CHARLESTON, W.Va. (AP) — Lawyers for the state of West Virginia concluded the first week of a trial against three major opioid makers Friday by outlining how pharmaceutical companies rebranded the highly addictive drugs decades ago to expand their prescriber base while downplaying the risks.

The bench trial began Monday in the state’s case against Johnson & Johnson subsidiary Janssen Pharmaceuticals Inc., Teva Pharmaceuticals Inc., AbbVie Inc.’s Allergan and their family of companies.

State lawyers spent hours on Friday questioning Matthew Perri, a pharmaceutical marketing expert who said he had “painstakingly” reviewed thousands of pages of marketing materials from the companies.

Much of the early testimony on Friday focused on materials produced by Cephalon Inc., a company bought by Teva, to sell fentanyl-based medications Actiq and Fentora.

Perri described a “paradigm shift” from the late 1990s to early 2000s in which the companies transitioned from marketing opioids as drugs designed for terminal cancer patients to drugs designed to treat long-term pain.

Materials used by sales representatives to market the drugs downplayed or failed to mention the risks of addiction associated with opioid use, Perri testified. Instead, marketing described drugs as “safe and highly effective” at controlling pain and “improving functionality and quality of life” for patients.

“It took down the barriers that were there, and effectively lowered the bar” for the prescription of opioid medications, he said. “Opioids could be prescribed sooner in the treatment process, with less worry.”

One 2010 training manual used by sales representatives marketing the morphine drug Kadian repeatedly minimized the risk of addiction among users. Allergan owns the rights to Kadian.

“Despite the continued unscientific beliefs of some clinicians, there is no evidence that simply taking opioids for a period of time will cause substance abuse or addiction,” the document reads.

The report says “it appears likely” that most patients who abuse opioids from pain management practices had an “abuse problem” beforehand.

“This topic is so important and so much misinformation exists,” it reads.

The bench trial is expected to last up to two months.

Earlier in the week, the judge heard a video deposition from the new White House drug czar Dr. Rahul Gupta, who testified that the opioid epidemic got so bad in drug-ravaged West Virginia that the state was having trouble finding foster parents to care for children.

Gupta previously served as West Virginia’s chief health officer from 2015 until 2018 and as as executive director of the Kanawha-Charleston Health Department. He was confirmed last fall by the U.S. Senate as the director of the White House Office of National Drug Control Policy.

His testimony was recorded before he was named to his White House position.

West Virginia long has led the nation in the rate of drug overdose deaths. Gupta said the opioid crisis also led to increases in public health problems such as Hepatitis B and HIV cases and neonatal abstinence syndrome, a withdrawal in newborns caused by exposure to drugs in the womb.

The lawsuit filed by Attorney General Patrick Morrisey accuses the companies of creating a public nuisance and violating the state’s Consumer Credit and Protection Act.

Attorneys for the companies said in opening arguments Monday that their individual products in question had considerably less than 1% of the market share in West Virginia, were medically necessary prescriptions and could not have contributed to the state’s opioid problems.

In November, a California judge ruled in favor of Johnson & Johnson, Allergan, Endo International, Teva and others, saying that local governments hadn’t proven in a lawsuit that the pharmaceutical companies used deceptive marketing to increase unnecessary opioid prescriptions and create a public nuisance.

Nationwide settlements were finalized in February by Johnson & Johnson and distributors AmerisourceBergen, Cardinal Health and McKesson over their role in the opioid addiction crisis. That cleared the way for $26 billion to flow to nearly every state and local government in the U.S. West Virginia previously reached settlements in separate lawsuits, including $37 million with distributor McKesson in 2019, and $20 million with Cardinal Health and $16 million with AmerisourceBergen in 2017.

In Charleston, a separate bench trial wrapped up last summer in federal court in a lawsuit accusing AmerisourceBergen, Cardinal Health and McKesson of fueling the opioid crisis in Cabell County and the city of Huntington. That judge has not indicated when he will rule.

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