During the testimony of a drug historian during the second day of a high profile Floriday opioid trial, attorneys defending Walgreens Pharmacy attempted to distance their client from blame, by blaming Purdue Pharma.
“Would you agree that Purdue went to a great length to say there was a low risk of addiction?” asked Walgreens attorney Kaspar Stoffelmayr.
“Yes,” Dr. David Courtwright agreed. He said that in the 1990s, doctors, the public and legislators relaxed their attitudes about the dangers of opioids, and that caused an epidemic
“Purdue had a huge sales force?”
“Yes.”
The trial in the Pasco County Florida Sixth Circuit Court inPort Richey is being streamed live courtesy of Courtroom View Network.
The case against Walgreens Pharmacies was originally filed by former Florida Attorney General Pam Bondi in 2018, accusing the company of flooding the state with opioid pills and creating an epidemic of addiction. The current Attorney General Ashley Moody now directs the lawsuit.
Defense attorneys argue that others caused the epidemic - pharmaceutical companies like Purdue Pharma, distributors like McKesson Corp. and AmerisourceBergen, internet pharmacies and irresponsible clinics known as “pill mills.”
Purdue Pharma, owned by the Sackler family, reached an $8.3 billion settlement agreement in 2020 after admitting company officials had knowingly conspired to aid doctors dispensing the drugs without a legitimate medical purpose.
The original Florida lawsuit included as defendants opioid distributors CVS Pharmacy, Teva Pharmaceutical, Allergan and Endo International. Those companies settled with the state for more than $878 million last month.
Similiar state-led lawsuits against opioid makers and distributors are currently going on in Washington State and West Virginia.
Courtwright, a health historian and professor emeritus with the University of North Florida, appeared Tuesday as an expert witness for the state. He said previously there had been four major drug epidemics in U.S. history, in the late 19th century (heroin), in the mid-1950s, in the early 1970s (an era of experimentation with recreational drugs) and the current epidemic beginning in the 1990s.
Courtwright said the medical community abandoned a formerly conservative approach to dispensing pills.
He recounted that after the country’s first epidemic in the late 1800s and evidence of the dangers of the drugs at the time (opium and morphine), over a period of decades the medical community and government legislation restricted availability. He called it “narcotic conservatism.”
“It was the conventional wisdom,” Courtwright said. “Unfortunately, doctors and the general public (1990s) changed its mind about the appropriate use of opiates, and there was a significant increase in prescribing of opioids for non-cancer pain.”
Where before opioid prescriptions were made for mostly end-of-life conditions and cancer, by the 1990s and beyond they were bring prescribed for conditions such as joint and back pain. By 2006, the amount of pills on the market soared. The result was more people exposed to opioids and more addicts.
Courtwright said companies profiting off the manufacture, distribution and sales of opioid drugs engaged in a misinformation campaign, distorting the past to expand the drug market and profits.
“There was a great deal of evidence that backed up conventional wisdom (more conservative approach),” Courtwright said.
Courtwright called those in the 1990s who favored loosening drug restrictions “revisionists.” He said it started with a few doctors, and spread to include manufacturers, distributors and national pharmacies.
Courtwight was asked by the state's attorney. “What do you mean by national pharmacies?”
“Companies like Walgreens and CVS (Pharmacy),” Courtwright answered.
“Was Walgreens involved in opioid revisionism?”
“I concluded that it was,” Courtwright said.
During cross examination, defense attorney Stoffelmayr, with the firm of Bartlit Beck, sought to portray Courtwright as a high-paid hireling witness for the state.
“The University of Florida does not have a pharmacy program, correct?” Stoffelmayr asked.
“Correct,” Courtwright said.
“They’re (state) paying you $550 an hour, right?”
“Correct.”
“If you were paid the same as a full-time job, that would be over $1 million, right?”
“I’ll take your word for it.”
“That’s $22,000 per week.”
“That sounds right.”
“That’s a good deal more than a professor at the University of North Florida makes.”
“Oh yes,” Courtwright answered.
“You’ve done reports in quite a few of these opioid cases.”
“Yes. This is my sixth trial.”
Courtwright agreed there were others involved in triggering the epidemic beyond Purdue, including the manufacturers Cephalon, Teva, McKesson Corp and AmerisourceBergen.
“There has never been a time when doctors were not concerned about pain,” Stoffelmayr said.
“Pain is one of the areas of concern historically,” Courtwright agreed.
“Doctors have always known that non-cancer chronic pain can cause enormous suffering, right?”
“Yes.”
“You’re not saying regular doctors were not upset when they saw patients in real chronic pain?” Stoffelmayr asked.
“They wished to help their patient’s suffering, yes.”
The opioid drug OxyContin produced by Purdue came on the market in 1996.
Stoffelmayr said Purdue had established a (pro-opioid) speaker’s bureau with 2,500 doctors, and organized conferences in cities like Toronto and Houston where pro-opioid teachers and leaders could be recruited.
“They had three-day retreats in places like California and Arizona,” Stoffelmayr said.
“Yes,” Courtwright agreed.
“These were swanky (vacation) resorts.”
“It was nice,” Courtwright said.
“Doctors could bring their spouses and Purdue would pay.”
“I don’t think there was a prohibition (against a spouse),” Courtwright said.
Such events Stoffelmayr said were intended to find talented speakers to promote the pro-opioid stance and the hope that inviting doctors to the resorts would result in them writing more opioid prescriptions.
Courtwright said it was an incentive to write more prescriptions, but not an absolute condition to attend such an event.
“It might translate into more prescribing?” Stoffelmayr asked.
“Yes.”
Stoffelmayr indicated Purdue and some of the larger manufacturers provided funding to advocacy groups like the American Pain Foundation, an organization that was supposed to look like a patient’s group, but was in fact a pro-opioid industry mouthpiece.
Courtwright agreed that funding of such groups over time resulted in partial industry control.
Stoffelmayr produced a document that said Walgreen goals were intended to prevent medication errors, explore effective pain management and manage arthritis pain.
“You don’t have a problem with that do you?” Stoffelmayr asked.
“No,” Courtwright said.
Another document stated that in 2001 Walgreens sponsored a seminar to discuss pain management for pharmacists.
“You wouldn’t have a problem with that?”
“No.”
Courtwright noted that his reports on the subject of opioid epidemics looked at the issue in a larger historical context.