Of the over 3,300 suits filed by municipalities, counties and tribal nations against opioid manufacturers, distributors and pharmacies, only three have thus far gone to trial. The most recent trial began Monday, pitting the epicenter of the opioid epidemic, West Virginia, against AmerisourceBergen Corp, McKesson Corp and Cardinal Health Inc.
According to a report by Reuters, the first plaintiff witness to be called was Corey Waller, a Michigan-based addiction and emergency medicine expert.
In his testimony, Waller described the neurochemical processes involving opioid addiction. (Opioids are synthetic opiate drugs including the infamous brand name version of oxycodone: Oxycontin.)
Waller said most synthetic opioid drugs are created via small chemical modifications of the same basic molecule that’s found in the opium poppy. Although there are subtle differences in terms of chemical structure, to the brain, Waller said, synthetic opioids and heroin are “identical.”
Added Waller, per Reuters, “The brain doesn’t know the drug you just gave it,” Waller said. “It just knows the action that it has.”
Consequently, when a user takes opioids, dopamine is released. Often called the “reward” chemical, dopamine release is associated with happiness and motivation. However, Waller suggested that opioid drugs release up to nine times more dopamine than what a person might experience on the “best day ever.”
Waller described the inordinate release of opium thusly: “It’s a car that has the gas pushed to the ground and just let go without a driver.”
The downside to the high dopamine release is that in the future, the brain ultimately lowers the production of the neurotransmitter. As a result, users become addicted to opioids because “they need the drugs just to maintain a baseline level of dopamine needed to function normally,” Waller said.
When cross-examined by defense attorneys, Waller said he believed doctors were prescribing opioid drugs to aggressively treat pain, but had been doing so in good faith.
Attorneys for the defendants argue that their clients should not be held liable for simply filling orders, the amount of which were determined by doctors’ prescribing decisions and by federal regulators’ quotas on production, per Reuters. Furthermore, defense attorneys deny the city of Huntington and Cabell County’s claims that the drug distributors ignored evidence that opioid drugs were being diverted to illegal channels.
U.S. District Judge David Faber is presiding over the bench trial (no jury), which may last up to three months. Should the plaintiffs emerge victorious, it could help lay the groundwork for settlements in a sprawling nationwide litigation over the opioid crisis.
Reuters reports that the city of Huntington and Cabell County are seeking compensatory damages to address the heavy toll the opioid crisis has taken on their communities. Another plaintiff expert witness estimated the cost of the fallout caused by the opioid crisis in this area of West Virginia at $2.6 billion. The city and county, Reuters adds, previously opted out of a proposed $26 billion nationwide settlement with the three distributors and Johnson & Johnson.