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Opioid Litigation Daily Media Report - 2/20/18

Commentary and FYIs

The other side of the opioid epidemic — we're people in severe pain (Opinion)
Feb 16, 2018 | The Hill
By Kate Nicholson

When I went into the office one Saturday afternoon in August 1994, I planned to spend a few hours finishing a brief that was due in federal court Monday morning.
The Poison We Pick (Opinion)
Feb 20, 2018 | New York Magazine
By Andrew Sullivan

It is a beautiful, hardy flower, Papaver somniferum, a poppy that grows up to four feet in height and arrives in a multitude of colors. It thrives in temperate climates, needs no fertilizer, attracts few pests, and is as tough as many weeds. The blooms last only a few days and then the petals fall, revealing a matte, greenish-gray pod fringed with flutes. The seeds are nutritious and have no psychotropic effects. No one knows when the first curious human learned to crush this bulblike pod and mix it with water, creating a substance that has an oddly calming and euphoric effect on the human brain. Nor do we know who first found out that if you cut the pod with a small knife, capture its milky sap, and leave that to harden in the air, you’ll get a smokable nugget that provides an even more intense experience. We do know, from Neolithic ruins in Europe, that the cultivation of this plant goes back as far as 6,000 years, probably farther. Homer called it a “wondrous substance.” Those who consumed it, he marveled, “did not shed a tear all day long, even if their mother or father had died, even if a brother or beloved son was killed before their own eyes.” For millennia, it has salved pain, suspended grief, and seduced humans with its intimations of the divine. It was a medicine before there was such a thing as medicine. Every attempt to banish it, destroy it, or prohibit it has failed.
We need federal limits on prescribing opioids (Opinion)
Feb 18, 2018 | The Hill
By Dr. Richard S. Larson

The United States has long been plagued by drug addiction, but our current epidemic of opioid abuse, with its growing toll of overdose deaths, is starkly different.
Local drugstores also play a part in the opioid crisis (Letter to the Editor)
Feb 19, 2018 | Washington Post
By Edward R. Moore

The Feb. 16 Politics & the Nation” article “Lawmakers say opioid shippers sent 12.3 million pills to one W.Va. pharmacy” served as an indictment of the pharmaceutical industry, particularly the large national distributors, as responsible in large part for the opioid epidemic.
What tobacco industry’s past could forecast for opioid crisis’s future
Feb 19, 2018 | The Daily Free Press (MA)
By Hannah Shearer

Smoking kills over 480,000 Americans each year and costs the United States $300 billion a year in medical care, according to a study from the Center for Disease Control. Before 1998’s Master Settlement Agreement, these numbers were even higher.
Kentucky accuses Cardinal Health of contributing to opioid epidemic
Feb 19, 2018 | Reuters
By Nate Raymond

Kentucky’s attorney general on Monday filed a lawsuit against drug distributor Cardinal Health Inc, accusing it of contributing to the opioid epidemic by failing to halt or report suspiciously large or frequent orders by pharmacies of prescription painkillers.
Following the money between patient groups and Big Pharma (Opinion)
Feb 17, 2018 | CBC News
By Kelly Crowe

Why would more than two dozen patient advocacy groups want to stop Health Canada from trying to lower prescription drug prices in Canada?
Pharmaceutical Companies Reportedly Paid $10 Million to Encourage Use of Opioids
Feb 16, 2018 | National Law Review
By Shanon M. McNulty

A U.S. Senate committee reported Monday (Feb. 12, 2018) that the five largest opioid manufacturers paid more than $10 million directed in particular to patient advocacy groups and professional medical societies who would then encourage the use of those highly addictive drugs.

Southeast (NC, LA, FL, AL, GA)

Guilford County will sue opioid manufacturers and distributors over drug crisis
Feb 16, 2018 | FOX 8 (NC)
By Alex Rose

Guilford County Board of Commissioners on Friday announced plans to file a lawsuit against many of the major opiate manufacturers and distributors.
Alamance County moves forward on opioid lawsuit
Feb 19, 2018 | Burlington Times News (NC)
By Isaac Groves

The Alamance County Board of Commissioners voted 5–0 to go to the next step of hiring a law firm to sue opioid manufacturers and distributors.
Thibodaux City Council to vote on joining opioid lawsuit
Feb 18, 2018 | Hourma Today (LA)
By Bridget Mire

The Thibodaux City Council will decide Tuesday whether to hire attorneys for representation in pending litigation against opioid manufacturers and distributors.
It’s past time to hold opioid manufacturers accountable (Opinion)
Feb 20, 2018 | Prince Williams Times (FL)
By Pete Candland

If you are an innocent party in a car accident and suffering injuries that require medical treatment, it is a well-established legal principle that damages to your car and any medical expenses are recovered from the person responsible for the injuries.
Council to consider joining lawsuit against opioid manufacturers
Feb 19, 2018 | Alexander CIty Outlook (AL)
By Mitch Sneed

The impact of opioid abuse across the state and nation has been making headlines and Monday night the Alexander City City Council will consider joining several other Alabama towns and cities in a lawsuit against the manufacturers of the drugs.
Athens-Clarke, Oconee suing opioid companies
Feb 20, 2018 | Athens Banner-Herald (GA)
By Lee Shearer

Athens-Clarke and Oconee counties have joined a growing number of other governments and hospital authorities across the country in a multi-state federal lawsuit targeting makers and distributors of opioid drugs.

Northeast (MA, MD)

More Mass. Cities and Towns Plan To File Lawsuits Against Opioid Companies
Feb 19, 2018 | New England Public Radio (MA)`
By Alden Bourne

Pittsfield, Sturbridge, West Springfield, Palmer, and Charlton are among the cities and towns in central and western Massachusetts that are taking legal action against manufacturers and distributors of opioids.
Central Mass. towns join legal fight against Big Pharma to recover costs incurred by opioid crisis
Feb 17, 2018 | Telegram & Gazette (MA)
By Craig S. Semon

Eight Central Massachusetts municipalities, among more than 30 statewide, have signed on to join litigation seeking to recover municipal costs incurred because of the opioid crisis.
Massachusetts Opioid Litigation Attorneys make their case to municipalities
Feb 20, 2018 | MassLive (MA)
By Conor Berry

The Town of Wilbraham is among the communities considering whether to tap the services of Massachusetts Opioid Litigation Attorneys, or MOLA, a consortium of law firms filing suit against the world's biggest pharmaceutical companies to hold them accountable for the state's opioid crisis.
Carroll should sue opioid manufacturers (Opinion)
Feb 19, 2018 | Carroll County Times (MD)
By Staff

Carroll County commissioners last week asked its legal staff to look into whether it would be wise for the county to join many others in Central Maryland and file a lawsuit against the pharmaceutical companies that manufacture and marketed prescription opioid drugs like OxyContin that many believe are at the root of the resurgence of heroin and subsequent addiction epidemic.

Midwest (WI, MI, IA)

La Crosse County joins opioid lawsuit
Feb 16, 2018 | WXOW (WI)
By Claire Sarafin

La Crosse County will join a lawsuit against big pharma over the opioid drug crisis.
County considers opioid suit
Feb 19, 2018 | The Daily Mining Gazette (MI)
By Garrett Neese

Houghton County officials are considering joining other Michigan municipalities in a suit against pharmaceutical companies responsible for manufacturing the opioids brought into the county.
Counties join together in opioid lawsuit
Feb 19, 2018 | Clinton Herald (IA)
By John Rohlf

Forty-six Iowa counties, including Clinton County, have joined an opioid lawsuit that was filed in January in the Northern District of Ohio.

Northwest (OR)

Portland Might Become the Latest City to Sue Over the Opioid Crisis
Feb 16, 2018 | Portland Mercury (OR)
By Dirk VanderHart

The City of Portland is about to jump into the fight against opioid manufacturers.

Broadcast Media Coverage

NBC Nightly News
Feb 19, 2018 | NBC Nightly News
By National Programming

Video Link: http://app.criticalmention.com/app/#clip/view/32806442?token=37955281-c710-4903-850c-33b87f7fb67c
Key Capitol Hill Hearings
Feb 16, 2018 | CSPAN
By National Programming

Video Link: http://app.criticalmention.com/app/#clip/view/32806523?token=37955281-c710-4903-850c-33b87f7fb67c
FOX and Friends Sunday
Feb 18, 2018 | Fox News
By National Programming

Video Link: http://app.criticalmention.com/app/#clip/view/32806486?token=37955281-c710-4903-850c-33b87f7fb67c
NBC 5 Today at 5am
Feb 19, 2018 | KXAS (NBC)
By Dallas, TX

Video Link: http://app.criticalmention.com/app/#clip/view/32806467?token=37955281-c710-4903-850c-33b87f7fb67c
Good Day Philadelphia Weekend
Feb 17, 2018 | WTXF (Fox)
By Philadelphia, PA

Video Link: http://app.criticalmention.com/app/#clip/view/32806493?token=37955281-c710-4903-850c-33b87f7fb67c
Eyewitness News at 6:00
Feb 17, 2018 | WSOC (ABC)
By Charlotte, NC

Video Link: http://app.criticalmention.com/app/#clip/view/32806530?token=37955281-c710-4903-850c-33b87f7fb67c
WFMY News 2 at 6
Feb 16, 2018 | WFMY (CBS)
By Greensboro, NC

Video Link: http://app.criticalmention.com/app/#clip/view/32806716?token=37955281-c710-4903-850c-33b87f7fb67c
FOX8 News at 6:00A
Feb 20, 2018 | WGHP (Fox)
By Greensboro, NC

Video Link: http://app.criticalmention.com/app/#clip/view/32806550?token=37955281-c710-4903-850c-33b87f7fb67c
This Week in Cincinnati
Feb 18, 2018 | WCPO (ABC)
By Cincinnati, OH

Video Link: http://app.criticalmention.com/app/#clip/view/32806693?token=37955281-c710-4903-850c-33b87f7fb67c
KOCO 5 News at 6am Saturday
Feb 17, 2018 | KOCO (ABC)
By Oklahoma City, OK

Video Link: http://app.criticalmention.com/app/#clip/view/32806697?token=37955281-c710-4903-850c-33b87f7fb67c
Northwest Now
Feb 16, 2018 | KBTC (PBS)
By Seattle, WA

Video Link: http://app.criticalmention.com/app/#clip/view/32806537?token=37955281-c710-4903-850c-33b87f7fb67c

Commentary and FYIs

The other side of the opioid epidemic — we're people in severe pain (Opinion)

Feb 16, 2018 | The Hill

By Kate Nicholson

When I went into the office one Saturday afternoon in August 1994, I planned to spend a few hours finishing a brief that was due in federal court Monday morning.
At the time, I was an attorney for the justice department. After 30 minutes of working at my desk, my back started to burn; it felt as if acid were eating my spine. In rapid succession, my muscles seized and threw me from my chair. I landed on the floor, stunned, as my body seared with pain.
What I didn’t know then was that the pain would persist, and that I would be unable to sit, stand, or walk unassisted for almost twenty years. Nor could I have imagined that I would take opioids.

Opioids fill the news with a steady stream of stories of lives lost from overdose and abuse. What we rarely hear is the other side — opioids are also the most powerful pain medication we have. For me, they were life-restoring.
Appropriate pain management that included prescription opioids lifted me from the desperate circumstances of being bedridden and unable to sleep for months at a time to someone who negotiated major settlement agreements. I argued important cases in federal court, and supervised thousands of matters in U.S. Attorney’s Offices across the country.
I still could not sit or stand — I negotiated via video-teleconference, argued from a reclining lawn chair, and managed cases from a jerry-rigged, platform bed — but I could and did work and function.
Pain patients today are not so fortunate.  In our effort to thwart the genuine problem of drug overdoses, we are taking life-sustaining medicine away from suffering people.
Long-term, legitimate pain patients who have relied on opioid analgesics can no longer fill their prescriptions in the many states that set maximum dosage and supply limits, often of three to seven days.
Even in states that contain exceptions for long-term pain care, insurance companies and pharmacy policies use such laws as a reason to deny coverage or fills. Pain patients are being denied treatment and involuntarily tapered off of opioid medications, even if they’ve never shown any risks of abuse.
The Department of Veterans Affairs, which sponsored one of the first systematic efforts to discontinue opioid treatment, recently issued an abstract reporting that the results were not fewer overdose deaths but increased suicide mortality.
While there is no question that looser prescribing of opioids in the 1990s and early 2000s contributed to the overdose crisis, illegal fentanyl and heroin drive overdoses today, not new prescriptions.
The prescribing of opioids has dropped every year since 2012 and is at 10 year low — and yet drug overdose deaths have skyrocketed. Meanwhile, our public policy looks backward in time, intruding on the doctor patient relationship and burdening patient care.
The Attorney General recently responded to the concerns of pain patients by telling them to “take a few Bufferin or something and go to bed.”
His comment shows an astonishing misunderstanding of a condition whose quality of life index (QLI) is akin to that of late-stage cancer. Fifty million Americans suffer from severe or persistent pain, which twenty-five times more than those who misuse opioids.
Chronic pain is also the primary cause of disability in the US, and it costs the economy half a trillion dollars every year.
There is an important but often glossed over distinction between using medication for a health condition in a way that restores function, enabling work and participation in family life, and misusing a substance in a manner that destroys function.
Most people who take opioids for pain do not abuse them: studies show risk for addiction in such patients varying between .07 and 8 percent. And, when opioids are prescribed properly with screening and follow through care, the risk of addiction goes down significantly.
The substantial majority of people who have misused prescription opioids never received them in a healthcare setting; they obtained them from medicine cabinets, family and friends, or bought on the street.
Like many pain patients, I initially resisted taking opioids. I exhausted every other possible treatment first.
Because my condition resulted from a surgery when a doctor severed nerve plexuses in my spine, I tried infusions, nerve blocks and even a repeat surgery. I did physical therapy, acupuncture, and biofeedback. But nothing abated the pain.
Treatment with opioids and integrative care allowed me to maintain a job, a sense of purpose, and community until I found my way to healing.  Mine is a story rarely told of someone who took opioid analgesics for years and went off them without incident when the pain remitted.  Given the environment today, such stories may well become extinct.
Kate Nicholson is a civil rights attorney, a nationally-recognized expert in the Americans with Disabilities Act, and a chronic pain survivor. She is writing a book about pain, and recently gave a TEDx talk on the subject.

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The Poison We Pick (Opinion)

Feb 20, 2018 | New York Magazine

By Andrew Sullivan

It is a beautiful, hardy flower, Papaver somniferum, a poppy that grows up to four feet in height and arrives in a multitude of colors. It thrives in temperate climates, needs no fertilizer, attracts few pests, and is as tough as many weeds. The blooms last only a few days and then the petals fall, revealing a matte, greenish-gray pod fringed with flutes. The seeds are nutritious and have no psychotropic effects. No one knows when the first curious human learned to crush this bulblike pod and mix it with water, creating a substance that has an oddly calming and euphoric effect on the human brain. Nor do we know who first found out that if you cut the pod with a small knife, capture its milky sap, and leave that to harden in the air, you’ll get a smokable nugget that provides an even more intense experience. We do know, from Neolithic ruins in Europe, that the cultivation of this plant goes back as far as 6,000 years, probably farther. Homer called it a “wondrous substance.” Those who consumed it, he marveled, “did not shed a tear all day long, even if their mother or father had died, even if a brother or beloved son was killed before their own eyes.” For millennia, it has salved pain, suspended grief, and seduced humans with its intimations of the divine. It was a medicine before there was such a thing as medicine. Every attempt to banish it, destroy it, or prohibit it has failed.
The poppy’s power, in fact, is greater than ever. The molecules derived from it have effectively conquered contemporary America. Opium, heroin, morphine, and a universe of synthetic opioids, including the superpowerful painkiller fentanyl, are its proliferating offspring. More than 2 million Americans are now hooked on some kind of opioid, and drug overdoses — from heroin and fentanyl in particular — claimed more American lives last year than were lost in the entire Vietnam War. Overdose deaths are higher than in the peak year of AIDS and far higher than fatalities from car crashes. The poppy, through its many offshoots, has now been responsible for a decline in life spans in America for two years in a row, a decline that isn’t happening in any other developed nation. According to the best estimates, opioids will kill another 52,000 Americans this year alone — and up to half a million in the next decade.
We look at this number and have become almost numb to it. But of all the many social indicators flashing red in contemporary America, this is surely the brightest. Most of the ways we come to terms with this wave of mass death — by casting the pharmaceutical companies as the villains, or doctors as enablers, or blaming the Obama or Trump administrations or our policies of drug prohibition or our own collapse in morality and self-control or the economic stress the country is enduring — miss a deeper American story. It is a story of pain and the search for an end to it. It is a story of how the most ancient painkiller known to humanity has emerged to numb the agonies of the world’s most highly evolved liberal democracy. Just as LSD helps explain the 1960s, cocaine the 1980s, and crack the 1990s, so opium defines this new era. I say era, because this trend will, in all probability, last a very long time. The scale and darkness of this phenomenon is a sign of a civilization in a more acute crisis than we knew, a nation overwhelmed by a warp-speed, postindustrial world, a culture yearning to give up, indifferent to life and death, enraptured by withdrawal and nothingness. America, having pioneered the modern way of life, is now in the midst of trying to escape it.
How does an opioid make you feel? We tend to avoid this subject in discussing recreational drugs, because no one wants to encourage experimentation, let alone addiction. And it’s easy to believe that weak people take drugs for inexplicable, reckless, or simply immoral reasons. What few are prepared to acknowledge in public is that drugs alter consciousness in specific and distinct ways that seem to make people at least temporarily happy, even if the consequences can be dire. Fewer still are willing to concede that there is a significant difference between these various forms of drug-induced “happiness” — that the draw of crack, say, is vastly different than that of heroin. But unless you understand what users get out of an illicit substance, it’s impossible to understand its appeal, or why an epidemic takes off, or what purpose it is serving in so many people’s lives. And it is significant, it seems to me, that the drugs now conquering America are downers: They are not the means to engage in life more vividly but to seek a respite from its ordeals.
The alkaloids that opioids contain have a large effect on the human brain because they tap into our natural “mu-opioid” receptors. The oxytocin we experience from love or friendship or orgasm is chemically replicated by the molecules derived from the poppy plant. It’s a shortcut — and an instant intensification — of the happiness we might ordinarily experience in a good and fruitful communal life. It ends not just physical pain but psychological, emotional, even existential pain. And it can easily become a lifelong entanglement for anyone it seduces, a love affair in which the passion is more powerful than even the fear of extinction.
Perhaps the best descriptions of the poppy’s appeal come to us from the gifted writers who have embraced and struggled with it. Many of the Romantic luminaries of the early-19th century — including the poets Coleridge, Byron, Shelley, Keats, and Baudelaire, and the novelist Walter Scott — were as infused with opium as the late Beatles were with LSD. And the earliest and in many ways most poignant account of what opium and its derivatives feel like is provided by the classic memoir Confessions of an English Opium-Eater, published in 1821 by the writer Thomas De Quincey.
De Quincey suffered trauma in childhood, losing his sister when he was 6 and his father a year later. Throughout his life, he experienced bouts of acute stomach pain, as well as obvious depression, and at the age of 19 he endured 20 consecutive days of what he called “excruciating rheumatic pains of the head and face.” As his pain drove him mad, he finally went into an apothecary and bought some opium (which was legal at the time, as it was across the West until the war on drugs began a century ago).
An hour after he took it, his physical pain had vanished. But he was no longer even occupied by such mundane concerns. Instead, he was overwhelmed with what he called the “abyss of divine enjoyment” that overcame him: “What an upheaving from its lowest depths, of the inner spirit! … here was the secret of happiness, about which philosophers had disputed for many ages.” The sensation from opium was steadier than alcohol, he reported, and calmer. “I stood at a distance, and aloof from the uproar of life,” he wrote. “Here were the hopes which blossom in the paths of life, reconciled with the peace which is in the grave.” A century later, the French writer Jean Cocteau described the experience in similar ways: “Opium remains unique and the euphoria it induces superior to health. I owe it my perfect hours.”
The metaphors used are often of lightness, of floating: “Rising even as it falls, a feather,” as William Brewer, America’s poet laureate of the opioid crisis, describes it. “And then, within a fog that knows what I’m going to do, before I do — weightlessness.” Unlike cannabis, opium does not make you want to share your experience with others, or make you giggly or hungry or paranoid. It seduces you into solitude and serenity and provokes a profound indifference to food. Unlike cocaine or crack or meth, it doesn’t rev you up or boost your sex drive. It makes you drowsy — somniferum means “sleep-inducing” — and lays waste to the libido. Once the high hits, your head begins to nod and your eyelids close.
When we see the addicted stumbling around like drunk ghosts, or collapsed on sidewalks or in restrooms, their faces pale, their skin riddled with infection, their eyes dead to the world, we often see only misery. What we do not see is what they see: In those moments, they feel beyond gravity, entranced away from pain and sadness. In the addict’s eyes, it is those who are sober who are asleep. That is why the police and EMS workers who rescue those slipping toward death by administering blasts of naloxone — a powerful antidote, without which death rates would be even higher — are almost never thanked. They are hated. They ruined the high. And some part of being free from all pain makes you indifferent to death itself. Death is, after all, the greatest of existential pains. “Everything one achieves in life, even love, occurs in an express train racing toward death,” Cocteau observed. “To smoke opium is to get out of the train while it is still moving. It is to concern oneself with something other than life or death.”
This terrifyingly dark side of the poppy reveals itself the moment one tries to break free. The withdrawal from opioids is unlike any other. The waking nightmares, hideous stomach cramps, fevers, and psychic agony last for weeks, until the body chemically cleanses itself. “A silence,” Cocteau wrote, “equivalent to the crying of thousands of children whose mothers do not return to give them the breast.” Among the symptoms: an involuntary and constant agitation of the legs (whence the term “kicking the habit”). The addict becomes ashamed as his life disintegrates. He wants to quit, but, as De Quincey put it, he lies instead “under the weight of incubus and nightmare … he would lay down his life if he might get up and walk; but he is powerless as an infant, and cannot even attempt to rise.”
The poppy’s paradox is a profoundly human one: If you want to bring Heaven to Earth, you must also bring Hell. In the words of Lenny Bruce, “I’ll die young, but it’s like kissing God.”
No other developed country is as devoted to the poppy as America. We consume 99 percent of the world’s hydrocodone and 81 percent of its oxycodone. We use an estimated 30 times more opioids than is medically necessary for a population our size. And this love affair has been with us from the start. The drug was ubiquitous among both the British and American forces in the War of Independence as an indispensable medicine for the pain of battlefield injuries. Thomas Jefferson planted poppies at Monticello, and they became part of the place’s legend (until the DEA raided his garden in 1987 and tore them out of the ground). Benjamin Franklin was reputed to be an addict in later life, as many were at the time. William Wilberforce, the evangelical who abolished the British slave trade, was a daily enthusiast. As Martin Booth explains in his classic history of the drug, poppies proliferated in America, and the use of opioids in over-the-counter drugs was commonplace. A wide range of household remedies were based on the poppy’s fruit; among the most popular was an elixir called laudanum — the word literally means “praiseworthy” — which took off in England as early as the 17th century.
Mixed with wine or licorice, or anything else to disguise the bitter taste, opiates were for much of the 19th century the primary treatment for diarrhea or any physical pain. Mothers gave them to squalling infants as a “soothing syrup.” A huge boom was kick-started by the Civil War, when many states cultivated poppies in order to treat not only the excruciating pain of horrific injuries but endemic dysentery. Booth notes that 10 million opium pills and 2 million ounces of opiates in powder or tinctures were distributed by Union forces. Subsequently, vast numbers of veterans became addicted — the condition became known as “Soldier’s Disease” — and their high became more intense with the developments of morphine and the hypodermic needle. They were joined by millions of wives, sisters, and mothers who, consumed by postwar grief, sought refuge in the obliviating joy that opiates offered.
Based on contemporary accounts, it appears that the epidemic of the late 1860s and 1870s was probably more widespread, if far less intense, than today’s — a response to the way in which the war tore up settled ways of life, as industrialization transformed the landscape, and as huge social change generated acute emotional distress. This aspect of the epidemic — as a response to mass social and cultural dislocation — was also clear among the working classes in the earlier part of the 19th century in Britain. As small armies of human beings were lured from their accustomed rural environments, with traditions and seasons and community, and thrown into vast new industrialized cities, the psychic stress gave opium an allure not even alcohol could match. Some historians estimate that as much as 10 percent of a working family’s income in industrializing Britain was spent on opium. By 1870, opium was more available in the United States than tobacco was in 1970. It was as if the shift toward modernity and a wholly different kind of life for humanity necessitated for most working people some kind of relief — some way of getting out of the train while it was still moving.
It is tempting to wonder if, in the future, today’s crisis will be seen as generated from the same kind of trauma, this time in reverse.
If industrialization caused an opium epidemic, deindustrialization is no small part of what’s fueling our opioid surge. It’s telling that the drug has not taken off as intensely among all Americans — especially not among the engaged, multiethnic, urban-dwelling, financially successful inhabitants of the coasts. The poppy has instead found a home in those places left behind — towns and small cities that owed their success to a particular industry, whose civic life was built around a factory or a mine. Unlike in Europe, where cities and towns existed long before industrialization, much of America’s heartland has no remaining preindustrial history, given the destruction of Native American societies. The gutting of that industrial backbone — especially as globalization intensified in a country where market forces are least restrained — has been not just an economic fact but a cultural, even spiritual devastation. The pain was exacerbated by the Great Recession and has barely receded in the years since. And to meet that pain, America’s uniquely market-driven health-care system was more than ready.
The great dream of the medical profession, which has been fascinated by opioids over the centuries, was to create an experience that captured the drug’s miraculous pain relief but somehow managed to eliminate its intoxicating hook. The attempt to refine opium into a pain reliever without addictive properties produced morphine and later heroin — each generated by perfectly legal pharmaceutical and medical specialists for the most enlightened of reasons. (The word heroin was coined from the German word Heroisch, meaning “heroic,” by the drug company Bayer.) In the mid-1990s, OxyContin emerged as the latest innovation: A slow timed release would prevent sudden highs or lows, which, researchers hoped, would remove craving and thereby addiction. Relying on a single study based on a mere 38 subjects, scientists concluded that the vast majority of hospital inpatients who underwent pain treatment with strong opioids did not go on to develop an addiction, spurring the drug to be administered more widely.
This reassuring research coincided with a social and cultural revolution in medicine: In the wake of the AIDS epidemic, patients were becoming much more assertive in managing their own treatment — and those suffering from debilitating pain began to demand the relief that the new opioids promised. The industry moved quickly to cash in on the opportunity: aggressively marketing the new drugs to doctors via sales reps, coupons, and countless luxurious conferences, while waging innovative video campaigns designed to be played in doctors’ waiting rooms. As Sam Quinones explains in his indispensable account of the epidemic, Dreamland, all this happened at the same time that doctors were being pressured to become much more efficient under the new regime of “managed care.” It was a fateful combination: Patients began to come into doctors’ offices demanding pain relief, and doctors needed to process patients faster. A “pain” diagnosis was often the most difficult and time-consuming to resolve, so it became far easier just to write a quick prescription to abolish the discomfort rather than attempt to isolate its cause. The more expensive and laborious methods for treating pain — physical and psychological therapy — were abandoned almost overnight in favor of the magic pills.
A huge new supply and a burgeoning demand thereby created a massive new population of opioid users. Getting your opioid fix no longer meant a visit to a terrifying shooting alley in a ravaged city; now it just required a legitimate prescription and a bottle of pills that looked as bland as a statin or an SSRI. But as time went on, doctors and scientists began to realize that they were indeed creating addicts. Much of the initial, hopeful research had been taken from patients who had undergone opioid treatment as inpatients, under strict supervision. No one had examined the addictive potential of opioids for outpatients, handed bottles and bottles of pills, in doses that could be easily abused. Doctors and scientists also missed something only recently revealed about OxyContin itself: Its effects actually declined after a few hours, not 12 — thus subjecting most patients to daily highs and lows and the increased craving this created. Patients whose pain hadn’t gone away entirely were kept on opioids for longer periods of time and at higher dosages. And OxyContin had not removed the agonies of withdrawal: Someone on painkillers for three months would often find, as her prescription ran out, that she started vomiting or was convulsed with fever. The quickest and simplest solution was a return to the doctor.
Add to this the federal government’s move in the mid-1980s to replace welfare payments for the poor with disability benefits — which covered opioids for pain — and unscrupulous doctors, often in poorer areas, found a way to make a literal killing from shady pill mills. So did many patients. A Medicaid co-pay of $3 for a bottle of pills, as Quinones discovered, could yield $10,000 on the streets — an economic arbitrage that enticed countless middle-class Americans to become drug dealers. One study has found that 75 percent of those addicted to opioids in the United States began with prescription painkillers given to them by a friend, family member, or dealer. As a result, the social and cultural profile of opioid users shifted as well: The old stereotype of a heroin junkie — a dropout or a hippie or a Vietnam vet — disappeared in the younger generation, especially in high schools. Football players were given opioids to mask injuries and keep them on the field; they shared them with cheerleaders and other popular peers; and their elevated social status rebranded the addiction. Now opiates came wrapped in the bodies and minds of some of the most promising, physically fit, and capable young men and women of their generation. Courtesy of their doctors and coaches.
It’s hard to convey the sheer magnitude of what happened. Between 2007 and 2012, for example, 780 million hydrocodone and oxycodone pills were delivered to West Virginia, a state with a mere 1.8 million residents. In one town, population 2,900, more than 20 million opioid prescriptions were processed in the past decade. Nationwide, between 1999 and 2011, oxycodone prescriptions increased sixfold. National per capita consumption of oxycodone went from around 10 milligrams in 1995 to almost 250 milligrams by 2012.
The quantum leap in opioid use arrived by stealth. Most previous drug epidemics were accompanied by waves of crime and violence, which prompted others, outside the drug circles, to take notice and action. But the opioid scourge was accompanied, during its first decade, by a record drop in both. Drug users were not out on the streets causing mayhem or havoc. They were inside, mostly alone, and deadly quiet. There were no crack houses to raid or gangs to monitor. Overdose deaths began to climb, but they were often obscured by a variety of dry terms used in coroners’ reports to hide what was really happening. When the cause of death was inescapable — young corpses discovered in bedrooms or fast-food restrooms — it was also, frequently, too shameful to share. Parents of dead teenagers were unlikely to advertise their agony.
In time, of course, doctors realized the scale of their error. Between 2010 and 2015, opioid prescriptions declined by 18 percent. But if it was a huge, well-intended mistake to create this army of addicts, it was an even bigger one to cut them off from their supply. That is when the addicted were forced to turn to black-market pills and street heroin. Here again, the illegal supply channel broke with previous patterns. It was no longer controlled by the established cartels in the big cities that had historically been the main source of narcotics. This time, the heroin — particularly cheap, black-tar heroin from Mexico — came from small drug-dealing operations that avoided major urban areas, instead following the trail of methadone clinics and pill mills into the American heartland.
Their innovation, Quinones discovered, was to pay the dealers a flat salary, rather than a cut from the heroin itself. This removed the incentives to weaken the product, by cutting it with baking soda or other additives, and so made the new drug much more predictable in its power and reliable in its dosage. And rather than setting up a central location to sell the drugs — like a conventional shooting gallery or crack house — the new heroin marketers delivered it by car. Outside methadone clinics or pill mills, they handed out cards bearing only a telephone number. Call them and they would arrange to meet you near your house, in a suburban parking lot. They were routinely polite and punctual.
Buying heroin became as easy in the suburbs and rural areas as buying weed in the cities. No violence, low risk, familiar surroundings: an entire system specifically designed to provide a clean-cut, friendly, middle-class high. America was returning to the norm of the 19th century, when opiates were a routine medicine, but it was consuming compounds far more potent, addictive, and deadly than any 19th-century tincture enthusiast could have imagined. The country resembled someone who had once been accustomed to opium, who had spent a long time in recovery, whose tolerance for the drug had collapsed, and who was then offered a hit of the most powerful new variety.
The iron law of prohibition, as first stipulated by activist Richard Cowan in 1986, is that the more intense the crackdown, “the more potent the drugs will become.” In other words, the harder the enforcement, the harder the drugs. The legal risks associated with manufacturing and transporting a drug increase exponentially under prohibition, which pushes the cost of supplying the drug higher, which incentivizes traffickers to minimize the size of the product, which leads to innovations in higher potency. That’s why, during the prohibition of alcohol, much of the production and trafficking was in hard liquor, not beer or wine; why amphetamines evolved into crystal meth; why today’s cannabis is much more potent than in the late-20th century. Heroin, rather than old-fashioned opium, became the opioid of the streets.
Then came fentanyl, a massively concentrated opioid that delivers up to 50 times the strength of heroin. Developed in 1959, it is now one of the most widely used opioids in global medicine, its miraculous pain relief delivered through transdermal patches, or lozenges, that have revolutionized surgery and recovery and helped save countless lives. But in its raw form, it is one of the most dangerous drugs ever created by human beings. A recent shipment of fentanyl seized in New Jersey fit into the trunk of a single car yet contained enough poison to wipe out the entire population of New Jersey and New York City combined. That’s more potential death than a dirty bomb or a small nuke. That’s also what makes it a dream for traffickers. A kilo of heroin can yield $500,000; a kilo of fentanyl is worth as much as $1.2 million.
The problem with fentanyl, as it pertains to traffickers, is that it is close to impossible to dose correctly. To be injected at all, fentanyl’s microscopic form requires it to be cut with various other substances, and that cutting is playing with fire. Just the equivalent of a few grains of salt can send you into sudden paroxysms of heaven; a few more grains will kill you. It is obviously not in the interests of drug dealers to kill their entire customer base, but keeping most of their clients alive appears beyond their skill. The way heroin kills you is simple: The drug dramatically slows the respiratory system, suffocating users as they drift to sleep. Increase the potency by a factor of 50 and it is no surprise that you can die from ingesting just a half a milligram of the stuff.
Fentanyl comes from labs in China; you can find it, if you try, on the dark web. It’s so small in size and so valuable that it’s close to impossible to prevent it coming into the country. Last year, 500 million packages of all kinds entered the United States through the regular mail — making them virtually impossible to monitor with the Postal Service’s current technology. And so, over the past few years, the impact of opioids has gone from mass intoxication to mass death. In the last heroin epidemic, as Vietnam vets brought the addiction back home, the overdose rate was 1.5 per 10,000 Americans. Now, it’s 10.5. Three years ago in New Jersey, 2 percent of all seized heroin contained fentanyl. Today, it’s a third. Since 2013, overdose deaths from fentanyl and other synthetic opioids have increased sixfold, outstripping those from every other drug.
If the war on drugs is seen as a century-long game of chess between the law and the drugs, it seems pretty obvious that fentanyl, by massively concentrating the most pleasurable substance ever known to mankind, is checkmate.
Watching as this catastrophe unfolded these past few years, I began to notice how closely it resembles the last epidemic that dramatically reduced life-spans in America: AIDS. It took a while for anyone to really notice what was happening there, too. AIDS occurred in a population that was often hidden and therefore distant from the cultural elite (or closeted within it). To everyone else, the deaths were abstract, and relatively tolerable, especially as they were associated with an activity most people disapproved of. By the time the epidemic was exposed and understood, so much damage had been done that tens of thousands of deaths were already inevitable.
Today, once more, the cultural and political elites find it possible to ignore the scale of the crisis because it is so often invisible in their — our — own lives. The polarized nature of our society only makes this worse: A plague that is killing the other tribe is easier to look away from. Occasionally, members of the elite discover their own children with the disease, and it suddenly becomes more urgent. A celebrity death — Rock Hudson in 1985, Prince in 2016 — begins to break down some of the denial. Those within the vortex of death get radicalized by the failure of government to tackle the problem. The dying gay men who joined ACT UP in the 1980s share one thing with the opioid-ridden communities who voted for Donald Trump in unexpected numbers: a desperate sense of powerlessness, of living through a plague that others are choosing not to see.
At some point, the sheer numbers of the dead become unmissable. With AIDS, the government, along with pharmaceutical companies, eventually developed a plan of action: prevention, education, and research for a viable treatment and cure. Some of this is happening with opioids. The widespread distribution of Narcan sprays — which contain the antidote naloxone — has already saved countless lives. The use of alternative, less-dangerous opioid drugs such as methadone and buprenorphine to wean people off heroin or cushion them through withdrawal has helped. Some harm-reduction centers have established needle-exchange programs. But none of this comes close to stopping the current onslaught. With HIV and AIDS, after all, there was a clear scientific goal: to find drugs that would prevent HIV from replicating. With opioid addiction, there is no such potential cure in the foreseeable future. When we see the toll from opioids exceed that of peak AIDS deaths, it’s important to remember that after that peak came a sudden decline. After the latest fentanyl peak, no such decline looks probable. On the contrary, the deaths continue to mount.
Over time, AIDS worked its way through the political system.
More than anything else, it destroyed the closet and massively accelerated our culture’s acceptance of the dignity and humanity of homosexuals. Marriage equality and open military service were the fruits of this transformation. But with the opioid crisis, our politics has remained curiously unmoved. The Trump administration, despite overwhelming support from many of the communities most afflicted, hasn’t appointed anyone with sufficient clout and expertise to corral the federal government to respond adequately.
The critical Office of National Drug Control Policy has spent a year without a permanent director. Its budget is slated to be slashed by 95 percent, and until a few weeks ago, its deputy chief of staff was a 24-year-old former campaign intern. Kellyanne Conway — Trump’s “opioid czar” — has no expertise in government, let alone in drug control. Although Trump plans to increase spending on treating addiction, the overall emphasis is on an even more intense form of prohibition, plus an advertising campaign. Attorney General Jeff Sessions even recently opined that he believes marijuana is really the key gateway to heroin — a view so detached from reality it beggars belief. It seems clear that in the future, Trump’s record on opioids will be as tainted as Reagan’s was on AIDS. But the human toll could be even higher.
One of the few proven ways to reduce overdose deaths is to establish supervised injection sites that eventually wean users off the hard stuff while steering them into counseling, safe housing, and job training.
After the first injection site in North America opened in Vancouver, deaths from heroin overdoses plunged by 35 percent. In Switzerland, where such sites operate nationwide, overdose deaths have been cut in half. By treating the addicted as human beings with dignity rather than as losers and criminals who have ostracized themselves, these programs have coaxed many away from the cliff face of extinction toward a more productive life.
But for such success to be replicated in the United States, we would have to contemplate actually providing heroin to addicts in some cases, and we’d have to shift much of the current spending on prohibition, criminalization, and incarceration into a huge program of opioid rehabilitation. We would, in short, have to end the war on drugs. We are nowhere near prepared to do that. And in the meantime, the comparison to act up is exceedingly depressing, as the only politics that opioids appear to generate is nihilistic and self-defeating. The drug itself saps initiative and generates social withdrawal. A few small activist groups have sprung up, but it is hardly a national movement of any heft or urgency.
And so we wait to see what amount of death will be tolerable in America as the price of retaining prohibition. Is it 100,000 deaths a year? More? At what point does a medical emergency actually provoke a government response that takes mass death seriously? Imagine a terror attack that killed over 40,000 people. Imagine a new virus that threatened to kill 52,000 Americans this year. Wouldn’t any government make it the top priority before any other?
In some ways, the spread of fentanyl — now beginning to infiltrate cocaine, fake Adderall, and meth, which is also seeing a spike in use — might best be thought of as a mass poisoning. It has infected often nonfatal drugs and turned them into instant killers. Think back to the poison discovered in a handful of tainted Tylenol pills in 1982. Every bottle of Tylenol in America was immediately recalled; in Chicago, police went into neighborhoods with loudspeakers to warn residents of the danger. That was in response to a scare that killed, in total, seven people. In 2016, 20,000 people died from overdosing on synthetic opioids, a form of poison in the illicit drug market. Some lives, it would appear, are several degrees of magnitude more valuable than others. Some lives are not worth saving at all.
One of the more vivid images that Americans have of drug abuse is of a rat in a cage, tapping a cocaine-infused water bottle again and again until the rodent expires. Years later, as recounted in Johann Hari’s epic history of the drug war, Chasing the Scream, a curious scientist replicated the experiment. But this time he added a control group. In one cage sat a rat and a water dispenser serving diluted morphine. In another cage, with another rat and an identical dispenser, he added something else: wheels to run in, colored balls to play with, lots of food to eat, and other rats for the junkie rodent to play or have sex with. Call it rat park. And the rats in rat park consumed just one-fifth of the morphine water of the rat in the cage. One reason for pathological addiction, it turns out, is the environment. If you were trapped in solitary confinement, with only morphine to pass the time, you’d die of your addiction pretty swiftly too. Take away the stimulus of community and all the oxytocin it naturally generates, and an artificial variety of the substance becomes much more compelling.
One way of thinking of postindustrial America is to imagine it as a former rat park, slowly converting into a rat cage. Market capitalism and revolutionary technology in the past couple of decades have transformed our economic and cultural reality, most intensely for those without college degrees. The dignity that many working-class men retained by providing for their families through physical labor has been greatly reduced by automation. Stable family life has collapsed, and the number of children without two parents in the home has risen among the white working and middle classes. The internet has ravaged local retail stores, flattening the uniqueness of many communities. Smartphones have eviscerated those moments of oxytocin-friendly actual human interaction. Meaning — once effortlessly provided by a more unified and often religious culture shared, at least nominally, by others — is harder to find, and the proportion of Americans who identify as “nones,” with no religious affiliation, has risen to record levels. Even as we near peak employment and record-high median household income, a sense of permanent economic insecurity and spiritual emptiness has become widespread. Some of that emptiness was once assuaged by a constantly rising standard of living, generation to generation.
But that has now evaporated for most Americans.
New Hampshire, Ohio, Kentucky, and Pennsylvania have overtaken the big cities in heroin use and abuse, and rural addiction has spread swiftly to the suburbs. Now, in the latest twist, opioids have reemerged in that other, more familiar place without hope: the black inner city, where overdose deaths among African-Americans, mostly from fentanyl, are suddenly soaring. To make matters worse, political and cultural tribalism has deeply weakened the glue of a unifying patriotism to give a broader meaning to people’s lives — large numbers of whites and blacks both feel like strangers in their own land. Mass immigration has, for many whites, intensified the sense of cultural abandonment. Somewhere increasingly feels like nowhere.
It’s been several decades since Daniel Bell wrote The Cultural Contradictions of Capitalism, but his insights have proven prescient. Ever-more-powerful market forces actually undermine the foundations of social stability, wreaking havoc on tradition, religion, and robust civil associations, destroying what conservatives value the most. They create a less human world. They make us less happy. They generate pain.
This was always a worry about the American experiment in capitalist liberal democracy. The pace of change, the ethos of individualism, the relentless dehumanization that capitalism abets, the constant moving and disruption, combined with a relatively small government and the absence of official religion, risked the construction of an overly atomized society, where everyone has to create his or her own meaning, and everyone feels alone. The American project always left an empty center of collective meaning, but for a long time Americans filled it with their own extraordinary work ethic, an unprecedented web of associations and clubs and communal or ethnic ties far surpassing Europe’s, and such a plethora of religious options that almost no one was left without a purpose or some kind of easily available meaning to their lives. Tocqueville marveled at this American exceptionalism as the key to democratic success, but he worried that it might not endure forever.
And it hasn’t. What has happened in the past few decades is an accelerated waning of all these traditional American supports for a meaningful, collective life, and their replacement with various forms of cheap distraction. Addiction — to work, to food, to phones, to TV, to video games, to porn, to news, and to drugs — is all around us. The core habit of bourgeois life — deferred gratification — has lost its grip on the American soul. We seek the instant, easy highs, and it’s hard not to see this as the broader context for the opioid wave. This was not originally a conscious choice for most of those caught up in it: Most were introduced to the poppy’s joys by their own family members and friends, the last link in a chain that included the medical establishment and began with the pharmaceutical companies. It may be best to think of this wave therefore not as a function of miserable people turning to drugs en masse but of people who didn’t realize how miserable they were until they found out what life without misery could be. To return to their previous lives became unthinkable. For so many, it still is.
If Marx posited that religion is the opiate of the people, then we have reached a new, more clarifying moment in the history of the West: Opiates are now the religion of the people. A verse by the poet William Brewer sums up this new world:
Where once was faith,
there are sirens: red lights spinning
door to door, a record twenty-four
in one day, all the bodies
at the morgue filled with light.
It is easy to dismiss or pity those trapped or dead for whom opiates have filled this emptiness. But it’s not quite so easy for the tens of millions of us on antidepressants, or Xanax, or some benzo-drug to keep less acute anxieties at bay. In the same period that opioids have spread like wildfire, so has the use of cannabis — another downer nowhere near as strong as opiates but suddenly popular among many who are the success stories of our times. Is it any wonder that something more powerful is used by the failures? There’s a passage in one of Brewer’s poems that tears at me all the time. It’s about an opioid-addicted father and his son. The father tells us:
Times my simple son will shake me to,
syringe still hanging like a feather from my arm.
What are you always doing, he asks.
Flying, I say. Show me how, he begs.
And finally, I do. You’d think
the sun had gotten lost inside his head,
the way he smiled.
To see this epidemic as simply a pharmaceutical or chemically addictive problem is to miss something: the despair that currently makes so many want to fly away. Opioids are just one of the ways Americans are trying to cope with an inhuman new world where everything is flat, where communication is virtual, and where those core elements of human happiness — faith, family, community — seem to elude so many. Until we resolve these deeper social, cultural, and psychological problems, until we discover a new meaning or reimagine our old religion or reinvent our way of life, the poppy will flourish.
We have seen this story before — in America and elsewhere.
The allure of opiates’ joys are filling a hole in the human heart and soul today as they have since the dawn of civilization. But this time, the drugs are not merely laced with danger and addiction. In a way never experienced by humanity before, the pharmaceutically sophisticated and ever more intense bastard children of the sturdy little flower bring mass death in their wake. This time, they are agents of an eternal and enveloping darkness. And there is a long, long path ahead, and many more bodies to count, before we will see any light.

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We need federal limits on prescribing opioids (Opinion)

Feb 18, 2018 | The Hill

By Dr. Richard S. Larson

The United States has long been plagued by drug addiction, but our current epidemic of opioid abuse, with its growing toll of overdose deaths, is starkly different.
It is partially driven by soaring rates of opioid prescribing, rather than by illegal street drugs. Deaths from prescription opioids have climbed in parallel with opioid prescribing in the U.S., which quadrupled from 1999 to 2010.
Retail pharmacies dispensed 215 million opioid prescriptions in 2016 — enough to provide a bottle of narcotics to two-thirds of all Americans.

This epidemic calls for federal action to limit the quantity of opioids prescribed. This starts with acknowledging that the medical establishment helped create the crisis in the first place by over-prescribing opioids to treat chronic non-cancer pain.
An often-overlooked fact is that there was a marked change in the culture of prescribing on the part of physicians and other clinicians starting a few decades back.
Aggressive marketing by pharmaceutical companies played a role, as did the possibility of under-treating pain, the availability of new, long-acting opioid formulations and lack of education on the part of prescribers regarding the abuse potential of opioids. Once opioid-phobic, U.S. physicians have seemingly become liberal opioid prescribers.
This cultural shift led to exponential growth in the quantity of opioids prescribed for chronic non-cancer pain, an increase in the average length of time opioids were prescribed and higher dosages used by patients for a long period of time. Not surprisingly, our homes, schools and workplaces have been flooded with prescription opioid drugs, and millions of Americans have become needlessly addicted.
Governors and state legislatures have started taking action. A National Conference of State Legislatures report in July found that at least 23 states have passed laws to restrict prescribing. Most of the new state laws limit first-time opioid prescriptions to a supply ranging from three to 14 days.
Three steps should be adopted immediately. First, restrict first-time outpatient prescriptions to three days with one refill — only if needed — and prohibit outpatient prescriptions to adolescents. Use of narcotic painkillers before high school graduation is strongly associated with later opioid misuse, as well as heroin use.
Second, require that the lowest effective dose be prescribed in the form of immediate-release tablets. Short-acting forms and low dosages cut the risk of addiction. And third, restrict the broad range of clinicians who can prescribe opioids to specialists with demonstrated expertise in opioid management, who would work in coordination with primary care physicians.
Such sweeping federal legal or regulatory changes would require the support of physicians. While, the pharmaceutical industry has been justly criticized for its aggressive marketing of opioid drugs, less attention has been paid to the willingness of physicians to change the culture of prescribing. It’s time that we remember our duty to our patients.
Federal action could provide nationwide consistency to these state efforts. It could come from Congress as federal law, or in the form of regulation by the Food and Drug Administration or the Drug Enforcement Agency.
Alternatively, the Centers for Medicare and Medicaid Services could reduce or eliminate reimbursements to providers as an incentive to prescribe opioids responsibly.
As the carnage of addiction and death has worsened, agencies such as the Centers for Disease Control and Prevention proposed comprehensive approaches for attacking the problem, including physician education, increasing addiction treatment and improved access to naloxone, which can revive someone overdosing on opioids.
But in tackling this problem, we should not forget that it is largely driven by our prescription practices. Modifying our own prescribing behavior would go a long way to mitigate the epidemic.
Richard S. Larson, M.D., Ph.D., is executive vice chancellor at the University of New Mexico Health Sciences Center. The opinions expressed are those of the author and not the institution.

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Local drugstores also play a part in the opioid crisis (Letter to the Editor)

Feb 19, 2018 | Washington Post

By Edward R. Moore

The Feb. 16 Politics & the Nation” article “Lawmakers say opioid shippers sent 12.3 million pills to one W.Va. pharmacy” served as an indictment of the pharmaceutical industry, particularly the large national distributors, as responsible in large part for the opioid epidemic. However, the pharmacy in a “small town in West Virginia” and other drug outlets that receive huge amounts of pills certainly deserve much of the blame for our opioid problem. I have never seen any discussion in the news about these final distributors. Is the pharmacy in Mount Gay-Shamrock that got the 12.3 million pills still in business and distributing opioids? And what, if anything, is being considered by lawmakers to halt the final distribution of large quantities of opioids by these local outlets by requiring them to report the disposition of the pills?

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What tobacco industry’s past could forecast for opioid crisis’s future

Feb 19, 2018 | The Daily Free Press (MA)

By Hannah Shearer

Smoking kills over 480,000 Americans each year and costs the United States $300 billion a year in medical care, according to a study from the Center for Disease Control. Before 1998’s Master Settlement Agreement, these numbers were even higher.
The agreement is a deal between 46 states’ attorneys general and the five largest tobacco companies in America about the promotion and marketing of tobacco products. It made it illegal for tobacco companies to use cartoon characters or target teenagers in their advertising, and bans distribution of tobacco company branded merchandise.
Cheryl Healton, dean of New York University’s College of Global Public Health, spoke at Boston University School of Public Health on Wednesday about the lessons from the settlement and how they could be applied to other industries selling harmful products in the future.
The biggest propeller of change, Healton said, is action taken by states’ attorneys general.
“States’ attorneys general have an obligation to protect the American public from predatory marketing and harmful products,” Healton said in an interview with The Daily Free Press.
However, she said, there are reasons that attorneys general would not sue a company, including if the industry benefits their sector, or if there wasn’t enough proof to make a strong enough case against the industry.
“Without a real stick, there can be no carrot,” she said, “The industry is not in the business of just giving their money if they don’t have to.”
Part of the settlement states that if all states participate, annual recovery payments will increase from $5 billion in 2001 to $9 billion in 2018. The money from the settlement, Healton said, could be important for fueling local economies, including funding public education.
“Public education can play a far more important role in this circumstance that we find ourselves in — with respect to sugar sweetened beverages, opioids, and guns — then we probably have given it credit for,” she said.
Healton showed older tobacco commercials, which attendees collectively deemed concerning by raising their hands. Newer ads, which warn consumers about the dangers of using tobacco have significantly influenced consumers’ attitudes toward cigarettes, Healton said.
“Attitudes can move rapidly,” she said. “Unless they’re absolute core value hardened attitudes. And I think some of those do exist with respect to guns — I don’t think they exist with sugar sweetened beverages. I don’t think they exist for opioids.”
While it could prove difficult to change the sugar-sweetened beverage industry, Healton said, the opioid industry will be having its own settlement very soon. Recently, the opioid industry met for six days, and will meet again in March to further discuss regulations with a judge, Healton said.
“There are settlement talks beginning related to the 250 cases that have brought against the opioid industry,” Healton said. “We should get a letter in the right way into the hands of that judge.”
Sandro Galea, dean of BU’s School of Public Health, said he believes the opioid industry will be the next to enter a major settlement.
“I think it will be the pharmaceutical industry around opioids,” Galea said, in an interview with The Daily Free Press. “Hopefully [the companies will] offer restitution for lives lost.”
After her speech, Healton spoke with attendees directly, discussing the issue personally with a long line of guests eagerly waiting to speak with her.
Mary Crane, 61, Cambridge, was one of the few at the talk that wasn’t a health care professional but felt passionate about the cause, nonetheless.
“I’ve smoked my entire life,” she said, “I wanted the best for my children, so I stopped. It wasn’t until a decade later that I learned they were smoking. I can’t help but wonder what was worse for them — the ads or me.”

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Kentucky accuses Cardinal Health of contributing to opioid epidemic

Feb 19, 2018 | Reuters

By Nate Raymond

Kentucky’s attorney general on Monday filed a lawsuit against drug distributor Cardinal Health Inc, accusing it of contributing to the opioid epidemic by failing to halt or report suspiciously large or frequent orders by pharmacies of prescription painkillers.
Attorney General Andy Beshear in the lawsuit accused Cardinal of unfair, misleading and deceptive business practices that he said led to the excessive distribution of opioids in Kentucky.
The lawsuit alleged that Dublin, Ohio-based Cardinal Health, one of the country’s largest wholesale drug distributors, ignored red flags that prescription opioids were being diverted for illegal uses, allowing it to profit in the process.
The lawsuit is the third that Beshear has filed against an opioid manufacturer or distributor. It comes amid a wave of lawsuits by cities, counties and states seeking to hold corporations responsible for the drug abuse epidemic.
“I‘m committed to hauling each of these opioid companies into a Kentucky court to answer for their actions that have devastated our families, communities and state,” Beshear said in a statement.
Cardinal Health said in a statement that it cares deeply about opioid abuse and addiction and it believes there is an “urgent need” to work toward solutions to address the public health crisis.
“We do not believe litigation is the solution to this problem and will defend ourselves vigorously against baseless lawsuits,” the company said.
The lawsuit seeks to recover the costs that it says Kentucky has incurred as a result of Cardinal’s actions as well as unspecified penalties and fines.
Opioids were involved in more than 42,000 overdose deaths in 2016, according to the U.S. Centers for Disease Control and Prevention.
A growing number of lawsuits by states, counties and cities have accused drugmakers of pushing addictive painkillers through deceptive marketing and wholesale distributors of failing to report suspicious drug orders.
Two other state attorneys general have sued Cardinal Health. The company says it faces at least 343 opioid-related lawsuits, which were largely brought by counties and municipalities.
In December 2016, Cardinal Health agreed to pay $44 million to resolve claims by the U.S. Justice Department that it failed to alert the U.S. Drug Enforcement Administration to suspiciously large orders of addictive painkillers.
The following month, the company announced that it had reached a $20 million settlement with West Virginia to resolve a lawsuit filed in 2012 over its distribution of opioids in the state.

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Following the money between patient groups and Big Pharma (Opinion)

Feb 17, 2018 | CBC News

By Kelly Crowe

Why would more than two dozen patient advocacy groups want to stop Health Canada from trying to lower prescription drug prices in Canada?
"It seems startling because you would think lower drug prices are in the interests of patients," said Sharon Batt, a Dalhousie University researcher who studies the links between such groups and the pharmaceutical industry.
The coalition of 28 groups argues that lower drug prices could be bad for patients because it would prompt drug companies to stop selling new drugs in Canada and to pull research out of Canada, which could mean fewer clinical trials.
This coalition and other Canadian patient advocacy groups receive funding from the pharmaceutical industry — an issue that made headlines this week after a U.S. senator revealed links between opioid manufacturers and patient advocacy groups.
The coalition's message echoed the one being advanced by the pharmaceutical industry lobby group Innovative Medicines Canada, which made a similar argument in a series of full-page ads this week in The Hill Times, a newspaper that covers the federal government and politics.
"Far-reaching changes to Canada's patented drug regime will lead to job losses, a cutback in R&D investment and reduced access to the latest therapies," said the full back-page notice in Monday's edition.
The Canadian patient groups said their position on changes to Canada's Patented Medicine Prices Review Board was made "independently from all funding bodies and solely represent[s] the views of the patient groups themselves." 'We all feel the same way'
The similarity between the two messages is no coincidence, said Louise Binder with the Save Your Skin Foundation who organized the coalition of groups representing patients with cancer, arthritis and a variety of rare diseases.
"We all feel the same way — that there may be better ways to resolve this problem," said Binder. She said she did not work with the industry group to co-ordinate the campaign against Health Canada's proposed changes.
Binder said she has accepted funding from pharmaceutical companies including Novartis, Janssen, Pfizer and AstraZeneca. Many of the other groups in the coalition have also disclosed industry support.
Innovative Medicines Canada did not answer questions from CBC News about why the two campaigns are so similar.
In a statement, president Pamela Fralick said, "We have voiced our concerns about the effects of the proposed changes in speeches and in the media. We have also discussed these concerns with all levels of governments, as well as various stakeholders, including patient groups, think-tanks and researchers."
The timing of the full-page ads and the patient news release coming out in the same week wasn't a coincidence either. Both Binder and Fralick said it's because Health Canada closed its consultations on the policy changes on Wednesday.Groups maintain independence
Earlier this week in the U.S., Democratic Senator Claire McCaskill released a report revealing financial ties between opioid manufacturers and patient advocacy groups.
Between 2012 and 2017, five leading opioid manufacturers contributed almost $9 million US to patient groups, and the report concluded that money had an influence.
"Through criticism of government prescribing guidelines, minimization of opioid addiction risk and other efforts, ostensibly neutral advocacy organizations have often supported industry interests at the expense of their own constituencies," the report said.
Payments from Purdue Pharma, makers of oxycontin, accounted for about half of the funding.
Purdue Pharma Canada, which operates independently of its U.S. counterpart, provides financial support for Canadian patient advocacy groups. It was "a founding partner" in the creation of an influential Canadian patient advocacy group, the Canadian Pain Coalition (CPC), Purdue Canada told CBC News in an email, adding it has not supplied funding to the group since 2010.
The CPC has also accepted funding from other pharmaceutical companies over the years but was forced to dissolve in November when its funds dried up.
"Within Canada, pain has not been recognized as a national priority, and it's just really difficult to find funding," said Lynn Cooper, who was executive director of the coalition when it ceased operations.
The Chronic Pain Association of Canada is also listed by Purdue Canada as one of its grant recipients over the past two years.
"Last year, we had grant funding of $18,000 from the pharmaceutical industry. It went to arranging and holding meetings of leaders of local support groups in Toronto (I'm in Edmonton) and in Atlantic Canada," executive director Barry Ulmer said in an email, adding that the group is run by volunteers.
At Action Ontario, a group that advocates for people suffering from neuropathic pain, Lisa Hooper said all funding comes from industry. But she said the money comes with no strings attached. "We in no way, shape or form promote the drug companies," she told CBC News.
At the People in Pain Network, Richard Divine said he happily accepts industry funding because his group is run by volunteers on a shoestring budget. "We do not allow them to dictate what we do with it," he told CBC News, adding that Purdue has provided funds in the past but Pfizer and Merck have turned down their requests.
Researcher Batt says the groups may maintain their independence but they could get cut off if they don't play along.
"They're being cherry-picked," said Batt. "The companies will fund them as long as they're onside with the same point of view that the companies have. If they start to contradict what the companies are saying, they're going to get cut off."
Batt says patient groups can have a positive impact, "but they've been so compromised by their relationships, these close relationships that have developed between the groups and the companies, that they've undercut their own power to serve the interests of patients."

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Pharmaceutical Companies Reportedly Paid $10 Million to Encourage Use of Opioids

Feb 16, 2018 | National Law Review

By Shanon M. McNulty

A U.S. Senate committee reported Monday (Feb. 12, 2018) that the five largest opioid manufacturers paid more than $10 million directed in particular to patient advocacy groups and professional medical societies who would then encourage the use of those highly addictive drugs.
In a 23-page report released by Senate Homeland Security and Governmental Affairs Committee, Sen. Claire McCaskill (D-Mo.), the ranking Democrat on that Committee, called these groups opioid "cheerleaders." The committee has been investigating the financial ties between the pharmaceutical industry and outside groups from 2012-17. In particular, the committee has been looking into Purdue Pharma, Janssen Pharmaceuticals, Mylan, Depomed and Insys Therapeutics and 14 patient advocacy groups.
U.S. News & World Report reported, "It looks pretty damning when these groups were pushing the message about how wonderful opioids are and they were being heavily funded, in the millions of dollars, by the manufacturers of those drugs," Lewis Nelson, a Rutgers University doctor and opioid expert, told The Center for Public Integrity.
Purdue, which was the largest donor to outside advocacy groups took out a full-page ad in the front section of USA Today in the same edition that reported this story. In an effort to fight the bad publicity coming out of the Senate, Purdue wrote, "We manufacture prescription opioids. How could we not help fight the prescription and illicit opioid abuse crisis?" It went on to talk about how the company was founded in 1892 by two doctors and its "strong heritage of a research-driven, science-based company. ... Today, it's what has spurred us to redouble our efforts in the fight against the prescription and illicit opioid abuse crisis."
The Senate committee reported that the largest recipients of the pharma money was the U.S. Pain Foundation, the National Pain Foundation and the Academy of Integrative Pain Management, organizations which promote opioids as safe and effective for treating chronic pain and minimizes the risk of addiction. The money reportedly was used to send out "opioid-friendly messaging" to undercut state and federal efforts to curb opioid prescribing.
Although Purdue also said that it is cutting its sales force in half to 200 people who make doctors' offices visit to pitch opioids, McCaskill said that this is but "the tip of the iceberg" in how drug companies themselves with their large profits shape health care policy and even legislation.
Multiple states, cities and counties across the U.S. have issued lawsuits against the leading pharmaceutical companies for downplaying the risks involved with prescribing opioids and thus fueling the opioid epidemic, which accounted for at least 42,000 deaths in 2017 alone.

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Southeast (NC, LA, FL, AL, GA)

Guilford County will sue opioid manufacturers and distributors over drug crisis

Feb 16, 2018 | FOX 8 (NC)

By Alex Rose

Guilford County Board of Commissioners on Friday announced plans to file a lawsuit against many of the major opiate manufacturers and distributors.
"There are three distributors in the country that handle over 85 percent of the opioid market and those three distributors have annual profits of over $400 billion," Guilford County Attorney Mark Payne said. "So these are companies that have those resources, and have got those resources in ways that frankly they shouldn't have, and so we think it's fair for us to try and make them part of the solution as well."
The lawsuit comes in response to what the county called "the rampant drug crisis plaguing Guilford County."
"In the nation, the leading cause of death for people under age 50 is now opioid overdoses and opioid related deaths," Payne said. "That's more than heart attacks, that's more than car wrecks. That to me is a staggering figure."
The lawsuit asserts that the manufacturers and distributors have unlawfully contributed to a public nuisance in Guilford County.
Guilford County EMS reports that in 2017, there were over 700 opioid overdose reversals and 80 verified opioid/heroin overdose deaths.
“This is an important step in addressing a serious problem in Guilford County. We have lots of dedicated people in the field addressing this issue every day. I feel it is important to try to get some resources to help address this problem from some of the corporations that contributed to it in the first place.” Board Chair Alan Branson said in a news release.
Guilford County has hired the McHugh Fuller Law group to take on this litigation along with the Guilford County Legal Department. Payne believes the lawsuit will be filed within the next month and is hopeful it will move along quickly with the help of a specialized coalition of law firms helping the county.
The cost of the suit will be fronted by those private firms, according to Payne, and will not impact the taxpayers. If there is a settlement, or any payments towards the county, those law firms will receive a percentage for their work.

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Alamance County moves forward on opioid lawsuit

Feb 19, 2018 | Burlington Times News (NC)

By Isaac Groves

The Alamance County Board of Commissioners voted 5–0 to go to the next step of hiring a law firm to sue opioid manufacturers and distributors.
“I just think we need to proceed,” Commissioner Tim Sutton said. “Waiting for another meeting is needless.”
The commissioners heard from three law firms, two of them part of multistate partnerships with other firms, to sue for the damage the opioid crisis has done in Alamance County.
While class-action lawsuits have not been well received by the courts, Ohio Federal Judge Dan Polster has been positive about local government lawsuits and says there will be a resolution this year.
“This litigation is moving at Mach speed,” said Erin Dickinson, one of the founders of Whitefish Bay, Wis., law firm Crueger Dickinson.
Dickinson told the commissioners her firm was working with lawyers who have been involved in successful opioid litigation for years, and others in North Carolina who could keep close ties with counties here that sign on with their consortium.
That partnership, Dickinson said, was working with more than 100 counties around the country and two in North Carolina so far. There would be no fees up front, Dickinson said, but attorneys would take 25 percent of what the county won in a suit, and nothing if the county lost.
She didn’t want to talk about possible legal strategies in open session.
The second firm, the Paynter Law Firm in Hillsborough, is not representing any counties so far, Stuart Paynter said, but he touted the firm’s local connection and experience in complex litigation. Paynter said there were a number of options, including state and federal litigation.
Paynter also said there could be a “staged” contingency fee depending on how much time and effort the suit took.
“You don’t necessarily want to pay the full 25 percent if it settles in six months,” Paynter said.
The third was Caswell County lawyer George Daniel, who has spoken before the board several times about an opioid lawsuit. His firm is working with Barron & Budd, which has offices in several states. Daniel said 24 North Carolina counties were working with his group, including most of the counties neighboring Alamance.
The commissioners voted to adopt a resolution giving County Attorney Clyde Albright the authority to move forward, but the next step will be for the commissioners to meet in closed session to choose which firm to hire.

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Thibodaux City Council to vote on joining opioid lawsuit

Feb 18, 2018 | Hourma Today (LA)

By Bridget Mire

The Thibodaux City Council will decide Tuesday whether to hire attorneys for representation in pending litigation against opioid manufacturers and distributors.
Law firm Porteous, Hainkel and Johnson and attorney Stuart Smith will be considered.
The attorneys could not be reached for comment, but Mayor Tommy Eschete said they wouldn’t charge for their services unless the city was awarded money through a judgment or settlement.
Eschete said he doesn’t expect a large settlement, but possibly enough money to put toward drug abuse programs.
“If we don’t get anything, we don’t get anything,” he said. “But it would be an opportunity for us to capture some revenue to partner with some other agencies for education programs.”
The Lafourche Parish Coroner’s Office reported 17 fatal drug overdoses last year, seven of which involved opioids or opiates.
Such lawsuits have been filed throughout the country, many of them transferred into multi-district litigation in Ohio. The Terrebonne Parish Council on Jan. 23 appointed a team of attorneys to look into joining the litigation.
The City Council will meet at 5 p.m. Tuesday on the second floor of City Hall, 310 W. Second St.

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It’s past time to hold opioid manufacturers accountable (Opinion)

Feb 20, 2018 | Prince Williams Times (FL)

By Pete Candland

If you are an innocent party in a car accident and suffering injuries that require medical treatment, it is a well-established legal principle that damages to your car and any medical expenses are recovered from the person responsible for the injuries.
But when it comes to holding the parties responsible for the costs the taxpayers have to pay for the opioid crisis, whether for direct treatment; criminal justice costs; treating babies born dependent on opioids; increased transmission of infectious diseases that requires healthcare services; costs for treating overdoses; and injuries associated with intoxication; then there are apparently some who want to look the other way and unfairly force taxpayers to foot the bill.
Several months ago, I recommended that the Prince William County Board of Supervisors seek the recovery of taxpayer funds expended by the county to address all costs related to the opioid addiction from the opioid manufacturers. It is clear that they are the responsible parties who became "pill mills" with predatory marketing practices that facilitated the current opioid crisis we are facing in America. This brought in billions of dollars to the opioid manufacturers while causing millions of Americans to become addicted to these potentially dangerous drugs.
The opioid crisis that has swept the country is responsible for the deaths of more than 140 Americans every day. And it is costing counties and other localities millions and millions of dollars every year.
From the time I first made this recommendation to my colleagues on the board, many other communities have begun the process of filing lawsuits against those opioid manufacturers who created this crisis in the first place. But we have not taken action in Prince William County.
As I understand it, some are concerned about the “appearances” of Prince William County engaging in litigation against these predatory opioid manufacturers. From my perspective, I am concerned about the unfunded impacts of allowing these predatory opioid manufacturers to fleece the taxpayers from every corner of the Commonwealth with the direct costs for addressing the crisis they have created.
We continue to hear the reports from our public safety officials about the alarming rise in opioid use and opioid caused deaths across the county. In the upcoming county budget, we are exploring ways to leverage other government dollars and programs to help combat this epidemic, but it is only going to become more expensive to Prince William County taxpayers.
There is nothing different here than what state governments had to do to recover the tobacco-related health care costs that were tied to the aggressive marketing by tobacco manufacturers.
My proposal to recover the costs of the opioid crisis is simple: You caused the opioid crisis, you pay for it.
When it comes to patients who need assistance with the management of acute and chronic pain, there is no question that these opioid manufacturers have had a direct hand in creating the opioid addiction crisis that we are now experiencing.
The cost of treating and addressing the costs to society of opioid addiction is staggering, and much of that burden is now being placed upon taxpayers, including right here in Prince William County.
The time has come to hold the parties responsible to pay for it.
Pete Candland, a Republican, is the Gainesville District representative on the Prince William County Board of Supervisors.

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Council to consider joining lawsuit against opioid manufacturers

Feb 19, 2018 | Alexander CIty Outlook (AL)

By Mitch Sneed

The impact of opioid abuse across the state and nation has been making headlines and Monday night the Alexander City City Council will consider joining several other Alabama towns and cities in a lawsuit against the manufacturers of the drugs.
According to supporting documentation, the council agenda will consider a resolution to authorize the mayor to execute an agreement with attorney Tom Whatley and Beasley, Allen Crow, Methvin, Portis & Miles, P.C. to represent the city’s interest in the lawsuit.
The agreement reads in part:
“Opioid manufacturers and distributors are the primary defendants in these lawsuits. There are two main litigation theories asserted against these defendants: Suing the manufacturers for promoting use of opioids for non-cancer pain management and misrepresenting the addiction potential of these drugs; and suing the primary distributors for flooding the market with opioids by failing to provide required oversight in the distribution chain and to report suspicious orders.”
The firms will work on a contingency basis, collecting 33 percent of any awards that result from the legal action.
The council will also finalize a deal with Tallapoosa County to begin housing its inmates at the Tallapoosa County Jail, enabling the city to “get out of the jail business.”
The contract calls for the city to pay a $50 book-in fee, $10 per day for meals, pay all medical costs for its inmates and provide transportation to the facility.
In other items, the council will consider:
• A resolution to award bid 18-04 to Samson Equipment Co., Inc. of Birmingham for an amount not to exceed $268,234. The contract calls for the company to supply a sewer vacuum truck that will be used in the sewer department. The item was part of the budget’s fleet line item.
• A resolution to authorize the mayor to approve the issuance of a Note/Bond for the Special Care Facilities Financing Authority.
• A resolution to authorize the mayor to execute an agreement with EEFS Company P.C. to provide CE&I Services on the Sportplex Bridge Replacement Project for an amount not to exceed $63,395. The company will serve as managers of the project and lend engineering support.
• A resolution to accept funds from the Tallapoosa County Commission to fund recreational programs for county youth.
• A resolution to authorize the mayor to donate a permanent easement to BellSouth Telecommunications, LLC, d/b/a AT&T Alabama across the 17-acre parcel it purchased along Lee Street earlier this year so the company can continue to provide telecommunications services.
• A resolution to oppose HB110 and SB130 unless the bill includes the Alabama League of Municipalities’ Proposed Amendments. The bills deal with taxes on ecommerce sales from state residents.

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Athens-Clarke, Oconee suing opioid companies

Feb 20, 2018 | Athens Banner-Herald (GA)

By Lee Shearer

Athens-Clarke and Oconee counties have joined a growing number of other governments and hospital authorities across the country in a multi-state federal lawsuit targeting makers and distributors of opioid drugs.
The Athens law firm Blasingame, Burch, Garrard & Ashley filed a complaint in the United States District Court’s Middle District of Georgia Wednesday, and followed up Thursday with a similar complaint on behalf of Oconee County, said James Matthews, a Blasingame Burch partner.
The law firm earlier filed lawsuits against major opioid manufacturers and distributors on behalf of rural Candler County and the Candler County Hospital Authority.
Matthews said he expects the firm to file 25 or more complaints against the opioid manufacturers and distributors for other Georgia governments and agencies.
The more than 20 named defendants in the 176-page complaint Athens-Clarke County filed Wednesday include Cardinal Health Inc., Cephalon Inc., Johnson & Johnson, Ortho-McNeil Janssen Pharmaceuticals Inc, Allergan PLC, and Watson Pharma Inc., among others.
“Plaintiff brings this civil action to eliminate the hazard to publish health and safety caused by the opioid epidemic; to abate the nuisance caused thereby, and to recoup monies that have been spent, or will be spent, because of Defendants’ false, deceptive and unfair marketing and/or unlawful diversion of prescription opioids,” according to the complaint.
Those costs include money for medical care, costs for rehabilitation and related services, and “costs associated with law enforcement and public safety" relating to the opioid epidemic, according to the Athens-Clarke complaint.
“Cities, counties and states are hugely affected by this, so the potential legal damages are very high,” Matthews said.
One rural South Georgia county had to establish a drug court primarily because of opioid-related cases at a cost of $400,000 a year, he said.
The Georgia complaints will be combined with dozens of similar lawsuits across the United States in a process called multi-district litigation. The cases will be grouped with dozens or hundreds of others in the federal Northern District of Ohio.
Fulton and DeKalb counties have also sued companies over the costs of dealing with opioid addiction and overdoses, but those cases were filed in Georgia state courts, Matthews said.
Lawyers sometimes use the same multi-district approach when many claims arise from a defendants' alleged actions.
In the 1990s, most states joined in a lawsuit against tobacco companies over the costs of smoking and tobacco use, eventually reaching a $10 billion settlement with the companies. Lawsuits arising from the massive 2010 Deepwater Horizon oil spill in the Gulf of Mexico were also handled through multi-district litigation.
Blasingame Burch has developed a reputation for expertise in such multi-district litigation in medical cases, in part because of its lawsuits filed on behalf of women who suffered injuries resulting from the use of a kind of plastic mesh for repair in vaginal surgery.
About 95 percent of around 100,000 plaintiffs nationwide - many but not all represented by Blasingame, Burch, Garrard & Ashley - have now settled with defendants in the mesh litigation, Matthews said.
Ohio District Court Judge Dan Polster has appointed a lead counsel for the opioid litigation, but Matthews hopes to be appointed to a plaintiffs’ steering committee, not yet named, according to the Fulton County Daily Report, an Atlanta legal newspaper.
The litigation could take years to resolve, and the judge has told lawyers he wants the first year to be spent on trying to settle the cases, Matthews said.
An eventual settlement or judgment might help pay for future anti-opioid measures now working their way through Georgia and other state legislatures, said University of Georgia law professor Elizabeth Weeks Leonard.
Georgia's state Senate recently approved legislation to establish a commission to study the addiction and substance abuse, for example.
Multi-district cases can also be helpful for the defense side, Leonard said. Like the plaintiffs, the defense lawyers don’t have to defend what is essentially the same case in multiple courtrooms.
The opioid crisis means more work for law enforcement, agreed Oglethorpe County Sheriff David Gabriel.
“It’s definitely a problem,” he said. “I think you’re seeing it everywhere.”
Victims of the drug often begin with a legitimate need for the pain-killers, but become addicted, he said.
“The biggest issue is that opioids are a route to people getting on heroin,” he said. Oglethorpe county had one death last year attributed to heroin, he said.
Opioid pills are expensive, so those who become addicted may turn to heroin as a cheaper alternative, and to crime as a way to pay for drugs, he said.
“It’s down to money at the end of the day,” he said.

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Northeast (MA, MD)

More Mass. Cities and Towns Plan To File Lawsuits Against Opioid Companies

Feb 19, 2018 | New England Public Radio (MA)`

By Alden Bourne

Pittsfield, Sturbridge, West Springfield, Palmer, and Charlton are among the cities and towns in central and western Massachusetts that are taking legal action against manufacturers and distributors of opioids.
Across the state, 33 municipalities have decided to do so.
Attorney Peter Merrigan represents them.
"The suit against the manufacturers arises out of their misrepresentation of the addictiveness of opioids," he said. "The suit against the distributors arises from their failure to follow federal law, namely the Controlled Substances Act, and their duty and obligation to report suspicious orders."
The lawsuit seeks compensation for costs stemming from the opioid crisis and funding for future recovery efforts.
Merrigan said another 30 municipalities across Massachusetts have verbally committed to joining the legal fight.

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Central Mass. towns join legal fight against Big Pharma to recover costs incurred by opioid crisis

Feb 17, 2018 | Telegram & Gazette (MA)

By Craig S. Semon

Eight Central Massachusetts municipalities, among more than 30 statewide, have signed on to join litigation seeking to recover municipal costs incurred because of the opioid crisis.
And the number of cities and towns is expected to keep growing.
In Central Mass., Auburn, Charlton, Dudley, Northbridge, Southbridge, Sturbridge, Sutton and Winchendon have agreed to join other Massachusetts municipalities in litigation. Although they haven’t formally signed the lawsuit, Millbury and Webster both voted last week in favor of joining the litigation.
In addition, 30 more municipalities have provided verbal commitments and have contracts forthcoming, according to J. Tucker Merrigan, a partner at Sweeney Merrigan Law, LLP, of Greenfield and Boston. He said the opioid crisis has hit the commonwealth hard and now is the time to fight back and recoup losses but, he acknowledged, the resolution is not going to be quick and easy.
“We’re going up against the world’s largest pharmaceuticals, manufacturers and distributors, the biggest companies in the world,” Mr. Merrigan said. “It could take years but, given what we know now, it could also be a motivation to try to talk resolution, but it would be extremely complicated. So even when there is a demonstrated interest in resolving it, it will still take a significant amount of time.”
The mass tort litigation is being filed through the Massachusetts Opioid Litigation Attorneys, a consortium of lawyers suing large pharmaceutical manufacturers and distributors on behalf of the taxpayers of individual municipalities. In addition to Sweeney Merrigan Law, MOLA consists of the firms of Rodman, Rodman & Sandman of Malden and KP Law, PC in Boston.
“The manufacturers’ case is primarily based on the marketing efforts and the misrepresentation of the addictive properties or opioid drugs,” Mr. Merrigan said. “They were marketed as a chronic lifetime drug to be taken every day with a bad back, for example. And of course, the coined term by them would be ‘pseudoaddiction,’ which stands for the fact that individuals’ pill-seeking behavior is not the result of an addiction but, in fact, a reflection of under-treatment of pain.”
As for the pharmaceutical distributors, Mr. Merrigan said they are pursuant to the federal Controlled Substance Act of 1970.
“Federal law requires drug distributors to report orders of unusual size or frequency or that deviant from a buyer’s usual pattern,” Mr. Merrigan said. “And they’re under the duty to make that report to the DEA.”
Mr. Merrigan said the three biggest pharmaceutical distributors that failed their duty under the Controlled Substance Act are all Fortune 15 companies - McKesson Corp. (ranked 5), AmerisourceBergen Drug Corp. (11) and Cardinal Health Inc. (15). Those three companies combined made more than $490 billion in revenue last year, he said.
MOLA is also working on the lawsuit with six national law firms, including Levin, Papantonio, Thomas, Mitchell, Rafferty & Proctor, PA in Pensacola, Florida; Greene, Ketchum, Farrell, Bailey & Tweel, LLP of Huntington, West Virginia; Baron & Budd, PC in Dallas; Hill Peterson Carper Bee & Dietzler PLLC in Charleston, West Virginia; Powell & Majestro, PLLC in Charleston, West Virginia; and McHugh Fuller Law Group in Hattiesburg, Mississippi.
In consideration, the municipalities that have signed on agree to pay 25 percent of the total recovery, whether the claim is resolved through compromise, settlement or trial and verdict (and appeal). The municipalities pay nothing if there is no recovery, according to the agreement.
“It’s important to know that this is not a class action case, so the recovery for each municipality will be different,” Mr. Merrigan said. “However, in the discussion of reported overdoses and reported deaths, it’s our position that many of those statistics are actually under-reported and the number is much higher. However, the CDC says over 63,000 people died as a result of overdose deaths nationally in 2016.”
The litigation focuses on the wholesale distributors and manufacturers of opioids and their role in the diversion of millions of prescription opiates into the illicit market which has resulted in opioid addiction, abuse, morbidity and mortality.
The firm intends to present a damage model designed to abate the public health and safety crisis. This damage model may take the form of monetary damages and/or equitable remedies (e.g., an abatement fund). The purpose of the lawsuit is to seek reimbursement of the costs incurred fighting the opioid epidemic and/or recover the funds necessary to abate the health and safety crisis caused by the “unlawful conduct” of the whole distributors and manufacturers of the opioids, according to the agreement.
In 2010, the state Department of Public Health reported 560 opioid-related deaths; in 2011, 656 opioid-related deaths; in 2012, 742 opioid-related deaths; in 2013, 961 opioid-related deaths; in 2014, 1,352 opioid-related deaths; in 2015, 1,648 confirmed opioid-related deaths, plus an additional 120 unreported opioid-related deaths for a total of 1,768 deaths; in 2016, 2,083 confirmed deaths, plus an additional 72 unreported opioid-related deaths for a total of 2,155 estimated; and in 2017, 1,501 confirmed deaths, plus an additional 476 unreported opioid-related deaths for a total of 1,977 estimated.
The figures of confirmed and estimated cases of opioid-related overdose deaths for 2017 shows an 8.3 decrease from 2016′s total confirmed and estimated cases, according to the DPH.
In Worcester County, the number of reported opioid-related overdose deaths have been gradually increasing. In 2010, there were 80 opioid-related overdose deaths; 82 in 2011; 91 in 2012; 115 in 2013; 162 in 2014; 224 in 2015; and 260 in 2016, according to the DPH.
From 2010 to 2016, opioid-related overdose deaths in Worcester County have more than tripled, from 80 in 2010 to 260 in 2016.
However, the number of opioid-related overdose deaths, from 2012 to 2016, are relatively low for the Central Massachusetts municipalities that have already signed onto the lawsuit.
Worcester, which hasn’t yet signed on to the lawsuit, has much higher numbers than its Central Mass. neighbors. The number of opioid related overdose deaths for Worcester are 29 for 2012; 43 for 2013; 56 for 2014; 79 for 2015; and 73 for 2016, according to the DPH.
According to statistics from the Worcester Police Department, there were 70 confirmed and suspected fatal heroin or opiate-related overdoses last year, a scant 4 percent decrease from the 73 overdose deaths reported to the DPH for 2016. Opioid-related overdose deaths in Worcester peaked in 2015 with 79, which was a 41 percent increase from 56 deaths in 2014, according to the DPH.
Overall 911 calls for overdoses of any drug, both fatal and nonfatal, in Worcester increased by 7 percent to 1,238 in 2017 from 1,156 in 2016. This number is the highest reported by police in 10 years.
According to Amy Peterson, communications specialist for the Worcester City Manager’s office, City Manager Edward M. Augustus Jr. is very interested in joining this legal action and is reviewing proposals from different law firms with the city solicitor. He expects to make an announcement sometime this week, she said.
Even more alarming than the opioid overdose death numbers are the opioid prescription numbers.
The DPH’s Prescription Drug Monitoring Program (for October-December 2017) reports 79,203 opioid prescriptions for Worcester County, with 5,011,873 opioid solid dosage units administered and 34,919 individuals receiving opioid prescriptions. The same report also found 35 individuals with activity of concern “thresholds,” based only on a three-month time period.
In order to obtain timelier estimates of the total number of opioid-related overdose deaths in Massachusetts - confirmed and probable – the DPH used predictive modeling techniques for all cases not yet finalized by the Office of the Chief Medical Examiner. Based on the data available as of Jan. 25, the Department of Public Health estimates that there will be an additional 113 to 128 deaths in 2015, and an additional 67 to 77 deaths in 2016, once these cases are finalized.
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Massachusetts Opioid Litigation Attorneys make their case to municipalities

Feb 20, 2018 | MassLive (MA)

By Conor Berry

The Town of Wilbraham is among the communities considering whether to tap the services of Massachusetts Opioid Litigation Attorneys, or MOLA, a consortium of law firms filing suit against the world's biggest pharmaceutical companies to hold them accountable for the state's opioid crisis.
Sweeney Merrigan Law LLP, a firm with offices in Boston, Falmouth and Greenfield, is among the law firms involved with MOLA. Retired Judge Thomas T. Merrigan, of Greenfield, is a partner in the firm. Greenfield has been particularly hard hit by heroin and was featured in a 2014 episode of "Parts Unknown," Anthony Bourdain's popular CNN show.
MOLA litigation is aimed at recovering monetary damages for municipalities from Big Pharma, an industry that's "all but criminally flooded our communities with opioids," MOLA's legal team states on its website.
"I've had preliminary discussions with the police and fire chiefs about this, talked a little bit with counsel, and a little bit about how it would work," Wilbraham Town Administrator Nick Breault said this week to the Board of Selectmen, which agreed to mull whether to use MOLA's services.
"In speaking with the attorneys, they're saying that they would look at this as an action similar to Big Tobacco," said Breault, emphasizing that it's not a class-action suit, but rather a chance for Massachusetts communities to receive funds "based on whatever factors they're trying to mitigate."
"You kind of lost me at 'a team of lawyers are here to help us,'" said Selectman Robert J. Boilard, eliciting chuckles from the audience.
"But I'm looking at what they're aiming to do -- like you said, it's like the Big Tobacco," Boilard said. "They're trying to get monetary damages from the pharmaceutical companies to help the municipalities fight the opioid crisis. We all know who's going to end up paying for that, but I'm going to read up more on this."
Selectmen Chairman Robert W. Russell asked how quickly Wilbraham must respond to MOLA. "There is no rush at this point," said Breault, who agreed to revisit the issue with the board at a future meeting.

Municipal expenditures related to fighting the scourge of opioids may range from increased spending for law enforcement, needle exchanges, and implementing the use of Narcan, a drug that counteracts opiod overdoses, among other potential recoverable costs.

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Carroll should sue opioid manufacturers (Opinion)

Feb 19, 2018 | Carroll County Times (MD)

By Staff

Carroll County commissioners last week asked its legal staff to look into whether it would be wise for the county to join many others in Central Maryland and file a lawsuit against the pharmaceutical companies that manufacture and marketed prescription opioid drugs like OxyContin that many believe are at the root of the resurgence of heroin and subsequent addiction epidemic.
Our only question is what took so long?
Other jurisdictions have sued alleging deceptive marketing practices by these companies, claiming they funded research that led to biased findings about the dangers of opioid pills, then spread false information to both doctors and consumers. For example, a number of studies have shown OxyContin was marketed as not especially addictive, but that obviously turned out not to be the case.
While there are comparatively few deaths related directly to prescription drug overdoses, the overprescribing of prescription opioids for pain is generally regarded as the reason for the rise in opioid misuse and abuse, addiction and the subsequent resurgence of heroin and other street opioids, including the powerful and deadly synthetic fentanyl.
In 2017, 41 overdoses deaths were tied to legal or illegal opioid drugs, according to Carroll County Sheriff’s Office statistics. There were also at least 371 nonfatal opioid related overdoses responded to by law enforcement last year. Already, at least 10 people have died in Carroll County due to drug or alcohol-related overdoses in 2018, according to the sheriff’s office.
Some of the suits, such as the one filed by Anne Arundel County government, also targets doctors and practices noted by the Maryland Attorney General’s Office as having improper prescribing practices.
Lawsuits filed in other jurisdictions seek to force drug companies to change how they do business and any money awarded would presumably be put toward fighting the effects of the opioid crisis in those communities.
When the commissioners briefly discussed the possibility of filing or joining a lawsuit last week , the debate essentially centered around whether they should pursue legal action simply to ensure themselves a piece of the pie should a large settlement be reached — Commissioner Stephen Wantz compared it to the 1998 settlement between states and the tobacco companies. “There were billions of dollars that came back to state and local jurisdiction to be used for health initiatives as it pertained to those who had been either smokers or what have you,” he said.
But we agree with Commissioner Richard Rothschild that Carroll shouldn’t sue merely because it could be a way to fund their own battle against the epidemic. However, there is significant evidence that pharmaceutical companies have most certainly played a role in how this crisis has unfolded (and, sadly, companies that make drugs that can help, such as Suboxone and Vivitrol, continue to find ways to manipulate the system to charge exorbitant prices and profit from people suffering through this crisis).
Carroll shouldn’t join or file any lawsuits strictly for a money grab, but if the commissioners believe as others do that Big Pharma needs to be held accountable for their role in the epidemic, then there is no question they should follow through.

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Midwest (WI, MI, IA)

La Crosse County joins opioid lawsuit

Feb 16, 2018 | WXOW (WI)

By Claire Sarafin

La Crosse County will join a lawsuit against big pharma over the opioid drug crisis.
Thursday night, the La Crosse County Board voted to join more than 60 Wisconsin counties in the lawsuit.
La Crosse will be added to the lawsuit which is endorsed by the Wisconsin Counties Association. There is no cost for the county to join the lawsuit.
The lawsuit seeks compensation for millions of dollars in costs of social services law enforcement and emergency care in response to the opioid epidemic. The legal action alleges that pharmaceutical drug makers and physicians pursued fraudulent marketing practices for prescription painkillers.
The lawsuit maintains that conduct contributed to the nationwide public health crisis.
La Crosse County, other Wisconsin counties and lawsuits in other states have been joined into one suit filed in a federal court in Ohio.
Some of the defendants in the lawsuit include Purdue Pharma, Teva Phamaceuticals and Johnson and Johnson.
The litigation also claims physicians were instrumental in promotion of opioids for sale and distribution.
827 people died of opioid overdose in Wisconsin in 2016.

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County considers opioid suit

Feb 19, 2018 | The Daily Mining Gazette (MI)

By Garrett Neese

Houghton County officials are considering joining other Michigan municipalities in a suit against pharmaceutical companies responsible for manufacturing the opioids brought into the county.
Attorneys Mark Bernstein of the Sam Bernstein Law Firm of Farmington Hills and Paul Novak of the Detroit office of Weitz & Luxenberg addressed the County Board Tuesday on the issue.
The suit would seek monetary compensation for the damage done to the county, Bernstein said. But it would also demand the court order the companies to add practices that will limit the diversion and misuse of the product and how they are marketed.
While the drugs are valuable treatments, they’re only meant to be used in narrow circumstances, Bernstein said, such as pain management, oncological care and immediate post-discharge care.
“They’re not supposed to be used for a root canal, or lower back pain, or an abscess,” he said. “Thirteen percent of humans who take this drug for eight days are still taking it a year later. They may be taking it as a prescription from a doctor, but more likely they’re finding this drug on the black market.”
In Houghton County, there have been 80 prescriptions for every 100 men, women and children a year, Novak said.
“There have been significant increases not only in the number of deaths attributable to opioid overdoses but an increase in prescribing conduct and a whole array of the costs that come with addiction to opioids,” such as additional law enforcement responses to emergencies or substance abuse treatment costs, Novak said.
“All of these expenses are the types of things that…we’re attempting to collect on behalf of those local governments and their taxpayers so the costs of this epidemic are borne by the manufacturers and the wholesalers and the distributors, not the taxpayers,” he said.
The county would get 70 percent of the settlement. The law firms, which would advance the cost of the suit, would get the other 30 percent.
Other U.P. municipalities, such as Baraga, Chippewa, Delta and Dickinson counties, Iron Mountain and Escanaba have also joined the suit. Novak and Bernstein represent about 30 municipalities and expect to get another 10 to 20.
Nationwide, there are up to 500 cases, he said.
In addition to solutions through the justice system, Bernstein said, action should also be taken through tighter regulations and additional laws to prevent diversion and misuse.
The pressure of the suits may already be having an effect, Bernstein said. Purdue Pharma, the largest manufacturer of oxycodone in the country, announced last week it would no longer send sales representatives into physicians’ offices to promote prescribing the drug.
The suit is a “mass-action” case rather than a class action, meaning Houghton County’s case will still be settled separately, Bernstein said.
A federal judicial panel certified the multi-district litigation in November and chose a federal judge in Cleveland to adjudicate the case.
Those cases will have “an enormous judicial economy of scale,” he said.
Houghton County will share in the discovery process along with the other plaintiffs. A plaintiff executive committee, including Bernstein and Novak’s firms, will represent the municipalities in court.
Near the end of the year, the judge will select about a half-dozen bellwether cases, representing a range of states and population sizes. Those cases will help determine possible monetary damages for similar communities represented in the suit.
Bernstein said it would likely take 25 to 35 hours of municipal time to help fill out a plaintiff’s fact sheet to determine the increases in costs locally. That number would be higher if Houghton County were one of the communities selected as a bellwether case, Novak said.
“After juries come back on a few of them, the parties on both sides start to have an idea of what the cases are worth and negotiate them,” Novak said. “But at the end of the day, it’s Houghton County’s decision as to whether to accept a settlement or not of Houghton County’s lawsuit.”
Board Chairman Al Koskela, pointing to people who still smoke cigarettes, said he didn’t think the suit would reduce the number of people in jail on drug offenses.
He said the suit would “fleece” drug companies, which he worried would increase the price for people using the drugs deliberately. Novak said the companies being sued have already made settlements, with no impact on price.
“Are we going to eliminate as a result of this lawsuit all illegitimate opioid prescriptions? No,” he said. “But if instead at the end of the day we’re not consuming 80 percent of the world’s opioid prescriptions — it’s 50 percent, or 40 percent — that would still be an outrageously high level of the world’s consumption, but it’d be an improvement from where we are today.”
Houghton County tabled a decision on the matter so board members could read the materials the attorneys provided.

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Counties join together in opioid lawsuit

Feb 19, 2018 | Clinton Herald (IA)

By John Rohlf

Forty-six Iowa counties, including Clinton County, have joined an opioid lawsuit that was filed in January in the Northern District of Ohio.
The Clinton County Board of Supervisors in December unanimously approved a resolution to execute an engagement letter with Simmons Hanly Conroy LLC, Crueger Dickinson LLC and von Briesen & Roper, s.c., as counsel for claims against opioid manufacturers.
Krista Baisch of the Crueger Dickinson Law firm, in an Iowa opioid litigation update, stated the Iowa cases were consolidated and are part of 415 cases in the Multi-District Litigation pending in the Northern District of Ohio. The update states the Multi-District Litigation includes cases filed by counties, cities, Indian tribes, hospitals, third-party payors and individuals.
United States District Court Judge Dan Aaron Polster ordered the next settlement conference, with the designated settlement teams, to be held at 9:30 a.m. Eastern time March 6. The teams are ordered to email or fax to chambers a single, joint report updating the court on the status of negotiations no later than noon Eastern time March 2.
Attorneys from multiple law firms in January filed a complaint against many defendants concerning the opioid lawsuit. Attorneys for the plaintiffs are Nick Mauro of Crawford and Mauro Law Firm; Charles Crueger, Erin Dickinson and Krista Baisch of Crueger Dickinson Law Firm; and Paul Hanly Jr. and Sarah Burns of Simmons Hanly Conroy, LLC.
A complaint and jury demand was filed against Purdue Pharma L.P.; Purdue Pharma, Inc.; The Purdue Frederick Company, Inc.; Teva Pharmaceuticals USA, Inc.; Cephalon, Inc.; Johnson & Johnson; Janssen Pharmaceuticals, Inc.; Ortho-McNeil-Janssen Pharmaceuticals, Inc.; N/K/A Janssen Pharmaceuticals, Inc.; Janssen Pharmaceutica, Inc.; N/K/A Janssen Pharmaceuticals, Inc.; Endo Health Solutions, Inc.; Endo Pharmaceuticals, Inc.; Perry Fine, Scott Fishman and Lynn Webster.
The complaint lists five causes of action against all defendants, alleging Iowa’s Private Right of Action for Consumer Frauds Act Violations of Iowa Code 714H.3, public nuisance, violations of the Common Law prohibition on unjust enrichment, intentional misrepresentation and civil conspiracy.
The complaint requests the court enter judgement against the defendants. The complaint also requests the court award plaintiffs compensatory damages in an amount sufficient to fairly and completely compensate plaintiffs for all damages, costs and attorney fees, declaratory judgement requiring the defendants to abate the public nuisance, punitive damages, interest costs and disbursements and “such other and further relief as this Court deems just and proper.”

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Northwest (OR)

Portland Might Become the Latest City to Sue Over the Opioid Crisis

Feb 16, 2018 | Portland Mercury (OR)

By Dirk VanderHart

The City of Portland is about to jump into the fight against opioid manufacturers.
A resolution set to come before Portland City Council next week will authorize the City Attorney's office to join hundreds of other jurisdictions around the country—including Multnomah County—that are suing drugmakers for what they say were irresponsible business practices that led to the opioid epidemic being felt nationwide. The city's rationale: that crisis has ratcheted up costs for firefighters who distribute overdose-fighting drugs, has contributed to Portland's housing and homelessness problem, and has cost the city money in treating opioid addictions for those covered by its health insurance, among other things.
"Manufacturers knowingly misled doctors and patients regarding the benefits of prescription opioids for treatment of chronic pain and trivialized the significant risk of addiction," reads an impact statement filed with the resolution. "At the same time, distributors failed to monitor prescription opioid distribution and report suspicious orders. These actions resulted in an opioid epidemic, involving a dramatic increase in opioid addiction and overdose deaths. Manufacturers and distributors of prescription opioids have experienced significant profits, while the City of Portland, like other jurisdictions, has borne the increased costs for emergency medical services, policing, housing, and medical expenses."
The resolution doesn't list which specific manufacturers the city plans to sue, or how much money it will seek. If it follows the lead of county officials,companies like Purdue Pharma, Teva Pharmaceutical Industries, and Johnson & Johnson could be on the list of defendants. Multnomah County's ongoing lawsuit seeks $250 million.
The action—all but certain to pass—comes at an interesting time. Attention has begun to shift back to the toll methamphetamine use has taken in Oregon. A story that ran this week in the New York Times was centered in Portland, and noted that deaths related to meth occur in Oregon at a far higher rate than heroin-related deaths.
“Everybody has meth around here — everybody,” one heroin user told the paper. “It’s the easiest to find.”

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Broadcast Media Coverage

NBC Nightly News

Feb 19, 2018 | NBC Nightly News

By National Programming

Video Link: http://app.criticalmention.com/app/#clip/view/32806442?token=37955281-c710-4903-850c-33b87f7fb67c
Rough Transcript: but what's flying under the radar -- is the connection between opioid makers -- and advocacy groups for people who deal with chronic pain. here's nbc's katie beck. here's nbc's katie beck. a new investigation led by senar claire mccaskill exposing the financial ties between opioid manufacturersand advocacy grou. sot- mccaskill i believe that sf these groups were fronting for e opioid industry and that's whate found. the congressional revief donations from a handful of opid manufacturers - names such as pe as insys - found nearly 9 millin dollars in varying amounts funnd to 14 advocacy groups over five years. (sot- mccaskill) "you these nice-sounding names, and e organizations, and you don't ree that many of them are being funy the very people that manufacture 4:38 PMopioids" (sot-fugh berman "businesses don't give money t advocacy groups without gettinga return on investment. dr. adre fugh-berman studies drug marketg practices and has been hired to testify in state lawsuits againt opioid manufacturers. (sot-h berman) "these groups have mini addiction risks/ they've actualy lobbied to fight laws that-- seo prevent over prescription." according to the report, even fd fault with cdc guidelines seekio curb opioid dosing. another, te national pain foundation, defena convicted doctor charged with overprescribing... up to 1600 pa day. sot- mccaskill "beware any organization if you don't kw who's paying the bills." purd insys told us the money was to support organizations aiming top pain patients receive appropriae care. the national pain foundn didn't respond to request for ct but told senate investigators io longer accepts contributions frm pharmaceutical companies. othr groups criticized the report cag it unfair to equate financial st with industry influence. cate beck: "they say, "we're pro pa we're not pro industry. senar mccaskill: "i would urge them t all of the donations they recein their website and let the public decide." to decide whether t money is buying the message.

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Key Capitol Hill Hearings

Feb 16, 2018 | CSPAN

By National Programming

Video Link: http://app.criticalmention.com/app/#clip/view/32806523?token=37955281-c710-4903-850c-33b87f7fb67c
Rough Transcript: thank you, mr. secretary, let me ask you to respond in writing to the following specific questions. as you know, last year president trump said that big pharma was essentially committing murder. 6:36 PMhe also said quote, we have to create new bidding procedures for the drug industry because they are getting away with murder. we are the largest buyer of drugs in the world and yet we don't bid properly. we are going to start bidding, we are going to save billions of dollars, end quote. of course, the administration has not begun any bidding. it has done nothing to bring down the spiraling cost of prescription drugs. i would ask you the same questions that i asked your predecessor and your staff can turn to his answers as an excellent example of avoiding a real answer and dodging the question. whether you can confirm that the administration has abandoned president trump's promise to have medicare price negotiation and to support the safe drug importation to allow a little competition to bring down prices. two questions that i will put in the same words that i sent to mr. price that he refused to directly answer. secondly, instead of addressing 6:37 PMthe murder, president trump in his budget proposes to reward the murderers. i want to ask you about president trump's plan to heighten prescription drug premiums for every part d person on medicare and whether or not it isn't true that while you pretend to lower the cost for some, that medicare has already estimated that premiums will rise as much as $44 per month for every part d recipient because of the change you plan to make in the way medicare rebates are done, and that this plan will simply put more money in the pockets of big pharma and cost taxpayers and part d recipients more. next question concerns opioids. as you know, 41 attorneys general have conducted an investigation of the role that pharma played in causing the opioid crisis. hundreds of localities have brought legal action against pharma. you know that medicare covers nearly 4 in 10 non-elderly adults with an opioid addiction and in 2013, medicaid spent $9.4 billion for their care. my question is, can you report to us on what this administration has done to investigate the role of pharmaceutical manufacturers and when can we expect the administration to bring legal action against these pharmaceutical companies for their role in creating this problem and stop billing it all to the taxpayer. finally for today, sir, would you answer as to whether you will commit to provide the information required by law on non-bid contracts that hhs has entered which hhs has refused to provide in accord with law throughout 2017 and into this year so we know on contracts and grants what no-bid contracts your department

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FOX and Friends Sunday

Feb 18, 2018 | Fox News

By National Programming

Video Link: http://app.criticalmention.com/app/#clip/view/32806486?token=37955281-c710-4903-850c-33b87f7fb67c
Rough Transcript: philadelphia's district attorney is dropping 51 drug charges while decriminalizing marijuana possession. larry says it will free up resources for more serious crimes. but will still prosecute drug dealers. he just recently filed a lawsuit against opioid manufacturers while the city considers adding a safe injection site for drug users.

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NBC 5 Today at 5am

Feb 19, 2018 | KXAS (NBC)

By Dallas, TX

Video Link: http://app.criticalmention.com/app/#clip/view/32806467?token=37955281-c710-4903-850c-33b87f7fb67c
Rough Transcript: new information this morning about how the opioid industry is shaping public opinion. a report says drugmakers gave millions of dollars to patient advocacy groups. those groups then in turn promoted the medications used. the report released by missouri senator claire mccaskill. the drugmakers said they did not set conditions on how the money was to be spent or force the groups to advocate for their pain painkillers. this could bolster hundreds of lawmakers aimed at drugmakers. more than 63,000 people died of opioids from 2016.

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Good Day Philadelphia Weekend

Feb 17, 2018 | WTXF (Fox)

By Philadelphia, PA

Video Link: http://app.criticalmention.com/app/#clip/view/32806493?token=37955281-c710-4903-850c-33b87f7fb67c
Rough Transcript: the fight to end the opioid crisis continues. philadelphia district attorney larry krasner has filed a second lawsuit against opioid makers. he claims ten different pharmaceutical companies have fueled the city's crisis through deceptive marking. the drug companies have said they don't believe litigation is the answer but have pledged to help.

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Eyewitness News at 6:00

Feb 17, 2018 | WSOC (ABC)

By Charlotte, NC

Video Link: http://app.criticalmention.com/app/#clip/view/32806530?token=37955281-c710-4903-850c-33b87f7fb67c
Rough Transcript: guilford county leaders say they plan to file a lawsuit against major drug manufacturers and distributors, the suit claims the company is unlawfully contributed to a public nuisance in the county, which had 80 overdose deaths in 2017. we told you, mecklenburg and bert county readers have already filed lawsuits against leaders. approximately 300 lawsuits, nationwide, have been filed against the opioid industry.>>>

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WFMY News 2 at 6

Feb 16, 2018 | WFMY (CBS)

By Greensboro, NC

Video Link: http://app.criticalmention.com/app/#clip/view/32806716?token=37955281-c710-4903-850c-33b87f7fb67c
Rough Transcript: county commissioners announced they're taking action against the opioid epidemic county commissioners announced they will file a civil lawsuitagainst many of the major opiate manufacturers and distributors they say the drugs have contributed to a nuisance in guilford county county join to get ken stokes and rockingham counties along with several others nationwide in filing lawsuits against drug manufacturers to fight the opioid cris

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FOX8 News at 6:00A

Feb 20, 2018 | WGHP (Fox)

By Greensboro, NC

Video Link: http://app.criticalmention.com/app/#clip/view/32806550?token=37955281-c710-4903-850c-33b87f7fb67c
Rough Transcript: a local county is moving forward with its lawsuit against opioid manufacturers. alamance county commissioners voted to hire a law firm to sue the companies that make and distribute the drugs. according to the times news -- the next step is to choose from three law firms during a closed session. alamance is one of many counties filing suits against opioid makers.

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This Week in Cincinnati

Feb 18, 2018 | WCPO (ABC)

By Cincinnati, OH

Video Link: http://app.criticalmention.com/app/#clip/view/32806693?token=37955281-c710-4903-850c-33b87f7fb67c
Rough Transcript: let's talk about the heroin opioid crisis and the epidemic. obviously the trump administration has released funding aside from the emergency declaration to help - the health emergency declaration which realy didn't do much. there are funds being trickled out to the states to help. how much more responsibility do you believe actually lands on the pharmaceutical companies and the distributors for geting us into this problem in the first place? > first of al the opioid addiction problem is multifaceted. we have a state that directs everybody to college. you have kids that are in high school that don't want to go to college. when i met with ohii did 11:13 AMindividual who were addicts, it's one of the biggest concerns. when i went to high school i was told i would be useless if i didn't get a college education. we have to change that. we have to lok at the manufacturers. remember, there's a whole chain. manufacturers, distributors, doctors, patients. what i learned on the patient side was, on the patient side, they want no pain. they want to go home with no pain. i go back to when i was in high schol i was in a motorcycle acident. terrible motorcycle accident, hit a car at 55 miles per hour, went over the car, put the bike under it, ended up down the road 100 yards. went to the hospital, no broken bones, but bruises al over. but i went to schol the next day with a bottle of aspirin. the diference back then, we weren't to the point where you had to have opioids. we went back to school with pain. there are some people who say i can't take the pain. i understand that. but i think it's all of the above. we have to lok at our hospitals and our doctors prescribing and why they prescribe it. some of it is post. i'm not blaming them. some of the policies that the federal government puts out says you have to get these people pain-free. but at the same time we have to look at the manufacturers. it's not just one silver bulet. that's why i got frustrated when we say we've got to go after the manufacturers. you can't just go after the manufacturers. there's distributors, there's doctors, there's patients. it's a multifaceted thing.

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KOCO 5 News at 6am Saturday

Feb 17, 2018 | KOCO (ABC)

By Oklahoma City, OK

Video Link: http://app.criticalmention.com/app/#clip/view/32806697?token=37955281-c710-4903-850c-33b87f7fb67c
Rough Transcript: attorney general mike hunter has been working to fight the opioid cris in our state. koco's jessica schambach has more. >> we're losing an average of a thousand people a year to overdose deaths >> >> oklahoma's attorney general discussing the 'state of addiction' on koco's facebook live. mike hunter formed the state's first opioid commission and made recommendations to lawmakers. what changes could we see this legislative session? >> we're proposing that we tax opioid wholesalers and distributors, manufacturers :30 the tax is proposed at 10% that'll create 15-$17 million we're direct that money into treatment programs to hopefully get people well >> the commission came up with 31 recommendations for change, including getting rid of paper prescriptions and using electronic ones, instead. >> it's just too easy to fraudulently create a prescription with papter >> hunter also leading the charge to hold drug companies responsible for the opioid problem in our state. >> the basis of our lawsuit is these companies have been brainwashing prescribers for the last 20 years.

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Northwest Now

Feb 16, 2018 | KBTC (PBS)

By Seattle, WA

Video Link: http://app.criticalmention.com/app/#clip/view/32806537?token=37955281-c710-4903-850c-33b87f7fb67c
Rough Transcript: here in pierce county, prosecutor mark lindquist filed a lawsuit against three big-pharma companies, and the outside lawyers took it on contingency. when you consider that, and all the suits being filed around the state and the country, it looks like we could be headed for another tobacco-style settlement and possible financial windfall. the bottom line? we've tried a war on drugs and it failed miserably. any settlement money for opioids has to go into treatment.

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