Local News | What you need to know in Baltimore's opioid case before it heads to jurors

More than six weeks after Baltimore opened its civil case against a pair of drug distribution companies the city accuses of fueling the opioid epidemic, the trial is nearing a conclusion.

Lawyers for the city and drug distributors are expected to give closing arguments Thursday before Circuit Judge Lawrence P. Fletcher-Hill sends the case to the jury for consideration.

Baltimore alleges that the companies, McKesson and AmerisourceBergen, flooded the city with hundreds of millions of addictive pain pills with little regard for the havoc they knew the drugs were capable of wreaking.

The companies counter that cartels, gangs and street crews are to blame for bringing heroin and illicit fentanyl to Baltimore, which they say drove up the city's overdoses rather than prescription opioids.

After hearing days of testimony, watching countless hours of videotaped depositions and reviewing scores of documents, it will be up to the jury to decide who to believe.

Jurors will first consider whether it is more likely than not the companies did something wrong that contributed to Baltimore's opioid crisis, said Carl W. Tobias, Williams Chair in Law at the University of Richmond School of Law. If the jury finds the companies liable, it will then consider the issue of damages.

Fletcher-Hill ruled during the trial that the jury will not be allowed to consider punitive damages, or money the companies would have to pay as punishment for their actions -- a big win for the drug distributors. The judge allowed the rest of the case to continue.

"I'm satisfied there is sufficient evidence, however narrow it is, that could be viewed by a reasonable juror to satisfy the City's obligations to prove unreasonable conduct and that that conduct had a substantial factor effect on causing some portion of the opioid problem in Baltimore, and that, to the extent of that portion, that can be linked causally to the City's claims for past damages and for future damages," Fletcher-Hill said the day of his ruling, Oct. 22.

Tobias told The Baltimore Sun that Fletcher-Hill's ruling was "very significant in terms of the damages piece because punitive damages are meant to punish and make an example of the defendant and oftentimes they're much larger than compensatory damages." Punitive damages, he added, "can be 10 times the compensatory damages, which I think are going to be substantial in this kind of case."

Rather than punish defendants, compensatory damages are meant to reimburse plaintiffs for costs they incurred or will incur because of the defendants actions.

Baltimore's legal team hired William V. Padula, a professor of pharmaceutical and health economics at the University of Southern California's Mann School of Pharmacy and Pharmaceutical Sciences, to calculate how much the opioid epidemic had cost the city.

He estimated that Baltimore spent at least $197 million over the last 13 years -- an average of more than $15 million a year -- combatting the raging opioid crisis via its police, fire and health departments and the Mayor's Office for Homeless Services. His calculations projected those city agencies would incur more than $73 million in expenses related to the opioid epidemic from 2024 to 2029.

Padula's testimony followed that of a range of city employees who spoke in court of the everyday toll of the epidemic: A fire official said the department responds to up to 6,000 opioid overdoses a year. A leader in the Department of Public Works' Solid Waste Bureau testified to waste-laden blocks associated with opioid use. A health department employee described the agency's efforts to combat the crisis, such as distributing clean needles to users.

Dr. Joshua Sharfstein, former Baltimore health commissioner and Maryland health secretary, said the city was "on the right trajectory" with declining heroin overdoses in the early 2000s "until something came along and knocked us off." That something, he said, was the proliferation of prescription opioids in Baltimore.

City lawyers say drug manufacturers misleadingly marketed the painkillers as harmless and distribution companies sent massive quantities of pills to pharmacies around Baltimore, hooking a broader population on addictive opioids. When the country cracked down on painkillers, the city argues, people's prescriptions ran out and they were forced to turn to heroin and, more recently, fentanyl, which is many times more potent.

McKesson and AmerisourceBergen collectively controlled about 60% of the prescription opioid market in the Baltimore area for more than a decade, city lawyers said in opening statements. From 2006 to 2019, those companies sent 320 million pills of oxycodone -- just one kind of opioid painkiller -- to pharmacies in and around Baltimore.

Defense attorneys said their clients were merely supplying drugs for prescriptions doctors legally called in. They argued the companies had no way of knowing whether the scripts were legit.

But Ruth Carter, a former Drug Enforcement Administration agent, testified McKesson and AmerisourceBergen ignored "red flags" that the painkillers they sold were ending up in the wrong hands.

A DEA agent in October 2005 requested documents about drug distributor McKesson's sale of opioids to an internet pharmacy in East Baltimore.

In a March 2009 email to colleagues, a McKesson official noted that a Dundalk pharmacy owner was hiring guards to prevent the sale of prescription opioid pills in his parking lot.

An opioid manufacturer in November 2012 warned McKesson about its concerns over a different East Baltimore pharmacy's dispensing of opioids.

In each case, the company continued selling pills to the pharmacies for some amount of time.

"In my opinion, they did not respond to the red flags in a timely manner or in an adequate manner. I don't believe they did an adequate job preventing diversion," said Carter, referring to the phenomenon of prescription drugs being sold illicitly.

McKesson sent one of its once largest customers, Drug City Pharmacy in Dundalk, 3 million oxycodone pills a month at one point. Company regulators regularly signed off on requests from a sales representative to increase the pharmacy's monthly supply because its "business is increasing at a very high rate."

That pharmacy, Carter testified, was filling large quantities of prescriptions from distant pill mill doctors who ran pain clinics eventually shut down by federal law enforcement. It's also the place where the owner hired off duty cops to catch people selling pills in the parking lot.

"This is just so much oxycodone," Carter said. "There's no explanation I can think of."

The owner of the pharmacy at the time in question, Mark Lichtman, said in a videotaped deposition that McKesson salesman Garry Adam "congratulated me for being the top oxy person for McKesson." Adam testified in the case after city attorneys played footage of Lichtman's deposition, and said when a McKesson lawyer asked him whether he ever said as much to Lichtman that his former customer was "a liar."