A top official in the Nassau County Medical Examiner’s Office testified on Wednesday in a landmark trial that when he first arrived in the county in 2009, police and prosecutors seemed unaware of the looming opioids epidemic.
But Dr. Joseph Avella, chief of toxicology, said that after he tried to bring to their attention what he was seeing in his office as cases of opioid overdose deaths rose sharply, officials responded.
"By the time I got to Nassau County, there was a natural and I think an appropriate concern about heroin, but in my estimation I didn’t see that the police department and the district attorney’s office … I don’t think that they fully grasped the problems that we were seeing with prescription opioids," Avella said.
"At that point I tried to make it clear to some people … make them aware of this problem," he said. Later, "I felt there was a response, absolutely."
The case numbers rose dramatically, he said.
"We began to see a number of fentanyl cases that we had never seen before. Fentanyl, we used to encounter it you know, say three, four, five times a year. We were now all of a sudden seeing fentanyl cases 50, 60, 70 times a year. Much, much greater frequency."
Avella was testifying in the trial at Touro College in Central Islip the day after opioids manufacturers and distributors reached a $1.1 billion settlement with New York State and Nassau and Suffolk counties.
But the trial is continuing, with three remaining drug manufacturers and a drug distributor — Allergan PLC, Teva Pharmaceutical Industries and Endo International, along with distributor Anda Pharmaceutical Products.
The New York opioid litigation is the first case of its kind in the nation to go before a jury. Other states are looking at it as possible bellwether in litigation involving the opioid epidemic.
Lawyers for New York State and the counties say they will prove that the defendants created a "public nuisance" by pushing the drugs that created the opioid epidemic that has devastated Long Island families and communities, killing thousands.
Attorneys for the drugmakers and distributors have said their clients are not responsible for the opioid epidemic, arguing that they followed all regulations and are being made scapegoats for the actions of health regulators who encouraged opioid use, doctors who overprescribed the painkillers and other forces beyond their control.
The $1.1 billion settlement announced Tuesday is part of a potential $26 billion national settlement that would involve governments around the country. New York’s agreement will stand even if the national deal falls through, attorneys said.
Avella was shown numerous charts that his office produced illustrating the rise in use of opioids such as oxycodone. The charts showed how that drug and others began to overtake heroin as a leading cause of death by overdose in Nassau.
One chart showed that the number of deaths from oxycodone in Nassau rose from three to 36 between 2004 and 2011, while the number of heroin deaths went from 24 to 32 in the same period.
The total nonheroin deaths from opiates went from 28 to 96 in that time period, the chart showed.