Editor’s note: This story was originally published by Mountain State Spotlight.

By Eric Eyre and Amelia Ferrell Knisely, Mountain State Spotlight

CHARLESTON — The nation’s three largest drug distributors failed to set up effective programs to stop prescription painkillers from being diverted and sold illegally on the black market, a former investigator with the U.S. Drug Enforcement Administration testified Wednesday at a landmark trial in Charleston.

After analyzing DEA data and the companies’ “due diligence” files, James Rafalski, an expert witness for the City of Huntington and Cabell County, concluded the wholesale distributors — McKesson, Cardinal Health and AmerisourceBergen — didn’t properly report suspiciously large orders of pain pills to the DEA for more than a decade.

During the trial, now in its fourth week, the companies’ executives have pinned much of the blame for the opioid crisis on the DEA’s failure to act. Rafalski’s testimony Wednesday provided a look into what he called the distributors’ flawed reporting practices.

“The systemic [failure] was widespread,” Rafalski said. He included the Huntington market in that failure.

Paul Farrell Jr., Cabell County’s lawyer, argued the drug companies never pulled the fire alarm despite numerous warnings about suspicious orders of oxycodone and hydrocodone.

“This should have been blocked,” he said.

Cabell County and Huntington filed lawsuits against the drug distributors in 2017, alleging the companies caused a “scourge of death and addiction” by flooding their communities with powerful prescription painkillers. More than 3,000 local governments across America have filed similar lawsuits. Cabell County and Huntington are the first to have their cases go to trial.

Rafalski’s findings echoed the conclusions of a 2018 congressional investigation into “pill’’ dumping” by the same distributors in West Virginia. 

On Wednesday, attorneys for the distributors suggested that doctors, manufacturers like OxyContin-maker Purdue Pharma, and the DEA were to blame for the opioid epidemic.

The companies’ lawyers said DEA field offices didn’t keep track of reports about suspicious orders of pain pills, and some offices didn’t even know that distributors were supposed to submit the reports. The DEA has never established standards to help distributors identify suspect orders from pharmacies, according to the distributors.

The companies’ attorneys also pointed fingers at regional distributor Miami-Luken, which shipped large quantities of prescription opioids to Cabell County. Miami-Luken closed several years ago, after two of its former executives were indicted on federal charges for failing to identify and block suspicious orders from now-shuttered pharmacies in West Virginia and other states. 

What’s more, the distributors’ lawyers noted that the DEA approved opioid manufacturing quotas that allowed higher numbers of painkillers nationwide amid a surge of drug overdose deaths.

Rafalski testified Wednesday that distributors, before 2007, would flag orders that looked suspicious, but still ship the opioid drugs to pharmacies and report the questionable orders to the DEA at a later date.

Since then, the companies have blocked those sales while reviewing them. Each distributor established its own program for identifying suspicious orders — typically by placing monthly limits on painkiller sales to individual pharmacies.

“We wanted to allow them flexibility,” Rafalski said Wednesday of the drug distributors each setting up its own program.

The opioid crisis — first triggered when people got hooked on easily available prescription painkillers, then switched to heroin, and now fentanyl and methamphetamine — has been costly: thousands of lives lost, families torn apart, grandparents raising children, overcrowded jails and soaring addiction treatment costs.

Huntington and Cabell County, along with other local governments in West Virginia, have opted out of a tentative $26 billion national settlement with the three distributors and with one of the manufacturers of opioids, Johnson & Johnson. Farrell has said West Virginia’s portion of the “global” settlement wasn’t nearly enough. The Mountain State’s potential share has yet to be disclosed to the public.

Reach reporter Eric Eyre at ericeyre@mountainstatespotlight.org.

Reach reporter Amelia Ferrell Knisely at ameliaknisely@mountainstatespotlight.org.