It would cost $472 million per year to cover medication-assisted addiction treatment under a plan Baltimore is hoping a court will approve so that it can tackle the raging opioid epidemic, an economist testified Thursday.

During his testimony, William V. Padula, a professor of pharmaceutical and health economics at the University of Southern California’s Mann School of Pharmacy and Pharmaceutical Sciences, explained his calculations for the cost of the sprawling plan, which a public health professor laid out in court Wednesday and Thursday.

In addition to treatment, the 15-year plan calls for harm reduction measures like distributing sterile syringes to people who inject opioids and providing places for people to consume drugs under the supervision of medical professionals with life-saving resources on hand. Padula put the cost of those measures at $102 million annually.

Padula’s testimony comes during the second phase of Baltimore’s civil case against drug distributors McKesson and AmerisourceBergen, now known as Cenora. A jury in November ordered the companies to pay $266 million for flooding Baltimore with hundreds of millions of addictive opioid painkillers from 2006 to 2019.

Now it’s up to Circuit Judge Lawrence P. Fletcher-Hill to determine how much else, if anything, the drug distributors have to pay more to resolve the crisis jurors found them liable for.

Baltimore originally asked Fletcher-Hill to make the companies pay $11 billion, but dropped its monetary demands to approximately $5.2 billion after the first trial. It reduced the cost by constraining the plan only to people who already misused opioids, no longer including projections of people who would develop an addiction in the future.

“The judge will have to ascertain whether the city’s evidence is sufficient to prove what abatement will cost, how it will be done, and who will do it,” Carl W. Tobias, Williams Chair in Law at the University of Richmond School of Law, said in an email.

Baltimore’s lawyers argue McKesson and AmerisourceBergen have to pay billions to offset the damage they caused by flooding the area with addictive painkillers with little regard for the havoc the companies knew they would wreak.

The companies’ reckless distribution of opioids, the city said, hooked a new generation of people in Baltimore on painkillers, a population that went on to overdose and die at staggering rates when they moved on to heroin and much more potent fentanyl after their prescriptions ran out.

Lawyers for McKesson and AmerisourceBergen disagree. They argue that the city is abusing the civil justice system to force two companies to pay for societal issues they had no role in.

In court papers, they called the city’s abatement plan a “sweeping, 15-year social policy plan related to opioid addiction and many other social issues — e.g., homelessness, re-entry after incarceration, foster care, job training, food support, and bolstering the healthcare workforce.” They said such measures are for a legislature to address, not a court.

Fletcher-Hill previously expressed reservations about the city using its public nuisance lawsuit to “address social problems of this breadth and complexity,” saying he believed such problems would be better addressed by other branches of government.

Attorneys for the companies elicited from Padula that he did not take into account insurance coverage of opioid treatment or analyze what services are already available in Baltimore.

“That wasn’t part of my assignment,” Padula said several times during cross examination. “My assignment was simply to cost out the abatement plan.”

Padula’s testimony followed that of Susan G. Sherman, a social and behavioral scientist at the Johns Hopkins Bloomberg School of Public Health whose decades of research focuses on people who use opioids.

Sherman testified about the detailed plan she created to curb Baltimore’s opioid crisis through medication-assisted treatment, harm reduction and education.

She estimated her recommendations, if adopted, would in 15 years bring down the fatality of overdoses by 23%, reduce initiation of nonmedical prescription opioid use by 7.5% and increase the percentage of opioid users in the city who were in treatment from approximately 13% today to 41%.

Sherman proposes the expansion of a range of measures Baltimore already has, like distribution of the opioid overdose reversing drug naloxone and syringe services programs where people who use opioids can receive clean needles, reducing the risk of associated infectious diseases like HIV and Hepatitis B.

Her plan also calls for a dramatic increase in the distribution of naloxone, a drug that reverses opioid overdoses, and test strips for users to check if their drugs are contaminated by potent synthetic opioid fentanyl or Xylazine, a veterinary tranquilizer that both amplifies the effects of opioids and causes people who take it to develop awful abscesses.

A standard 4 milligram dose of the drug costs $26.05, according to Padula. Fentanyl and Xylazine test strips cost $.75 and $1.25 each, respectively, the economist said.

During cross-examination, attorneys for McKesson and AmerisourceBergen attempted to sow doubt about the data supporting Sherman’s recommendations, each of which came with costly price tags calculated by Padula.

The drug distributors’ lawyers also at times seemed as though they were relitigating the previous trial, where they argued that gangs and cartels were to blame for the scourge of heroin and fentanyl killing Baltimoreans. They also argued to the jury that the companies supplied opioids to meet the demand of doctors’ prescriptions.

Through their questions, they highlighted a study that showed most participants started with heroin or another illicit drug rather than a prescription opioid.

They elicited from Sherman that her plan made no recommendations for changes to the distribution of opioids by McKesson and AmerisourceBergen.

“I was not asked to opine on this,” Sherman responded to a question about recommendations for the companies.

Have a news tip? Contact Alex Mann at amann@baltsun.com.