Thread by @HesslerHD

I’m back for day 37 of the #opioidtrial in Charleston, W.Va. Yesterday, the defense flew through 4 witnesses, who they used in an attempt to disprove testimony from plaintiff witnesses. Get caught up here: herald-dispatch.com/news/defense-w…

I think today’s edition of the @heralddispatch is really representative of how the opioid epidemic is still ongoing. Three of our four main stories are opioid related.

The sides have agreed to hold closing arguments July 27 and 28 and will receive six hours each (the three defendants receiving two hours each).

Good thing my Summersville lake vacation wasn't scheduled for that week or anything. ☹️

John "Tri" MacDonald, president of the Berkley Research Group, has been called to the stand. He will be the only witness today.

MacDonald analyzed a lot of data sets surrounding opioid distribution to research the opinions he will be testifying to today.

He's an expert in data analytics related to the pharmaceutical supply chain

MacDonald said West Virginia has a history of having a higher drug volume per capita compared to the United States. In 2005, WVians averaged 15.3 scripts per person, 41% higher than national average. By 2015 it was 21.8, about 72% higher than the US

MacDonald called the state Virginia and the judge called him out on it. He profusely apologized to West Virginians.

He said West Virginia opioid prescriptions per capita is about 40.5% higher than national average.

He said non-opioid pain relievers from 2013-16, West Virginia averaged 24% more than the national average. For opioids, it was 30%

He reviewed the opioid shipment data set created by Craig McCann, a data analyst, and methodologies James “Ralf​” Rafalski, a retired diversion investigator at the DEA, who had used McCann's data to come up with his determination.

Rafalski previously testified the defendants failed in flagging suspicious orders because they failed to conduct due diligence when a pharmacy ordered over its monthly opioid threshold.

Rafalski had said no matter which system you input the defendants’ shipment data into, anywhere from 20% to 99.8%, most categories showing more than 50%, of their shipments — amounting to millions of pills — should have been flagged and reported to the DEA.

MacDonald said the methodologies applied to non-controlled products shipped by CH from 2006 to 2018 also shows the vast majority of medication - for thyroids, high blood pressure, diabetics, etc - should not have been shipped.

“It’s indiscriminate,” he said. “It just flags.”

If I remember correctly, judge Faber allowed Rafalski to testify in May, but said he would rule later on whether it would be allowed to be entered into the record or not, since the judge has more leeway in a bench trial.

He still hasn't made a ruling on the matter yet and the defense is focusing a lot on its case on debunking his theory to get the testimony tossed, if I am processing this correctly.

MacDonald said Rafalski's methodology did not account for growth of pharmacies, or a growth in the amount of prescriptions which were increasing during the time frame.

From 2006 to 2018, 92% of the medicines shipped by Cardinal Health were non-opioids, he said.

The defense is finished. Taking a break before cross examination.

Cabell attorney Mike Fuller is asking questions now. He is questioning which due diligence files MacDonald reviewed to make his opinions. He said the defense only turned over a couple dozen files as part of evidence exchange in the case.

MacDonald said he did not review every single due diligence report, he was not doing an audit. He said he just looked them over on a sample level and could tell due diligence, like site visits, was being done.

He said he is aware Cardinal Health had a suspicious order monitoring system, which leaned on pill shipment threshold limits, and he believes it was executed as designed. He is not offering an opinion on whether the thresholds were accurate, however.

"I was looking for indications of the process, not to validate that each step of the process in each instance took place," he said.

Essentially he's not saying if the system was a good one or not, he is just saying that Cardinal Health followed the system they put in place.

"Perfect," Fuller responded to his last statement.

Fuller said, likewise, MacDonald did not look at national trends of a growing opioid crisis for part of his analysis.

https://twitter.com/HesslerHD/status/1413493141055807490?s=20

Fuller has pulled out a document regarding a Congressional hearing on opioid abuse in the country. The report said:
“While oxycontin diversion and abuse appear to have begin more in rural areas like Appalachia, it now has spread to urban areas.”

MacDonald said he is unsure how that is relevant to individual orders which should have been blocked.

Another report said "Rural communities (like Kentucky, Ohio and West Virginia) were reportedly being devastated by the abuse and diversion of OxyContin."

Fuller asked if distributors should have taken that into account, but MacDonald gave the same answer. He said the amount of pills being shipped matched that prescribed by doctors.

From 2006 to 2014, Cardinal Health shipped 131 million pills to West Virginia, which has a population of 1.8 million people. Comparatively, Taxes received 79.3 million pills for its population of 25.2 million. Illinois, population 12.8 million, received 77.9 million opioids.

MacDonald said a lot of factors play into that, like market share. It does not have any impact on him evaluating single orders, he said.

"Pointing that one state is larger than the other does not provide context to me," he said.

MacDonald said he cannot testify if the due diligence was good enough, but said Cardinal Health was conducting due diligence when an order was flagged.

85% of Cardinal Health's shipments were non-controlled substance. But of the 15% of controlled substances they shipped, half were opioids, Fuller said.

This should be Texas, not taxes

A lot of opioid shipment thresholds set by the companies were set at 3x of the average number of opioids shipped. Fuller insinuating distributors were upping the average by setting thresholds so high.

Fuller is finished. Jennifer Wicht for Cardinal Health back up for questioning.

MacDonald is done for the day and that's a wrap on the week. and we are done for the day. I expect there will be six witnesses testify next week.

Working on story now.

Opioid distributors accused by Cabell County and Huntington of pumping an excessive amount of pills into the area presented a witness Friday they hope will persuade a judge to toss testimony surrounding a lack of blocked orders.

herald-dispatch.com/news/witness-a…