This article was originally published by the Huntington Herald-Dispatch.
CHARLESTON — There were 24 doctors who were among the top 1% of opioid prescribers in Cabell County over two decades, but it is the outliers of those outliers who set a dreadful foundation that led to the current opioid crisis, experts say.
From 1997 to 2017, Cabell County had about 1,100 prescribers. Three of those doctors — Delano Webb, Philip Fisher and Gregory Chaney — were in the top 0.02%, 0.03% and .5% of the highest opioid prescribers in the country.
While those three doctors eventually had their licenses revoked by their regulator, the impact they made on Cabell County has left and will leave lasting negative effects within the county for years, plaintiffs argue.
Drug distributors AmerisourceBergen, Cardinal Health and McKesson are at the center of a trial in Charleston after they were accused by Cabell County and Huntington of fueling opioid abuse by shipping 127.9 million opiate dosage units into the county from 2006-14 before users were forced to turn to illicit drugs when the number of pills shipped dropped.
The distributors believe it was the Drug Enforcement Administration and an uprising in doctor prescription combined with West Virginians’ history of poor health as the culprit.
Lacey Keller, a data analyst for AK Analytics, testified at a trial in Charleston on Tuesday that opioid distributors had purchased pharmacy dispensing data, mainly the CS Ratings Program database, and would have had information available to them showing how many pills were being shipped and dispensed in the state as the flow of pills sharply increased.
The defendants have held they did not have that information because the federal government would not provide it. Keller said all they had to do was ask the pharmacy to which they shipped the pills.
To form her opinion, Keller used the data to examine factors that should have been a red flag to the defendants, such as which percent of controlled substances purchased compared to non-controlled substances, the volume of cash payments, sharp increases in opioid prescribing and more.
She referred to four top prescribing doctors who she said left a path of carnage via opioid prescribing before their licenses were voided.
Webb, a psychiatrist and pain management doctor, surrendered his medical license in 2017 and died shortly before the trial. He ranked 278th nationally in prescribing from 1997 to 2017, despite the fact he stopped prescribing in 2012.
During his time he sold 10 million dosage units of opioids and 226 million morphine milligram equivalent — a value that represents the potency of an opioid dose relative to morphine — about four times the volume of an average pain management specialist. Keller said that meant he was prescribing a higher strength of prescriptions over a long time.
By 2011, he was prescribing 1.1 million dosage units a year, the equivalent of more than 130 every hour, every day. Over 30% of the pills he prescribed were for 30-milligram doses of OxyContin, known on the street as “Oxy 30s.”
Data for The Medicine Shoppe in Huntington showed Webb accounted for 313 of 582 oxycodone prescriptions filled at the store. The doctor who prescribed the second most had written about half that amount.
A 1999 Herald-Dispatch article said Webb faced allegations that he had a sexual relationship with a 19-year-old patient, which occurred prior to 1980, to whom he prescribed controlled substances.
West Virginia workers’ compensation banned Webb in 2005 from receiving payment for treating injured workers after he was accused of over-prescribing.
Fisher, who is serving a federal sentence for a failed plot to kill his sister, had his license suspended in 2010 when the West Virginia Board of Osteopathy found his drug prescribing practices contributed to the death of at least seven of his patients while he worked at Huntington Spine Rehab and Rest Ensured Sleep Technologies, in Barboursville. He was also accused of having sexual relations with some patients.
His office and home were raided in December 2010, but no criminal charges were filed in that matter.
Chaney was a leading prescriber of opioids from 2012-15 and was prescribing 25 times more than the average general practitioner in 2015. He pleaded guilty in 2017 to obtaining a controlled substance by fraud in federal court and was sentenced to serve six months in prison.
Chaney, once the owner of Tri-State Medical Center, wrote an employee a prescription in 2015 for 120 Oxy 30 pills without a physical examination or finding it was medically necessary. The employee was then asked to turn the pills over to Chaney in exchange for about $830 in unpaid wages.
Also mentioned by Keller was Anita Dawson, a former Milton doctor who was sentenced in 2013 in federal court for aiding and abetting in obtaining controlled substances by misrepresentation, fraud, forgery and subterfuge. She admitted to supplying prescription drugs to a patient who caused a wreck on W.Va. 10, which killed Carole Crawford, her 16-year-old daughter Meaghan and her 15-year-old classmate Kelsey Kuhn in 2009.
During Dawson’s sentencing, it was said nine others died of drug overdoses under her care. She admitted that from July 2006 to May 2009 she prescribed nearly 6,000 oxycodone pills and 220 Endocet pills to a patient who was seeking pain medication for misuse.
Jennifer Wicht, from Cardinal Health, said Keller has no knowledge of the Controlled Substances Act, nor what the distributors are required to do by law, including obtaining dispensing data. One of the databases Keller used to make her findings is incomplete and uses just a sample of information, not the whole picture, Wicht said. Keller said it includes 93% of all retail pharmacy data.
Wicht said Keller could not state that any of the prescriptions written by the doctors was not proper because it was outside of her expertise. She added that Keller’s testimony did not talk about the thousand other prescribers who were prescribing properly.
Dr. Rahul Gupta, former state health officer for the West Virginia Bureau of Public Health, testified that a top prescriber alone would not be enough to initiate an investigation, Wicht said.
Paul Schmidt, an attorney for McKesson, said it is license boards that set prescription practices, not the distributors. Typically, if disciplinary action was taken against a doctor, it was kept confidential, he added.
While Keller’s testimony answered the question “what,” three days of testimony were spent reviewing the “why.” Before Keller took the stand Tuesday, the defense continued to attempt to poke holes in the plaintiffs’ gateway theory connecting heroin abuse to prescription opioids.
After hours of cross-examination from McKesson attorney Timothy Hester, Kathrine Keyes, an epidemiologist, stayed true to her finding when Cabell attorney Paul T. Farrell Jr. asked her a final question.
The finding was that the 80 million pills shipped into the county from 2006-14 was a substantial factor in the opioid epidemic. She said specifically the increase of prescription opioids led to the increase of heroin.
Hester referred to a paper whose author referenced 14 of the 16 papers Keyes had used to form her opinion. His paper differed from hers, however, and said studies that address patterns of heroin use and prescription opioids are observational and non-experimental, so conclusions about cause and effect cannot be reached.
Keyes referred to the next sentence, which said the studies are still plausible.