the marketplace, you have to have a prescription,” he said.

An association between quantity of opioids distributor & death cannot be connected to bad conduct by the distributors, he said.
“If you’re asking if that says anything about distributor behavior, probably not,” he said, adding “Association just shows that things move together.”

Association ≠ causation, he said.

The plaintiffs witnesses would disagree with his testimony herald-dispatch.com/_zapp/plaintif…

What led to the increase in opioid mortality rate around 2011 - when the number of opioid pills being shipped to the county dramatically decreased - was illicit drug use, like heroin and fentanyl, whose overdose rates have nearly increased six times its 2011 rate.

Prescription opioid overdose deaths have been dropping since 2011, he said, but the decrease is very slight, a graph they're displaying shows.

Murphy said to see correlation between the current illicit opioid crisis being caused by prescriptions shipped a decade ago, you should see matching age groups for those who prescribed opioids and those who died from illicit drugs.

In the United States the age group of 51+ accounted for about 56% of opioid prescriptions ,but mortality rates from heroin use 2010-18 was predominately in the 15-30 - 25% - and 31 to 50 - 35% - age range for men.

He said data shows that higher powered illicit opioids were more easily accessible in the eastern United States, which is what led to the opioid crisis, not prescription pills.

He said while the west was receiving black tar heroin, the eastern coast was receiving powdered heroin, which was easier to mix with other drugs, like fentanyl.
“It’s not prescriptions, per say,” he said. “It’s the changes in the illicit drug market.”

I would love to hear Murphy’s findings when looking at Cabell County and WV’s death rates specifically, since at opioid distribution’s ceiling, Cabell and Huntington received about three times as much as national shipment rates.

We are going to lunch until 2. I’ll tweet more from Murphy’s testimony later.

Enu Manigi said the defense will probably be done in the middle of next week?! How exciting. It was supposed to go until mid-August.

We are done for the day. Sorry about the tweets. It was fast paced today.

DAY 36: After flying through testimony from 4 witnesses in an attempt to counter 7 weeks of testimony from witnesses for the state and county, attorneys said Thursday they expect to finish calling witnesses to the stand mid-week in the coming week.

herald-dispatch.com/news/defense-w…