Lawyers for the city of Baltimore are making the case that opioid distributors McKesson and Amerisource Bergen were irresponsible in how they kept track of pharmacy orders, which led to dangerous amounts of prescription drugs finding their way to the streets of the city in the late 2000s and 2010s.
City lawyers called 31-year Drug Enforcement Agency investigator Ruth Carter to the stand this week to show negligence on the part of opioid distributors.
“I don’t believe [McKesson] did an adequate job with diversion,” Carter testified. “There was no due diligence in my opinion and there were glaring red flags.”
The plaintiffs are using DEA memos and a memorandum of understanding (MOU) between McKesson and the Controlled Substances Act (CSA) to show that McKesson had a responsibility to monitor and report suspicious drug orders from pharmacies.
The CSA only allows for four types of registrants to handle controlled substances: manufacturers, distributors, pharmacies and doctors. Each of those registrants have certain responsibilities to keep controlled substances in a closed loop to prevent them from making it onto the street.
A DEA memo from the mid-2000s, stated that even one pharmacy being supplied incorrectly by a distributor could cause serious community damage.
The MOU and DEA memos showed that the company was responsible for creating its own monitoring system that would flag suspicious pharmacies and that distributors would be responsible for reporting those incidents.
That could include large volume orders, high percentages of opioids compared to other drugs coming from one pharmacy or inspectors seeing out-of-state plates on cars in drugstore parking lots.
However, McKesson did not make a single suspicious order report to the DEA from 2008 to 2012 in Baltimore.
Carter said there were multiple pharmacies in the area like Drug City in Dundalk and NewCare Pharmacy that sent up numerous red flags. NewCare gave out about 3 million OxyContin pills in a one-year period, an amount that Carter called egregious.
The plaintiffs are also showing the jury internal McKesson documents where the standard procedure was to not flag pharmacies as suspicious because they would have to be reported to the DEA.
McKesson’s system for monitoring was to create thresholds for how many pills a pharmacy would get and they would be flagged if they passed that limit. However, according to the documents McKesson frequently warned pharmacies when they got close to the limits to game the system. Furthermore, McKesson would then increase the threshold for the pharmacies so that they never reached the limit.
“There’s really no reason to have a threshold if you do that,” Carter said.
Carter also pointed out that McKesson would sometimes send sales reps to check in on pharmacies that had concerning activity.
“It’s two conflicting departments [regulation and sales],” Carter said. “Reps want the threshold to increase because they sell more product.”
The trial is expected to go on until November if the parties do not settle. Other potential witnesses include former Mayor Stepanie Rawlings-Blake and Police Commissioner Richard Worley.
