CLEVELAND — National pharmacies like Walmart, Walgreens and CVS and a regional pharmacy in Giant Eagle colluded with pharmaceutical companies in flooding opioid drugs throughout Trumbull and Lake Counties, and throughout the rest of the country, according to Dr. Anna Lembke, a psychiatrist and professor at Stanford University.

Lembke was the primary witness during day three of an opioid trial being watched by the nation as a possible template other communities may use in lawsuits against drug companies and pharmacies.

Lembke testified that pharmaceutical manufacturers and distributors worked to delude the public and others on the medical benefits of using opioids as long-term pain remedies.

“There is no evidence the use of opioids are good for the relief of chronic pain,” Lembke said.

Trumbull and Lake counties filed a joint lawsuit over the number of prescription painkillers dispensed in the counties between 2012 and 2016. The amount equaled 400 pills for every resident in Trumbull County, and in Lake County, it equaled 265 pills for every resident.

Estimates are each county would have to spend upward of $1 billion to address the ramifications of the drug epidemic

Since the early 1980s the major pharmaceutical companies, working with distributors and pharmaceutical companies purposefully provided misinformation stating opioids can be used to relieve chronic pain, according to Lembke.

It was during this time that a paradigm shift began in medicine and doctors began prescribing opioids more freely than at anytime before, she stated.

The misinformation initially led to a demand for medically prescribed opioids, which eventually lead to a surge of people getting illegal drugs, such as heroin and fentanyl on the streets.

It was also in the 1980s when there was an increased use of hospice care for people growing older that resulted in a corresponding effort to relieve the pain being experienced by those patients.

“The companies began telling doctors that these opioids were not addictive, so they could prescribe them at higher and higher dosages without side effects,” Lembke said.

However, the opposite was true.

The higher the dosages and the longer opiates are used, the more addictive they become, according to Lembke. Misinformation provided by the drug companies stated that doctors could tell what patients had a greater chance of becoming addicted.

“We don’t have reliable tools to determine who will, or will not, become addicted,” Lembke said. “Increased prescriptions led to increased supply led to increased exposure, which led to several generations of addictions.”

Lembke said her research of company documents show they were not innocent providers of drugs prescribed by physicians.

Each of the companies sought to increase sales of the drugs through a variety of programs that allowed patients to obtain opioid drugs for free or at heavily discounted prices. The companies also sponsored “educational seminars” for their pharmacists using misinformation provided by the pharmaceutical companies.

Pharmacies, including CVS and Walgreens, began soliciting the drug companies about ways to reach their pharmacists and retail stores for educational seminars and providing places to leave materials about their products for a price.

“This lead to a prescription opioid crisis that later led to a flood of illegal use of heroin and fentanyl,” she said.