States are treating drug makers like street dealers to address the US opioid epidemic

A nation in pain.
A nation in pain.
Image: public domain/el
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Drug dealers expect to deal with law enforcement scrutiny and take calculated risks that they may end up in court for pushing illegal product on the streets. Less so, prescription pain-pill makers. But now, some of the world’s biggest pharmaceutical companies are getting a taste of the medicine street dealers deal with every day.

On June 15, the chief prosecutors of at least 13 US states (including Massachusetts, Texas, Illinois, and Pennsylvania) announced a bipartisan nationwide investigation of opioid manufacturers’ business practices. (The exact number of participating states isn’t yet clear but those leading the charge say that a majority are involved, Reuters reports). The attorneys general believe a group of as-yet-unnamed drug companies misled doctors and their patients about the appropriate use of opioids for chronic pain and thus fueled a national crisis. ”Due to the nature of the ongoing investigation, the state attorneys general are not identifying any targets at this time,” said Massachusetts attorney general Maura Healey in a statement announcing her leadership in the investigation coalition.

The investigation is likely a first step towards a lawsuit, assuming prosecutors find the evidence they need to proceed. The national coalition of attorneys general says it will use its investigative tools, including subpoenas for documents and testimony, to determine the appropriate course of action. In other words, prosecutors will force companies to talk and hand over possibly incriminating documents, putting drugmakers in the awkward position of having to cooperate or defy the law and face charges for obstructing the investigation. “I am working with my colleagues in actively investigating whether manufacturers used illegal practices in the marketing and sale of opioids and worsened this deadly crisis,” said Healey.

Opioids, including prescription painkillers and heroin, killed more than 33,000 people in the US in 2015, according to the country’s Centers for Disease Control and Prevention. That is more than any year on record, and the numbers seem to be climbing still. In Massachusetts alone, opioid overdoses kill more than five people every day, said Healey. The state Department of Public Health estimates that more than 2,000 people died from opioid-related overdoses in 2016, which is the highest number ever recorded in the state and a 17% increase from the previous year.

The national investigation is part of a larger trend. States are struggling to treat addicted populations, and they want the businesses that profited to pay for their pain. It seems they believe the best vehicle to obtain payment will be lawsuits based on deceptive business practices, like false advertising.

Ohio and Mississippi have already filed lawsuits targeting Purdue Pharma, Johnson & Johnson, Endo International, Teva Pharmaceutical Industries, and Allergan for “overstating the drugs’ benefits and playing down the addictive qualities.” Two California counties and nine in New York; the cities of Chicago, Illinois and Dayton, Ohio; and three Tennessee district attorneys have all initiated similar suits in the last three years. The companies named in these suits have all denied the allegations, saying the US Food and Drug Administration approved their products and that warning labels disclose all the risks.

Notwithstanding that, Teva, an Israeli-based pharmaceutical maker, is awaiting judicial approval of a proposed settlement (paywall) with California’s Santa Clara and Orange counties, which sued the company in 2014. If the deal is approved by a judge, Teva will pay $1.6 million to contribute to state substance addiction treatment programs in order to resolve claims it used misleading marketing practices to push opioid painkillers.

Although Teva admits no wrongdoing and said it agreed to the deal because it believes in addressing public health issues related to opioids, under the terms of the agreement, Teva would also have to refrain from misleading advertising and promoting opioid painkillers for off-label use. It will also have to disclose when it pays to publish articles discussing opioids in medical journals, and make the risk of addiction clear in any mention of the benefits of its painkillers, Santa Clara County Counsel’s Office said on June 1.