In May 2008, as the opioid epidemic was raging in America, a representative of the nation's largest manufacturer of opioid pain pills sent an e-mail to a client at a wholesale drug distributor in Ohio.
Victor Borelli, a national account manager for Mallinckrodt, told Steve Cochrane, vice president of sales for KeySource Medical, to check his inventories and "if you are low, order more. If you are okay, order a little more, capesce?"
At Mallinckrodt, Borelli used the phrase "ship, ship, ship" to describe his job and then joked, "destroy this e-mail … Is that really possible? Oh Well …"
Those excerpts are quoted in a 144-page plaintiffs' filing along with thousands of pages of documents unsealed by a judge's order on Friday in a landmark case in Cleveland against many of the largest companies in the drug industry. A Drug Enforcement Administration database has revealed that the companies inundated the nation with 76 billion oxycodone and hydrocodone pills from 2006 through 2012. Nearly 2,000 cities, counties and towns are alleging that the companies knowingly flooded their communities with opioids, fueling an epidemic that has killed more than 200,000 since 1996.
The plaintiffs' documents depict some employees as driven by profits, undeterred by knowing their products were wreaking havoc. The defendants' response is due July 31.
In January 2009, Borelli told Cochrane in another e-mail that 1,200 bottles of oxycodone 30 mg tablets had been shipped. "Keep 'em comin'!" Cochrane responded. "Flyin' out of there. It's like people are addicted to these things or something. Oh, wait, people are …" Borelli responded: "Just like Doritos, keep eating. We'll make more."
The two could not immediately be reached for comment.
The Controlled Substances Act requires drug companies to control against diversion, and to design and operate systems to identify "suspicious orders," defined as "orders of unusual size, orders deviating substantially from a normal pattern, and orders of unusual frequency." The companies are supposed to report such orders to the DEA and refrain from shipping them unless they can determine the drugs are unlikely to be diverted to the black market. The plaintiffs, in the filing, allege that the companies ignored red flags and failed at every level.
At Cardinal Health, one of the nation's largest drug distributors, then-CEO Kerry Clark in January 2008 wrote in an e-mail to Cardinal senior officials that the company's "results-oriented culture" was perhaps "leading to ill-advised or shortsighted decisions," the filing contends.
In the previous 18 months, Cardinal had been hit with nearly $1 billion in "fines, settlements, and lost business as a result of multiple regulatory actions," the filing alleges, including the suspension of licenses at its distribution centers for failing to maintain effective controls against opioid diversion.
On Aug. 31, 2011, McKesson's director of regulatory affairs, David Gustin, told his colleagues he was concerned about the "number of accounts we have that have large gaps between the amount of Oxy or Hydro they are allowed to buy and the amount they really need," according to the filing. "This increases the 'opportunity' for diversion by exposing more product for introduction into the pipeline than may be being used for legitimate purposes."