Preview Newsletter
Opioid Litigation Daily Media Report - 11/21/2017
-
Minnesota counties, cities join national surge of opioid epidemic lawsuits
Nov 20, 2017 | Becker's Hospital Review
By Brian Zimmerman
County board commissioners from at least six Minnesota counties have authorized attorneys to enter agreements with private law firms to either file a lawsuit or consider litigation against drugmakers and distributors to recoup expenses related to the public cost of responding to the opioid epidemic, according to a report from the StarTribune. -
City joins lawsuit against opioid manufacturers
Nov 21, 2017 | Connersville News Examiner (IN)
By James Sprague
Add the city of Connersville to the ever-growing list of cities and municipalities nationwide filing suit against opioid manufacturers and distributors, in response to the ongoing opioid epidemic across the country. -
Quotables: Westmoreland County's opioid lawsuit
Nov 21, 2017 | Tribune Review (PA)
By Staff
It is, as one lawyer put it, “an opportunity, not a guarantee.” Nevertheless, a lawsuit advanced by Westmoreland County commissioners against manufacturers, distributors and doctors over the opioid crisis signals a determination to wring justice from the cause of human destruction that has cost the county millions of dollars and far too many lives. -
Firm asks county to file opioid lawsuit
Nov 20, 2017 | Effingham Daily News (IL)
By Graham Milldrum
Effingham County officials were presented a possible new tool in the battle against the opioid epidemic during the county board meeting on Monday. -
Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet
Nov 21, 2017 | Bloomberg
By Robert Langreth
Six months after surgery to repair a damaged urinary tract in 1998, computer technician Doug Hale woke one morning with excruciating, burning pain. Hale’s suffering persisted for years, despite all sorts of treatments. Finally, in 2006, he was prescribed strong doses of opioids. -
Purdue Pharma kicks off opioid settlement talks as marketing scrutiny intensifies: Bloomberg
Nov 20, 2017 | FiercePharma
By Eric Sagonowsky
Facing a rash of lawsuits claiming aggressive opioid marketing led to a nationwide epidemic, Purdue Pharma is initiating settlement talks, according to Bloomberg. -
Opioid lawsuits are stacking up. But will they pay off for NY counties?
Nov 21, 2017 | North Country Public Radio (NY)
By Lauren Rosenthal
At least four counties across the North Country are moving ahead with plans to file lawsuits inspired by the opioid crisis. -
Lawyers competing for lucrative opioid litigation go before county Judiciary
Nov 20, 2017 | Madison -St. Clair Record (IL)
By Ann Maher
Lawyers competing to represent Madison County in lucrative contingency fee litigation against manufacturers and distributors of opioid drugs touted their experience to members of the Judiciary Committee meeting on Friday. -
Nevada cities, counties take wait-and-see approach to potential opioid lawsuit as Reno, Clark County move forward
Nov 21, 2017 | Nevada Independent (NV)
By Riley Snyder
Several major Nevada cities and counties are taking a wait-and-see approach to potential litigation against pharmaceutical opioid manufacturers, even as the city of Reno and Clark County consider filing lawsuits against major drug companies. -
Opioid Crisis Driven By Shady Drug Company Tactics, Investigators Say
Nov 20, 2017 | Newsweek
By Jessica Friger
Many say the opioid crisis that has killed more than 183,000 Americans since 1999 is driven by crooked pharmaceutical executives who have done just about everything, legal or otherwise, to convince the public that opioid painkillers are safe. Even President Donald Trump, who recently declared the epidemic a public health emergency, said companies that make the potent and highly addictive painkillers are responsible for the surge in deaths.
Litigation Coverage
Commentary and FYIs
-
Minnesota counties, cities join national surge of opioid epidemic lawsuits
Nov 20, 2017 | Becker's Hospital Review
By Brian Zimmerman
County board commissioners from at least six Minnesota counties have authorized attorneys to enter agreements with private law firms to either file a lawsuit or consider litigation against drugmakers and distributors to recoup expenses related to the public cost of responding to the opioid epidemic, according to a report from the StarTribune.
The counties poised to file lawsuits include Chisago, Hennepin, Mower, Ramsey, Steele and St. Louis. Additionally, the city council of Minneapolis approved a lawsuit Friday. The Minneapolis Fire Department has responded to more than 360 opioid overdose emergencies and administered more than 500 doses of naloxone since May 2016.
"The misrepresentations, deceptive and dangerous marketing practices, oversupply and failure to comply with federal reporting requirements of opioid manufacturers and distributors are among the leading causes of our current spiral of opioid-related addiction, overdoses and deaths," said Susan Segal, city attorney for Minneapolis. "With the city council's action today, Minneapolis will be joining with other cities, counties and states to seek redress and to put a stop to the dangerous practices of pharmaceutical manufacturers and distributors."
The city of St. Paul also plans to file suit, according to comments made by a mayoral spokesperson cited by the StarTribune.
-
City joins lawsuit against opioid manufacturers
Nov 21, 2017 | Connersville News Examiner (IN)
By James Sprague
Add the city of Connersville to the ever-growing list of cities and municipalities nationwide filing suit against opioid manufacturers and distributors, in response to the ongoing opioid epidemic across the country.
The city announced Monday, in advance of its Board of Works and Public Safety meeting, that it had hired the law firm of Cohen & Malad, LLP to file a lawsuit on behalf of the city against the opioid manufacturers Purdue Pharma, Cephalon Inc., Teva Pharmaceuticals, Johnson & Johnson, Janssen Pharmaceuticals, Noramco Inc., Endo Pharmaceuticals, Mallinckrodt PLC, Allergan PLC and Watson Pharamaceuticals, “for their part in causing the opioid crisis that has devastated connersville residents and placed a heavy burden on the City’s resources.”
The lawsuit also is against opioid distributors AmerisourceBergen Drug Corporation, Cardinal Health Inc., and McKesson Corporation, due to the allegations that “these distributors failed in their duty to report and stop suspicious orders of opioids that flooded the city,” read a statement from Cohen & Malad LLP. “For example, in 2012, there were 181 opioid prescriptions per 100 Fayette County residents.”
Connersville is the latest in more than 75 cities and counties nationwide – including Indianapolis, Hammond, Terre Haute, Muncie and Scott County in Indiana, along with Cincinnati and Dayton, Ohio – to file suit of some sort against the companies, with those suits alleging “that these manufacturers deceptively marketed the appropriate uses, risks and safety of opioids,” according to a statement from Cohen & Malad, LLP.
“Opioid manufacturers and distributors must be held accountable for their roles in creating this crisis,” said Lynn Toops of Cohen and Malad LLP, in a statement Monday. “The City of Connersville is taking an important step in response to the needs of its residents.”
Beth Butsch-Gottlieb, attorney for the city of Connersville, said Monday that the lawsuit will not cost the city any money whatsoever, unless there is a settlement in the lawsuit between the city and the drug manufacturers. The city entered into what is known as a “contingency contract,” which does not require the payment of litigation fees or attorney fees at the filing of a lawsuit, but rather only if there is a settlement in the case.”
“We are out no money up front, and if there is a settlement, then we’ll pay the litigation expenses and the attorney fees,” she said. “I think this is a cutting-edge lawsuit, and I think it’s time for the city to be proactive rather than reactive. So we’re going to join in this cutting-edge lawsuit. Just because we’re a small town doesn’t mean we have to act like a small town.”
Connersville Mayor Harold Gordon said the lawsuit against the opioid manufacturers and distributors is something the city needs to do, given the battle it has waged on its streets for the past few years.
“I think this is something we should do,” he said. “Because the city’s incurred costs, like anything else, and manpower, and sometimes you’ve got to call in people to handle certain things. I think it’s something we need to do, and it holds (these companies) accountable, also.”
A vote on the city filing the lawsuit, by either the Board of Works or the City Council, was not required in order to sign the contract with Cohen and Malad.
“The mayor has the statutory authority to execute contracts,” Butsch-Gottlieb said. “So he does have the authority to do that.”
Both bodies, however, were made aware of the city’s decision to file the suit.
They might not be alone locally, either, as the Fayette County Commissioners have on their agenda for this morning’s meeting the same topic – filing suit against the drug companies.
Gordon reiterated his belief that the lawsuit was something the city needed to move on.
“The city’s incurred costs,” he said. “We need to get some of it back.”
He added that some of the overdoses deaths in Connersville might not have occurred, if the drug companies had acted appropriately in the past.
-
Quotables: Westmoreland County's opioid lawsuit
Nov 21, 2017 | Tribune Review (PA)
By Staff
It is, as one lawyer put it, “an opportunity, not a guarantee.” Nevertheless, a lawsuit advanced by Westmoreland County commissioners against manufacturers, distributors and doctors over the opioid crisis signals a determination to wring justice from the cause of human destruction that has cost the county millions of dollars and far too many lives.
Toward this end the county has hired two law firms, Marc J. Bern & Partners of New York and Robert Peirce & Associates in Pittsburgh, which will receive a quarter of any financial judgment. Other Pennsylvania counties, including Armstrong and Washington, have filed similar lawsuits. For Westmoreland, damages could exceed $19 million. But more than any financial settlement, Westmoreland's fight is a wake-up call that where fault is fond for this drug-induced scourge, a meaningful penalty will be extracted.
“We're suing 24 different manufacturers, distributors and doctors.”
ROBERT PEIRCE
Attorney
“Ultimately, it could be in the tens of millions of dollars. We're expanding the web. Damages are like throwing a pebble into the pond.”
MARC BERN
Attorney
“We will still have to do a more thorough assessment of the damages. But the pharmaceutical companies are absolutely responsible for what we are dealing with today.”
TED KOPAS
Westmoreland County commissioner
“This is just the tip of the iceberg.”
CHARLES ANDERSON
Westmoreland County commissioner
-
Firm asks county to file opioid lawsuit
Nov 20, 2017 | Effingham Daily News (IL)
By Graham Milldrum
Effingham County officials were presented a possible new tool in the battle against the opioid epidemic during the county board meeting on Monday.
The plan comes from Goldenberg, Heller and Antognoli, a law firm that is suing opioid manufacturers and distributors on behalf of several counties in Southern Illinois. Tom Lech told the board Monday his firm is one of several working together nationwide.
The law firm is asking the county to file such a lawsuit. He presented the board with local statistics.
In Effingham County, there are 71.2 prescriptions per 100 people, he said, about 25 percent above the state average. This has caused an outbreak of addiction, which he said was the direct result of advertising and manipulation of scientific understanding in pursuit of profit.
"They were obsessed with expanding this market," Lech said, adding the manufacturers and distributors of the drugs have no regard for human cost.
If successful, the plan would give the county money to pay for education, safety programs and rehabilitation. The firm would only be paid if there was a decision in their favor, Lech said.
County board members Jeff Simpson and Rob Arnold said they were also contacted by other firms.
Effingham County State's Attorney Bryan Kibler said he wanted the board to consider what path they should take in terms of litigation.
"I know we typically don't like to get involved with litigation, which is the proper way to think about this," he said.
However, he added a number of his colleagues have begun legal action.
In other business Monday, the board was told it can feel a little safer, at least as far as the National Weather Service is concerned. The county was re-certified as a StormReady County. The county first earned the certification in June 2011.
"In today's world, I cannot stress enough the importance of preparedness and hazard mitigation," said Chris Miller of the NWS when he presented the certification.
The certification can result in lower flood insurance rates as well.
When the NWS reviewed the renewal paperwork, it found the county emergency management agency had worked to establish connections with local governments and expanded their programs, Miller said.
It's important that agencies plan for all sorts of disasters, he said, noting that 90 percent of presidential disaster declarations involve weather.
"We're here in the Midwest. We get everything," he said, adding that requires a broad spectrum of planning.
The new certification lasts until 2023.
Also Monday, the county approved payment of $75,000 to Pictometry to take photos of the communities of Altamont, Dieterich, Effingham and Teutopolis. The company uses multiple cameras mounted on airplanes to create a mosaic of property in the county, which is then used for tax evaluation.
It will be paid out of the GIS fund and is the second time the company has surveyed the county.
The board also approved guidelines for speakers at county board and committee meetings. They set the time limit at two minutes, although the board may authorize additional time.
-
Millions of Patients Face Pain and Withdrawal as Opioid Prescriptions Plummet
Nov 21, 2017 | Bloomberg
By Robert Langreth
Six months after surgery to repair a damaged urinary tract in 1998, computer technician Doug Hale woke one morning with excruciating, burning pain. Hale’s suffering persisted for years, despite all sorts of treatments. Finally, in 2006, he was prescribed strong doses of opioids.
Fast-forward 10 years. Still on his pain killers, Hale was popping so many of the highly addictive pills that he regularly ran out of his prescription early. His doctor cut off his supply and urged Hale to enter a detox program. That didn’t work. Hale, still in agonizing pain and now suffering from intense withdrawal symptoms, returned to his doctor and pleaded to get back on his opioid regime. The doctor refused. The next day, Hale put the barrel of a small-gauge gun in his mouth and pulled the trigger.
It would be tempting to view Hale’s death, at 53, as one more sad entry in the never-ending national tragedy of opioid deaths. In fact, it’s much more than that. Hale’s story is a window into the country’s silent majority of opioid sufferers. These are the millions of painkiller-dependent users inhabiting a vast gray zone somewhere between medical patient and drug addict, who are finding themselves suddenly abandoned in droves by the medical system. Under threat of lawsuits and government and insurance industry crackdowns, doctors have been cutting off the supply of painkillers, forcing many of their patients to quit cold turkey after years or even decades of dependence, sometimes with catastrophic consequences. Worst of all, those left suddenly without their meds often have nowhere to turn for help.
“These are victims of our era of aggressive prescribing,” said Andrew Kolodny, co-director of opioid policy research at Brandeis University’s Heller School for Social Policy and Management. “These patients become hot potatoes that no one wants.”
Roughly 8 million Americans are on long-term opioid therapy for chronic pain, and as many as a million are taking dangerously high doses, said Michael Von Korff, a senior researcher at the Kaiser Permanente Washington Health Research Institute. In the Medicare program alone, 500,000 patients were on high opioid doses in 2016, according to a 2017 report from the U.S. Department of Health and Human Services.
Many health professionals, fearing sanctions or even the loss of their licenses following government cases against a handful of doctors, have been caught up in a broader crackdown sweeping the pharma industry. In 2016, the Centers for Disease Control and Prevention issued guidelines for treating chronic pain, warning doctors to avoid prescribing high opioid doses when possible. Doctors have been heeding the message. Since peaking in 2010, prescriptions for more dangerous, higher-dose opioids dropped 41 percent from 2010 to 2015, according to a CDC analysis.
Meanwhile, more than a dozen states and about 100 counties and cities have already sued Purdue Pharma LP, other opioid makers and drug distributors, in a strategy echoing the litigation that led to the 1998 $246 billion settlement with Big Tobacco. Purdue is proposing a global settlement in an attempt to end state investigations and lawsuits, Bloomberg News reported on Nov. 17. And last month, President Donald Trump declared widespread opioid abuse a public health emergency.
Purdue Pharma, the maker of OxyContin, said it is “deeply troubled” by the national opioid crisis and is distributing the CDC’s treatment guidelines to doctors. Johnson & Johnson, maker of the fentanyl-containing Duragesic patch, said it is “committed to working with federal, state and local officials to help find meaningful solutions” to the opioid problem. Teva Pharmaceutical Industries Ltd., which sells generic opioid pain killers, declined to comment but in the past has denied wrongdoing.
In the battle to wean patients off opioids, dosage has emerged as a critical issue. Chronic pain sufferers on high doses aren’t necessarily addicts, at least not the sort who would resort to buying drugs on the street, experts say. Some may indeed benefit from the drugs and function well on them. Yet many aren’t getting better or going back to work and still report high levels of pain, despite big doses. Even patients taking high doses prescribed by their doctors run the risk of overdosing, recent studies showed. As many as 25 percent of pain patients may exhibit some level of misuse of the drugs, studies have found.
With most medical and government resources focused on treatment for more obvious drug abusers, few formal programs exist to help patients dependent on opioids. And there is little guidance for doctors, who are more accustomed to prescribing than un-prescribing drugs. A few hospitals such as the Mayo Clinic and the Cleveland Clinichave intensive outpatient pain-rehab programs, but they are pricy. The Mayo Clinic’s costs roughly $30,000 to $40,000, though most insurance companies cover at least part of the program, which offers help to specifically taper patients off opioids. The three-week intensive program consists of counseling and alternative treatments such as physical and occupational therapy.
Experts who have studied opioid dependence say that, in some cases, it’s too risky to reduce doses until complex psychological problems are under control. But that message isn’t always getting through to doctors. “We have created this monster, and we think we can stop this by just stopping opioids,” said Ajay Manhapra, a Yale University lecturer and addiction medicine specialist who treats patients at the Hampton VA Medical Center in Hampton, Virginia. Researchers who think drug doses can be brought down quickly “are very naive.”
Clare Rhodes, a 63 year old San Jose resident, took OxyContin for more than a decade following a 2001 back operation — first prescribed by a surgeon who promised it wasn’t addictive. She was cut off in 2012, after her doctor was arrested for prescribing opioids to addicts. Even though she had never misused her meds, other pain doctors covered by her workers’ compensation policy refused to take her case, so she was forced to go cold turkey. The withdrawal symptoms lasted a year and were worse than the side effects she got from breast cancer chemotherapy treatment. Rhodes was constantly agitated, suffered diarrhea, broke out in cold sweats and was unable to sleep more than an hour at a time.
Now Rhodes runs a private Facebook group for chronic pain patients. Few patients are being eased off the drug gradually, she said. Many are forced off their meds after their doctors retire or move to another clinic. So many patients on the discussion group expressed suicidal thoughts that she tried to find a psychiatrist or psychologist to offer guidance, but no one was willing to take on that responsibility. “It is an insane situation,” said Rhodes. “They are simply being cut off. It is unconscionable that doctors are doing this to their patients.”
Some have seized on medical opioid addiction as a business opportunity. Breaking Benzo, a telemedicine startup in Palo Alto, California, offers online psychiatry appointments and round-the-clock access to health coaches to help people quit opioids or anti-anxiety drugs called benzodiazepines. The service, available in California, costs $349 a month, doesn’t currently take insurance and plans to expand to at least 10 other states by next year, including hard-hit states Ohio, West Virginia and Kentucky. It is in the process of getting certified for insurance coverage.
The medical system didn’t quite know how to handle the case of Doug Hale.
A paralegal and computer technician, Hale once enjoyed an active life that included scuba diving, softball and hiking. That was before a progression of medical problems forced him to go on disability. In 1998, he needed major surgery from an obstructed urinary tract. Months later, he developed a painful and mysterious bladder inflammation.
Over the next five years, Hale tried and failed a long list of non-narcotic treatments, including behavioral therapy, nerve blocks and nerve stimulators before doctors started him on opioids in 2004, according to his wife.
He progressed through a laundry list of opioids, including Dilaudid, hydrocodone, oxycodone and fentanyl, before ending up on high doses of methadone, a long-acting opioid painkiller that is better known for its use in treating heroin addiction. Complicating his care was a cerebral hemorrhage in 2006 that left him with short-term memory loss, migraines and seizures.
The final years of Hale’s life were a blur of doctor visits for chronic pain, seizures and other medical problems. Most of his treatment was through his primary care doctor, Stephen Kornbluth, and other doctors at Castleton Family Health Center near Hale’s home in Rutland, Vermont. He also traveled to New Hampshire to see a neurologist and a pain doctor and twice checked into a detox center at a psychiatric hospital for week-long treatments. Nothing worked.
By April 2016, Hale was taking 16 methadone pills a day, a huge dose. His daily intake was many times the level the CDC says can significantly increase overdose risk. It still wasn’t enough to ease Hale’s pain. He started taking two or three additional pills a day and ran out a week early.
Hale and his wife sought additional methadone at an April 9 appointment. The doctor who saw him that day warned that his misuse was “exceedingly dangerous” and could put Hale “at risk for death,” according to the doctor’s notes from the encounter. But worried about severe withdrawal symptoms, she renewed the prescription for a week, until Hale’s next regularly scheduled visit with Kornbluth, who also opted to extend prescribing the drug at a lower dose.
But after Hale ran out early again in May, Kornbluth finally lowered the hammer. He told Hale and his wife, Tammi, that he wasn’t comfortable continuing the drugs beyond a month, and offered to send him yet again to a detox clinic. “Too many times she and he have messed up, though I am not convinced that there is abuse consciously,” Kornbluth wrote in medical records that Tammi Hale later received from the clinic. Hale’s wife says Kornbluth gave the couple a different reason for the discontinuation. “‘I don’t want to risk my license for you any more,’ those were his exact words,” said Tammi Hale. “We felt we had been dumped and abandoned.”
“I remember saying to the wife that I can’t prescribe because there was very inconsistent use, and I couldn’t in good conscience write for that,” said Kornbluth in response. “She kept saying she was very comfortable with that, she understood.” He said he made clear he was not opposed to Hale trying to get opioids from a pain specialist. Far from being abandoned, Hale had numerous consultations with specialists, Kornbluth said.
By mid-July, after his second stay at the detox clinic, Hale had hardly slept in two weeks. Though now entirely off opioids, he had constant tremors and shaking. He broke down crying at a visit with Kornbluth. In September, the Hale couple applied for a last ditch option: a methadone clinic for addicts. But the clinic turned him down on the basis that he wasn’t truly an addict.
On Monday, Oct. 10, Hale and his wife saw Kornbluth. The doctor refused their entreaties to restart the opioids. That day, Kornbluth was still working on finding a program that would take Hale, who, the doctor later wrote in his records, fell through “the cracks” between medical providers.
The next day, Hale was dead. “Can’t take the chronic pain anymore,” he wrote in a wobbly penned suicide note. “No one except my wife has helped me.”
-
Purdue Pharma kicks off opioid settlement talks as marketing scrutiny intensifies: Bloomberg
Nov 20, 2017 | FiercePharma
By Eric Sagonowsky
Facing a rash of lawsuits claiming aggressive opioid marketing led to a nationwide epidemic, Purdue Pharma is initiating settlement talks, according to Bloomberg.
he privately held company, which makes Oxycontin and faces legal heat along with other prominent opioid drugmakers, is proposing a global settlement, four sources told the news service. The company didn't immediately respond to a FiercePharma inquiry.
Along with Endo International, Johnson & Johnson's Janssen, Teva Pharmaceutical and Allergan, Purdue Pharma is named in an opioid marketing investigation by attorneys general from 39 states. The effort initially focused on Purdue, but investigators expanded their probe in September, homing in on some other big names in the pharmaceutical business.
In unveiling the broadened probe, Connecticut Attorney General George Jepsen said officials are open to settlement talks.
"We have encouraged, and will continue to encourage, the pharmaceutical industry—both manufacturers and distributors—to engage constructively with the attorneys general towards meaningful agreements that may be achievable sooner than full scale investigations and litigation may permit," he said in a statement.
"As we have shown in other contexts, broad coalitions of attorneys general can effectively impact national problems through litigation or settlements, often more effectively than they can when acting alone," Jepsen said in a statement.
If the sides come to an agreement, settlement funds could help states cope with the devastating opioid epidemic that has intensified in recent years. Top drug distributors AmerisourceBergen, McKesson and Cardinal Health are also involved in the investigation.
In addition to that effort, more than a dozen states and 100 counties have already filed lawsuits against opioid companies alleging their marketing played a role in the devastating opioid epidemic, according to Bloomberg. Officials contend the companies talked up the benefits of opioid treatment for pain patients and downplayed the risks.
The wave of opioid cases by state and local governments resembles the legal strategy leading up to the landmark Big Tobacco settlement in 1998 worth $246 billion, according to Bloomberg.
As it's navigating the issue, the news service reports that Purdue has brought on veteran mass tort attorney Sheila Birnbaum, a prominent corporate defender in important and complex cases.
As industry watchers know, the company is no stranger to scrutiny on OxyContin. Among the states suing the company are New Hampshire and Ohio, and New Hampshire's attorney general previously blasted the company for stonewalling his efforts.
-
Opioid lawsuits are stacking up. But will they pay off for NY counties?
Nov 21, 2017 | North Country Public Radio (NY)
By Lauren Rosenthal
At least four counties across the North Country are moving ahead with plans to file lawsuits inspired by the opioid crisis.
The lawsuits will target big drug companies that allegedly downplayed the health risks of prescription painkillers and possibly set the stage for people to become addicted. So far, Clinton, Essex, St. Lawrence and Warren counties have all hired attorneys. Other local governments are feeling pressure to do the same, but some officials have asked exactly what it’s worth to go to court."Aren't they accountable, too?"
The Lewis County legislature had that exact argument at a meeting in early November. The county had been contacted by Simmons, Hanly, Conroy P.C., a high-powered law firm that’s been taking drug companies to court for years now.
Lewis County has been hit hard by addiction, but some lawmakers were skeptical that filing their own lawsuit would make things any better. Republican Mike Tabolt of Croghan attacked the idea. "What about the doctors," asked Tabolt. "Aren't they accountable, too? And what about the people who get hooked on drugs? Most of them start with alcohol. Why don’t we go after the breweries and distilleries?"
The vote was six to two against hiring lawyers. But Stephen Acquario, president of the New York State Association of Counties, or NYSAC, said Lewis County may change its mind about that. "I think at the end of the day, nearly every New York county will have filed an action," Acquario said.Where are these lawyers coming from?
NYSAC has been working with a handful of law firms and connecting them with individual county governments that might be open to suing the pharmaceutical industry.
Acquario said the goal is to get money back for taxpayers, who have spent a lot of it responding to addiction in their communities. The list of expenses is long, Acquario said, and includes "the cost of foster care and families that are disrupted, jail costs, law enforcement, public health, mental health, health insurance, workers compensation, [and] the lost societal productivity of an individual who becomes addicted and bleeds over into the use of illegal drugs, such as heroin and fentanyl."
A lot of the lawyers on these opioid cases are working on contingency. They may not charge a fee up front, but they will take a share of any settlement. (STAT News recently reported that Simmons, Hanly, Conroy P.C., would take 25 percent.) However, each county will have to tally up what the opioid epidemic is costing it. It's expensive research, which could be a hindrance for joining the lawsuits.
So far, though, roughly 20 local governments across New York State have indicated they’re going to court. So have counties in other states, including Connecticut, Illinois, Louisiana and Pennsylvania."Litigation is a form of regulation"
As claims against drug manufacturers pile up, University of Buffalo law professor Christine Pedigo Bartholomew said, people could be in for a long fight. "I think that the complicated moving parts here are going to preclude a quick, nationwide settlement," Bartholomew said.
Bartholomew has studied big civil lawsuits like the ones against the tobacco industry back in the 1980s and '90s. She said solid research about the long-term effects of smoking helped resolve those cases, but opioid addiction is still getting worse in some parts of the country. Not knowing the full impact is going to be a challenge in court.
As for the argument that drug companies are responsible for people getting hooked on painkillers? "I think pharmaceutical companies are gonna come out and say, ‘We may have done wrong.’ Or, probably not going to say that," Bartholomew said. "But even if they were willing to make that statement, there’d be a lot of pushback as far as trying to calculate at what point their harm or wrongdoing is mitigated by the patient’s conduct as well."
Whether patients got their painkillers legally or bought them off the black market is one of many painful questions that could come up in court. Considering how complicated things may get, Bartholomew said she understands if places like Lewis County don’t want to get involved with litigation — but she added that it's still a good option.
"The way our judicial system works at this point, litigation is a form of regulation," Bartholomew said. "It’s not simply to be litigious. It’s about making sure our economy, healthcare, whatever you’re looking at are functioning correctly."
-
Lawyers competing for lucrative opioid litigation go before county Judiciary
Nov 20, 2017 | Madison -St. Clair Record (IL)
By Ann Maher
Lawyers competing to represent Madison County in lucrative contingency fee litigation against manufacturers and distributors of opioid drugs touted their experience to members of the Judiciary Committee meeting on Friday.
Paul Hanly of New York, a partner at Alton-based Simmons Hanly Conroy, said, "We believe we can assist in the recovery of substantial amounts of money for your county" due to a conspiracy that resulted in the "over-proliferation" of drugs in the community.
Hanly said his firm currently represents 100 counties across the country in litigation that seeks to recover costs that addiction imposes on public entities - such as law enforcement, courts and medical providers. His firm essentially handles approximately one third of all litigation filed to date. He said he expects the number to reach 1,000 counties within a year.
In 2003, Hanly said his firm began suing Purdue Pharma over misrepresenting the risks of its narcotic OxyContin. He said his firm "discovered criminality" which it passed on to the U.S. Department of Justice that in turn led to the federal government's $634 million fine against the company and its executives.
"Apparently, that didn't dissuade them," he said.
Hanly said he counsels clients that if "you don't sue, you don't get to participate."
"History teaches us in mass pharmaceutical cases that if you are not a participant that the likelihood you will have a seat at the table when the money gets distributed is remote," he said.
Former Madison County chief judge Ann Callis, now in private practice at Goldenberg Heller in Edwardsville, said her firm already represents 15 local governments in Illinois, including counties of St. Clair, Bond, Jersey and the city of Granite City.
She said the legal theories her firm would advance would include racketeering and public nuisance claims.
As a former chief judge she said she implemented civil reforms in Madison County - one being a requirement that legal filings could not be filed under seal - and therefore she "would never sign on to a lawsuit that was remotely frivolous," she said.
"Everything would be transparent," she said, including the law firm's contract with the county. "Everything is negotiable...that's what I love about this lawsuit."
She said she believes her purpose in life is to help people.
"I believe in this lawsuit," she said. "I can ensure people in this room and the citizens that I would fight for them in this lawsuit. As your attorney I would fight for you."
Committee chair Mike Walters said he would like to be able to hear from representatives of the pharmaceutical industry and doctors, saying that there are "bad apples" in every walk of life and that his committee should be "real careful" about not confusing good ones from bad ones.
He said that once his committee has heard from "everyone," he will look at options and proceed accordingly.
"If we do proceed with the lawsuit, it will come out of our committee," he said. "I am not sure how we choose a law firm and how to negotiate the contingency fees. If we do not proceed with the lawsuit, I am not sure what (State's Attorney) Tom (Gibbons) will do."
He also said that he doesn't want to see a problem that has happened with asbestos litigation be repeated in opioid litigation, where many of the original asbestos producers and distributors are "all out of business."
"Who pays now is mom and pop shops, who didn't have anything to do with it in the minds of many," he said. "I'm fearful that if we start with pharmaceuticals then it's doctors, then pharmacist companies, then Walgreen and CVS. That's a fear I have."
Troy attorney Don Weber, a former Madison County circuit judge and state's attorney, spoke at the end of the hearing criticizing the contingency fee arrangement by saying the lawyers stand to gain much more than individual counties when attorney fees recovered are one-third of the total.
By using an example raised by Hanly in the $634 million fine against Purdue Pharm, he said that if 1,000 counties were to reach a $600 million opioid settlement that would mean $200 million to lawyers and $400 million to counties. But each county would end up with $400,000. He said that even if counties recovered $2 million apiece in settlement, lawyers would get more than $600 million.
He said the "whole thing" has been politicized.
"I'm not saying there isn't an opioid epidemic," he said. ."I'm saying the main problem is the drug dealers... with a really strong (prosecution) program we would be sending them all to prison."
He said that no firm should be hired that has been a major contributor to either political party, which would exclude the Goldenberg and Simmons' firms.
"If they really feel this is such a serious problem they should just donate their time or limit their total fee to $100,000...and have the rest come back to the county."
Gibbons, who participated in the hearing, responded to Weber that he "looked forward" to Weber's firm's proposal with those kind of terms.
-
Nov 21, 2017 | Nevada Independent (NV)
By Riley Snyder
Several major Nevada cities and counties are taking a wait-and-see approach to potential litigation against pharmaceutical opioid manufacturers, even as the city of Reno and Clark County consider filing lawsuits against major drug companies.
A handful of cities and counties in Nevada’s most densely populated areas told The Nevada Independent that they were reviewing or considering filing lawsuits against the manufacturers of prescription opioids, even as Attorney General Adam Laxalt has warned Reno officials that filing a separate suit could jeopardize a multistate opioid investigation.
Laxalt and Reno mayor Hillary Schieve have spent the last several weeks publicly arguing over the best jurisdiction for a lawsuit — the Republican attorney general sent a letter warning her efforts could “unintentionally undermine” participation in a 41-state case against a handful of opioid distributors and manufacturers, while Schieve has blamed Laxalt for “pitting Nevadans against Nevadans” on the issue.
That battle hasn’t deterred Clark County Commission Chairman Steve Sisolak — a Democrat running against Laxalt in the 2018 gubernatorial race — who said he scheduled a meeting this week with an outside attorney to go over legal options for the county and any potential lawsuit against opioid manufacturers. He disagreed with Laxalt’s assessment that the state had the primary standing to go after opioid manufacturers.
“The initial evidence that I have seen, that was presented to me when I had this discussion initially, was that it’s more productive to do it under the local jurisdiction than on a statewide basis,” he said.
Nevada has been hard-hit by opioid abuse and overdoses — the state has the fourth-highest drug overdose mortality rate, 20.7 per 100,000 residents in 2010, and the state’s doctors write 94 painkiller prescriptions for every 100 residents. The CDC counted 619 drug-overdose deaths in the state in 2015
Sisolak said that he had contacted a different private attorney than the one being considered by Reno, and would have to make a “legal calculation” based on input from the Clark County District Attorney’s office before taking action.
A spokeswoman for the attorney general’s office did not return request for comment.In his letter to Schieve, Laxalt argued that state law reserved the right to sue under deceptive trade practices to the attorney general, and that cities and counties would need to employ “novel” legal theories in any potential lawsuits.
Schieve told The Nevada Independent on Monday that she hopes to schedule a special meeting of the City Council to vote on authorizing the lawsuit sometime in December. Las Vegas trial attorney Peter Wetherall gave a presentation on potential litigation options to city council members two weeks ago.
Washoe County Commission Chairman Bob Lucey said Monday that he applauded Schieve for her efforts and had also been in talks with outside attornies to represent the city in a potential suit. Lucey, who said he had also spoken to commissioners in rural Humboldt, Lincoln and Nye counties about the issue, stressed that the county hadn’t made a final decision on which course of action to take.
“It’s kind of an ongoing conversation at this point, but no decision has been made,” he said.
The city of Henderson has not been contacted by Schieve over joining the suit, but city spokesman David Cherry said the city has contacted outside attorneys and that the issue is “currently under review” with the city attorney.
Julie Duewel, a spokeswoman for Sparks, said the city’s attorney was reviewing the possibility of filing or joining a lawsuit against opioid manufacturers amid the actions taken by Schieve, but that only the most preliminary steps had been taken at this point.
Delen Goldberg, a spokeswoman for the city of North Las Vegas, said that jurisdiction hasn’t been contacted about joining the suit but was open to any solutions to the opioid crisis.
“That said, our city leaders think the increase in opioid abuse is a terrible problem, and they’d certainly be in favor of discussing any possible solutions,” she said in an email.
Las Vegas city spokesman Jace Radke said the city was not considering a lawsuit at the present time.
-
Opioid Crisis Driven By Shady Drug Company Tactics, Investigators Say
Nov 20, 2017 | Newsweek
By Jessica Friger
Many say the opioid crisis that has killed more than 183,000 Americans since 1999 is driven by crooked pharmaceutical executives who have done just about everything, legal or otherwise, to convince the public that opioid painkillers are safe. Even President Donald Trump, who recently declared the epidemic a public health emergency, said companies that make the potent and highly addictive painkillers are responsible for the surge in deaths.
Fentanyl is one of the most dangerous opioids on the market, 50 times more potent than heroin. The U.S. Centers for Disease Control and Prevention reports that overdoses on this synthetic opioid have increased 540 percent in the past three years, and many say the drug is responsible for the current epidemic. Insys Therapeutics, one of the companies that produce a form of fentanyl, is now mired in an ugly legal battle after multiple executives—including its founder, John Kapoor—were arrested on conspiracy charges in late October. Attorneys general in New Jersey, Arizona, Oregon, Illinois and Massachusetts have filed lawsuits claiming the company plotted to illegally boost sales of its drugs. In all of the lawsuits, Insys is charged with lying to insurance companies, fabricating information about patients and providing incentives to physicians to prescribe the drug.
Insys Therapeutics produces Subsys, a powerful fentanyl-based liquid that earned approval from the U.S. Food and Drug Administration in 2012 specifically for use by cancer patients with pain that doesn’t respond to other painkillers—what’s known as “breakthrough cancer pain.” Subsys is a fast-acting spray used under the tongue; the mucous membranes beneath the tongue have an abundance of capillaries, so the medication is absorbed directly into the bloodstream without needing to go through your digestive system. This delivery method is highly effective, but it means that overdosing on Subsys is far too easy—and possibly just a few accidental sprays away.
Ongoing federal investigations suggest Insys ran an elaborate scheme to push the drug on non-cancer patients—what’s called “off-label use”—despite the fact that the company has not submitted clinical data to prove Subsys is safe and effective to manage pain not related to cancer. The U.S. Attorney’s Office in the District of Massachusetts charged Kapoor with “leading a nationwide conspiracy to profit by using bribes and fraud to cause the illegal distribution of a fentanyl spray.” The charges include racketeering, mail and wire fraud, and violation of a federal law passed in 2014 (known as the Anti-Kickback Statute) that prevents drug companies from providing large incentives to physicians for prescribing their drugs. Kapoor resigned from the company’s board of directors in late October, but said in a statement, “I am confident that I have committed no crimes and believe I will be fully vindicated.” (He pleaded not guilty at his arraignment in Boston on November 16.)
Many details of how Insys pushed its drug came to light through a congressional investigation led by Democratic Senator Claire McCaskill of Missouri, a ranking member of the U.S. Senate Committee on Homeland Security and Governmental Affairs. In September, the committee—chaired by Wisconsin Republican Ron Johnson—published the first of what her staff says will likely be several reports on the unethical sales and marketing practices of companies that produce opioid drugs. It laid out how Insys created a separate department to convince insurance companies to sign off on coverage of the drug for patients who weren’t authorized to take it. These employees posed as representatives from the doctors’ offices of patients who were prescribed the medication.
In response to the opioid crisis, the committee has issued requests for documents from five companies that produce the majority of the supply of opioid prescription painkillers in the U.S.—Purdue Pharma, Janssen Pharmaceuticals Inc., Insys, Depomed and Mylan. Insys was the first subjected to McCaskill’s scrutiny. She says Insys has followed in the tradition of the unethical marketing and sales practices developed in the 1990s by Purdue, which told physicians that pain is undertreated in the U.S., that opioids were the best way to treat them, and that the drugs aren't addictive. "As it turns out, these messages were exaggerations at best and outright lies at worst," she said during a roundtable discussion about her report in September.
All of these companies have settled lawsuits about such practices or have lawsuits pending. Purdue Pharmaceuticals—maker of OxyContin—reached a number of unprecedented settlements, including one in 2007 that involved 26 states. Since then, the lawsuits against opioid manufacturers have continued to pile up. There are lawsuits against opioid makers in just about every state, prompting many experts to suggest that the legal battle against the prescription painkiller epidemic is starting to look a lot like the late 1990s fight against Big Tobacco.
Subsequent reports, such as one from Reuters, suggest some 80 Insys employees engaged in various schemes to get the medication into the hands of more patients who didn’t need them.
Sarah Fuller was one of those unfortunate people, says her mother, Deborah. The 32-year-old died of a Subsys overdose in March 2016, but she never had cancer. The family is now suing Insys. Sarah had suffered from fibromyalgia and chronic pain related to two automobile accidents some 10 years before.
Deborah barely knew anything about fentanyl until after her daughter’s death, when she began going through Sarah’s belongings. That’s where she found the pharmaceutical pamphlet Sarah had been given during one of the many appointments with the doctor who wrote her Subsys prescription. Deborah read the pamphlet cover-to-cover, and recalls that when she finished reading she was mostly confused, since it was made clear in the information that the drug was only for patients with cancer.
Though it would be months before the family received the results of Sarah’s toxicology report, Deborah felt she already knew the drug had killed her daughter. “When I got into what it really is and the dangers of the drug, I thought, Why in the name of God would they prescribe that to her?” she tells Newsweek. “She was so not at all a candidate for the drug.”
She believes Sarah was, however, an ideal target for doctors to push off-label use of Subsys. Like most of the 100 million Americans who suffer from debilitating, chronic pain, Sarah desperately wanted to make it stop. “She would call me and say, ‘I hurt all over,’” says Deborah. While the pamphlet Deborah found listed the risks of the drug, the language was hard to understand and not written for patients, especially patients like Sarah who, her mother says, had suffered with lifelong learning disabilities and was prepared to try just about anything to get through the day without hurting.
Deborah says her daughter was also eager to stop taking Lyrica, which another doctor had prescribed to manage her fibromyalgia. The drug is known to cause significant weight gain; Sarah added 100 pounds to her 5-foot-3-inch frame while taking it. Her mother says her daughter longed to lose weight in time for her wedding, which would have been this past August.
Sarah had initially sought out a new doctor to find a way to treat her pain without medication. Her mother said she had a history of prescription painkiller use that had landed her in the hospital before. This time she wanted to manage her pain without any prescriptions—possibly with physical therapy or even surgery. But the new doctor began prescribing opioids anyway. Before putting Sarah on Subsys, her doctor prescribed other painkillers, including OxyContin and Percocet. This would show the insurance company that Sarah had tried the less potent and cheaper options—called “step therapy”—but was still experiencing pain. Investigations into Insys show this was a standard protocol of doctors who needed to give the impression to an insurance company that the other prescription painkillers weren’t working for the patient. In order for a doctor to receive kickbacks from Insys, insurance companies would need to approve prescription requests for Subsys, which costs thousands of dollars per month. In Sarah’s case, Medicare paid as much as $24,000 per month for her Subsys prescription, according to documents collected by the family’s lawyer after her death. The drug is far more expensive than other popular painkillers. According to the family attorney’s records, a prescription for OxyContin at a CVS pharmacy costs a little more than $250 per month. Her patient records from every visit to the doctor didn’t document any changes in her pain, even when she was taking Subsys.
Sarah’s fiancé says Subsys initially “seemed like a miracle drug.” But soon he noticed changes in her; she became more withdrawn and lethargic. She complained of sleepiness, dizziness and weakness, all side effects of the medication. Over a period of more than a year, Sarah began spending an increasing amount of time at home, says Deborah. She stayed in her bed with shades drawn so her bedroom was pitch black. Unless Sarah had to work or was going out for dinner with her fiancé, she was at home in her pajamas, most likely sleeping. “Two weeks before she died [from the overdose] she kept saying ‘I feel like I’m dying,’” says her mother. “And I said, ‘You need to get off of this stuff. All of it.’”
Months later, Sarah’s toxicology report revealed she had higher-than-lethal levels of fentanyl in her blood, suggesting that she had been prescribed a higher dose than she should be taking. The family’s attorney says Sarah’s doctor continued to increase the Subsys dose over time. The toxicology report also suggested that the Subsys had interacted with Xanax, another medication prescribed by the same doctor to help her sleep. Using both drugs together can be deadly. (The Fuller family recently reached a confidential settlement with Sarah’s doctor, according to their attorney.)
The family’s attorney obtained an audio recording of a call between an Insys employee and a representative from Sarah’s insurance company’s pharmaceutical service to get prior authorization for her Subsys prescription. The Insys employee said she worked “with” Sarah’s doctor. She also misrepresented Sarah’s condition, claiming she suffered from breakthrough cancer pain. The Insys representative also said other drugs, like OxyContin, had “an inadequate analgesic effect” and the “patient is opioid tolerant” and therefore needed Subsys. The family attorney said there were no notes in her medical records to document changes in her pain.
“They lied so they could make their money,” says Deborah about the phone call.
After Sarah’s death, Deborah also learned the doctor’s office had arranged an in-person meeting for Sarah with an Insys pharmaceutical representative in order to “educate” her about the drug. At the meeting, the pharmaceutical representative showed Sarah how to use Subsys. Pharma reps don’t typically meet with patients, a practice that is established to be unethical, at best.
Many of the details from Sarah’s case appeared to be common practice for Insys. Over the summer, for example, Anthem health insurance filed a lawsuit against the company, claiming that half of the patients on its insurance plan using Subsys were never diagnosed with cancer.
Insys declined to comment on Sarah’s case, which is still pending, but it released a statement in September in response to ongoing accusations, insisting it has changed its business practices, and that employees are no longer communicating directly with insurance companies.
But Insys denies its product is in any way responsible for the uptick of overdose deaths from fentanyl. “It’s inaccurate and misleading to suggest that Subsys has contributed to the abuse of illicit synthetic fentanyl,” according to the statement, which added that the opioid crisis began more than 15 years ago, while Subsys has only been available since 2012.
While it’s true that Insys isn’t the only company producing fentanyl-based painkillers, the indictment of so many top executives is unprecedented in this case. Paying fines for causing addiction and death is no longer enough. There’s clearly more pain coming for everyone in this business.
Litigation Coverage
Commentary and FYIs
Add recipients
Suggested