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Brain can't tell pills from heroin - W.Va. opioid lawsuit plaintiffs' expert

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(Reuters) - Prescription opioid drugs such as oxycodone have exactly the same effect on the brain as heroin, according to testimony on Tuesday by an expert witness for the West Virginia city and county suing the three largest U.S. drug distributors for fueling a deadly opioid epidemic.

Corey Waller, a Michigan-based addiction and emergency medicine expert, was the first witness called by the city of Huntington and Cabell County in the long-awaited trial of their case against AmerisourceBergen Corp, McKesson Corp and Cardinal Health Inc.

During his direct examination by Cabell lawyer Paul Farrell of Farrell Law in Charleston, West Virginia federal court, Waller outlined the chemistry of opioid drugs and the science behind addiction.

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Most opioids are created through small chemical modifications of the same basic molecule, found in the opium poppy, Waller explained. To the brain, he said, synthetic opioids and heroin are "identical."

"The brain doesn't know the drug you just gave it," Waller said. "It just knows the action that it has."

That effect is to trigger the release of dopamine, the "reward" chemical closely linked to happiness and motivation, Waller said. A dose of an opioid, he said, can release up to nine times more dopamine than what a person might experience on the "best day ever."

"It's a car that has the gas pushed to the ground and just let go without a driver," Waller said.

In response, Waller said, the brain lowers its production of dopamine in the future, meaning opioid users eventually need the drugs just to maintain a baseline level of dopamine needed to function normally.

Under cross-examination by Jennifer Wicht of Williams & Connolly, a lawyer for Cardinal, Waller said that when he was practicing emergency medicine in the mid-2000s, opioids were regularly prescribed by doctors to treat chronic pain as part of a broad push in the medical profession to treat pain more aggressively.

"You have no reason to believe that they were not operating in the good faith practice of medicine, correct?" Wicht asked.

Tablets of the opioid-based Hydrocodone at a pharmacy in Portsmouth, Ohio, June 21, 2017. REUTERS/Bryan Woolston/File Photo

"I believe that they were acting in good faith," Waller said.

The distributors' primary defense in the case is that the amount of opioids dispensed is determined by doctors' prescribing decisions and by federal regulators' quotas on production. They argue that they cannot be liable for simply filling orders, and deny plaintiffs' claims that they ignored evidence that drug were being diverted to illegal channels.

The outcome of the bench trial before U.S. District Judge David Faber, expected to last up to 12 weeks, could help lay the groundwork for settlements in a sprawling nationwide litigation over the opioid crisis, which encompasses more than 3,300 lawsuits by local governments against opioid manufacturers, distributors and pharmacies.

Huntington and Cabell are seeking money to address the toll the opioid crisis has taken on their communities — estimated by one of their expert witnesses at $2.6 billion. They previously opted out of a proposed $26 billion nationwide settlement with the three distributors and drugmaker Johnson & Johnson.

The case is City of Huntington, West Virginia et al v. AmerisourceBergen Drug Corp et al, U.S. District Court, Southern District of West Virginia, No. 3:17-cv-01362.

For Cabell County: Paul Farrell of Farrell Law

For Huntington: Anne Kearse of Motley Rice

For AmerisourceBergen: Robert Nicholas of Reed Smith

For Cardinal: Enu Mainigi of Williams & Connolly

For McKesson: Paul Schmidt of Covington & Burling

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