Baltimore finished presenting its legal case against a pair of opioid distributors Monday, marking the end of a crucial phase in a trial that accuses the companies of contributing to a deadly addiction and overdose crisis.

“The city rests,” said Bill Carmody, the lead attorney with Baltimore’s outside law firm, Susman Godfrey.

The opioid trial is far from over, though. The distributors, McKesson and AmerisourceBergen, will begin presenting their cases this week. The trial is expected to continue into next month.

The city’s final witness was Gary Tuggle, a Baltimore native and veteran of the Drug Enforcement Administration who served as an interim commissioner of the Baltimore Police Department in 2019.

At the city’s request, Tuggle evaluated DEA data on prescription opioid orders from 2006 to 2019 — the years for which the federal data is publicly available — and tallied how many “suspicious” orders, according to Tuggle’s analysis, went to Baltimore pharmacies.

Tuggle concluded that the distributors shipped hundreds of thousands of suspicious orders to pharmacies in Baltimore and Baltimore County during those years. His estimate for the total number of suspicious orders ranges from under 350,000 to more than 500,000 because he used multiple methods to calculate orders that were unusually large or otherwise stood out as suspect.

In all, the companies shipped between 116 million and 170 million doses of oxycodone that Tuggle flagged as being part of suspicious orders, according to his testimony.

Orders that Tuggle considered suspicious made up as much as a third of the distributors’ business in Baltimore and Baltimore County by some estimates, he said.

Drug distributors are required to monitor suspicious orders of controlled substances, block them from shipping, and report them to the DEA. The city claims in its lawsuit that McKesson and AmerisourceBergen ignored that obligation and shipped orders that they should have known were problematic.

Tuggle also said he saw little evidence that the companies did enough to examine opioid orders and their pharmacy customers.

“I saw very little due diligence and the due diligence that I did see was grossly inadequate,” Tuggle said.

“Regulation aside, I think there’s an inherent responsibility to conduct due diligence for public safety,” he said later in his testimony.

Lawyers for the drug distributors spent hours attacking Tuggle’s methodologies on cross examination.

For example, once Tuggle identified a suspicious order in the data, he marked all other shipments of opioids to that pharmacy as suspicious for the rest of that month. He explained that he chose this method because the drug distributors should have blocked all orders to the pharmacy until they could investigate the suspicious order, but lawyers for the drug companies argued that the method inflated the number of flagged orders Tuggle identified.

Andrew Stanner, an attorney for McKesson, also pointed out that Tuggle was a top official at the DEA when the agency approved “astronomical” quotas for opioid production in the United States.

The DEA quotas set a ceiling for the production of controlled substances that can be legally manufactured. During the height of opioid prescribing in the United States, the DEA dramatically increased the production quotas for opioids like oxycodone. The agency has faced criticism for its response to the prescription drug crisis, and drug companies like the defendants argue that it offered little guidance on how to interpret suspicious order regulations.

The DEA had access to the same federal sales data that Tuggle used to search for suspicious orders, Stanner noted during his questioning.

The city’s case lasted over a month, though court has not been in session for about half of October because of scheduling conflicts. Jurors have been asked to provide their availability through mid-November.

The drug companies have claimed that illicit drugs like heroin and fentanyl are the true culprits behind Baltimore’s deadly opioid crisis. They have pointed to the illegal drug trade and claim they followed the law by shipping legal prescription opioids to registered pharmacies after doctors wrote prescriptions for patients.

The city’s legal team has argued that Baltimore was making progress in reducing opioid overdose deaths until cheap, easily accessible painkillers flooded the community. Baltimore’s overdose death rate from 2018 to 2022 was nearly double that of any other large American city, a Banner/New York Times investigation found.

Madeleine O’Neill is a Baltimore-based freelance journalist.