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Lawyers for opioid makers challenge addiction expert's testimony

The opioid drug Opana ER, which was manufactured

The opioid drug Opana ER, which was manufactured by Endo Pharmaceuticals. Credit: Howard Schnapp

Attorneys for pharmaceutical manufacturers on Tuesday challenged the credibility and testimony of a Stanford University addiction expert who testified that their clients’ misleading promotional materials helped fuel the opioid epidemic that has devastated thousands of Long Island families since the late 1990s.

Under contentious cross-examination from Harvey Bartle, an attorney for Teva Pharmaceuticals, Dr. Anna Lembke acknowledged that she has been paid hundreds of thousands of dollars appearing as an expert witness for plaintiffs suing opioid makers in recent years. Bartle later played a video of Lembke at a 2015 Stanford panel on opioids, where she said that opioid prescriptions surged in the 1980s because of a "groundswell" among doctors who feared they were not doing enough to alleviate pain, especially among those with cancer or at the end of life.

Lembke, a professor of psychiatry and a physician who treats patients struggling with substance abuse, said the increase in prescriptions "came from a really good place" and "really needed to happen" during that panel appearance.

Lembke said Bartle had mischaracterized her testimony.

Lembke had testified Monday that defendants Teva Pharmaceuticals, Endo Pharmaceuticals and Allegan Finance used misleading promotional materials to convince health care providers that their opioid medications were safe — with disastrous results for thousands of Long Island residents who have died from overdoses.

The lawsuit filed in New York State Supreme Court alleges drug manufacturers and distributors created a public nuisance by misleading physicians and patients with marketing that minimized the dangers and addiction risks of opioids. State and county officials say they hope to hold the companies accountable for the death and misery caused by the opioid epidemic and to recoup hundreds of millions of dollars for treatment, recovery and prevention.

Attorneys for the drugmakers and distributors have said their clients are not responsible for the epidemic, arguing 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.

Bartle also suggested that "pill mill" doctors — corrupt physicians who wrote opioid prescriptions to addicts for profit — had far more responsibility for the opioid epidemic than Lembke had testified. He brought up Queens physician Dante Cubangbang, who federal prosecutors alleged in a 2018 indictment had sold millions of pills to individuals without legitimate medical reasons.

New York State regulators knew Cubangbang — who pleaded guilty in federal court — had profited from the opioid epidemic, Bartle said.

Bartle also suggested that Lembke had not reviewed evidence of other parties' responsibility for the opioid epidemic, such as corrupt doctors.

Lembke said attorneys for New York State had not provided Cubangbang's indictment or other documents related to his arrest. "I don’t think it would have been necessary" to see the indictment before she testified, she said.

Earlier in the day, under cross-examination from Endo attorney Jim Heirschlein, Lembke admitted that she did not know how many physicians in Nassau, Suffolk or New York State had been influenced by the pharmaceutical promotional messages or how many prescriptions for opioids had been written in the states since the late 1990s, when the epidemic began.

"You don’t know what the correct number should be," Heirschlein said.

Allegan Finance attorney Mike Brock told the jury and Lembke that the company did not acquire the opioid pain medication Kadian until late 2008, decades after OxyContin manufacturer Purdue began its campaign to promote opioid use for pain in the 1990s. Lembke also acknowledged she did not know how many times sales reps for the company had visited doctors and other health care providers after the company acquired Kadian.

"You don’t know the impact of those sales calls, whether the sales went up or the sales went down, correct?"

"For specific Kadian products, no," she said.

The landmark opioid litigation, before state Supreme Court Justice Jerry Garguilo, will be the first of its kind in the nation to go before jurors, who are expected to hear from hundreds of witnesses.

Former FDA commissioner David Kessler is expected to be the next witness called by the plaintiffs.

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