CARDINAL

as it shipped billions of opioids into Ohio and other U.S. states. In fact, Cardinal has paid out almost $100 million in fines and settlements since 2008 in connection with the way it handled the dangerous drugs.

Ohio and many other states — as well as 1,800 cities and counties — are suing Cardinal and virtually every big company in the opioid prescription supply chain. The governments are arguing that the companies put greed over their ethical and legal duties. The resulting flood of opioids, the lawsuits say, seeded an epidemic of addiction that, according to one estimate, will cost almost a half-trillion dollars to cure.

A federal drug database unsealed as part of the federal litigation in Cleveland shows that between 2006 and 2012, Cardinal distributed more than 10 billion opioid pills across the United States, making it the third-largest distributor of such drugs.

Numbers from the same database show that between 2006 and 2014, Cardinal was the largest opioid distributor in Ohio, selling more than 1 billion pills during that period. They also show that the number of opioids distributed by Cardinal in Ohio increased 44 percent between 2006,

when the epidemic was just ramping up, and 2014, when it was raging.

Cardinal didn’t answer a question about this increase, nor did it answer questions about specific federal enforcement actions and claims made against it by state attorneys general. But spokeswoman Brandi Martin pointed to the suspicious orders that Cardinal reported to the U.S. Drug Enforcement Administration.

“As the (federal drug database) demonstrates, Cardinal Health has consistently reported sales of opioid-based medications, along with the quantity of the order and the identity of the receiving pharmacy to the DEA,” Martin said in an email.

“Until only very recently, Cardinal Health did not have access to the full set of data with information about the total shipment of opioid medicines a particular pharmacy received from other distributors. The DEA is the only entity to have had all of this data, and other entities, like the local government entities currently suing Cardinal Health, could have sought access to it. Cardinal Health questions whether this happened and, if not, why?”for its part, the DEA has said Cardinal did not consistently flag suspicious orders for opioids. In 2008, Cardinal paid the agency $34 million to

settle allegations that Cardinal failed to flag orders from “rogue internet pharmacy websites.”

“Despite DEA’S repeated attempts to educate Cardinal Health on diversion awareness and prevention, Cardinal engaged in a pattern of failing to report blatantly suspicious orders for controlled substances filled by its distribution facilities located throughout the United States,” DEA Acting Administrator Michele M. Leonhart said in a news release at the time.

Cardinal paid out additional settlements to the DEA in 2012 and 2016, the Ohio suit against opioid distributors says.

Cardinal’s Martin said distributors “have no law-enforcement power and cannot stop physicians from writing prescriptions for medication nor take unilateral action to block DEA- and statelicensed pharmacies’ ability to dispense medication.”

A lawyer with a prominent role in the Ohio opioid battle said Cardinal and other big distributors such as Mckesson Corp. and Amerisourcebergen are making a similar argument: They didn’t make the pills, they didn’t prescribe them and they didn’t sell them to customers, so they’re not responsible for the problems that were caused.

That argument is not sound, said Andrew

Kolodny, co-director of the Opioid Policy Research Collaborative at Brandeis University near Boston.

“They want everyone to think it is about the opioid manufacturers and that the distributors are just stocking the shelves. That is not true,” he said.

Plaintiffs in the Cleveland lawsuit point out that wholesalers handling federally controlled substances can’t plausibly argue that their role is the same as a truck driver carrying gravel to a construction site. They are “required to ‘maintain ... effective controls against diversion’ and to ‘design and operate a system to disclose ... suspicious orders of controlled substances,’” the suit says, quoting federal law.

Cardinal spokeswoman Martin said her company has worked to handle opioids responsibly.

“Over the years, we have also trained thousands of our people on anti-diversion practices,” she said. “Our people operate in good faith and our goal is to get it right, and we have stopped suspicious orders for the shipment of hundreds of millions of dosage units of controlled substances over the last decade.”

However, accusations that Cardinal failed to report suspicious orders, and that it continued to sell to customers for which it reported hundreds of such orders, extend well past the company’s settlement with the DEA in 2008.

For example, in its lawsuit against the company, New York Attorney General Letitia Jones contends that as Cardinal distributed hundreds of millions of opioids in the Empire State between 2010 and 2018, it appointed people with no experience to key compliance roles and provided them with no formal training. The suit accuses the company of warning customers of when their monthly limits were approaching and then helping them to circumvent the limits, The New York Times reported.

Even so, Cardinal and the other distributors are arguing in the federal case in Cleveland that the cities and counties suing them haven’t even shown that rogue opioid sales caused harm.

Ohio Attorney General Dave Yost rejects the claim by Cardinal and other opioid distributors that they’re equivalent to truck drivers, with little power to do more than haul and deliver their loads.

“There’s not a truck driver in the world that knows all the things these companies know,” he said. “They know exactly what they’re hauling, where they’re hauling, who they’re selling to and, most importantly, how much — piles and truckloads of this stuff.”