Going After the Opioid Middlemen

Listen to this episode

S1: They used to have this motto at the Charleston Gazette, the daily morning paper in West Virginia’s capital city. It was just two words, sustained outrage.

S2: And that means, you know, you just don’t

S3: do a one off stories

S2: that you do in order to bring

S3: issues of injustice to you have to really hammer away.

S1: This unofficial mantra is what convinced Eric er to pack up and move to this Appalachian state more than two decades ago.


S3: I call sustained outrage the rocket fuel from my reporting.

S1: Eric was a state House reporter for a long time, but he reserved most of his sustained outrage for the opioid crisis. Compared to other places, people here are much more likely to have an opioid prescription, much more likely to die from an overdose to Eric got obsessed with puzzling out how so many powerful narcotics got into his state in the first place. What he found was a web of drug distributors, companies that call themselves the central nervous system of health care companies like Cardinal Health, McKesson, AmerisourceBergen. They’re huge.

S3: This company that I didn’t know, Cardinal Health, let me see what it was just last time, sixteenth largest company in the Fortune 500. McKesson is the eighth largest and AmerisourceBergen is number 10. So you’ve got, I think, Wal-Mart’s number one in the Fortune 500 and you’ve got Apple and Amazon and you get these companies that nobody’s ever heard of.


S1: These companies had heard of Eric, though he’s learned that this week, that’s because one of the county’s hardest hit by opioid addiction in West Virginia has taken these companies to court. And his lawyers dredge up emails and documents about who knew what when. It’s put Eric’s reporting center stage,

S3: the trade group for these drug distributors had actually put together and see if I can get the I’m looking here at the transcript from yesterday’s hearing on the crisis playbook. They call it this is crisis playbook. I guess that means the opioid crisis playbook. But it was it was put together back in twenty fifteen and it mentions me by name and talks about how they can blunt my reporting on this issue.


S1: I noticed one reporter who’s covering this trial that’s happening right now. Well, he said, I think if I have a nickel for every time Eric Eres name has come up, I could buy myself lunch.

S3: Yeah, that was quite embarrassing. I’m glad I had a mask on so you could see was red in the face.

S1: Today on the show, a single county in West Virginia has decided to take on opioid distributors on their own, whether their case succeeds depends on a lot more than whether they win in court. I’m Mary Harris. You’re listening to what next? Stick around. The opioid middlemen who find themselves in court this week, they’re there because Eric says they’ve got this unique perch. They can see which pharmacies are ordering what. And that means they could have been a kind of early warning system for the opioid crisis instead. Lawyers for Campbell County will argue that these distributors left rural places on their own


S3: county as probably in the state with the highest overdose death rate, which is West Virginia. Campbell County is probably suffered more than any place in America. Back a couple of years ago, they were had incidents of twenty six overdoses in four hours. All the national media

S2: descended on on Huntington

S3: Campbell. So Huntington has been through a lot. The good news is they they started to make

S2: some progress on

S3: reducing overdose deaths. They had two years, consecutive years of decreases.

S2: But now that

S3: the pandemic hit, it’s unfortunately

S2: gone the other way.

S3: It’s trending upward again.

S1: So what is the county arguing?

S3: They’re arguing that these distributors flooded, saturated, showered their county with opioids and that led to a prescription drug problem,


S2: which

S3: then transferred

S2: to a heroin

S3: problem. And here and now is a meth and a fentanyl problem.

S2: They say that

S3: these companies were not submitting under DEA rules. They were supposed to be submitting

S2: what they call

S3: suspicious drug order reports,

S2: which are reports

S3: that pharmacies are ordering way more opioids than they really could possibly need. And they were ignoring this and that at the end of the day that they played

S2: a

S3: critical role in the opioid crisis and they need to be held accountable.

S1: You’ve noted that the argument that the county’s making here is akin to one that might be made against a polluter that, you know, they created an environment that was bad for the public’s health. It was a public nuisance.


S3: That’s probably one of the strongest arguments that that they can make because they’re sort of the other is the causation argument that they didn’t directly cause the opiate epidemic. But it’s going to be hard and making the switch from, you know, holding them accountable for the prescription pills and then the switch to heroin. There’s different layers and they’re trying to separate themselves directly from the proliferation of prescription opioids.


S1: The distributors are trying to separate themselves and say the heroin is not us. Right. We don’t distribute heroin.

S3: Yeah, there’s like a couple of degrees of separation. But, you know, there’s been a you know, there’s the CDC has done studies showing that,


S2: you know, 80 percent of

S3: people on heroin were using prescription drugs before they switched to heroin, prescription opioids in particular.

S1: So everyone’s kind of pointing at each other here.

S3: Yeah. Know people say, you know, what about the doctors? And I said, yes, it’s everybody. It’s the doctors. It’s the pharmacist, 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

S2: ignored reports of

S3: suspicious orders by pharmacies. I mean, it was just this entire system. And I can’t I almost forgot the lobbyists and the politicians, too. They contributed.


S1: I can’t leave them out.

S2: Yeah.

S1: The first time West Virginia sued a drug company over opioids was back in 2001, Purdue Pharma, the manufacturer of OxyContin, settled for ten million dollars. 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 one for comparison to. Counties in Ohio got three times as much money from opioid distributors as the entire state of West Virginia. So I asked Eric at the time, did those settlements seem like too little, too late?

S3: No, that’s what’s interesting, I mean, it didn’t it didn’t seem like 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


S2: that was for

S3: thirty six million. And it just it was it was kind of a different time. People weren’t really talking that much about opioids. So and there was some there was a lot of uncertainty in West Virginia here

S2: because we had a

S3: Supreme Court that was changing, becoming more conservative, anti consumer.

S1: And so did that mean advocates were kind of just happy to get anything?

S3: Yeah, and and they settled before the new Republican governor was sworn in. So there’s that fear as well.

S1: But for comparison, I think it’s useful to look at, for instance, big tobacco because it’s a little it’s a little apples and oranges, because the master settlement agreement was over multiple states, not just one, but still it was worth over 200 billion dollars. And so you look at settlements for 10 million and 30 million and you think that’s that’s a big difference when you sort of line them up a little bit and start thinking about how they all add up together.


S3: Yeah. And what’s interesting, too, is our former attorney general was Al Gore was heavily involved in the tobacco settlement and that was actually bringing in close to 60 million dollars a year to the state of West Virginia. A year. Yeah, over and over many years. So you’re right, when you compare that to, I think the grand total from the distributors

S2: that was received through the attorney

S3: general’s lawsuits

S2: was seventy two million. From what we know

S3: now, that was way too little, huh?

S1: So I guess I wonder if this history of settlements makes. The lawyers here for Kabo County. Want to fight harder because they’ve seen the settlements just look paltry in the years since and whether they think. You know, it’s hard to know what they’re thinking, but whether there’s some logic of we might as well just take this to court and duke it out, because we have really been on the short end of the stick in the past and we can’t do that again.


S3: I think there’s a feeling they represent clients, including like the mayor of Huntington and others. And and there’s this feeling that West Virginia kind of 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. I mean, the ones we just talked about previously were just, you know, settled and there was never any kind of trial. And and, you know, they’re going to bring their fire chief in and talk about, you know, which she sees every, you know, every day people dying of overdoses and having to respond to the same person over and over again. There’s there’s going to be one of the county commissioners is going to testify about their friends and families 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.

S1: We’ll be back after a break. One of the questions I had for Eric was about how much impact any kind of financial settlement would have on the lives of real people in West Virginia. In previous cases filed against these distributors, the state already got 72 million dollars. So I wondered, where was that money?

S3: Now, frankly, that’s been a mystery I that I need to solve. Yesterday we heard that actually the drug distributors at the hearing brought up that there’s no guarantee that any proceeds from any settlement will or

S2: award by the judge will go to people with

S3: this

S2: disorder, drug treatment

S3: programs, et cetera.


S2: Why? Because they said

S3: of the 72 million that they plan to show, and I haven’t seen the evidence yet, but they plan to show

S2: that a third of it went to drug

S3: 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. You know, one of the arguments that the drug users. It was surprising to me that they made yesterday in court. They said that, hey, West Virginia doesn’t need any more money for treating 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. Would they claim they have some public health official wrote a letter to them or wrote a letter to the governor’s office

S2: saying that they don’t need as

S3: much money as they thought they needed?

S1: So they’re saying the states being greedy.

S3: Yeah, and

S2: I I find

S3: that hard to believe, but that’s going to be one of their defenses. Hmm.

S1: I wonder if you think about what you think the most appropriate remedy would be here, because we’ve talked about how problematic some of the previous settlements have been. Too small or not enough oversight of where that money’s going. A lot of it going to cops instead of maybe treatment programs or needle exchanges. And in fact, in West Virginia, my understanding is that a lot of people are kind of opposed to needle exchanges. They feel like they might make their communities less safe for, you know, less pleasant. So. What does that mean for a lawsuit like this, how you structure in what’s actually needed on the other side of of getting money?


S3: 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

S2: created

S3: such onerous, onerous regulations

S2: for the few harm

S3: reduction. I think we have six harm reduction clinics, whereas Kentucky has like fifty five. You know, basically the harm reduction clinics are saying they’re going to be put out of business by these onerous regulations. Essentially what we’ve done is outlaw

S2: one of the principal primary treatment options that people with substance

S3: use disorder have. And it’s not just people getting, as you know, not getting just syringes. I mean, it’s

S2: they’re coming in and

S3: they’re going to get pointed

S2: into places that

S3: that

S2: actually treat substance use

S3: disorder, medication, assisted treatment, et cetera. It’s a way, you know, it’s a step through the door to getting the help that they need.

S2: And the West Virginia

S3: legislature,

S2: not only did they

S3: do nothing but address the

S2: the raging opioid crisis,

S3: they did things that

S2: actually weaken

S3: what we were currently doing, which was already very little. So I’m hoping that we can get this if this tide turn,

S2: but

S3: it’s going to depend on resources. And in the next best shot we have is a, you know, some sort of settlement from this litigation that’s ongoing right at this minute.

S1: 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?

S3: Yeah, I mean, I don’t think a lot of people anymore are really trying to blame. I think they’re trying to say we need help. I mean, we need prevention. We need money for harm reduction programs, for clean needle syringe exchanges.


S2: We need more

S3: beds. I think we

S2: have the last report I

S3: saw there was one hundred

S2: and fifty thousand

S3: West Virginians suffering from substance use disorder. And there’s something like the short term they call short term beds available for treatment

S2: was around a thousand.

S3: And I think another 12 hundred of long term treatment. And this is Mary. I mean, the thing that people don’t it’s not like the movies where

S2: somebody, you know, detox

S3: is in in four days

S2: or or,

S3: you know, goes through withdrawal for four days and then they pop up and they’re

S2: fine. I mean,

S3: everybody I talked to, I mean, you know,

S2: a lot of friends that I have

S3: that are in addiction treatment

S2: side, they say it’s like a

S3: good three to five years, three to five years. You know, 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 that can happen.

S2: People can get better, but people are tired

S3: of everybody pointing fingers at everybody. Just put the resources where they’re needed and maybe we can tackle this problem and save save more lives.

S1: Eric, thank you so much for joining me.

S3: Thanks for having me on. Really appreciate it.

S1: Eric Eyre is an investigative reporter. He works at Mountain State Spotlight now. He’s also the author of Death in Mudlick, a coal Country Fight Against the Drug Companies That Delivered the Opioid Epidemic. And that is also What Next is produced by Daniel Hewitt, Davis Land, Carmel Delshad, Mary Wilson and Ilana Schwartz, Allison Benedikt and Alicia Montgomery help us ask better questions every day. And I’m Mary Harris. I’ll get you back here tomorrow.