Medicinal morphine, derived from the opium poppy, triggered the country’s first major opioid epidemic in the late 19th century, with imports and consumption of medical opiates tripling between 1870 and 1890.

For doctors of the day, morphine administered with hypodermic needles was like a magic wand to quickly relieve pain in patients – but overprescribing quickly led to addiction and the growth of a black market for diverted morphine. medical supplies as well as illicit drugs like opium and heroin, said David Courtwright.

Medical historian and retired University of North Florida professor, Courtwright testified Tuesday afternoon and Wednesday morning in the Washington state case against three of the nation’s largest drug distributors in a civil trial which began on Monday.

The state, in a lawsuit, accused McKesson, Cardinal Health and AmerisourceBergen Drug of shipping large amounts of oxycodone, fentanyl and other pain relievers through Washington and failing to comply with the requirements they identify and report suspicious orders to the Federal Drug Enforcement Administration, contributing to the state’s opioid epidemic.

Courtwright’s testimony before King County Superior Court Judge Michael Scott apparently drew a historical parallel between the introduction of injectable morphine and Purdue Pharma’s launch of the opioid analgesic, OxyContin, in 1996. The drug was approved by the Food and Drug Administration a year earlier for the treatment of chronic and acute pain unrelated to cancer.

2019 lawsuit filed by State Attorney General Bob Ferguson against McKesson, Cardinal and AmerisourceBergen alleges drug distributors have contributed to the state’s current opioid crisis by promoting and helping market Purdue’s opioids in Washington pharmacies and hospitals. Courtwright’s testimony this week appears to rely on historical evidence of the close relationship between drugmakers and distributors to illustrate this point.

But lawyers for distributors said in opening statements that companies are not responsible for people who become addicted to prescription drugs taken out of medicine cabinets nationwide, or for the influx of fentanyl introduced into the United States. by criminal organizations. Lawyers for the companies noted that the DEA sets annual quotas for the manufacture of opioids for legitimate medical and scientific use, and drug distributors have never come close to meeting or exceeding these quotas.

In her testimony, Courtwright said that drug manufacturers and distributors have previously worked together to promote new products and increase sales.

“The epidemic of the late 19th century had a very strong medical component… as it did with the epidemic that began in the late 1990s and early 2000s,” Courtwright said.

At the same time, morphine addiction increased – the 1870s – when articles began appearing in medical journals warning of the dangers of injected morphine, Courtwright said. In the early 1880s, the medical community agreed that if misused, morphine could be addictive “and all that goes with it,” including overdose deaths, increased blood pressure. crime and other social issues, he said.

By the late 1880s, there were approximately 150,000 drug addicts in the United States who had been introduced to opiates by doctors, he said.

The years leading up to the turn of the 20th century saw the rise of “narcotic conservatism,” the ethic that physicians had to be careful in prescribing opiates and that they were not appropriate for treating types of drugs. pain that could be treated with alternatives like aspirin, which was introduced commercially in 1899, Courtwright testified.

The passage of the Harrison Narcotics Act in 1914 “truly marks the beginning of the closed system of narcotics control in the United States,” said Courtwright. It was the first time that drugmakers, distributors, doctors and pharmacists had to register with the government and keep careful records in an effort to limit the use of opiates to legitimate medical uses.

During World War II, “drug addiction in the United States reached an all-time high,” Courtwright said.

In 1970, President Richard Nixon enacted the Controlled Substances Act, which codified laws passed in the 1960s at the federal and state levels.

One of the legal provisions at the heart of the case currently being heard in Scott’s Seattle courtroom states that all registrants – manufacturers, distributors, physicians and pharmacists with access to controlled substances – have a duty to put in place controls and procedures to guard against theft and drugs. “Diversion to the black market.

The law also defines “suspicious orders” as orders of unusual size, orders that deviate significantly from a normal pattern, and orders of unusual frequency.

Narcotic conservatism – the idea that if people aren’t exposed to narcotics, they can’t become addicted to them – has been successful in reducing opioid addiction, Courtwright said. But that started to be called into question in the mid-1980s with a movement for more liberal prescription of narcotics to treat pain unrelated to cancer, he said.

A number of the early proponents Courtwright called “revisionists” became paid speakers for drugmakers, and manufacturers began funding “pain societies” and lobbied state medical boards to authorize the use of narcotics to treat pain not caused by cancer, he said.

A “significant episode” of this effort was the launch of OxyContin in 1996, Courtwright said.

On cross-examination by Kim Watterson, an AmerisourceBergen attorney who interviewed Courtwright on behalf of the three companies, Courtwright admitted that he had not interviewed doctors or pharmacists in Washington state and that in the 1980s, the risks associated with opioids were widely known for decades.

The bench trial is expected to last at least 12 weeks.


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