The defendants blame the lack of communications with the Drug Enforcement Administration, their regulatory body, a high rate of prescriptions by doctors and poor health of Western Virginians for the rise in pills shipped to the state.

Friday’s testimony opened with Dr. Joseph Werthammer, a pediatric neonatologist at Cabell Huntington Hospital, who discussed neonatal abstinence syndrome (NAS), a condition found in newborns as a result of the sudden stop of the baby’s in utero exposure to substances used by his mother.

Babies born with NAS may experience tremors, seizures, overactive reflexes, and tight muscle tone. This results in restlessness, excessive crying, unhealthy eating, and slow weight gain. This can have long term effects, and babies need specialized care and environments to help them heal.

A 2016 report from the Centers for Disease Control and Prevention said there was a 300% increase between 2000 and 2012 in the United States in babies born with a NAS. In 2016, nearly 5% of babies born in West Virginia were born addicted to drugs. Out of 1,000 live births in the state, 49.9 were born with a SIN. In 2014 it was 32.1 and in 2015 it was 34.4.

Werthammer said that in 2010 Cabell Huntington Hospital had around 50 to 60 patients, but in 2015 it was 250 per year. He estimates that approximately 2,500 children born with a SIN live in Cabell County.

A defense attorney said half of the babies Werthammer mentioned did not meet the threshold for needing medication to relieve symptoms.

“The other half is doing it,” Werthammer said.

The SIN can be caused by at least 15 drugs, one prescription, said a defense lawyer. Werthammer said nationally and locally about 85% of cases involve opiates, but Cabell now faces the problem of babies being born with multiple drugs in their system.

The opioid pills the distributors sent were for prescriptions prescribed by doctors, another defense lawyer said, in an attempt to show the doctors were at fault.

In a 2017 email chain between Werthammer and others, he wrote: “Unfortunately, it’s not a big pharmaceutical industry that wrote prescriptions; it was me and my colleagues.

In another messaging channel, he shared an article from 2017 that referred to how quickly a person can become addicted. Werthammer responded to someone’s response to the new information: “We have created a monster.”

While the defendants said this showed doctors were guilty of the opioid epidemic, the plaintiffs called to the stand a former Cardinal Health sales representative who oversaw The Medicine Shoppe at 2402 Adams Ave., which has saw a sharp increase in the distribution of opioids after the closure of SafeScript Pharmacy. .

SafeScript, an ABDC customer, was shut down in the spring of 2012 after its owner was arrested when he was found in a truck with a woman, a possible drug registry and other evidence that would indicate a hijacking of illicit drugs was in progress. According to information from the DEA Drug Database, the Huntington Pharmacy averaged 35,551 dosage units of oxycodone per month from 2006 until it closed.

One distributor’s misfortune was another’s fortune, complainants say, because SafeScript customers didn’t stop using opioids – they just moved to The Medicine Shoppe, a Cardinal Health customer.

DEA data showed The Medicine Shoppe received an average of 18,600 opioid dose units per month from 2006 to 2014, 3.9 million tablets, about 3.7 times the national average and over 2, 5 times the state average.

When asked if he was aware, The Medicine Shoppe received nearly 3.7 million oxycodone pills from Cardinal Health from 2006 to 2014, Jesse Kave, a Cardinal Health salesperson, said that he did not know.

Kave said that if he has access to what a company is buying through trend reports, it isn’t something he checks often and it’s not part of his job.

Cabell County attorney Mike Fuller pointed to Kave’s 2020 deposition in which he said The Medicine Shoppe had a “ton” of suspicious orders. Kave said he didn’t remember saying that.

Fuller showed a 2011 email in which Kave told his bosses doctors were shifting their prescribing standards from OxyContin to oxymorphone. Fuller then turned to a July 2012 pharmacy investigation report, which was conducted after an opioid surge due to the SafeScript shutdown.

A pharmacist in charge of The Medicine Shoppe said doctors are prescribing high levels of Oxy 15 and 30, high doses of opioids, for pain management. In fact, 71% of his distributed oxycodone had been 15s and 30s, which showed disproportionate growth.

Fuller said a high rate of prescriptions for a drug known to be abused should have been a wake-up call when Kave said prescriptions for the drug had declined.

Scott Lemley, current Director of Innovations for Huntington who previously worked as a Criminal Intelligence Analyst for the Police Department and the Mayor’s Office of Drug Control Policy, predicted the crisis that Huntington was about to face because of from pharmacies like SafeScript and The Medicine Shoppe, plaintiff attorneys mentioned.

The Huntington Police Department’s 2011 annual report, which Lemley oversaw, said the most prevalent emerging threat to the community was the illegal diversion of strong pain relievers, such as oxycodone and oxymorphone.

The onset of the crisis could be seen in the seizures of the K-9 unit of 2012-13. In 2012, the unit seized 699 grams of heroin and in 2013 it increased to 1,865 grams. Prescription pill seizures increased from 3,300 dosage units to 11,000.

He testified on Friday that they saw an increase in prescription opioid abuse, but was overtaken by heroin around 2014.

During his work with the mayor’s office on drug control policy, Lemley said the team visited the community and used their data analysis to build relationships with residents. As a result, they understood the problem better.

Drug-related incidents in 2004 were very limited, he said, but by 2014-16, they had taken over the entire community. He also collected data on opioid overdoses, which showed that opioid abuse did not discriminate based on race, age or sex. Everyone was affected.

“It exploded,” he said. “We realized we couldn’t get away with this.”

He said they approached state delegates, the Cabell-Huntington health department and other organizations to develop programs, like the harm reduction program or the distribution of naloxone, to ‘help those who needed it.

Huntington’s attorney Temitope Leyimu referred to a strategic plan released by the ODCP that noted thousands of hours of interaction between law enforcement officers, medical professionals, the social service administration, educators and more to help tackle the crisis.

Steve Ruby, an attorney for Cardinal Health, said illegal drug dealers working in an outdoor drug market in the Fairfield West neighborhood are the root of the Huntington drug problem.

The root of the problem predated that, he said. The downfall of Huntington began in the 1980s, when many manufacturing plants began to downsize and shut down. By 2000, most well-paying manufacturing plants were gone, according to a report by Lemley.

The loss of income led to a reduction in city services, such as the police and the drug unit, and left the city in a vulnerable position, Lemley wrote, and drug dealers took note.

The tipping point was when four teenagers were killed in 2005 near Charleston Avenue in Huntington. From there, the town of Huntington could no longer ignore that there was a problem with drugs and violent crime.

Ruby said nowhere in the report blamed the distributors.

The defense said Lemley’s data did not track the type of drug the overdose was caused by and there was no way to tell how many were legally from prescription opioids. They also said it was made up of multiple sources in Huntington, which could cause more errors in the end result.