The federal courthouse in Charleston, where opioid distributors are on trail. Photo by Lauren Peace.

Craig McCann sat at the witness stand, calculator in hand. He’d been asked to crunch some numbers.

Crunching numbers is what McCann does for a living. The economics consultant was called to testify Monday in the trial on behalf of Cabell County and the City of Huntington against the drug distributors Cardinal Health, McKesson and AmerisourceBergen because of his expertise sorting through drug manufacturing and distribution data kept by the U.S. Drug Enforcement Agency.

The data over a nine year period — broken down by McCann — shows that every year distributors pumped disproportionately more doses of opioids per person into Cabell County than they did the rest of the country.

Between 2006 to 2014, McCann showed, distributors supplied approximately 40 doses of the drugs oxycodone and hydrocodone annually, per person nationally. In Cabell County, they supplied 122 doses per person. 

Approximately 109.8 million doses of opiates were pumped into the county over the nine-year period. McCann said that about 90% of that volume came from the distributors currently on trial.

When looking specifically at the “Big Three” on trial, McCann said that data showed AmerisourceBergen supplied about eight times the number of doses annually per capita to Cabell County as it did to the broader country. Cardinal Health distributed about four times as many.

The economist stopped short of breaking down the number of doses per capita supplied by McKesson, but showed that approximately 76% of total shipments by the distributor into Cabell County  were shipped to a Veterans Affairs clinic — “the first instance when we see a significant amount [of oxycodone and hydrocodone] going to anything but chain pharmacies,” McCann said.

According to McCann’s analysis, “effectively all [shipments] came from a single distribution center for each of these three distributors.”

That means the volume of pills being pumped into Cabell County and the state wasn’t watered down or spread out across multiple depots. They came from a single hub, where the abnormally high supply could have been detected.

But distributors didn’t act.

Crunching the numbers

Reaching such conclusions wasn’t an easy task. McCann had sorted through approximately 500 million records of data using statistical processing software and aided by an army of math Ph.Ds.

But when asked on the stand to calculate the total number of oxycodone and hydrocodone doses distributed by the “Big Three” between 2006 and 2014, McCann stumbled.

“The calculator won’t take numbers that large. I’m sorry,” he said.

At the end of his testimony, attorneys for all three distributors objected to McCann’s  graphs and stats.

“To combine different data sources [and make judgments is] improper,” said McKesson attorney Paul Schmidt.

U.S. District Judge David Faber said he wouldn’t rule until defense lawyers cross-examined McCann after Cabell County attorney Peter Mougey finished questioning. 

But on Monday, little time was left for the defense to have their say.

The afternoon largely consisted of continued comparisons of average opioid distribution by each individual company to pharmacies at the national, state and county level. 

But the plaintiffs went a step further, singling out massive outliers: pharmacies in West Virginia that had at times received approximately 50 times the average national monthly supply. At its height, Family Discount Pharmacy in Logan County, received approximately 100,000 doses of hydrocodone every month in 2010.

Attorneys for the drug distributors again objected to that data point, arguing that nitpicked distribution to pharmacies outside of the geographic boundaries of Cabell County were not relevant to the case. 

Still, pharmacies in Cabell County also showed an increase. SafeScript pharmacy in Huntington, for example, received 35,000 dosage units of oxycodone from AmerisourceBergen on average each month — seven times the national average, McCann said.

Mougey also asked McCann questions about trends in distribution over time, showing that while opioid distribution per month increased between 2006 and 2011 across the country, the increase in Cabell County was higher. 

Tomorrow, the defense will have the opportunity to cross-examine McCann. Once that’s complete, plaintiffs are expected to call four current AmerisourceBergen employees to the stand, including Senior Vice President Chris Zimmerman and Vice President David May.

To read updates from the trial and for additional coverage, check out Lauren’s tweets:

Reporter Eric Eyre contributed reporting to this piece.

Lauren Peace is a Report for America Corps Member who covers public health.