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San Francisco’s opioid lawsuit against Walgreens and a number of pharmaceutical companies commenced its trial, late last month. The suit was filed in 2018 against a panoply of defendants, but many of them have since been dismissed.thanks to settlements. But some parties remain, including Walgreens, Actavis, Teva Pharmaceuticals and Endo Pharmaceuticals.

The trial marks another instance of a governmental entity accusing drugmakers and sellers of creating a “public nuisance,” an attempt to collect damages over an addiction epidemic that persists to this day. This past November, an Orange County Superior Court judge ruled in favor of four pharmaceuticals, including Teva, in a suit brought by four cities and counties. That same month, the Oklahoma Supreme Court overturned a $465 million ruling against Johnson & Johnson.

A jury trial in Florida ended midtrial, when Walgreens agreed to settle claims brought by the Sunshine State and its cities and counties for $683 million. Florida has received more than $3 billion from opioid litigation settlements, some from Teva and Allergan.

According to the report by Courthouse News, the San Francisco opioid trial picked up Monday May 9, after a one-week hiatus with the expert testimony of Dr. Anna Lembke, who said Walgreens and three other defendants in the civil suit helped spread misinformation that led to the opioid crisis that took nearly half a million lives. Lembke, is a Stanford University professor who teaches, conducts research and treats patients and the author ofDrug Dealer, MD” and “Dopamine Nation.”

The defendants in this case used misinformation to target doctors,” Lembke testified. “Walgreens actively collaborated with Purdue to educate their pharmacists on the use of treating pain with opioids.”

She added: “Walgreens strategized with Purdue about how to get these messages out there.

After a 45-minute presentation, Lembke faced cross-examination by lawyers for Teva and Allergan who attempted to get Lembke to admit their clients played minor roles in the opioid crisis and that any misinformation they disseminated – for example, that addiction rarely resulted from opioid prescriptions – was intended for “internal use” only.

Lembke pushed back, saying many of the internal documents were used to train sales representatives who visited doctors to convince them of both the safety of opioids and the necessity of treating pain seriously. “This massive misinformation campaign stripped doctors of the true appreciation of the danger of opioid use,” Lembke said.

Teva attorney Wendy Feinstein in her cross-examination, pushed the idea that the FDA and DEA shared responsibility for the oversupply and overprescription of opioids. The FDA, she noted, approved Oxycontin and other powerful narcotics for the treatment of pain, while the DEA sets production quotas – limits on how many opiates can be produced by various manufacturers.

There is lots of blame to go around,” Lembke said.

State governments, too, played a role in the paradigm shift. California passed a number of laws, including the Intractable Pain Act in 1990 and the Pain Patients Bill of Rights in 1997, the latter of which required “doctors to advise patients who suffer from -‘severe, chronic (and) intractable’ pain that powerful narcotics are legally available that could grant them relief.”

Later, Allergan attorney Hariklia Karis asked Lembke if she thought that doctors were more influenced by sales representatives than they were by the FDA-approved drug labels, which state warnings about the various dangers of taking a drug.

“Yes,” Lembke said, adding doctors don’t always have time to keep up with the latest research and are “much more influenced by peers and sales reps.”

Lembke’s testimony will resume Wednesday.