opioid prescriptions Story Archives - West Virginia Public Broadcasting

Virginia Doctor Who Prescribed More Than 500k Doses Of Opioids Granted New Trial

Authorities said Joel Smithers headed a drug distribution ring that contributed to the opioid abuse crisis in Kentucky, Ohio, Tennessee, Virginia and West Virginia.

A Virginia doctor who was sentenced to 40 years in prison after prescribing more than half a million doses of highly addictive opioids in two years has been granted a new trial by a federal appeals court that found the instructions given to jurors at his trial misstated the law.

Joel Smithers was convicted in 2019 of more than 800 counts of illegally prescribing drugs.

During his trial, prosecutors said patients from five states drove hundreds of miles to see him to get prescriptions for oxycodone, fentanyl and other powerful painkillers. Authorities said Smithers headed a drug distribution ring that contributed to the opioid abuse crisis in Kentucky, Ohio, Tennessee, Virginia and West Virginia.

In a ruling issued Friday, a three-judge panel of the Richmond-based 4th U.S. Circuit Court of Appeals vacated Smithers’ convictions and ordered a new trial.

Jurors at Smithers’ trial were instructed that in order to find Smithers guilty of illegally prescribing drugs, they must find that he did so “without a legitimate medical purpose or beyond the bounds of medical practice.”

But the appeals court found that that jury instruction was improper, citing a 2022 U.S. Supreme Court ruling that said a defendant must “knowingly or intentionally” act in an unauthorized manner to be guilty of that charge. Even though the jury convicted Smithers in 2019, his case was subject to the 2022 Supreme Court decision because his appeal was still pending when that ruling was issued.

Justice Roger Gregory, who wrote the 3-0 opinion for the 4th Circuit panel, cited Smithers’ testimony at his trial, when he said almost all of his patients had had significant car or workplace accidents and that he believed there was a legitimate medical purpose for each of the prescriptions he wrote. Gregory wrote that even though “a jury might very well not have believed Smithers’ testimony that he acted with a legitimate medical purpose,” the defense provided evidence that could have led to a finding of not guilty on each of the unlawful distribution charges against Smithers.

“In sum, because there was evidence upon which a jury could have reached a contrary finding, the instructional errors were not harmless,” Gregory wrote.

During Smithers’ trial, a receptionist testified that patients would wait up to 12 hours to see Smithers, who sometimes kept his office open past midnight. Smithers did not accept insurance and took in close to $700,000 in cash and credit card payments over two years, prosecutors said.

“We understand the 4th circuit decision following a recent change in the law and look forward to retrying the defendant, ” U.S. Attorney Christopher Kavanaugh said in a statement Monday.

Beau Brindley, an attorney for Smithers, said that since the 2022 Supreme Court decision, “only one thing decides a doctor’s guilt or innocence: his own subjective beliefs about his prescriptions.”

“Under this new legal standard, with the focus now solely on his intent, Dr. Smithers looks forward to being fully exonerated at trial,” Brindley said in a statement.

After West Virginia Opioid Verdict, Another Case Postponed

The trial for a lawsuit accusing three major U.S. drug distributors of causing a health crisis throughout West Virginia has been postponed.

A trial in a lawsuit accusing three major U.S. drug distributors of causing a health crisis throughout West Virginia was postponed Tuesday, a day after the companies prevailed in another case in the state.

Attorneys who represented Cabell County and the city of Huntington on the losing end of a verdict announced in federal court Monday were granted a continuance of a trial a day later in Kanawha County Circuit Court. The trial involves more than 100 other cities and counties statewide against the same defendants: AmerisourceBergen Drug Co., Cardinal Health Inc. and McKesson Corp.

Attorneys for the municipalities and the companies met in the judge’s chambers just prior to the start of the hearing. Once in the courtroom, attorneys for the plaintiffs asked that the start of the trial be continued. The defense had no objections and the request was approved.

In the federal bench trial, U.S. District Judge David Faber said the plaintiffs offered no evidence that the companies distributed controlled substances to any entity that didn’t hold a proper registration from the U.S. Drug Enforcement Administration or the state Board of Pharmacy. The defendants also had systems in place to monitor suspicious activity, as required by the Controlled Substances Act, he said.

“Plaintiffs failed to show that the volume of prescription opioids distributed in Cabell/Huntington was because of unreasonable conduct on the part of defendants,” Faber wrote in a decision that came nearly a year after closing arguments in that case.

The Cabell County-Huntington lawsuit alleged the distributors created a public nuisance by flooding the Ohio River community with 81 million pills over eight years. The suit sought more than $2.5 billion that would have gone toward abatement efforts. But Faber said West Virginia’s Supreme Court has only applied public nuisance law in the context of conduct that interferes with public property or resources. He said to extend the law to cover the marketing and sale of opioids “is inconsistent with the history and traditional notions of nuisance.”

The companies blamed an increase in prescriptions written by doctors along with poor communication and pill quotas set by federal agents.

Huntington has long been an epicenter of the nationwide opioid addiction and overdose epidemic that has been linked to more than 500,000 deaths over the past two decades. That status led West Virginia to being aggressive in lawsuits over the trauma earlier than most states. It settled with the three distributors in 2017 and 2019 in deals worth a total of $73 million.

But the state did not participate in a $21 billion nationwide settlement with those companies that was finalized this year and would have resulted in a larger payout for West Virginia than what the state received in the earlier deals.

The nationwide impact of Monday’s ruling in West Virginia could be muted because the companies have struck the broader settlement, which is intended to have most of the funds go to fighting the opioid crisis.

In another lawsuit, the state of West Virginia reached a tentative $161.5 million settlement in May with Teva Pharmaceuticals Inc., AbbVie’s Allergan and their family of companies and a $26 million settlement in March with Endo Health Solutions.

W.Va. Drug Plan Calls for Limiting Prescriptions

Updated Friday January 12 at 4:18 p.m.

State health officials are proposing a multifaceted plan for confronting the drug crisis killing hundreds of West Virginians each year, one that would require action by everyone from lawmakers to doctors to judges to emergency responders to the general public.

Some of the changes might be possible to make administratively, but much of the work will depend on legislative approval.

“We have to stop this terrible drug epidemic. We have to,” Gov. Jim Justice said in his address to state lawmakers Wednesday night. “If we don’t it will cannibalize us.”

A dozen state senators that day had introduced legislation to generally limit initial doctor and dentist prescriptions of opiates for acute, or short-term, pain to seven days. The bill would limit those painkiller prescriptions to three days for minors and for emergency-room outpatients.

These and many other changes are recommended in a plan released Thursday by a panel of public health experts from West Virginia and Johns Hopkins University with state agency and public input. They’re taking additional comments for another week.

This plan recommends limiting initial opioid prescriptions, increasing oversight to stop inappropriate painkiller prescribing, and requiring all emergency responders to carry overdose antidotes. It also calls for expanding public awareness that addiction is a treatable disease, increasing diversion of criminal drug case defendants to treatment programs and increasing treatment options for all patients.

The report further calls for expanding programs to support families with someone addicted, expanding peer-based support and better access to contraceptives for people with drug disorders.

More than 30,000 West Virginians are already in drug treatment. The state has the nation’s highest drug overdose death rate, fueled by prescription painkillers.

Overdose deaths increased from 735 in 2015 to a record 884 statewide in 2016, and the toll could be rising still.

“Mixtures of opioids and stimulants such as amphetamines, methamphetamines, and cocaine are surging in 2017,” the panel wrote. “It appears likely there may be over 1,000 overdose deaths in West Virginia in 2017.”

Most involved opioids. While steady increases from 212 fatal overdoses in 2001 were initially driven by pharmaceuticals, the authors noted a shift to illicit heroin that began in 2012 has since increased with more potent fentanyl added to street drugs.

By examining hundreds of deaths, the Bureau of Public Health found that 81 percent had interacted with health systems, 56 percent had been jailed, and 71 percent were on Medicaid. Males were twice as likely to die from overdoses as females.

The report calls for mandatory hospital and emergency responder reporting of non-fatal overdoses, so that outreach can be arranged.

“This is a public health crisis of the highest order,” said Dr. Rahul Gupta, who heads the bureau.

The report is posted online at http://dhhr.wv.gov/bph/Pages/default.aspx.

Morrisey Announces Opioid Public Service Announcements

West Virginia Attorney General Patrick Morrisey says a series of public service announcements is aimed at encouraging state consumers to explore alternatives to opioid prescription pills for pain therapy.

Morrisey unveiled the public service announcements Thursday that will appear in print, radio and social media websites. He says the PSAs also will promote a better understanding of the opioid epidemic.

Consumers are being encouraged to ask their doctors why they are being prescribed opioids, whether alternative treatments are available and, if not, whether a lower effective dosage is available.

Morrisey wants to reduce opioid use in West Virginia by 25 percent.

The initiative is a cooperative effort between the attorney general’s office and the West Virginia boards of medicine and osteopathic medicine.

Obama Administration Doubles Down on Efforts to Reduce Opioid Abuse

President Obama’s administration is doubling down on efforts to reduce prescription opioid and heroin abuse across the nation after two major announcements in the past week.

Last week the Centers for Disease Control and Prevention released revised guidelines for the prescription of opioids for chronic pain. President Obama also announced that he would speak at the National Prescription Drug and Heroin Summit in Atlanta next week.

“The president’s trip to Atlanta follows his trip last year to West Virginia where he met with many people affected by the opioid epidemic,” says Michael Botticelli – Director of National Drug Control Policy. Botticelli hosted a conference call with reporters Tuesday to detail the Obama administration’s continued efforts to combat substance abuse.

“In West Virginia he announced a number of new public and private sector actions to address the epidemic, including a presidential memorandum on prescriber training and opioid use disorder treatment,” he says.

The revised CDC prescribing guidelines were not a direct result of Obama’s trip to West Virginia, but are a part of the efforts to reduce opioid and heroin use across the nation – particularly in hard hit areas like Appalachia. Botticelli says the guidelines are intended to be of particular help to primary care providers who currently account for prescribing nearly half of all opioids.

But the White House is not just looking to change policies in the fight against drug use. Earlier this month the federal government also awarded 94 million dollars to 271 health centers in 45 states, the District of Columbia and Puerto Rico. Five clinics in West Virginia received more than one and a half million dollars of that grant money.

“These critical funds for states will help to improve and expand substance abuse disorder services with an emphasis on medication assisted treatment for opioid use disorders,” says Botticelli.

Botticelli says funding states is a critical piece of the federal strategy for combating the epidemic and that letters were sent out to all 50 governors highlighting best practices. These include requiring all providers to be trained in opioid prescription, requiring providers to use their state’s prescription drug monitoring program and supporting syringe services programs.

Appalachia Health News is a project of West Virginia Public Broadcasting, with support from the Benedum Foundation.

CDC Issues New Guidelines for Opioid Prescriptions

As the rates of drug abuse–and more directly opioid abuse–continue to grow in West Virginia, new federal guidelines could help cut down on the number of prescribed opioids.

The federal Centers for Disease Control and Prevention have released new guidelines for doctors who prescribe opioids for chronic pain. The guidelines advise primary care doctors to cut down on the number of prescriptions of medicines like OxyContin and Percocet and try to find other means to treat the pain—pushing them to look toward more holistic care methods. The guidelines aren’t intended for doctors treating cancer patients or for end-of-life care.

Primary care doctors prescribe half the opioid painkillers consumed in the United States and according to the CDC, 1 in 4 patients with chronic pain can experience opioid dependence.

Last month Senator’s Shelley Moore Capito and Kirsten Gillibrand from New York introduced legislation requiring the CDC to issue guidelines for prescribing opioids for acute pain, such as pain following a broken bone, wisdom tooth extraction or other surgeries. The CDC began working on the guidelines released Tuesday last year.