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Doctor testifies oversupply of opioids key to 20-year epidemic

A doctor testified Tuesday 57% of non-medical users of opioids in West Virginia during the past 20 years obtained the pills from a friend or relative for free.

Dr. Katherine Keyes was a witness for the state in its lawsuit against opioid manufacturers Johnson & Johnson subsidiary Janssen Pharmaceuticals Inc., Teva Pharmaceuticals and Allergan Finance LLC. The state claims the manufacturers helped fuel the opioid epidemic doing so through their marketing strategies.

Keyes, a professor of epidemiology at the Columbia University Mailman School of Public Health, testified the pills were readily available because of an oversupply of opioids from the manufacturers through prescribing doctors.

“Most people who are obtaining from friends and family are not obtaining them from doctor shoppers, but from friends or family who have them prescribed from their primary care physician. It’s not necessarily doctor shopping,” Keyes said.

Keyes, the only witness on the stand Tuesday, said studies she’s reviewed and conducted herself point to excess prescribing as the most significant source of the oversupply.

“Pill mills and doctor shopping certainly contributed to the oversupply but there was just an overall increase in the number of prescriptions and the dose and duration of those prescriptions that significantly established the opioid supply in West Virginia,” Keyes told Mercer County Circuit Derek Swope who is conducting the bench trial now in its second week.

According to Keyes, the widespread availability of pills created an increase in both medical and non-medical use of opioids in West Virginia.

“Through my review of the literature and my examination of the data, I concluded the driving force in increasing the opioid-related morbidity, mortality including opioid use disorder, was and continues to be the widespread availability of opioids,” Keyes said. “This began with the opioid supply increasing dramatically in West Virginia in the mid-1990s.”

Keyes also testified that her research shows more than 73,000 individuals in the state currently suffer from Opioid Use Disorder (OUD). She testified West Virginia had an estimated 10,927 individuals with OUD in 1999, reaching a high of 92,512 residents with OUD in 2011.

She said there’s currently a prevalence of OUD in 4% of the state’s population which is double the U.S. prevalence of 2%.

Keyes also spent a significant amount of time during direct examination Tuesday detailing the state’s opioid deaths. She said the deaths have come in three waves starting with prescription drugs which moved to heroin and then to fentanyl.

“They’re all ripples from this initial oversupply of prescription opioids that really set the stage for two decades of increase in overdose deaths,” Keyes said.

Under cross-examination, lawyers for the manufacturers attempted to punch holes in Keyes’ research claiming her numbers were inflated by a multiplier she created. An attorney for Janssen pressed Keyes for specifics.

“Did you make any effort to even determine whether there were any overdose deaths in West Virginia from a Janssen opioid medicine during the time Janssen was marketing its products in West Virginia?”
Keyes pointed the attorney to information listed by the state Department of Health and Human Resources.

Testimony is scheduled to continue today in the ceremonial courtroom at the Kanawha County Courthouse in Charleston.