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Opioid Litigation Media Report 10/20/17
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Radnor Town Hall: Opioid problem knows no boundaries, officials say
Oct 19, 2017 | Delco Times News (PA)
By Linda Stein
Sometimes it starts with pills. Sometimes it starts with marijuana. But the scourge of opioid addiction strikes everywhere, including upscale suburbs like those on the Main Line. -
Milwaukee County panel backs hiring legal experts to file suits against opioid drug makers
Oct 19, 2017 | Milwaukee Journal Sentinel (USA Today Network)
By Don Behmn
Milwaukee County's growing opioid crisis has prompted a panel of supervisors to endorse hiring legal experts to prepare lawsuits against pharmaceutical companies and distributors suspected of contributing to an epidemic of overdose deaths and addiction. -
Trump's opioid commission turns to the role of health insurers in addiction crisis
Oct 20, 2017 | USA Today
By Gregory Korte
President Trump's opioid commission will turn its attention Friday to the role health insurance policies might play in contributing to the addiction crisis, the chairman of the commission said. -
Blindsided Trump officials scrambling to develop opioid plan
| Politico
By Brianna Ehley, Josh Dawsey, and Sarah Karlin-Smith
President Donald Trump overrode his own advisers when he promised to deliver an emergency declaration next week to combat the nation’s worsening opioid crisis. -
Fox51 Good Day
Oct 20, 2017 | KFKX Fox Tyler, Tx
View clip here: https://app.criticalmention.com/app/#clip/view/30194301?token=6060f27e-9723-4d31-b820-713b00d62816
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Radnor Town Hall: Opioid problem knows no boundaries, officials say
Oct 19, 2017 | Delco Times News (PA)
By Linda Stein
Sometimes it starts with pills. Sometimes it starts with marijuana. But the scourge of opioid addiction strikes everywhere, including upscale suburbs like those on the Main Line.
That was the sobering message from the Delaware County Heroin Task Force presentation on Opioid Use at the Radnor Township Building Tuesday.
Steve Graham Jr., a resident who is a recovering addict, shared his experiences. Although he had a privileged upbringing, and attended Malvern Prep and Cornell University, he became hooked on pills. It started when Graham was in college and had “a bunch of injuries.”
“My drug of choice was downers, opiates and marijuana,” Graham said. “Cornell was a high-stress environment.” He took drugs on weekends but eventually found out, “the more you take it, the more you need it.
“I wanted to get clean,” he said. “It wasn’t easy…That addiction was so strong.”
As for parents who deal with addicted children, he said, “It’s not your child anymore. I did things I never would do. It takes over your brain. You do anything to get high.” At the end of his addiction, Graham had a $500-a-day pill habit and “the pain to get off [drugs] was incredible,” he said.
With the help of his “very supportive family,” Graham has been off drugs for six years. When his wife left, “to me that was rock bottom,” Graham said. He knew he had to do something, he said, and went to Alcoholics Anonymous and Narcotics Anonymous. He went to three meetings a day and also sought doctors for treatment. He took Suboxone, a medicine used to treat addiction.
“It saved my life,” he said. “It’s one tool in your tool belt.”
Graham also said that he does not think that the standard 30-day drug treatment programs are long enough and that 90 days should be the minimum.
In the meantime, he has lost friends to addition.
“I’m really grateful to be here and be clean. I try to help as many kids as possible,” he said.
Delaware County Councilman David White, who co-chairs the Delaware County Heroin Task Force with District Attorney Jack Whalen, said the county recently filed a lawsuit against the major pharmaceutical companies, including Purdue Pharma, Teva, Johnson & Johnson and others that market opioid drugs.
“These pharmaceutical companies colluded,” said White. “They literally told the doctors these drugs were not addictive.”
Some 80 percent of opioids manufactured in the world are sold in the United States, he said. So far this year, there have been 185 drug-related deaths and 162 were opioid related.
“We can see exactly what their plan was,” said White, about the pharmaceutical companies. “Their plan was to sell pills. We’re going after these pharmaceuticals. They need to be held accountable.”
The county hopes to use money gained from the lawsuit to help fund treatment programs, he said.
“They’re the ways we’re trying to think outside the box,” White said. District Attorney “Jack Whelan and I started the Heroin Task Force…This is an epidemic that affects anyone.” Whether people are rich or poor, men or women, “it makes no difference,” he said. The overdose victims range from 18 to 65, he said.
“We believe we have a great case,” said White. “[Delco] District Attorney Whalen will continue this fight and we will win this war. We’re losing hundreds of people from this.”
He recommended that people remove unneeded pills from their medicine cabinets and bring them to the township building in Radnor where there is a box for safe disposal in the basement. Lower Merion Township also has a safe disposal box in its township building.
Radnor Police Sgt. Joe Pinto agreed, saying “when it comes to heroin there is no stereotype” and people are dying in the smallest houses to “million dollar homes.”
Before Superintendent William Colarulo joined the department, drug cases were handled “on the street level.” People caught with drugs would go to jail. But now the township partners with the county drug task force to go after dealers that supply narcotics, Pinto said.
“Our goal is to stop the drugs at the source,” Pinto said. “They’re just preying on these people who are victims.” Drug use leads to “ancillary crimes” like thefts from cars, retail theft or burglaries, he said. Addicts steal to “get objects they can turn into money to purchase drugs.”
In Radnor Township, statistics show heroin incidents included six in 2013, three in 2014, seven in 2015 and 27 in 2016. As of Aug. 17, there have been 11 this year. Five people died from opioids in 2016 and one so far this year, Pinto said. Police used Narcan (which can revive a person who has overdosed on an opioid) five times in 2016 and once in 2017. Pinto has seen people who are revived by Narcan curse at the officer who saved them for interfering with their high.
“It’s important for a community like Radnor to get out in front of it,” said Pinto.
Radnor Commissioner Luke Clark said there is a lot of intergovernmental cooperation throughout the county. Pinto said county detectives help the township with undercover operations.
As the father of three young children, Clark asked what he can do to keep them safe from drugs, in addition to getting rid of unused painkillers. When Clark was in high school at The Haverford School, two of his friends began to use drugs.
“One ended up in jail on continual probation violations and could not get off of it,” he said. “Another went to jail for DUIs and could not get off heroin.
“My friends were not supervised,” he said. “It led to some issues down the road.”
The Radnor Township Police are “the top line of defense. They are all over this,” said Clark. People need to know how a small amount of carfentanyl will kill you as will fentanyl that drug dealers mix with heroin, he said.
“This is not joke,” Clark said. As a lawyer who handles family law cases he sees parents with drug problems and the custody master held a bar association forum on that problem.
“In my capacity as a commissioner, we are aware of the problem,” said Clark. “We are looking at what we can do about this. It’s not something we can turn a blind eye to.”
Whelan said fentanyl “is everywhere” but there have been no carfentanyl cases in Delaware County so far, although there was one in Montgomery County.
“Carfentanyl is used to tranquilize elephants,” Whelan said. “If someone is using carfentanyl, they’re not going to make it.”
The stronger the heroin is, the more Narcan is needed to revive them, he said.
In one case it took six doses of Narcan to revive a person.
“It’s extremely dangerous,” Whelan said. People taking heroin “don’t know what’s in it,” he said. It can be cut with fentanyl or other substances. In the 1970s heroin was only 10 percent pure, he said. Now the heroin in the Philadelphia region is 90 percent pure. There are also risks of exposure to fentanyl and carfentanyl for first responders.
Pinto said they were forced to “change our entire way we handle narcotics.” The police had used field kits to test for drugs. Now they “double bag them and put warning signs on them” and send the suspected drugs to a lab. They also keep a Narcan dispenser in the evidence room and, for safety, officers do not handle drug evidence alone.
Delaware County recently purchased a new device that can be used to detect either drugs or explosives that are still inside containers, said Whalen. The detector, which cost around $50,000, will help with safety, he said.
“We’re about to make it available to all our police departments and the bomb squad,” he said. Also, the county will supply masks and gloves for first responders that need them.
White said Delaware County also offers a new second chance court along with a drug court to help drug offenders get treatment.
“It’s a long-term recovery court,” said White. “To complete your sentencing you need to recover.” The drug court recovery rate is about 84 percent and Whalen praised the drug court judges.
“The only way we’re going to beat this epidemic is we’re all going to have to work together,” said White. “Each judge is very concerned and they want to see success.”
Clark noted that during the academic year, one third of Radnor’s population is comprised of college students.
Valley Forge Military Academy & College President John C. Church Jr., a retired Marine colonel, said the college has a “medical amnesty program” where “it’s incumbent on the cadet to indicate a problem. It’s a recovery approach and that’s the way to go.” With the younger students in the academy, parents are brought in, he said. But for the college students, “medical amnesty is a quick way to get them into a program and get them help. We are not going to arrest our way out of this problem.”
In response to questions from resident Sarah Armstrong, Whelan said that people typically become addicted to opioids after being injured in sports or a car accident. Also, some people “have more propensity to get addicted,” he said. There is also the “gateway effect” with alcohol and marijuana leading to pills and heroin. He’s “gotten a lot of letters from people in prison” attesting to that, he said.
“It would be a critical mistake to legalize marijuana,” said Whelan. “It’s detrimental to our children, detrimental to our society.”
If parents condone teenage drinking, their teenagers are “going on to the next drug and the next one,” he said. Marijuana affects teenager’s brains, he said.
And a very small percentage of people manage to get off heroin, he said.
“It’s an overwhelming drug,” said Whelan. “It affects the brain. It reconditions the brain.” Typically, it takes six months for the brain to recover, he said.
He urged parents to be careful about what drugs are prescribed for their children.
“If your child has their wisdom teeth taken out, do you really want to give them opioids?” Whelan asked. He urged parents to “strictly monitor that. A lot of time for minor problems, physicians are giving them prescription drugs.”
Pinto said that once addicted, people go from pills that they can’t afford anymore to heroin.
Jim Yannopoulos, a resident, asked Graham how long it took him to reach the low point where he was ready to quit and was told six years.
“You pointed out you were never involved in law enforcement…People who don’t have the money are more likely to come in contact with law enforcement,” said Yannopoulos.
He asked what signs friends and family should look for.
Graham said signs of drug use include touching their nose a lot and sweating, or changes in personality from being outgoing and friendly to withdrawing into the basement to watch TV. Also, discovering missing money.
“We have to start with the doctors,” said Graham. If he had not been prescribed so many drugs, he might not have become addicted, he said.
“A lot of this starts with education and doctors,” said Graham. Although there is a fine line since some people with real pain issues need relief.
“My wife didn’t know for years, “he said. “I was in front of her all day, every day.”
With heroin, look for physical evidence like glassine bags, a spoon, a tourniquet to tie around their arm, said Whelan. He warned parents not to be deterred from looking into their children’s rooms by notions of privacy.
“As a parent, it’s my house,” said Whelan.
Graham added that there can be track marks and bruising on arms or wearing long sleeves in hot weather to hide marks.
Whelan said that while most doctors are good, his office has prosecuted doctors who operate pill mills. One doctor in Media recently was sentenced to 10 to 20 years, he said.
“I actually never went to doctors,” said Graham. “Dealers used elderly women and men to get the drugs and sell them to us … I never went to a doctor. There was more risk of getting caught.”
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Milwaukee County panel backs hiring legal experts to file suits against opioid drug makers
Oct 19, 2017 | Milwaukee Journal Sentinel (USA Today Network)
By Don Behmn
Milwaukee County's growing opioid crisis has prompted a panel of supervisors to endorse hiring legal experts to prepare lawsuits against pharmaceutical companies and distributors suspected of contributing to an epidemic of overdose deaths and addiction.
The county board's judiciary committee on Thursday recommended board approval of Corporation Counsel Margaret Daun's request to bring in outside counsel to initiate one or more lawsuits to recover some costs of battling the epidemic.
"Our citizens are suffering and dying," Daun said Thursday.
Companies that have repeatedly testified before Congress that these prescription painkillers would not be addictive, as well as distributors that ship such extreme volumes of the drugs into communities that the availability feeds a secondary black market, should be held accountable, Daun said.
The corporation counsel's office is tracking similar lawsuits in Chicago, Dayton, Ohio, Suffolk County, N.Y., and other communities across the U.S. and would hire a law firm with experience, she said.
Outside legal counsel would be paid only if the county receives a financial settlement as a result of claims made against the companies, under terms of the resolution proposed by Daun.
"We pay nothing up front," Daun said Thursday.
The Milwaukee County medical examiner estimates there will be more than 325 opioid overdose deaths in the county this year, a pace that is closing in on nearly one opioid death every day in the county.
The office expects to record a total of 426 drug-related deaths in 2017, a nearly 25% increase from the 343 deaths last year.
"Milwaukee County has experienced a tremendous loss of lives," Supervisor Peggy West said in support of the request.
"We will try to redress these wrongs," Daun said.
The county has spent millions of dollars on programs and services aimed at curbing the crisis and widespread addiction to painkillers, according to Daun. West agreed that the epidemic has placed a costly burden on nearly all county services, from public and behavioral health to the medical examiner and law enforcement.
Milwaukee County Executive Chris Abele's recommended 2018 county budget includes $1.1 million in new spending targeting the local opioid crisis and addiction.
The plan includes adding two employees — a forensic chemist and forensic pathologist — for the medical examiner's office to respond to an increased volume of autopsies due to overdose deaths.
The medical examiner's office also would purchase an advanced mass spectrometer instrument to reduce the time required for screening drugs by 80%, and provide that information to law enforcement and public health officials. The county and City of Milwaukee would split the $400,000 cost of the equipment.
In 2018, the Behavioral Health Division would boost spending on the county's AODA (Alcohol and Other Drug Addiction) residential treatment program by $700,000, under the budget plan. The program serves county residents aged 18 to 59 with a history of alcohol or other drug abuse.
The division also receives $200,000 to establish a nonmedical peer-run respite program to help people deal with a short-term crisis and connect them to other services.
More than two dozen states, cities and counties in the U.S. already have filed lawsuits against drug companies. as well as drugstore chains.
Among the companies targeted in those legal actions: Purdue Pharma, maker of OxyContin; Endo Pharmaceuticals, maker of Percocet; Janssen Pharmaceuticals, maker of a fentanyl skin patch; and Cephalon Inc., maker of a fentanyl lozenge.
Fentanyl is a pain medication 50 times more powerful than heroin.
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Trump's opioid commission turns to the role of health insurers in addiction crisis
Oct 20, 2017 | USA Today
By Gregory Korte
President Trump's opioid commission will turn its attention Friday to the role health insurance policies might play in contributing to the addiction crisis, the chairman of the commission said.
"Why are we still not seeing addiction services covered, and mental health services covered as broadly as every other type of disease?" New Jersey Gov. Chris Christie asked in an interview with USA TODAY. "And what do we need to do to make sure that the law is enforced and followed?"
The Mental Health Parity and Addiction Equity Act of 2008 requires health insurers to treat mental health and substance abuse disorders the same as any other disease, without additional limits, co-pays or deductibles. But a report from a task force convened by President Barack Obama last year found that insurers still place a number limits on coverage, like more stringent pre-authorization requirements.
The role of health insurance companies has also come under increasing scrutiny for policies that sometimes favor powerful and addictive painkillers over less addictive — and more expensive — formulations.
More: As he chairs Trump's opioid commission, Christie champions his home-state drug companies
Testifying at the commission are executives from some of the nation's largest insurance companies: Aetna, Anthem, Blue Cross Blue Shield, Cigna, Harvard Pilgrim Health Care
Kaiser Permanente, UnitedHealth Group and UPMC Health Plan.Rep. Elijah Cummings, the ranking member of the House Oversight Committee, also has questions for many of those same companies. He's following up on a report by The New York Times last month that insurance companies "erected more hurdles to approving addiction treatments than for the addictive substances themselves."
"This is not a hypothetical problem," Cummings wrote in letters to seven insurance companies Thursday. "The over-prescription of opioids leads to addiction and death."
Also testifying at today's hearing of the opioid commission:
► Secretary of Labor Alexander Acosta, whose department regulates about 70% of the employer-provided health insurance plans.
► Secretary of Veterans Affairs David Shulkin, who oversees the largest health care system in the United States.
► Deputy Attorney General Rod Rosenstein, who will speak about efforts to crack down on the importation of fentanyl, a powerful opioid often substituted for heroin.
In previous meetings, the commission heard from advocates for people suffering from addiction and from the pharmaceutical industry.
The commission will hold its last meeting Nov. 1 before delivering its final report to Trump.
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Blindsided Trump officials scrambling to develop opioid plan
| Politico
By Brianna Ehley, Josh Dawsey, and Sarah Karlin-Smith
President Donald Trump overrode his own advisers when he promised to deliver an emergency declaration next week to combat the nation’s worsening opioid crisis.
“That is a very, very big statement,” he said Monday. “It's a very important step. ... We're going to be doing it in the next week.”
Blindsided officials are now scrambling to develop such a plan, but it is unclear when it will be announced, how or if it will be done, and whether the administration has the permanent leadership to execute it, said two administration officials.
“They are not ready for this,” a public health advocate said of an emergency declaration after talking to Health and Human Services officials enlisted in the effort.
Trump’s off-script statement stunned top agency officials, who said there is no consensus on how to implement an emergency declaration for the drug epidemic, according to interviews with officials from the White House, a half dozen federal agencies, state health directors and lobbyists.
Trump had previously promised an emergency declaration in August, after his handpicked opioid commission headed by New Jersey Gov. Chris Christie made it an urgent recommendation. But the commitment quickly got bogged down in White House infighting and concerns about the order’s scope and cost.
Members of Trump’s Domestic Policy Council, budget director Mick Mulvaney and former HHS Secretary Tom Price opposed the plan for months because of the multi-billion-dollar price tag, legal issues and questions about how it would be implemented, according to White House officials. Price argued that the government could respond efficiently without taking such a step.
"Everyone wants opioids to be a priority, but there's a lot of resistance to calling it an emergency" because of the legal and budgetary implications, said one senior administration official.
In the meantime, White House senior counselor Kellyanne Conway convened meetings and events on the problem, drawing episodic interest from the president, aides said.
Emergency declarations are typically used to respond to isolated events such as hurricanes and floods, or disease outbreaks. Using one to combat a nationwide epidemic with no obvious end point might require unprecedented resources and raises numerous legal and other questions, said one senior White House official.
By mid-October, with no commitment from the White House, Christie publicly needled Trump for not declaring the drug crisis an emergency, saying it was “not good.”
A few days later, Trump resurrected his promise.
“The reaction was universal,” said a senior health official specializing in drug policy. “Believe it when [we] see it.”
Multiple sources in and out of relevant federal agencies said that key leaders on the opioid issue had not been asked to draw up strategies and tactics.
A senior FDA official said she did not know who was in charge of the emergency declaration efforts and described the effort as “such a mess.”
“I would hope that the agency heads had been asked to formulate a plan, and if they haven’t by now it’s hard to believe there will be substance to any announcement made next week,” said Andrew Kolodny, executive director of Physicians for Responsible Opioid Prescribing, which advocates for state and federal policies to combat opioid misuse.
An HHS spokesman said Thursday night the agency is working with the White House on short-term and long-term strategies to combat the crisis and is providing advice on the declaration. A White House spokesman declined comment ahead of the announcement.
Complicating the administration's announcement are the vacancies at the top of four key health and law enforcement agencies that would execute the plan:
— Trump’s health department is without a secretary since Price resigned under pressure in September after spending more than $1 million in taxpayer money on private and government planes for travel.
— His Drug Enforcement Administration, pivotal to cracking down on drug distributors, is without a head after the acting director resigned last month in protest of Trump’s statements.
— His choice to lead the Office of National Drug Control Policy, Rep. Tom Marino (R-Pa.), withdrew his nomination Tuesday amid accusations he helped drug distributors pass an industry-friendly law that hobbled the DEA’s efforts to halt the spread of the opioid crisis.
— And his nominee to lead the Department of Homeland Security, which the president says will play a critical role in stopping the flow of illegal drugs into the country, hasn’t been confirmed.
“It is very difficult to make a big change in direction when the heads of almost every relevant agency are either not appointed or been forced to quit,” said Peter Lurie, most recently the associate commissioner for public health strategy and analysis at FDA.
Trump has installed several key health officials — CDC Director Brenda Fitzgerald, FDA
Commissioner Scott Gottlieb and Surgeon General Jerome Adams, who played a crucial role in responding to Indiana’s drug epidemic when he was the state’s health commissioner under then-Gov. Mike Pence. But it was unclear what role those officials or their agencies might have.
Policy experts say that Trump could go several ways to declare a formal emergency — or he could opt for an entirely different approach with a symbolic statement that simply directs agencies to work on solutions.
The Stafford Act is typically employed after natural disasters, giving the federal government authority to waive regulations and dispense federal dollars to affected communities — usually through FEMA. But White House officials are dubious about whether they can use that authority for a drug epidemic.
The Stafford Act stipulates that requests must come from governor who asserts an event has overwhelmed his state's resources. The only exception is if a president determines the primary responsibility for an emergency rests with the federal government.
Trump could also declare a public health emergency — an approach that is narrower in scope and would rely on the health department’s resources. Public health experts say that option is more likely. But the pot of new money available is minuscule — $57,000, according to an HHS spokesperson.
The agency might also pull money from existing block grant programs related to substance abuse and preventive health. But advocates oppose that, saying it would undermine other vital health programs.
The White House could also appeal to Congress to ask for support for the initiative — an approach that advisers were pushing.
State health officials say they are not waiting around for Trump to act. A half dozen have declared their own emergencies, enabling officials to divert resources to response efforts and expand access to naloxone, a medication designed to rapidly reverse opioid overdose.
“There are no silver bullets,” said Jay Butler, Alaska’s chief medical officer and president of the Association of State and Territorial Health Officials, a group of public health officials. “We can’t get distracted on unicorn hunts thinking there’s one solution to solving the complex issue of the opioid crisis. It’s not a problem that will be quickly or easily resolved.”
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Oct 20, 2017 | KFKX Fox Tyler, Tx
View clip here: https://app.criticalmention.com/app/#clip/view/30194301?token=6060f27e-9723-4d31-b820-713b00d62816
Rough transcript: Marion County is the latest to join in a lawsuit against pharmaceutical companies for their role in the opioid crisis. the commissioner opened the litigation this week. the suit will be filed in marshalls federal court. other counties are involved in similar legal action. the lawsuit accuses drug makers of inflating the drug's benefits in treating chronic pain and downplaying the addiction risks.
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