Executives at one of the US’s largest drug distributors circulated rhymes and emails mocking “hillbillies” who became addicted to opioid painkillers even as the company poured hundreds of millions of pills into parts of Appalachia at the heart of America’s opioid epidemic.
The trial of pharmaceutical firms accused of illegally flooding West Virginia with opioids was told last week that senior staff at AmerisourceBergen, the 10th-largest company in the US by revenue, routinely disparaged communities blighted by the worst drug epidemic in the country’s history.
One email in 2011 included a rhyme built around “a poor mountaineer” named Jed who “barely kept his habit fed”. According to the verse, “Jed” travels to Florida to buy “Hillbilly Heroin”, the nickname for OxyContin, the drug manufactured by Purdue Pharma which kickstarted an epidemic that has claimed more than 500,000 lives.
Florida was well known through the 2000s for lax regulation of pain clinics where doctors illegally prescribed and dispensed large amounts of opioids to those the verse calls a “bevy of Pillbillies”.
Another rhyme described Kentucky as “OxyContinville” because of the high use of the drug in the poor rural east of the state.
When Kentucky introduced new regulations to curb opioid dispensing, an AmerisourceBergen executive wrote in a widely circulated email: “One of the hillbilly’s [sic] must have learned how to read :-)”.
Another email contained a mocked up breakfast cereal box with the word “smack” under the words “OxyContin for kids”.
One of those who wrote and circulated disparaging emails was Chris Zimmerman, the senior executive responsible for enforcing AmerisourceBergen’s legal obligation to halt opioid deliveries to pharmacies suspected of dispensing suspiciously large amounts of the drugs, often in concert with corrupt doctors who made small fortunes writing illegal prescriptions.
After Florida cracked down on pill mills in 2011, Zimmerman sent an email to colleagues. “Watch out George and Alabama,” he wrote, “there will be a max exodus of Pillbillies heading north.”
Zimmerman told the trial he regretted circulating the mocking rhyme but it was “a reflection of the environment at the time”. He claimed the emails were simply a means of expressing frustration as the company worked to prevent opioids falling into the wrong hands. Zimmerman said the company culture was of the “highest calibre”.
Paul Farrell, a lawyer for a West Virginia county, put it to the executive that the emails reflected a culture of contempt.
“It is a pattern of conduct by those people charged with protecting our community, and they’re circulating emails disparaging hillbillies,” he said, according to the Mountain State Spotlight.
The city of Huntington and surrounding Cabell county are suing AmerisourceBergen and two other major distributors, McKesson and Cardinal Health, as part of a series of federal cases over the pharmaceutical industry’s push to sell narcotic painkillers which created the opioid epidemic.
This is the first case to go to a full trial after AmerisourceBergen, McKesson and two other companies agreed to pay $260m to settle another of the bellwether cases in Ohio two years ago.
The two West Virginia local authorities accuse the distributors of putting profit before lives and turning Cabell county into the “ground zero” of the epidemic. A data expert told the trial that over nine years the three distributors delivered about 100m opioid doses to Cabell county – which has a population of just 90,000.
Farrell put it to Zimmerman that he failed to enforce company policies to report suspicious orders to the Drug Enforcement Administration (DEA) and to withhold deliveries while they were investigated. Zimmerman claimed that if the company had stopped deliveries it would have harmed patients who needed the drugs.
“We’re a company, we’re not an enforcement agency and we’re not a regulatory agency,” he said.
Drug distributors delivered 1.1bn opioid painkillers to West Virginia between 2006 and 2014, even as the state’s overdose rate rose to the highest in the US.
In 2017, AmerisourceBergen paid $16m to settle legal action by West Virginia over opioid deliveries but did not admit wrongdoing. The same year, McKesson paid a record $150m fine after the DEA accused it of breaking the law.
Critics, including DEA officials, have accused the companies of regarding the fines as “the cost of doing business” and then carrying on as before.
Chris McGreal is the author of American Overdose, The Opioid Tragedy in Three Acts