How One West Virginia County Is Taking On Opioid Distributors

People in West Virginia are much more likely than those in other places to have an opioid prescription, and much more likely to die from an overdose. Eric Eyre, an investigative reporter at Mountain State Spotlight, dug into how so many powerful narcotics got into his state and found a web of drug distributors, companies that call themselves the “central nervous system” of health care—Cardinal Health, McKesson, AmerisourceBergen. They’re huge, ranking in the top 20 of the Fortune 500, and now West Virginia’s Cabell County, one of those hardest hit by opioid addiction, is taking them to court. On Wednesday’s episode of What Next, I spoke to Eyre about the lawsuit, who’s to blame for the opioid crisis, and what West Virginians want now. Our conversation has been condensed and edited for clarity.

Mary Harris: These opioid middlemen are in court because, you say, they have a unique perch. They can see which pharmacies are ordering what, so they could have been a kind of early warning system for the opioid crisis. Instead, lawyers for Cabell County will argue that these distributors left rural places on their own.

Eric Eyre: Cabell County—in the state with the highest overdose death rate, which is West Virginia—has probably suffered more than any place in America. Back a couple years ago, they had incidents of 26 overdoses in four hours. All the national media descended on Huntington, Cabell. Huntington has been through a lot. The good news is they started to make some progress on reducing overdose deaths. They had two consecutive years of decreases. But now that the pandemic hit, it’s unfortunately gone the other way. It’s trending upward again.

So what is the county arguing?

They’re arguing that these distributors flooded, saturated, showered their county with opioids, and that led to a prescription drug problem, which then transferred to a heroin problem, and now is a meth and a fentanyl problem. They say that these companies were not submitting, under DEA rules, what they call suspicious drug order reports, which are reports that pharmacies are ordering way more opioids than they really could possibly need. And that, at the end of the day, they played a critical role in the opioid crisis and they need to be held accountable.

You’ve noted that the county’s argument is akin to one that might be made against a polluter, that they created an environment that was bad for the public’s health. It was a public nuisance.

That’s probably one of the strongest arguments that they can make. The other is the causation argument. But it’s going to be hard making the switch from holding them accountable for the prescription pills and then the switch to heroin.

The distributors are trying to separate themselves and say the heroin’s not us, we don’t distribute heroin.

Yeah—there’s a couple degrees of separation. But the CDC has done studies showing that 80 percent of people on heroin were using prescription drugs before they switched to heroin, prescription opioids in particular.

So everyone’s kind of pointing at each other here.

Yeah. People say, what about the doctors? And I’d say yes, it’s everybody. It’s the doctors. It’s the pharmacists, the manufacturers, the distributors. The regulators—DEA dropped the ball, they didn’t spot some of these massive shipments that were coming into West Virginia. The board of pharmacy, which ignored reports of suspicious orders by pharmacies. It was just this entire system. And I almost forgot the lobbyists and the politicians too. They contributed.

The first time West Virginia sued a drug company over opioids was in 2001. Purdue Pharma, the manufacturer of OxyContin, settled for $10 million. Since then, the state has sued distributors twice. They got a little more money from those suits, but nothing like the settlements other states have won. For comparison, two counties in Ohio got three times as much money from opioid distributors as the entire state of West Virginia. So did those earlier settlements seem like too little, too late?

No, that’s what’s interesting. I mean, some people were complaining that it was a bad deal, but the first settlement they had was against AmerisourceBergen and Cardinal Health, and that was for $36 million. And it just was kind of a different time. People weren’t really talking that much about opioids. There was a lot of uncertainty in West Virginia because we had a Supreme Court that was changing, becoming more conservative, anti-consumer.

So advocates were kind of just happy to get anything?

Yeah. And they settled before the new Republican governor was sworn in, so there was that fear as well.

But it’s useful to look at, for instance, Big Tobacco. That master settlement agreement was over multiple states, not just one, but still it was worth over $200 billion. You look at settlements for $10 million and $30 million, and that’s a big difference.

Yeah. And what’s interesting too is our former Attorney General Darrell McGraw was heavily involved in the tobacco settlement, and that was actually bringing in close to $60 million a year to the state of West Virginia, over many years. So you’re right, when you compare that to, I think the grand total from the distributors that was received through the attorney general’s lawsuits was $72 million—from what we know now, that was way too little.

I wonder if this history of settlements makes the lawyers for Cabell County want to fight harder, and whether there’s some logic of “we might as well just take this to court and duke it out.”

There’s this feeling that West Virginia needs to see its day in court. It wants the world to know what happened here. It wants transparency. And they haven’t had that. There hasn’t been a trial. They’re going to bring their fire chief in and talk about what she sees every day, people dying of overdoses and having to respond to the same person over and over again. One of the county commissioners is going to testify about her friends and family that have been impacted by the crisis. You know, families that have lost, in the same family, more than one family member. So I think they want everybody to know what happened, how it happened, and why it happened.

How much impact would any kind of financial settlement have on the lives of real people in West Virginia? In previous cases filed against these distributors, the state already got about $72 million. Where is that money now?

Frankly, that’s been a mystery that I need to solve. Yesterday, actually, the drug distributors at the hearing brought up that there’s no guarantee that any proceeds from any settlement or award by the judge will go to people with opioid use disorder, drug treatment programs, etc. They plan to show that of the $72 million, a third of it went to drug treatment programs, a third of it went to law enforcement with no stipulation on how they could spend the money, and then a third went straight to our attorney general’s budget, his account. I haven’t seen the details of this, but it was supposed to all go to treatment.

The drug distributors said that West Virginia doesn’t need any more money for treating the overdose crisis, that they’ve gotten plenty of federal funds to handle that. That was news to me and that was news to a lot of other people. They claim some public health official wrote a letter to them or wrote a letter to the governor’s office saying that they don’t need as much money as they thought they needed.

So they’re saying the state’s being greedy.

Yeah. And I find that hard to believe, but that’s going to be one of their defenses.

What do you think the most appropriate remedy would be here? We’ve talked about how problematic some of the previous settlements have been, too small or not enough oversight, a lot of it going to cops instead of treatment programs or needle exchanges. What does that mean for a lawsuit like this, how you structure in what’s actually needed?

I think they can do it. And I’m glad you brought up the harm reduction programs, because our Legislature just a month or two ago, and the governor signed it into law, basically created such onerous regulations for the few harm reduction clinics (I think we have six, whereas Kentucky has like 55) that the clinics are saying they’re going to be put out of business by these onerous regulations. Essentially what we’ve done is outlaw one of the primary treatment options that people with substance use disorder have.

And it’s not just people getting syringes. They’re coming in and they’re going to get pointed into places that actually treat substance use disorder, medication-assisted  treatment, etc. It’s a step through the door to getting help that they need. And the West Virginia Legislature, not only did they do nothing that addressed the raging opioid crisis, they did things that actually weaken what we were currently doing, which was already very little. So I’m hoping that we can get this tide turned, but it’s going to depend on resources. And the next best shot we have is some sort of settlement from this litigation.

I wonder, when you speak to people in West Virginia, if they have a good sense of who they blame for what’s happened in your state.

I don’t think a lot of people anymore are really trying to blame. I think they’re trying to say, “We need help. We need prevention. We need money for harm reduction programs, for clean needle, syringe exchanges. We need more beds.” The last report I saw, there was 150,000 West Virginians suffering from substance use disorder, and short-term beds available for treatment was around a thousand, and I think another 1,200 of long-term treatment.

It’s not like the movies, where somebody detoxes in four days or goes through withdrawal for four days and then they pop up and they’re fine. Everybody I talk to, a lot of friends that I have that are in the addiction treatment side, they say it’s like a good three to five years. Three to five years. It’s not something you’re going to turn the tide overnight, and it’s something that they live with all the time. Thank goodness there are success stories, it can happen, people can get better. But people are tired of everybody pointing fingers at everybody. Just put the resources where they’re needed and maybe we can tackle this problem and save more lives.