CHARLESTON, W.Va. (AP) — The influx of prescription opioids into West Virginia communities was the main driver of the state’s drug crisis — more than poverty, job loss and other economic stressors, an epidemiologist testified Tuesday at the ongoing trial against three major pharmaceutical companies.

“The economic conditions were the kindling, but the opioid suppliers were the gasoline that was poured directly on that kindling,” said Dr. Katherine Keyes, director of Columbia University’s Psychiatric Epidemiology Training Program.

Keyes was questioned on the stand all day Tuesday in the state’s bench trial against Johnson & Johnson subsidiary Janssen Pharmaceuticals Inc., Teva Pharmaceuticals Inc., AbbVie Inc.’s Allergan and their family of companies.

The West Virginia trial began last week and is expected to last up to two months. State and local governments, Native American tribes, unions, hospitals and other entities have filed more than 3,000 lawsuits involving the opioid epidemic in state and federal courts.

Most allege the industry created a public nuisance in a crisis that has been linked to the deaths of 500,000 Americans over the past two decades.

A trial opened Monday in Florida’s opioid epidemic lawsuit against the Walgreens pharmacy chain, which state officials accuse of prioritizing profits over health by improperly dispensing millions of powerful painkillers that caused tens of thousands of deaths. Closing arguments are expected this week for an opioid-related trial in Washington.

Keyes described West Virginia, one of the poorest U.S. states, as the “epicenter of the opioid crisis in the U.S.” More people have died of overdoses in the state per capita than any other, all while the state has been grappling with a loss of jobs from the declining coal industry. West Virginia was one of the only U.S. states to lose population during the 2020 U.S. census.

But while she said there is a relationship between poverty and unemployment and drug deaths, the number of prescription drugs present in communities makes a much greater impact.

“Economic factors certainly are important and certainly play a role and we should be paying attention to those, but the opioid supply is by far the predominant risk factor,” she said.

Keyes said she’d cited at least 400 scientific papers in her research preparing for trial. One 2021 study reviewing opioid shipments to retail pharmacies across the country showed that Mingo County, West Virginia, had the highest rate of per capita pill volume in the country in 2008. The county saw an influx of 372 pills per capita, compared with a population-weighted national average of around 35.

Lawyers representing the pharmaceutical companies said West Virginia has greater rates of prescription drug use across the board. They also said there are higher rates of individuals who are diagnosed with chronic pain conditions in the state compared with the national average, a statistic likely related to the higher number of people working jobs that require manual labor.

During her testimony, Keyes said that the wave of prescription opioids drove a tsunami of drug dependence and prescription opioid-related overdose deaths. As the number of people being prescribed opioids decreased, people turned to heroin and fentanyl.

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