CINCINNATI -- What started as a trickle turned into a flood.
Over the past six months, dozens of county governments in Kentucky and Ohio have sued three major drug companies, alleging they're responsible, in part, for the region's opioid problem.
Cincinnati sued the three distributors in August, demanding the firms reimburse the city for the costs of curbing the epidemic. Hamilton County joined the suit a day later.
At least 23 Ohio counties in Ohio and 42 Kentucky counties have filed lawsuits against AmerisourceBergen, McKesson and Cardinal Health since July.
The suits allege the companies did not report suspicious orders as required by law, allowing opioids to flood the market and increasing the government's cost to respond to dramatic spikes in fatal overdoses.
Boone, Campbell and Kenton are among the Kentucky counties suing. Kentucky Attorney General Andy Beshear said pharmaceutical companies need to pay for the harm they have caused.
“We’re right here -- Kentucky, Ohio and West Virginia -- at Ground Zero, and it’s the challenge of our times,” he said.
In 2016, doctors prescribed an opioid drug to 2.3 million Ohioans, about 20 percent of the state’s population, according to a lawsuit filed by Butler County. Statewide, Ohio saw a 36 percent increase in fatal overdoses in 2016.
AmerisourceBergen, Cardinal Health and McKesson account for 85 to 90 percent of all revenues from drug distribution in the U.S., estimated at $378.4 billion in 2015, the suit says.
Butler County saw 153 fatal overdoses in 2016, more than five times the amount of fatal overdoses in 2012. The Butler County Coroner’s Office investigated 30 overdose deaths in the month of April alone; 28 of them were fentanyl or heroin-related, according to the suit.
MORE: Overdoses are the leading cause of death in Butler County so far this year, coroner reports
Clinton County alleges in its lawsuit that the opioid crisis has created an increase in the number of children in the care of Job and Family Services. The county will need an additional $1 million through the end of 2018, the lawsuit states.
Clermont County Commissioner David Painter said the drug distribution companies failed to protect the public, and they should pay for the harm caused by the drugs they sold.
“Frankly, the taxpayers don’t have that kind of money,” Painter said. “They didn’t create the opiate epidemic, and for us to resolve it with our contribution is a daunting task.”
Beshear said Kentucky filed a lawsuit against Endo Pharmaceuticals. The suit alleges the company's products, Opana and Opana ER, caused 190 overdoses in Kentucky last year.
“We are suing these large pharmaceutical companies because these products are ravaging these communities while these companies have made billions,” Beshear said. “Yet, they haven’t provided the first real dime to help us make up for the harm that’s been caused.”
In 2012, Endo Pharmaceuticals pulled its best-selling drug, Opana ER, off the market, CNN reported. The company claimed this was due to high chances of abuse. Opana ER contains oxymorphone, a powerful opioid similar to fentanyl but more potent than morphine and oxycodone.
Endo introduced a new formula of Opana ER and began phasing out the original version in February 2012. Only one difference separated the drugs: the new version had a hard outer coating, making pills more difficult to crush and snort. Endo said this would curb abuse, but the Food and Drug Administration disagreed.
In June, the agency asked Endo to take Opana ER off the market because “the benefits of the drug may no longer outweigh its risks.”
“The abuse and manipulation of reformulated Opana ER by injection has resulted in a serious disease outbreak. When we determined that the product had dangerous unintended consequences, we made a decision to request its withdrawal from the market,” said Dr. Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research.
The FDA says that was the first time the agency took steps to end the sale of a currently marketed opioid because of the public health consequences of abuse. Endo says neither the FDA's request, nor the decision to remove Opana ER, "reflect a finding that the product is not safe or effective when taken as prescribed."
Opana was the drug of choice in Scott County, Indiana, in 2016. People abusing the powerful painkiller typically crushed it, mixed it with liquid and then injected it. About 210 people contracted HIV from sharing and re-using dirty needles, cotton and cookers.
RELATED: Could Greater Cincinnati be the next Scott County?
In a statement to WCPO, Cardinal Health said:
"The people of Cardinal Health care deeply about the devastation opioid abuse has caused American families and communities and are committed to helping solve this complex national public health crisis. We are industry leaders in implementing state-of-the-art controls to combat the diversion of pain medications from legitimate uses, and have funded community education and prevention programs for a decade. We operate as part of a multi-faceted and highly regulated healthcare system – we do not manufacture, promote or prescribe prescription medications to members of the public – and believe everyone in that chain, including us, must do their part, which is ultimately why we believe these copycat lawsuits filed against us are misguided, and do nothing to stem the crisis. We will defend ourselves vigorously in court and at the same time continue to work alongside regulators, manufacturers, prescribers, pharmacists and patients to fight opioid abuse and addiction."
McKesson shared this statement:
“We take our responsibility to help manage the safety and integrity of the pharmaceutical supply chain extremely seriously and are committed to maintaining -- and continuously improving -- strong programs designed to detect and prevent opioid diversion. While we don’t manufacture, prescribe or dispense opioids to patients, we are doing everything we can to help address this crisis in close partnership with doctors, pharmacists, government and other organizations across the supply chain.”
AmerisourceBergen Drug Corp. shared this response:
AmerisourceBergen and other wholesale drug distributors are responsible for getting FDA-approved drugs from pharmaceutical manufacturers to DEA-registered pharmacies, based on prescriptions written by licensed doctors and health care providers. Our role in doing so is quite widespread across different therapies, with the distribution of opioid-based products constituting less than two percent of our sales.
We are dedicated to doing our part as a distributor to mitigate the diversion of these drugs without interfering with clinical decisions made by doctors, who interact directly with patients and decide what treatments are most appropriate for their care. Beyond our reporting and immediate halting of tens of thousands of potentially suspicious orders, we refuse service to customers we deem as a diversion risk and provide daily reports to the DEA that detail the quantity, type, and the receiving pharmacy of every single order of these products that we distribute.
We are committed to collaborating with all stakeholders on ways to combat opioid abuse.
Web Editor Abby Anstead contributed to this report.