Opioid Litigation Daily Media Report - 2/22/18

Camden County, NJ Suit

1. A N.J. County Sues Purdue Pharma, Sackler Family for Opioid Marketing

   Feb 21, 2018 | Wall Street Journal

   By Kate King
   
   
   Camden County in southern New Jersey has joined hundreds of counties nationwide in suing the opioid-painkiller manufacturer Purdue Pharma L.P., but in an unusual step it also has named as co-defendants members of the company’s controlling family, the Sacklers.
2. Purdue Pharma Triggered Opioid Epidemic, NJ County Says

   Feb 21, 2018 | Law360

   By Rachel Graf
   
   
   A New Jersey county hit OxyContin maker Purdue Pharma and several other opioid manufacturers, distributors and retailers with a suit in state court Wednesday accusing the former of sparking the opioid epidemic with deceptive marketing practices that the others eventually adopted.
3. Camden County sues opioid makers in pioneering suit

   Feb 21, 2018 | The Philadelphia Inquirer (PA)

   By Avalon R. Zoppo
   
   
   Camden County filed a pioneering lawsuit against several drug manufacturers and distributors Wednesday, seeking to recover millions of dollars the local government has spent combating the opioid crisis over the last decade.
4. Camden County Announces Wide-Reaching Lawsuit Against Opioid Manufacturers, Distributors

   Feb 21, 2018 | CBS Philly (PA)

   By Cleve Bryan
   
   
   The opioid epidemic continues to plague our nation and now some communities in South Jersey are taking a new approach to fight back against those they feel are responsible.
5. Camden County accuses Purdue Pharma of racketeering in lawsuit

   Feb 21, 2018 | NJTV News (NJ)

   By Brenda Flanagan
   
   
   “When you ignite a fire, you must bear responsibility to extinguish it,” charged David Mayer, the mayor of Gloucester Township, at a news conference in Camden.
6. Camden County Files Racketeering Lawsuit Against Opioid Manufacturers

   Feb 21, 2018 | NJ Pen (NJ)

   By Matt Skoufalos
   
   
   Amid a national wave of legal action against opioid manufacturers that lawmakers allege contrived a public health crisis and spurred heroin addiction, the Camden County government is suing the developers, manufacturers, and retailers of the drugs OxyContin and its derivatives.
7. NJ County Sues Purdue Pharma, Others As Opioid Fight Continues

   Feb 21, 2018 | Gloucester Township Patch (NJ)

   By Anthony Bellano
   
   
   As it continues its battle against the opioid epidemic gripping the county and the nation as a whole, Camden County announced it will file a lawsuit against the drug companies, owners, manufacturers, distributors and retailers they say ignited the epidemic.
8. Camden County Freeholders File Ground-Breaking Lawsuit to Battle Opioid Epidemic

   Feb 21, 2018 | South Jersey Observer (NJ)

   By Anne Forline
   
   
   In order to take Camden County’s ongoing fight against opioid addiction to the next level, the Freehold Board will file a ground-breaking lawsuit against the drug companies, owners, manufacturers, distributors and retailers that ignited the epidemic.
9. Camden County lawsuit targets firm that makes OxyContin

   Feb 21, 2018 | Courier Post (NJ)

   By Jim Walsh
   
   
   Camden County on Wednesday joined the ranks of public bodies asking a judge to hold drugmakers liable for the financial impact of the opioid epidemic.
10. Camden group says opioid manufacturer is same as drug cartel, files suit

    Feb 21, 2018 | NJ.com (NJ)

    By Paige Gross
    
    
    A South Jersey group spearheaded by a Camden County freeholder filed a lawsuit alleging a New Jersey pharmaceutical company that manufacturers OxyContin has been operating a criminal enterprise.
11. Camden files opioid lawsuit targeting drug companies, distributors and pharmacy chains

    Feb 21, 2018 | Philadelphia Business Journal (PA)

    By John George
    
    
    Camden became the latest city Wednesday to sue major players in the pharmaceutical industry. The city is seeking to hold them at least partially responsible for the opioid addiction that has plagued the South Jersey city along with the rest of the country.
12. Camden County sues opioid manufacturers, alleging racketeering

    Feb 22, 2018 | Philly Voice (PA)

    By John Kopp
    
    
    Camden County officials will file a lawsuit accusing opioid manufacturers of racketeering, alleging drugmakers operated a criminal enterprise as they marketed and distributed prescription painkillers throughout New Jersey.
13. In a legal first, Camden County files racketeering suit against OxyContin makers

    Feb 21, 2018 | ROI NJ (NJ)

    By Anjalee Khemlani
    
    
    Camden County is joining the legal fight against the opioid epidemic — but with an unprecedented argument.
14. Camden County sues drug makers to recoup the millions its spent fighting opioid crisis

    Feb 22, 2018 | WHYY (PA)

    By Joe Hernandez
    
    
    In a wide-ranging civil lawsuit filed in state court Wednesday, Camden County blames pharmaceutical companies for knowingly causing the opioid epidemic and forcing the local government to expend millions of dollars to fight it.

Commentary and FYIs

15. The Oxford Man Who Brought Down Big Tobacco Asks: Are Opioids the New Tobacco? (OPINION)

    Feb 21, 2018 | Hotty Toddy (MS)

    By Dick Scruggs
    
    
    Is the rising spate of opioid litigation comparable to the litigation that resulted in the mega-billion dollar settlement with Big Tobacco? The answer is, sort of. This article highlights the similarities and differences in these two public health initiatives.
16. Opioid lawsuits cropping up all over Texas, TLR says ‘enriching’ law firms won’t cure epidemic

    Feb 22, 2018 | SE Texas Record (TX)

    By David Yates
    
    
    Joining a nationwide trend, Texas municipals have begun suing the makers of opioids in recent months, alleging drug manufactures knew of the dangers but placed profits above the public good.
17. The Myth of What’s Driving the Opioid Crisis (Opinion)

    Feb 22, 2018 | Politico Magazine

    By Sally Satel
    
    
    As an addiction psychiatrist, I have watched with serious concern as the opioid crisis has escalated in the United States over the past several years, and overdose deaths have skyrocketed. The latest numbers from the Centers for Disease Control and Prevention show fatalities spiraling up to about 42,000 in 2016, almost double the casualties in 2010 and more than five times the 1999 figures. The White House Council of Economic Advisers recently estimated that the opioid crisis cost the nation half a trillion dollars in 2015, based on deaths, criminal justice expenses and productivity losses. Meanwhile, foster care systems are overflowing with children whose parents can’t care for them, coroners’ offices are overwhelmed with bodies and ambulance services are straining small-town budgets. American carnage, indeed.
18. Compassion Led Me to Rehab and It Can Help the Country Fight the Opioid Crisis (Opinion)

    Feb 22, 2018 | TIME

    By Mackelmore
    
    
    When I was 25, my dad asked me a simple question that ended up changing my life. He asked me if I was happy. At that point, my drug addiction had led me to a place of deep depression and self-hate. I couldn’t get away from the shadow that opioids had cast over my life. My love for making music was gone. My relationships with friends and family were strained at best, and permanently damaged at worst. I spent most of my time in my room with the blinds drawn. The world that I once loved was going on outside without me.
19. Bitter Pill

    Feb 21, 2018 | Arkansas Times (AR)

    By David Koon
    
    
    Though Lane Huie was 27 years old when he died in a car crash on July 4, 2013, his mother, Darla Huie, never knew her son as a fully functional adult. She could see his potential, of course, as every parent can see the potential in their child. But from the time he was 17 years old, the man he might have been otherwise was always distorted by a crippling, seemingly unbreakable addiction to opioids.
20. Attorney General Fox aims to stop opioid marketing

    Feb 21, 2018 | Fox Montana (MN)

    By Bless Zechman
    
    
    Attorney General Tim Fox has sent out his latest effort in combating substance abuse issues in Montana, this time attacking the way makers of opioid can market to their drug
21. Sen. Maria Cantwell calls for heavier penalties on drugmakers who fail to keep opioids off the street

    Feb 22, 2018 | Spokesman Review (WA)

    By Rachel Alexander
    
    
    Flanked by law enforcement, social service and public health workers, Sen. Maria Cantwell spoke Wednesday in Spokane about the importance of cracking down on prescription opioid manufacturers who let their drugs flood communities.

Northwest (OR)

22. Portland to sue opioid companies for costs of local havoc

    Feb 21, 2018 | OregonLIve (OR)

    By Brad Schmidt
    
    
    The city of Portland will join a national movement by suing drug companies behind America's opioid crisis.
23. City of Portland announces it will sue drug industry over opioid crisis

    Feb 21, 2018 | Portland Business Journal (OR)

    By Elizabeth Hayes
    
    
    Six months after Multnomah County filed a $250 million lawsuit against Purdue Pharma and other opioid manufacturers, the Portland City Council unanimously decided to also take legal action.
24. Portland plans to file suit against drug companies for role in city's opioid crisis

    Feb 21, 2018 | KATU On Your Side

    By Staff
    
    
    Portland is looking into suing opioid companies as a way to help recoup some of the money spent fighting the city’s opioid crisis.

Northeast (RI)

25. Town joins lawsuit vs. big pharma

    Feb 22, 2018 | The Jamestown Press (RI)

    By Tim Riel
    
    
    Drug overdoses have been responsible for 1,679 deaths since May 2011, according to the state Department of Health, which means an average of 21 Rhode Islanders are buried monthly from abuse.

Midwest (MI)

26. County joins national lawsuit against opioid manufacturers

    Feb 21, 2018 | Hillsdale Daily News (MI)

    By Corey Murray
    
    
    The Hillsdale County Board of Commissioners approved a resolution Feb. 13 approving outside counsel to represent the county in a nation-wide lawsuit against opioid manufacturers.

Southeast (AR)

27. Norfork joins opioid lawsuit, Gassville declines

    Feb 22, 2018 | The Baxter Bulletin (AR)

    By Scott Liles
    
    
    One Baxter County city recently voted to join a large class-action lawsuit against the manufacturers and distributors of opioid drugs, while another decided that it would not join the same lawsuit.

Southwest (NV)

28. North Las Vegas to sue pharmaceutical companies over opioids

    Feb 21, 2018 | Las Vegas Review Journal (NV)

    By Art Marroquin
    
    
    The North Las Vegas City Council on Wednesday night voted unanimously to file a civil lawsuit against pharmaceutical drug manufacturers, aimed at recovering money spent on battling opioid addiction through enforcement, medical treatment and social services.

Broadcast Media Coverage

29. Eyewitness News at 5am

    Feb 22, 2018 | KYW (CBS)

    By Philadelphia, PA
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/32887648?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f
30. News 12 New Jersey

    Feb 22, 2018 | N12NJ (News 12)

    By New York, NY
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/32887551?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f
31. NBC 10 News Today at 6a

    Feb 22, 2018 | WCAU (NBC)

    By Philadelphia, PA
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/32887584?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f
32. NJTV News With Mary Alice Williams

    Feb 22, 2018 | WNJT (PBS)

    By Philadelphia, PA
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/32887569?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f
33. FOX5 News This Morning

    Feb 22, 2018 | KVVU (Fox)

    By Las Vegas, NV
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/32887523?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f
34. News15 Today HR 4

    Feb 22, 2018 | KADN (Fox)

    By Lafayette, LA
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/32887537?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f
35. Montana This Morning

    Feb 22, 2018 | KPAX (CBS)

    By Missoula, MT
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/32887540?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f
36. WSBT 22 News on Fox

    Feb 22, 2018 | WSBTDT2 (Fox)

    By South Bend, IN
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/32887561?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f
37. FOX 12's 9 O'Clock News on PDX-TV

    Feb 22, 2018 | KPDX (MNT)

    By Portland, OR
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/32887589?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f
38. KOLR 10 News at 9 on Z

    Feb 22, 2018 | KOZL (Fox)

    By Springfield, MO
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/32887606?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f
39. WALB News 10 at 6

    Feb 22, 2018 | WALB (NBC)

    By Albany, GA
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/32887617?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f

Camden County, NJ Suit

1. A N.J. County Sues Purdue Pharma, Sackler Family for Opioid Marketing

   Feb 21, 2018 | Wall Street Journal

   By Kate King

   Camden County in southern New Jersey has joined hundreds of counties nationwide in suing the opioid-painkiller manufacturer Purdue Pharma L.P., but in an unusual step it also has named as co-defendants members of the company’s controlling family, the Sacklers.

   The lawsuit, filed Wednesday in Superior Court in the city of Camden is a rare example of plaintiffs seeking to hold Purdue’s controlling shareholders personally responsible for allegedly marketing opioids in a deceptive manner that played down the drugs’ addictive risks and helped spark widespread addiction.

   Camden County, which has about 500,000 residents and recorded 277 fatal overdoses last year, seeks compensation for costs related to the epidemic, which range from emergency and medical services to lost economic productivity due to addiction-induced absenteeism.

   The lawsuit didn’t specify an amount that Camden County is seeking, but a spokesman said the costs are estimated to be in the tens of millions of dollars.

   The suit also names as defendants more than a dozen other opioid manufacturers, distributors and retailers, claiming the companies conspired to market and sell painkillers to doctors and the American public, while minimizing the possibility of addiction and other health risks.

   “This meteoric rise in prescriptions (and the attendant rise in addiction to and abuse of prescription opioids and heroin) is not due to a medical breakthrough,” the lawsuit said. “Rather, it has been Defendants’ quest for greater profits.”

   The lawsuit names as defendants Purdue board member and former company President Richard Sackler, and the estates of brothers Raymond and Mortimer Sackler, who bought the company in the 1950s and transformed it from a small pharmaceutical firm into amassive enterprise that produces the powerful and addictive opioid OxyContin.

   John Puskar, spokesman for Purdue Pharma, said the company denies the allegations. “We are deeply troubled by the prescription and illicit opioid abuse crisis, and are dedicated to being part of the solution,” Mr. Puskar said in an email.

   A spokeswoman said the Sackler family declined to comment.

   Faced with a backlash over the addiction crisis, Purdue said earlier this month that it had reduced its sales force by more than 50% and that sales representatives would no longer visit doctors’ offices to promote opioid products.

   In 2007, Purdue and three of its executives pleaded guilty in federal court in Virginia to criminal charges of misleading the public about the addiction risks posed by OxyContin.

   The company agreed to pay $634.5 million to settle civil litigation and government penalties.

   The Wall Street Journal has reviewed more than 450 state, county and city lawsuits filed involving opioid painkillers in recent months, most of which named opioid-drug manufacturers and distributors rather than the members of the Sackler family as defendants.

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2. Purdue Pharma Triggered Opioid Epidemic, NJ County Says

   Feb 21, 2018 | Law360

   By Rachel Graf

   A New Jersey county hit OxyContin maker Purdue Pharma and several other opioid manufacturers, distributors and retailers with a suit in state court Wednesday accusing the former of sparking the opioid epidemic with deceptive marketing practices that the others eventually adopted.

   Camden County alleges that drugmaker Purdue Pharma LP triggered the current opioid epidemic in the 1990s with a marketing campaign that persuaded doctors to prescribe the drugs not just for cancer patients and those with terminal illnesses, but for anyone with common aches and pains, saying there wasn’t a risk of addiction.
   
   Other named defendants, including Teva Pharmaceutical Industries Ltd., McKesson Corp., CVS Health Corp. and Walgreens Boots Alliance Inc., further exacerbated the epidemic when they adopted these marketing practices, the suit says.
   
   “Purdue Pharma, manufacturer and marketer of OxyContin, executed an epic scheme to deceive doctors (and the public at large) into believing that opioids can be prescribed for long periods of time with little to no risk of addiction — a blatantly false premise,” the complaint says.
   
   Purdue Pharma developed OxyContin with a time-release formula that the company claimed would grant patients pain relief for 12 hours, according to the suit. Purdue Pharma allegedly marketed the drug as a 12-hour drug despite trials that indicated it lasted less than eight hours.
   
   Rather than increase the frequency of the prescriptions, Purdue Pharma encouraged doctors to increase the dosage, exposing the drugmaker to greater sales and patients to greater risks, the suit says. Purdue Pharma knew patients prescribed higher doses were more likely to overdose, according to the complaint.
   
   Purdue Pharma claimed the time-release formula presented a smaller risk of addiction, the suit says.
   
   “Purdue’s marketing of OxyContin transformed the practice of medicine,” the suit alleges. “Other drug companies began peddling their own narcotic painkillers for routine injuries all based on the twin falsities that these powerful narcotics were not addictive and were safe and effective treatments for routine pain.”
   
   The Camden County Police Department, specifically, responded to 941 opioid overdoses in 2016 and 2017, with 131 ending in death, according to the complaint. Nationwide, the number of opioid prescriptions rose to 259 million in 2012 from 76 million in 1991, the suit says.
   
   “By 2015, the amount of opioids prescribed was enough for every American to be medicated around the clock for three weeks,” the complaint says.
   
   A representative with Purdue Pharma didn’t respond Wednesday to a request for comment. Counsel for Camden declined to comment.
   
   Camden is represented by James E. Cecchi, Donald A. Ecklund and Michael A. Innes of Carella Byrne Cecchi Olstein Brody & Agnello PC, Michael Critchley Sr. and Michael Critchley Jr. of Critchley Kinum & Denoia LLC, and Christopher A. Seeger and David R. Buchanan of Seeger Weiss LLP.
   
   Counsel information for the drugmakers was not available Wednesday.
   
   The case is Camden County, New Jersey v. Purdue Pharma LP et al., case number L-000695-18, in the Superior Court of New Jersey. 
   

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3. Camden County sues opioid makers in pioneering suit

   Feb 21, 2018 | The Philadelphia Inquirer (PA)

   By Avalon R. Zoppo

   Camden County filed a pioneering lawsuit against several drug manufacturers and distributors Wednesday, seeking to recover millions of dollars the local government has spent combating the opioid crisis over the last decade.

   The suit is the first of its kind to attack pharmaceutical companies for their role in the deadly epidemic under state racketeering laws typically used to fight bribery, extortion, and other fraudulent practices, officials said.

   The 181-page complaint, filed in Camden County Superior Court, contends that drugmakers methodically targeted doctors, the public, and regulatory agencies with false marketing campaigns aimed at convincing Americans that opioids are not addictive. Meanwhile, the Centers for Disease Control and Prevention reports that 75 percent of patients in heroin treatment first became addicted to prescribed opioids. Officials say this “epic scheme” spurred the crisis that Camden County now faces.

   Named in the suit are more than a dozen drug manufacturers, distributors, and retailers. In what officials described as an unprecedented move, three members of the Sackler family, which owns OxyContin-maker Purdue Pharma, are also listed as defendants.

   “The Sackler family … in our minds, are no different than members of a drug cartel that distribute drugs illegally or the drug pushers on our streets,” said Camden County Freeholder Louis Cappelli, Jr. as he stood among victims of the epidemic and members of the county’s Addiction Awareness Task Force outside of Camden’s Hall of Justice.

   A representative for the family was not immediately available for comment.

   The suit aims to stop the distribution of addictive opioids and seeks funding for treatment and awareness programs in Camden County. It does not specify the monetary amount sought for damages.

   Over the last decade, officials say, the county has spent tens of millions of dollars fighting the epidemic in all sectors of the government, including law enforcement, emergency services, courts, and prisons.  In 2017, Camden County saw 277 overdoses and nearly 3,000 Narcan deployments.

   “We are far short of the funds we need to meet our objective,” Cappelli said. “It’s time somebody pays. Those who created this problem should help pay for the solution for this problem.”

   Dozens of state and local governments, which bear the brunt of the sweeping epidemic, have joined a legal movement to hold pharmaceutical companies accountable for the tens of thousands of opioid-related deaths each year. In January, New York Mayor Bill de Blasio announced a lawsuit against corporate giants in the pharmaceutical industry.

   In a statement, Purdue Pharma denied the allegations in Camden County’s lawsuit and said it was dedicated to ensuring that patients have “access to FDA-approved medicines” while working to solve the opioid epidemic. The company said it has developed three of the first four FDA-approved opioid medications with abuse-deterrent properties and it helps police obtain Naloxone, a medication designed to reverse opioid overdose.

   “We are deeply troubled by the prescription and illicit opioid abuse crisis, and are dedicated to being part of the solution,” the statement said. “We vigorously deny these allegations and look forward to the opportunity to present our defense.”

   For Patty DiRenzo, Camden’s lawsuit is a personal victory.

   Her son Salvatore Marchese died of an overdose after developing a drug addiction as a teenager. Marchese received treatment and was sober for two years when a doctor prescribed OxyContin for a toothache, she said, and he fell back into old habits. He was found dead in a car in Camden in 2010.

   “We’re losing this battle. [Drugmakers] need to be held accountable. They have billions of dollars and they need to use their money to save lives,” said DiRenzo, 58, who serves on the county’s addiction awareness task force.

   Justin Wroblewski, a former student athlete from Blackwood, is still in recovery after developing an addiction to opioids. The 24-year-old was a basketball and baseball star in high school with dreams of playing college sports, but his plans changed sophomore year when he was prescribed painkillers for a sports injury.

   “I wanted to get back on the field and do what I love to do,” he said. “It wasn’t long before the prescription ran out and the withdrawal symptoms started to set in.”

   Wroblewski said he has been sober for five years and hopes to see the sale of addictive pain medications curbed.

   That wish is already underway. Earlier this month, Purdue Pharma announced the company would stop marketing OxyContin to doctors after years of mounting criticism. The company also launched a medical affairs department composed of health professionals to field questions from prescribers.

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4. Camden County Announces Wide-Reaching Lawsuit Against Opioid Manufacturers, Distributors

   Feb 21, 2018 | CBS Philly (PA)

   By Cleve Bryan

   The opioid epidemic continues to plague our nation and now some communities in South Jersey are taking a new approach to fight back against those they feel are responsible.

   Seven years ago, Patty DiRenzo’s son joined the ever growing list of victims to the opioid abuse epidemic. She blames big pharma for the death of her son, Sal.

   “Had a toothache, went to the dentist and came home with 30 pills of Vicodin or OxyContin and that led to his complete spiral,” said DiRenzo.

   Now, DiRenzo and local governments taxed with the daily responsibility of treating overdose victims are fighting back against the opioid industry.

   “We paid for their lives with our loved ones’ deaths and they need to be held accountable,” said DiRenzo.

   On Wednesday, officials in Camden County announced a wide-reaching lawsuit against opioid manufacturers, distributors and retailers like Rite Aid and Walgreens.

   They’re uniquely applying criminal racketeering statutes against companies like Purdue Pharma, whose owners — the Sackler family — developed OxyContin and allegedly lied about its addictive powers to doctors and pharmacists.

   “The members of the Sackler family are the lowest form of humans you can possibly imagine,” said Louis Cappelli, chairman of the Camden County Board of Freeholders. “They have earned billions of dollars over the years at the expense of the American public.”

   Purdue, which is facing lawsuits from more than a dozen states, said in a statement, “We are deeply troubled by the prescription and illicit opioid abuse crisis, and are dedicated to being part of the solution. We vigorously deny these allegations and look forward to the opportunity to present our defense.”

   A spokesperson for Walgreens says they won’t comment on pending litigation, but Camden County’s lawyer says it is appropriate to go after individual pharmacies because they have a responsibility to let customers know about dangerous medications.

   The county is seeking money for drug treatment and an end to what they consider dangerous practices by big pharma.

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5. Camden County accuses Purdue Pharma of racketeering in lawsuit

   Feb 21, 2018 | NJTV News (NJ)

   By Brenda Flanagan

   “When you ignite a fire, you must bear responsibility to extinguish it,” charged David Mayer, the mayor of Gloucester Township, at a news conference in Camden.

   That’s why local officials support Camden County’s lawsuit accusing a long list of opioid makers and distributors of racketeering, particularly Purdue Pharma, which manufactured the highly addictive opioid OxyContin, specifically, Purdue’s private owners, the Sackler family — Richard, Mortimer and Raymond — who made more than an estimated $30 billion from it.

   ” … and in our minds, are no different from members of a drug cartel, that distribute drugs illegally or the drug pushers on our streets, who push heroin and fentanyl on a daily basis. Just so we’re clear, the members of the Sackler family are the lowest form of humans you can possibly imagine. They have earned billions of dollars over the years at the expense of the American public …” said Louis Cappelli Jr., Camden County’s freeholder director.

   The lawsuit, filed under New Jersey’s racketeering statute, alleges the Sacklers “ … executed an epic scheme to deceive doctors [and the public at large] into believing that opioids can be prescribed for long periods of time with little to no risk of addiction; a blatantly false premise … resulting in billions of dollars for Purdue and its top executives …” and that “ … the Sackler Family’s fraudulent and deceptive marketing scheme was joined and/or adopted by each of the Defendants, as well as those who acted in concert with them.”

   The lawsuit also names no less than eight drugmakers, three distributors and four drugstore retailers, and calls the operation a criminal enterprise ” … that marketed and shipped millions of highly addictive narcotics throughout the nation including Camden County, New Jersey,” said Cappelli Jr.

   “I don’t know how they sleep at night, I really don’t. Look at the devastation they’ve caused,” said Patty DiRenzo.

   DiRenzo’s son, Sal, died of an overdose in 2010. His name’s on a wall of Camden County opioid victims. His mom says people struggling with addictions still need help.

   “Nothing’s changed. What are we doing?” she asked. “I would hope it’d help in a way … they’d give money for funding. We need beds. We need detoxes and we need beds.”

   The Christie administration also filed lawsuits against Purdue Pharma and Insys, which markets a form of fentanyl, seeking money to pay for addiction treatment and education programs. The city of Paterson’s sued Purdue Pharma, too.

   The company’s response to Camden’s lawsuit states: “We vigorously deny these allegations and look forward to the opportunity to present our defense … We are deeply troubled by the prescription and illicit opioid abuse crisis, and are dedicated to being part of the solution. As a company grounded in science, we must balance patient access to FDA-approved medicines, while working collaboratively to solve this public health challenge …”

   In full page ads, Purdue said it will fight to end the opioid crisis, but Camden County wants cash to cover the epidemic’s ongoing damages.

   “You caused this health crisis and the death of our loved ones, and children, and you must now pay for it,” said DiRenzo.

   “We’re so desperate in trying to provide services to our residents, and at the same time, we have such a lack of funds and support from the federal government. Now’s the time to go after those who created this situation,” said Cappelli Jr.

   The suit was filed in Camden County Superior Court. It doesn’t request a specific award amount.

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6. Camden County Files Racketeering Lawsuit Against Opioid Manufacturers

   Feb 21, 2018 | NJ Pen (NJ)

   By Matt Skoufalos

   Amid a national wave of legal action against opioid manufacturers that lawmakers allege contrived a public health crisis and spurred heroin addiction, the Camden County government is suing the developers, manufacturers, and retailers of the drugs OxyContin and its derivatives.

   “We’ve come to a point where we’re so desperate in trying to provide services to our residents, and at the same time we have such a lack of funds and support from the federal government, [that]  now is the time for us to go after those who created this situation,” said Camden County Freeholder-Director Lou Cappelli.

   In addition to driving opioid producers to stop manufacturing the drugs, Cappelli said the suit would seek to recover funds for addictions awareness and treatment programs, including those for physicians and medical students.

   The suit names Purdue Pharma physician Richard Sackler, and the estates of Raymond and Mortimer Sackler, his late father and uncle, respectively.

   It alleges that Purdue collectively, and the Sacklers individually, drove the over-prescription of OxyContin for all manner of pain management, even knowing its highly addictive qualities. It further charges the manufacturers, distributors, and retailers of the drugs as being complicit in the practice.

   “Our approach is to identify those parties responsible for this particular drug, and add them to this suit, and take it to a new level by adding a RICO claim,” Cappelli said.

   Legally, the approach is comparable to the Master Settlement Agreement (MSA) that governed the multi-state lawsuits against tobacco manufacturers in the mid-1990s. That action resulted in the $206-billion settlement that also dissolved tobacco industry groups and halted tobacco marketing to children.

   Cappelli said the county lawsuit is distinguishable in strategy from the tobacco suits because it personally names the Sackler family in addition to various opioid manufacturers, distributors, and retailers.

   “As far as we know, nobody has gone after this family so far,” Cappelli said. “This is something that really has an immediate effect and is much more dangerous than tobacco.”

   Camden County is neither the first nor the only governmental jurisdiction to sue opioid manufacturers; according to The Clarion Ledger of Jackson, Mississippi, “every state attorney general has either filed a lawsuit against opioid makers or is involved in investigating whether these drugmakers misled health care providers about the addictiveness to opioids.”

   More than 200 such suits are being managed by U.S. District Judge Dan Polster of Cleveland, Ohio under a multi-district litigation (MDL) statute; according to Reuters, Polster is looking for “a quick settlement” of the issue.

   But Camden County is not part of that MDL action, which means that the defendants would have to broker their own settlement with the county or argue the case in court.Who are the Sacklers?

   Arthur Sackler, Raymond and Mortimer’s late brother, is widely credited with having conceived of modern-day pharmaceutical advertising.

   An October 2017 New Yorker report by Patrick Radden Keefe describes Arthur Sackler’s marketing practices as being integrated with the publication of supportive quasi-research and spurious physician endorsements of his products as far back as the tranquilizer epidemic of the 1960s:

   “As both a doctor and an adman, Arthur displayed a Don Draper-style intuition for the alchemy of marketing. He recognized that selling new drugs requires a seduction of not just the patient but the doctor who writes the prescription… So in selling new drugs he devised campaigns that appealed directly to clinicians, placing splashy ads in medical journals and distributing literature to doctors’ offices. Seeing that physicians were most heavily influenced by their own peers, he enlisted prominent ones to endorse his products, and cited scientific studies (which were often underwritten by the pharmaceutical companies themselves).”

   The legacy of the Sackler family is further complicated by its historic and global philanthropy, which Keefe outlines as nothing short of legacy whitewashing.

   Addictions awareness activist Patty DiRenzo of Blackwood said whatever amount of money the suit may recover from the Sacklers and their business partners isn’t enough to resolve “the devastation they caused.”

   DiRenzo, who lost her son, Salvatore Marchese, to an overdose in 2010, spoke about the lasting grief her family has suffered from opioid abuse.

   “They’re worth billions, the Sacklers,” she said.

   “They need to do something. They created it.”

   DiRenzo said she’d like to see money made available for drug counseling and treatment services, the overdose reversal drug naloxone, and physician education. She described how, after chipping a bone, her doctor prescribed OxyContin and argued with her when she refused the prescription.

   “I said, ‘I don’t need that,'” DiRenzo said. “Why are they doing that? There needs to be education.”

   Gloucester Township Mayor David Mayer was succinct in his condemnation of the defendants.

   “When you ignite a fire, you must bear responsibility for extinguishing it,” Mayer said.

   In addition to the Sacklers and Purdue Pharma, the Camden County RICO suit names:

   Abbott Laboratories

   Cephalon, Inc./

   Teva Pharmaceutical Industries Inc.

   Endo International plc

   Janssen Pharmaceuticals, Inc. (Johnson & Johnson)

   Insys Therapeutics, Inc.

   Mallinckrodt plc

   AmerisourceBergen

   McKessonCardinal Health

   Walgreens Boots Alliance, Inc.

   Costco Wholesale Corporation

   Rite Aid Corporation

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7. NJ County Sues Purdue Pharma, Others As Opioid Fight Continues

   Feb 21, 2018 | Gloucester Township Patch (NJ)

   By Anthony Bellano

   As it continues its battle against the opioid epidemic gripping the county and the nation as a whole, Camden County announced it will file a lawsuit against the drug companies, owners, manufacturers, distributors and retailers they say ignited the epidemic.

   The lawsuit is being filed under civil racketeering statutes that claim they owned and operated a criminal enterprise, marketed and shipped millions of highly addictive narcotics throughout the nation, including Camden County, officials said on Wednesday.

   The lawsuit names, among others, Purdue Pharma and its owners, the Sackler Family. The county accuses the Sackler Family of deceiving doctors and the public at large into believing that opioids can be prescribed for long-periods of time with little to no risk of addiction.
   

   It seeks financial and injunctive relief, as well as funding for programs to reduce the demand for and availability of heroin and prescription drugs. It looks to create awareness programs to help educate residents about resources available to prevent and treat addiction, and to create additional resources to treat and prevent addiction to heroin and prescription drugs.
   

   "The record profits achieved by Purdue Pharma, the Sackler family and those that worked in concert with them, were earned at the expense of the millions of individuals who became predictably addicted to the tsunami of opioids unleashed upon the marketplace," Camden County Freeholder Director Louis Cappelli Jr. said in a release announcing the lawsuit. "The meteoric rise in opioid prescriptions, and the attendant rise in addiction to and abuse of these drugs, is not due to a medical breakthrough, but rather the defendants' quest for greater profits at the expense of American lives."

   "We are deeply troubled by the prescription and illicit opioid abuse crisis, and are dedicated to being part of the solution," Purdue Pharma said in a statement. "As a company grounded in science, we must balance patient access to FDA-approved medicines, while working collaboratively to solve this public health challenge. Although our products account for approximately 2 percent of the total opioid prescriptions, as a company, we've distributed the CDC Guideline for Prescribing Opioids for Chronic Pain, developed three of the first four FDA-approved opioid medications with abuse-deterrent properties and partner with law enforcement to ensure access to naloxone. We vigorously deny these allegations and look forward to the opportunity to present our defense."
   

   Purdue Pharma said it has distributed the federal Centers for Disease Control and Prevention's Guideline for Prescribing Opioids for Chronic Pain for nearly two years, and has also directed prescribers to the Surgeon General's Turn the Ride Rx.
   

   The lawsuit contends that while Purdue Pharma and its top executives made billions of dollars off its scheme, 75 percent of patients in heroin treatment today started their opioid use with prescription medications, not heroin, according to the CDC.
   

   The lawsuit said that those who have an opioid dependency, but cannot obtain a prescription — either because they cannot afford it, or cannot find a doctor to fill it — turn from prescription pills to heroin, which is more potent and cheaper.
   

   "These individuals were knowingly poisoning our families and children and doing it all under the guise of pain management, when we really know it was all based on greed," Cappelli said. "This was a transparent flooding of the marketplace going back to 1995 when the FDA approved (oxycodone drugs) and has ended with their latest announcement that Purdue will no longer market this deadly addictive narcotic. Our families in Camden County deserve more, and today is the first step in making these defendants pay for their criminal behavior."
   

   Since the mid-1990s, the county claims the manufacturers aggressively marketed and falsely promoted opioids as presenting little to no risk of addiction, even when used long term for chronic pain. 
   

   "They infiltrated medical academia faculty and literature as well as regulatory agencies to convince doctors that treating chronic pain with long-term opioids was evidence-based medicine when, in fact, it was not," the county claims.

   "In New Jersey, deaths from heroin and fentanyl overdoses more than tripled in the last five years. That's tragic and unacceptable," Rep. Donald Norcross (D-1), vice chair of the Congressional Bipartisan Heroin Task Force, said. "Camden County, led by Freeholder Director Cappelli, has been fighting to curb the opioid epidemic on all fronts and knows we must do all we can to help those struggling with the disease of addiction. There is true human cost that's at stake."
   

   "We are in the middle of a major health crisis, losing a generation to addiction, brought on by Big Pharma and their deceptive and unlawful marketing of opioids — these companies need to be held responsible for the harm their deception has caused," said Gloucester Township resident Patty DiRenzo, whose son Sal lost his battle with addiction.
   

   In response, Purdue Pharma pointed to changes it has made to its commercial operation, including that it "will no longer be promoting opioids to prescribers."
   

   "Effective Monday, February 12, 2018, our field sales organization will no longer be visiting your offices to engage you in discussions about our opioid products," Purdue Pharma recently wrote in a letter to its healthcare providers. "Going forward, questions and requests for information about our opioid products will be handled through direct communication with the highly experienced healthcare professionals that comprise our Medical Affairs department."
   

   The company said its discussions with medical providers have always included the following points, among others:Opioids are not the first-line or routine therapy for chronic pain;There should be established goals for pain and function;Discussion on the risks and realistic benefits and availability of nonopioid therapies;Do not prescribe and extended-release/long-acting opioid for acute pain;Use immediate release when starting; andStart at a low dose and go slow.

   Purdue Pharma also said it laid off over half its salespeople last week, and the roughly 200 salespeople remaining will focus on marketing Symproic and other potential non-opioid products.
   

   Camden County said it has suffered significant costs and a loss of resources attempting to stifle the epidemic, an impact that has touched nearly every branch of government from emergency services to the courts, to care facilities and clinics, to prisons, and to the police department. 
   

   "In many cases, municipal law enforcement agencies have, by default, become the first responders to deal with the crisis," the county said. "This is not only counter-productive to law enforcement's intended mission, but not an effective way to stem of the epidemic of addiction."
   

   "Today we take a bold step to correcting the grave injustice that Purdue Pharma and others have perpetrated on thousands of individuals that have fallen to the epidemic of addiction," Gloucester Township Mayor David Mayer said.

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8. Camden County Freeholders File Ground-Breaking Lawsuit to Battle Opioid Epidemic

   Feb 21, 2018 | South Jersey Observer (NJ)

   By Anne Forline

   In order to take Camden County’s ongoing fight against opioid addiction to the next level, the Freehold Board will file a ground-breaking lawsuit against the drug companies, owners, manufacturers, distributors and retailers that ignited the epidemic.

   The lawsuit is being uniquely filed under civil racketeering statutes that deem these individuals owned and operated a criminal enterprise that marketed and shipped millions of highly addictive narcotics throughout the nation including, Camden County.

   “The record profits achieved by Purdue Pharma, the Sackler family and those that worked in concert with them, were earned at the expense of the millions of individuals who became predictably addicted to the tsunami of opioids unleashed upon the marketplace,” Cappelli said. “The meteoric rise in opioid prescriptions, and the attendant rise in addiction to and abuse of these drugs, is not due to a medical breakthrough, but rather the defendants’ quest for greater profits at the expense of American lives.”

   The revolutionary lawsuit names, among others, the Sackler Family, owners of Purdue Pharma, and peddlers of OxyContin. The Sackler Family executed an epic scheme to deceive doctors (and the public at large) into believing that opioids can be prescribed for long-periods of time with little to no risk of addiction; a blatantly false premise. The Sackler Family’s fraudulent and deceptive marketing scheme resulted in billions of dollars for Purdue and its top executives.

   “These individuals were knowingly poisoning our families and children and doing it all under the guise of pain management, when we really know it was all based on greed,” Cappelli said. “This was a transparent flooding of the marketplace going back to 1995 when the FDA approved Oxi’s and has ended with their latest announcement that Purdue will no longer market this deadly addictive narcotic. Our families in Camden County deserve more, and today is the first step in making these defendants pay for their criminal behavior.”

   From the mid-90s to the present, the manufacturing defendants aggressively marketed and falsely promoted opioids as presenting little to no risk of addiction, even when used long term for chronic pain. They infiltrated medical academia faculty and literature as well as regulatory agencies to convince doctors that treating chronic pain with long-term opioids was evidence-based medicine when, in fact, it was not.

   “In New Jersey, deaths from heroin and fentanyl overdoses more than tripled in the last five years. That’s tragic and unacceptable,” said Congressman Norcross, Vice-Chair of the Congressional Bipartisan Heroin Task Force. “Camden County, led by Freeholder Director Cappelli, has been fighting to curb the opioid epidemic on all fronts and knows we must do all we can to help those struggling with the disease of addiction. There is true human cost that’s at stake.”

   Increasingly, those who have an opioid dependency, but cannot obtain a prescription (either because they cannot afford it, or cannot find a doctor to fill it), turn from prescription pills to heroin – which is more potent and cheaper. Camden County’s lawsuit explains that 75 percent of patients in heroin treatment today, according to the U.S. Center for Disease Control, started their opioid use with prescription medications, not heroin.

   “We are in the middle of a major health crisis, losing a generation to addiction, brought on by Big Pharma and their deceptive and unlawful marketing of opioids – these companies need to be held responsible for the harm their deception has caused,” said Patty DiRenzo. whose son Sal lost his battle with addiction.

   Camden County has incurred significant costs and a loss of resources attempting to curb the epidemic, impacting virtually every branch of government from emergency services, to the courts, to care facilities and clinics, to prisons, and to the police department. In many cases, municipal law enforcement agencies have, by default, become the first responders to deal with the crisis. This is not only counter-productive to law enforcement’s intended mission, but not an effective way to stem of the epidemic of addiction.

   “Today we take a bold step to correcting the grave injustice that Purdue Pharma and others have perpetrated on thousands of individuals that have fallen to the epidemic of addiction,” said David Mayer, Mayor of Gloucester Township.

   In addition to monetary and injunctive relief, Camden County seeks funding for programs to reduce the demand for and availability of heroin and prescription drugs, create awareness programs to help educate residents about resources available to prevent and treat addiction and support the creation of additional resources to treat and prevent addiction to heroin and prescription drugs.

   Individual Defendants
   Dr. Richard Sackler of Purdue Pharma
   Estate of Mortimer Sackler of Purdue Pharma
   Estate of Raymond Sackler of Purdue Pharma

   Manufacturing Defendants
   Purdue Pharma L.P.
   Abbott Laboratories
   Cephalon, Inc.
   Teva Pharmaceutical Industries Inc.
   Defendant Endo International plc
   Janssen Pharmaceuticals, Inc.
   Defendant Insys Therapeutics, Inc.
   Defendant Mallinckrodt plc

   Distributor Defendants
   AmerisourceBergen
   McKesson
   Cardinal Health

   Retailer Defendants
   Defendant Health Corporation
   Walgreens Boots Alliance, Inc.
   Costco Wholesale Corporation
   Rite Aid Corporation

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9. Camden County lawsuit targets firm that makes OxyContin

   Feb 21, 2018 | Courier Post (NJ)

   By Jim Walsh

   Camden County on Wednesday joined the ranks of public bodies asking a judge to hold drugmakers liable for the financial impact of the opioid epidemic.

   "We think those who created the problem should help pay for the problem," Freeholder Director Louis Cappelli said Wednesday in announcing a lawsuit against multiple firms that make and sell prescription painkillers.

   He claimed Purdue Pharma, the maker of OxyContin, and other companies aggressively and deceptively marketed opiate-based pain relievers despite the risks of addiction and overdose.

   "This was absolutely calculated," Cappelli asserted at a news conference attended by elected officials and county residents hit by the opioid epidemic.

   He said any damages collected from defendants would help the county cover opioid-related expenses "from emergency services to the courts to care facilities, clinics, prisons and the police department."

   Cappelli noted the suit also targets ownership of Connecticut-based Purdue Pharma, which is controlled by members of the Sackler family.

   "The members of the Sackler family are the lowest form of humans that you can imagine," declared the freeholder

   Purdue rejected Cappelli's claims, saying it is "deeply troubled by the prescription and illicit opioid abuse crisis, and (is) dedicated to being part of the solution."

   "We vigorously deny these allegations and look forward to the opportunity to present our defense," the company said in a statement.

   Purdue noted its products have been approved by the Food and Drug Administration and make up 2 percent of all opioid prescriptions.

   The lawsuit seeks unspecified damages and is part of a growing effort to demand accountability from painkiller producers.

   More than 360 similar cases, filed by states, counties and municipalities, have been consolidated before a federal judge in Ohio.

   Plaintiffs in those suits include at least four North Jersey municipalities — Newark, Paterson, Ridgefield and Irvington.

   The state Attorney General’s Office sued Purdue Pharma and other drugmakers in October, alleging a “direct link” between efforts to sell prescription painkillers and the state’s opioid crisis.

   Among other claims, the lawsuits claim Purdue concealed the risk of addiction to people taking OxyContin. They also assert Purdue marketed the drug deceptively, overstating the drug’s benefits and paying experts for favorable studies.

   Purdue, which began marketing OxyContin in 1996, last week said it had cut its sales force by more than half, and that company representatives "will no longer be visiting (medical) offices to engage in discussions about opioid products."

   
   

   A statement on Purdue's website notes the company's support for measures intended to curb opioid abuse, including limits on the number of pills in initial prescriptions and databases meant to limit "doctor shopping."

   "We manufacture prescription opioids. How could we not help fight the prescription and illicit opioid abuse crisis?" the statement asks.

   But two county residents at Wednesday's press conference asserted the drug companies had fueled the opioid epidemic, in large part because people who could no longer obtain prescription pills turned to heroin.

   "The real drug dealer is Big Pharma," said Patty DiRenzo, a Blackwood mother who lost her 26-year-old son, Sal Marchese, to an overdose in September 2010.

   "We paid for their lies with our loved ones' lives," she said.

   And Justin Wroblewski, a Blackwood 24-year-old who became dependent on painkillers after a high-school sports injury, challenged Cappelli's estimate that 75 percent of opioid addictions start with prescription pills.

   "It always starts with prescription drugs," said Wroblewski, who now helps people seeking recovery. "Every single time."

   Both the state and Camden County’s lawsuits accuse Purdue of violating New Jersey’s Consumer Fraud Act, which allows for treble damages — permission for the court to triple the amount of damages awarded to a successful plaintiff, and with creating a public nuisance.

   Camden County’s complaint also alleges Purdue and other defendants conspired in violation of the state’s racketeering law. That statute also allows a judge to order treble damages.

   The suit says Purdue’s annual revenues from OxyContin grew from $48 million in 1996 to more than $3.1 billion in 2010.

   Fatal overdoses have climbed over the same period, going from 89 in 2010 to 277 last year, Cappelli said.

   The 176-page complaint, which at times draws heavily from media accounts, says OxyContin promoters wrongly told doctors the drug posed no threat to consumers.

   The suit notes an early marketer, defendant Abbott Laboratories of Illinois, "heavily incentivized its sales staff to push OxyContin, offering $20,000 cash prizes and luxury vacations to top performers."

   It says sales representatives “were called ‘royal crusaders’ and ‘knights’ in internal documents, and they were supervised by the ‘Royal Court of OxyContin’ — executives referred to in memos as the ‘Wizard of OxyContin,’ ‘Supreme Sovereign of Pain Management,’ and the ‘Empress of Analgesia.’

   Defendants include Dr. Richard Sackler, a former president and co-chairman of the firm, and the estates of his two brothers, Mortimer and Raymond Sackler.

   The suit also seeks damages from several pharmaceutical firms and distributors, including Abbott Laboratories of Illinois; Insys Therapeutics of Arizona and Cardinal Health of Ohio; as well as retailers like Rite Aid and Costco.

   "The retailers have a responsibility to know what they're distributing," Cappelli asserted.

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10. Camden group says opioid manufacturer is same as drug cartel, files suit

    Feb 21, 2018 | NJ.com (NJ)

    By Paige Gross

    A South Jersey group spearheaded by a Camden County freeholder filed a lawsuit alleging a New Jersey pharmaceutical company that manufacturers OxyContin has been operating a criminal enterprise.

    The suit alleges that members of the Sackler family, who run Purdue Pharma in Cranbury, markets OxyContin to doctors and consumers as a drug with little-to-no risk of addiction.

    "These people are no different than members of a drug cartel that distribute drugs illegally, or the drug pushers on our streets who push heroin and fentanyl on a daily basis," Freeholder Director Louis Cappelli, Jr. said Wednesday at the Camden County Hall of Justice.

    "Just so we are clear, the members of the Sackler family are the lowest form of humans you can possibly imagine. They have earned millions of dollars over the years at the expense of the American public," he said. 

    The suit claims the Sackler family participated in a racketeering scheme and that the individuals owned and operated a criminal enterprise that marketed and shipped millions of addictive drugs throughout the country, and in Camden.

    The group -- which is being represented by James E. Cecchi, of Carella, Byrne, Cecchi, Olstein, Brody & Agnello, P.C. -- is seeking an end to the distribution of the drug OxyCotin and monetary damages of an undetermined amount that would go toward treatment and education of community members and medical students.

    Patty DiRenzo, a member of the Camden County Addiction Awareness Task Force spoke about losing her son to heroin abuse after he became addicted to pain medication. 

    "The drug dealers who created this crisis are not the ones we picture in our minds," she said. "It's not kids selling on the street, the real drug dealer is big pharma." 

    Justin Wroblewski spoke about becoming addicted to opioids after suffering a sports injury in high school. He said as soon as his prescription ran out, he started buying pills off the street to deal with his withdrawal systems. 

    While Cappelli said research shows about 75 percent of people who use heroin start out on prescription opioids, Wroblewski believes it's much higher.

    "I don't know a single person who just started using heroin," Wroblewski said. "It always starts with prescription drugs." 

    While there are combative strategies cities can use to fight the opioid epidemic like the use of Narcan -- an emergency drug that can block the effects of an opioid overdose -- Cappelli and the rest of the Camden County Addiction Awareness Task Force believes they also have to stop the chain of distribution.

    While the suit is targeting Purdue Pharma and the individuals who run it, it's also alleging that other manufacturers and distributers have participated in racketeering. It includes Abbott Laboratories, Cephalon, Inc., Teva Pharmaceutical Industries Inc., Endo International plc, Janssen Pharmaceuticals, Inc., Insys Therapeutics, Inc. and Mallinckrodt plc.

    This group isn't the only one pursuing a case against pharmaceutical companies. Delaware Attorney General Matt Denn filed a lawsuit against Purdue Pharma and other companies Friday, while New York City did the same last month.

    Purdue Pharma did not yet respond to a request for comment. 

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11. Camden files opioid lawsuit targeting drug companies, distributors and pharmacy chains

    Feb 21, 2018 | Philadelphia Business Journal (PA)

    By John George

    Camden became the latest city Wednesday to sue major players in the pharmaceutical industry. The city is seeking to hold them at least partially responsible for the opioid addiction that has plagued the South Jersey city along with the rest of the country.

    In its lawsuit filed in the Superior Court of New Jersey, Camden takes a new twist, naming individual pharmaceutical company executives along with drug distribution companies and retail pharmacy chains.

    Among the defendants named in the lawsuit are Purdue Pharma and the Sackler family, owners of Purdue Pharma, the maker of OxyContin. The lawsuit alleges the Sackler family “executed an epic scheme to deceive doctors, and the public at large, into believing that opioids can be prescribed for long-periods of time with little to no risk of addiction.”

    Purdue, in response to the lawsuit, issued the following statement: “We are deeply troubled by the prescription and illicit opioid abuse crisis, and are dedicated to being part of the solution. As a company grounded in science, we must balance patient access to FDA-approved medicines, while working collaboratively to solve this public health challenge. Although our products account for approximately 2 percent of the total opioid prescriptions, as a company, we’ve distributed the CDC Guideline for Prescribing Opioids for Chronic Pain, developed three of the first four FDA-approved opioid medications with abuse-deterrent properties and partner with law enforcement to ensure access to naloxone. We vigorously deny these allegations and look forward to the opportunity to present our defense.”

    The Camden lawsuit — which seeks unspecified damages — was filed under racketeering statutes based on allegations that the individuals named as certain defendants “owned and operated a criminal enterprise that marketed and shipped millions of highly addictive narcotics throughout the nation," including Camden County.

    “The record profits achieved by Purdue Pharma, and those that [allegedly] worked in concert with them, was earned at the expense of the millions of individuals who became predictably addicted to the tsunami of opioids unleashed upon the marketplace,” said Camden County Freeholder Director Louis Cappelli Jr. “The meteoric rise in opioid prescriptions, and the attendant rise in addiction to and abuse of these drugs, is not due to a medical breakthrough, but rather the defendants’ [alleged] quest for greater profits at the expense of American lives.

    “These individuals were [allegedly] knowingly poisoning our families and children and doing it all under the guise of pain management, when we really know it was all based on greed,” Cappelli said. “This was a transparent flooding of the marketplace going back to 1995 when the FDA approved Oxi’s and has ended with [the recent] announcement that Purdue will no longer market [Oxycontin], this deadly addictive narcotic. Our families in Camden County deserve more, and today is the first step in making these defendants pay for their criminal behavior.”

    Business with local ties named as defendants are Endo International, a Dublin, Ireland, pharmaceutical company that has its U.S. headquarters in Malvern; Teva Pharmaceuticals, an Israeli drug company that has its North American headquarters in North Wales; Cephalon, a Teva subsidiary based in Frazer; AmerisourceBergen, a wholesale pharmaceutical distributor based in Valley Forge; along with Rite Aid, Walgreens and Costco — all of which operate dozens of pharmacies in the Philadelphia region.

    Other companies named as defendants are opioid makers Abbott Laboratories,
Janssen Pharmaceuticals, Insys Therapeutics, and Mallinckrodt plus distribution companies McKesson and Cardinal Health.

    Pharmaceutical and drug distributors companies have consistently defended their actions with respect to opioids. The companies have claimed: the lawsuits are legally and factually unfounded; they have acted appropriately, responsibly and in the best interests of patients regarding our opioid pain medications; and that they are committed to the appropriate promotion and use of opioid therapies.

    In response to the Camden lawsuit, Teva issued a statement: "Teva is committed to the appropriate use of opioid medicines, and we recognize the critical public health issues impacting communities across the U.S. as a result of illegal drug use as well as the misuse and abuse of opioids that are available legally by prescription. To that end, we take a multi-faceted approach to this complex issue; we work to educate communities and healthcare providers on appropriate medicine use and prescribing, we comply closely with all relevant federal and state regulations regarding these medicines. Through our R&D pipeline, we are developing non-opioid treatments that have the potential to bring relief to patients in chronic pain. Teva also collaborates closely with other stakeholders, including providers and prescribers, regulators, public health officials and patient advocates, to understand how to prevent prescription drug abuse without sacrificing patients’ needed access to pain medicine."

    AmerisourceBergen spokeswoman Lauren Esposito said the company is responsible for getting FDA-approved drugs from pharmaceutical manufacturers to DEA-registered pharmacies, based on prescriptions written by licensed doctors and health care providers.

    "Our role in doing so is quite widespread across different therapies, with the distribution of opioid-based products constituting less than 2 percent of our sales," Esposito said. "We are dedicated to doing our part as a distributor to mitigate the diversion of these drugs without interfering with clinical decisions made by doctors, who interact directly with patients and decide what treatments are most appropriate for their care.… We refuse service to customers we deem as a diversion risk and provide daily reports to the DEA that detail the quantity, type, and the receiving pharmacy of every single order of these products that we distribute. We are committed to collaborating with all stakeholders on ways to combat opioid abuse."

    Endo officials were not immediately available for comment.

    The new Jersey law firm Carella, Byrne, Cecchi, Olstein, Brody & Agnello of Roseland, Essex County, is representing Camden in the matter.

    The Camden lawsuit follows two other lawsuits filed with the past few weeks by both the city of Philadelphia and the Philadelphia District Attorney’s Office against pharmaceutical companies manufacturing opioid pain relief products.

    Nationally, about 200 civil cases have been filed by state, county and local governments — including lawsuits filed by New Jersey, Delaware County and Bensalem Township — against opioid manufacturers and pharmaceutical distributors in the federal courts, while dozens of other lawsuits have been filed in state courts. In addition, attorneys general from 41 states, including Pennsylvania, are working together to explore legal options.

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12. Camden County sues opioid manufacturers, alleging racketeering

    Feb 22, 2018 | Philly Voice (PA)

    By John Kopp

    Camden County officials will file a lawsuit accusing opioid manufacturers of racketeering, alleging drugmakers operated a criminal enterprise as they marketed and distributed prescription painkillers throughout New Jersey.

    Freeholder Director Louis Cappelli Jr. announced on Wednesday that he will file the lawsuit against the Sackler family – the owners of Purdue Pharma, which manufactures OxyContin – and a litany of drug companies, distributors and retailers.

    The lawsuit alleges the Sackler family – owners of Purdue Pharma, which manufactures OxyContin – executed a scheme to deceive doctors into believing opioids could be prescribed for lengthy periods of time with little risk of addiction. 

    The alleged scheme resulted in billions of dollars for Purdue and its top executives while predictably addicting millions of people to opioids, Camden officials claim. 

    "The meteoric rise in opioid prescriptions and the attendant rise in addiction to and abuse of these drugs is not due to a medical breakthrough," Cappelli said in a statement, "But rather the defendants' quest for greater profits at the expense of American lives."

    Pointing to statistics provided by the U.S. Center for Disease Control and Prevention, Camden officials allege that 75 percent of patients seeking heroin treatment began their opioid use with prescription drugs.

    "These individuals were knowingly poisoning our families and children and doing it all under the guise of pain management, when we really know it was all based on greed," Cappelli said.

    The lawsuit names Abbott Laboratories, Cephalon, Teva Pharmaceutical Industries, Endo International, Janssen Pharmaceuticals, Insys Therapeutics and Mallinckrodt.

    It also names as defendants three distributors – AmerisourceBergen, McKesson and Cardinal Health – and four retailers – Health Corporation, Walgreens Boots Alliance, Costco Wholesale Corporation and Rite Aid Corporation.

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13. In a legal first, Camden County files racketeering suit against OxyContin makers

    Feb 21, 2018 | ROI NJ (NJ)

    By Anjalee Khemlani

    Camden County is joining the legal fight against the opioid epidemic — but with an unprecedented argument.

    The county is filing a racketeering lawsuit against several pharmaceutical companies, as well as naming three individuals of the Sackler family, which owns Connecticut-based Purdue Pharma — the maker of OxyContin — as defendants.

    “In the hour that it takes to read this complaint, six Americans will fatally overdose from opioids, two opioid-dependent babies will be born and a significant number of former opioid addicts will turn to heroin,” the introduction to the 177-page lawsuit reads.

    “During that same hour, opioid manufacturers will earn approximately $2.7 million from opioids. The opioid addiction epidemic was ignited by the Sackler family.”

    Freeholder Louis Cappelli Jr. announced the lawsuit alongside other federal and state representatives Wednesday morning in a news conference in Camden.

    While Purdue Pharma has been under attack and the subject of other legal action during the explosion of the opioid epidemic crisis, both the racketeering element of the suit and the naming of individuals are firsts.

    “Owners of Purdue Pharma, and peddlers of OxyContin, the Sackler family executed an epic scheme to deceive doctors (and the public at large) into believing that opioids can be prescribed for long periods of time, with little to no risk of addiction; a blatantly false premise,” the suit said. “The Sackler family’s fraudulent and deceptive marketing scheme worked, and sales for OxyContin skyrocketed, resulting in billions of dollars for Purdue and its top executives — including Richard, Mortimer and Raymond Sackler.”

    The Sackler family’s wealth and its involvement in the making and marketing of OxyContin have been documented in multiple reports since 2015. Purdue Pharma previously paid a $600 million fine in 2007 over misleading marketing of the addictive drug. The company announced it would halt marketing of the drug recently.

    The lawsuit also goes after other pain medicine makers and their distributors and retailers, including Janssen Pharmaceuticals (a division of New Brunswick-based Johnson & Johnson), Teva Pharmaceuticals, Insys Therapeutics, Endo International, Abbott Laboratories and Cephalon Inc., Mallinckrodt, AmeriSource Bergen, Cardinal Health, Costco, Walgreens, Rite Aid and others.

    Coincidentally, the lawsuit was filed on the heels of Independence Blue Cross in Philadelphia and its affiliates, including Cranbury-based AmeriHealth New Jersey, announcing that they are taking on the full cost burden of Narcan, the brand of the opioid overdose reversal drug, until the end of the year for all members.

    In the lawsuit, the county explains the burden of the epidemic on its police force, as well as highlights the use of Narcan.

    “In 2016 and 2017, the Camden County Police Department expended 1,740 man-hours responding to 941 opioid overdoses. And, despite administering Narcan 141 times, there were 131 opioid overdose fatalities (90 of which occurred in 2017). While deaths are on the rise in Camden County, since 2014, the Camden County Police Department has saved 312 lives by administering Narcan to those who have overdosed on opioids. But, even so, opioid related deaths are on the rise,” the suit reads.

    U.S. Rep. Donald Norcross (D-NJ), who serves as vice chair of the Congressional Bipartisan Heroin Task Force, also highlighted the overdose deaths in his statement.

    “In New Jersey, deaths from heroin and fentanyl overdoses more than tripled in the last five years. That’s tragic and unacceptable,” he said. “Camden County, led by Freeholder Director Cappelli, has been fighting to curb the opioid epidemic on all fronts and knows we must do all we can to help those struggling with the disease of addiction. There is true human cost that’s at stake.”

    At the media conference, Cappelli highlighted the effects of the epidemic, including a barrier to medication for those who do actually need pain medication. State laws have restricted the number of days a prescription can be filled, and doctors are increasingly less willing to write opioid prescriptions.

    While the country tries to curb the epidemic, the companies and the Sackler family — which holds the patent for the drug — have made billions.

    “These individuals were knowingly poisoning our families and children and doing it all under the guise of pain management, when we really know it was all based on greed,” Cappelli said. “This was a transparent flooding of the marketplace going back to 1995, when the FDA approved Oxy, and has ended with their latest announcement that Purdue will no longer market this deadly, addictive narcotic. Our families in Camden County deserve more, and today is the first step in making these defendants pay for their criminal behavior.”

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14. Camden County sues drug makers to recoup the millions its spent fighting opioid crisis

    Feb 22, 2018 | WHYY (PA)

    By Joe Hernandez

    In a wide-ranging civil lawsuit filed in state court Wednesday, Camden County blames pharmaceutical companies for knowingly causing the opioid epidemic and forcing the local government to expend millions of dollars to fight it.

    The county is the latest local government in the Philadelphia area to sue drug makers for flooding the market with legal, but highly addictive painkillers in recent years, leading to a nationwide drug epidemic.

    In addition to accusing the pharmaceutical companies of deceptive marketing practices, Camden County claims that firms peddling addictive opioids should be on the hook for the expensive measures the county government has taken to combat addiction.

    Some of those costs, estimated to be in the millions, include medication, health insurance, addiction treatment, and drug-related hospital stays for county employees and retirees, according to the suit. The county has also seen budgets bulge for its police, jail, medical examiner, and homeless services as a result of the opioid epidemic.

    There are indirect costs to the drug crisis, too, the lawsuit alleges, such as the loss of productivity resulting from county workers who were absent for reasons related to their addiction.

    “The county has incurred significant costs and a loss of resources in trying to curb this epidemic,” said Louis Cappelli, director of the Camden County Freeholder Board. “In many of our municipalities, our police officers are now the first responders to deal with this crisis created by these greedy bastards.”

    Camden is no stranger to the opioid epidemic: The county had 277 fatal overdoses last year, according to data provided by officials. A third of them were in Camden city, where police responded to nearly one overdose per day.

    “It’s time for us to make them pay us back,” Cappelli said.

    The suit is seeking monetary and injunctive relief, as well as additional funding for awareness and treatment programs.

    Defendants in the case are manufacturers Purdue Pharma, Abbott Laboratories, Cephalon, Teva USA, Endo International, Janssen, Insys Therapeutics, and Mallinckrodt; drug distributors AmerisourceBergen, McKesson, and Cardinal Health; and retailers Rite Aid, Costco, Walgreens Boots Alliance, and Health Corporation.

    Also named in the 177-page complaint are Dr. Richard Sackler, the estate of Mortimer Sackler, and the estate of Raymond Sackler. All three men were part of the notorious Sackler family that owned and operated Purdue Pharma when it began producing the painkiller OxyContin.

    In the lawsuit, Camden County accuses the drug makers of racketeering, a statute more often used in organized crime cases.

    The drug makers “expanded the market for prescription opioids through a fraudulent and deceptive marketing campaign that over-emphasized” the need to treat patients for pain with opioids, the county claims in the court filing.

    Although the lawsuit was filed in civil court, other New Jersey officials have brought criminal charges against drug makers accused of playing a part in the opioid epidemic.

    Last year, former New Jersey Attorney General Christopher Porrino filed fraud and false claims charges against Insys Therapeutics — which is also named in the Camden County suit — and founder John Kapoor for fraudulently marketing the fentanyl spray Subsys, which the complaint claims caused the death of a 32-year-old Camden County woman.

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Commentary and FYIs

15. The Oxford Man Who Brought Down Big Tobacco Asks: Are Opioids the New Tobacco? (OPINION)

    Feb 21, 2018 | Hotty Toddy (MS)

    By Dick Scruggs

    Is the rising spate of opioid litigation comparable to the litigation that resulted in the mega-billion dollar settlement with Big Tobacco? The answer is, sort of. This article highlights the similarities and differences in these two public health initiatives.

    Recap of tobacco
    As a refresher, the Tobacco litigation was a legal action by state attorneys general, public health advocates and outside counsel to recover smoking-related health costs and to reform the marketing practices of the Tobacco Industry. The principal defendants were the five tobacco companies which accounted for nearly all of the cigarette sales in the United States.

    Mississippi filed the first suit in May 1994, followed by Minnesota, West Virginia, and Florida. Early successes in those suits prompted more than 40 states and territories to join the fight over the following two years. In early 1996 Liggett Group (L&M) settled, dispelling the myth of Tobacco’s solidarity and invincibility and prompting a dozen more states to join the litigation. In June 1997 a global settlement was reached with the remaining companies, an agreement that made them pay $368.5 billion to the states and the federal government. It also severely curtailed the marketing of tobacco products, especially advertising appealing to minors.

    The global settlement fell apart a year later when Congress failed to pass enabling legislation. The settlement was restructured several months later, however, so as to eliminate federal involvement. In the resulting “Master Settlement Agreement,” the amount was reduced to approximately $ 206 billion for 46 states, with another approximately $40 billion for four states who had separately settled in the interim.

    States’ legal theories
    The states’ respective legal theories varied, but nearly all contained counts for consumer fraud, public nuisance, restitution and unjust enrichment. Some states, like Florida, asserted Civil RICO claims. In general, however, the operative theories were equitable claims or consumer protection claims that only an attorney general had standing to bring.

    Venue decision
    Most states made strategic choices to bring their suits in state courts and assert only claims based in state law. There was a feeling among the states’ counsel that federal courts (after 12 years of business-friendly judicial appointments under Presidents Reagan and Bush) would not be receptive to litigation that threatened a large industry. Since states themselves are not considered “citizens” for purposes of diversity jurisdiction, the tobacco companies could not remove the cases to federal court.

    Damages model
    Although the scientific case had largely been made that cigarettes caused lung cancer, heart disease and high levels of general morbidity, quantifying the medical dollar cost of smoking was a daunting challenge. Luckily for the states, researchers at the University of California had independently developed reliable statistical methods to determine the “tobacco-attributable fraction” of overall health care costs. The Industry furiously attacked the use of statistical models for assessing legal damages, but the credentials, scientific rigor and peer review of the work of the team at Cal generally withstood the Industry’s evidentiary challenges.

    FDA intervention
    Of considerable help to the states (and visa versa) was the FDA’s 1995 initiative to class cigarettes as drugs (nicotine delivery devices) and thereby assert jurisdiction over cigarette manufacturing. This effort was an existential threat to the Tobacco Industry because FDA jurisdiction would likely have meant the banning of cigarettes. While not formally connected to the states’ suits, the FDA’s action added to the public sense that Big Tobacco was in trouble.

    Smoking guns
    The states’ suits also got huge boosts from leaked internal documents and testimony from corporate insiders. The so-called “Brown and Williamson” documents were a treasure trove of smoking guns (pun unavoidable). One of these, penned by a former corporate General Counsel, boasted that the Tobacco Industry “was in the business of selling nicotine, an addictive drug useful in the treatment of stress mechanisms.”

    Insiders
    As portrayed in the Academy Award-nominated movie “The Insider,” Dr. Jeffrey Wigand, a former tobacco company Vice-President of Research, provided documents and testimony that his company was lacing cigarettes with ammonia compounds and other dangerous chemicals to “boost the bioavailability” of nicotine. Dr. Wigand’s revelations were the subject of two 60 Minutes segments and a Pulitzer Prize-winning story for the reporters at The Wall Street Journal.

    Serendipitous factors
    Of arguably greater significance were serendipitous factors without which the tobacco litigation would likely not have succeeded:
    Moore’s prestige
    –Mississippi Attorney General Mike Moore, at the time President of the National Association of Attorneys General, commanded the respect of the other state AG’s, many of whom joined the litigation on the strength of Moore’s recommendation.
    MSM antipathy
    –The “mainstream media” seemingly held a grudge toward Big Tobacco for past bullying and threats of ruinous lawsuits. The states’ lawyers often got favorable press even when they fouled up. On the other hand, revelations and documents embarrassing to the Industry usually got front page coverage.
    Care in selecting co-counsel
    –In Mississippi and other states represented by the same private lawyers, great care was taken in the selection of co-counsel. Political affiliation and prestige were important factors in selecting a legal team. Big Tobacco had cultivated powerful law firms and politicians in every state, such that it was crucial to neutralize the Industry’s ability to undermine the litigation through vexing legislation and cronyism.
    Personal relationships
    — As it turned out, the personal relationships between AG Moore and the author with President Clinton, FDA Commissioner David Kessler, Presidential Adviser Dick Morris, and Senate Majority Leader Trent Lott proved to be key serendipitous factors in starting and nurturing the negotiations that led to the settlement.
    Experienced and well-healed lawyers
    –The value of the litigation experience and financial resources of many of the outside firms retained by the states cannot be overstated. Most of these firms agreed to contingency-like contracts where they carried all expenses and charged no fees unless there was a recovery.

    So, how does the Opioid litigation compare?

    Insufficiently mature to perfectly compare
    First off, the Opioid litigation is not yet sufficiently mature to make an unequivocal comparison with Tobacco. The writer of this article, moreover, has no special insight into the strategy and planning of the Opioid initiatives. Still, given the commonalities of outside counsel, legal theories, and political and attitudinal factors, it is possible to make some cautious comparisons with the Tobacco litigation:

    Gov’t plaintiffs
    Like the Tobacco suits, the principal parties plaintiff are governmental entities: Thus far, seven states, thirteen counties; five cities; and at least one large Indian nation (The Cherokee Nation in Oklahoma) have filed suit. There is also a parallel non-governmental class action pending in Arkansas. The profusion of county and municipal plaintiffs (and a tribal nation) is different from Tobacco, where only a few governmental subdivisions sued when their state attorneys general refused to join the litigation.

    Multiplicity of defendants
    Whereas there were only five principal defendants in Tobacco who accounted for nearly all cigarette sales, there are at least 20 opioid manufacturers and 13 distributors sued to date. The plethora of defendants complicates strategy for both the plaintiffs and defendants. Big Tobacco was highly unified in its legal, political and public relations strategies, even after Liggett broke ranks an settled. It is unclear how unified the Opioid defendants will become.

    Unified control

    Similarly, it is unclear how unified the Opioid plaintiffs are or might become. Whereas in Tobacco Mississippi Attorney General Moore, Arizona’s Grant Woods and Florida’s Bob Butterworth, along with their unified legal teams were the putative center of gravity among the state attorneys general, it is unclear whether Mr. Moore and Mr. Woods, despite their past success and reputation, will have the same valence in the Opioid litigation. At this stage, the litigation sounds more like musicians warming up than an orchestra playing a symphony.

    Consumer protection and equitable theories
    Like the Tobacco suits, the Opioid plaintiffs assert claims sounding in state consumer protection statutes and equitable principles (rather than tort), the latter theories being predominantly claims for public nuisance, restitution and unjust enrichment.

    Non-tort based
    These equitable, non-tort-based claims are the most threatening to the Opioid defendants, in this author’s judgment, because they do not hinge on fault, but rather on who should pay when the public is damaged by the conduct of a legal business. These non-fault-based equity claims enable the states to say, “so what” to the Industry’s defensive claims that the FDA preemptively regulated opioids and that their addiction warning labels were ipso facto sufficient.

    New “diversion” theory
    Unlike Tobacco, many of the Opioid plaintiffs are asserting claims for “diversion,” charging that the defendants breached duties to secure the distribution chain from diversion of large quantities of opioid-containing prescription drugs to criminals. The diversion theory was not used in the Tobacco litigation and seems to be unique to the Opioid cases. The Cherokee Nation asserts only diversion claims against the Opioid distributors–curiously leaving the manufacturers out of their litigation entirely.

    The essence of the Opioid claims is that the manufacturers and distributors of opiate-containing drugs fostered the explosion in the abuse of all types of addicting drugs–whether manufactured by a defendant or resorted to by addicted patients when their prescribed drugs became legally unavailable. Having allegedly caused the epidemic, the plaintiffs want the manufacturers and distributors to pay for the enormous governmental costs of treatment and law enforcement.

    Defenses Preemption
    The defenses asserted by the Opioid defendants prominently include federal “preemption” by dint of FDA approval of opioids and the labels/warnings accompanying their sale. This is similar to the argument made by the Tobacco industry that the Federal Cigarette Labeling Act preempted state-based claims that cigarette warnings were insufficient. In addition to preemption and the standard technical objections to the specificity of the states’ factual pleadings, the Opioid defendants challenge factual causation, i.e., that there’s a causal connection between the defendants’ opioids and the epidemic of drug abuse sweeping the nation. Causation will be an issue for the states unless they develop statistical or other methods of linking opioids with the epidemic of general drug abuse.

    Tobacco lawyers now going after Opioid defendants
    It is significant that the states have retained many of the key lawyers from the Tobacco litigation. Former Mississippi Attorney General Mike Moore, who originated and led the Tobacco litigation, now represents Mississippi and Ohio. Former Arizona Republican Attorney General Grant Woods is another leader from the Tobacco wars. Law firms like Motely-Rice of South Carolina and Nix-Patterson of Texas were leaders in the Tobacco litigation. These and other firms bring experience and deep pockets to the Opioid cases. (Ironically, The Cherokee Nation is represented by William Ohlemeyer of the Boies-Schiller firm, who formerly defended Big Tobacco and was Associate General Counsel of Altria Group [formerly Phillip Morris]).

    The Opioid defendants likewise have retained Tobacco and mass tort-experienced lawyers in addition to the usual blue-chip firms. Shiela Birnbaum of Quinn Emanuel, who is defending Purdue Pharma, is a particularly able and experienced mass tort litigator who also has a vision for resolutions.

    Damages difficulty
    Importantly, it is not yet clear how the states and governmental plaintiffs will calculate damages. Governmental entities undoubtedly bear heavy costs in law enforcement and medical treatment resulting from the opioid epidemic. It seems more than a stretch, however, to claim that all of the costs of law enforcement are related to illegal opioids, or that all government-borne health care costs are opioid-related. After all, there are other addicting drugs that might not follow from the use of opioids, such as methamphetamine, barbiturates and benzodiazepines.

    This issue was addressed in Tobacco (as discussed above) through the use of statistical models comparing the health costs of smokers with those of non-smokers, controlling for other factors that drive health expenditures such as obesity, alcohol and risky lifestyles. Whether it is feasible with similar statistical methods to derive an opioid-attributable-fraction of law enforcement and medical costs is not apparent. Perhaps the states will prove-up damages in other ways?

    Empty chair potential
    A related uncertainty is whether all potentially liable Opioid defendants have been joined in the suits. In Tobacco, there were only five well-known companies who sold cigarettes. In contrast, there are at least 20 opioid manufacturers and a dozen distributors sued so far. While there are overlaps in Opioid defendants among the different suits, the lack of uniformity creates the potential for “empty chair” defenses where the missing defendant gets blamed by the others for causing the problem. This seems to be a vulnerability in The Cherokee Nation’s suit against only distributors.

    Equally sympathetic press
    It is likely that the “mainstream media” will be sympathetic to the states’ litigation. Given the daily headlines of drug company price gouging and false advertising, of drug-related violence and overdoses resulting in the deaths of increasing numbers of young Americans, Big Pharma is not a very appealing defendant. Moreover, unlike Big Tobacco, the manufacturers and distributors of opioid-containing drugs have been heavily sanctioned by federal and state regulators. (Purdue Pharma has already paid more than $600 million and pleaded guilty to misbranding the opioid drug OxyContin by falsely touting it as less addictive than rival products.) These factors could create a de facto presumption of liability.

    Long before the first state Tobacco case was filed, the states’ lawyers conducted extensive opinion research better to inform their legal claims and strategy. Public attitudes about Tobacco, litigation in general, and many other relevant issues were polled and focus-grouped. The Tobacco industry had for years conducted extensive attitudinal research about smoking and health. Presumably, the lawyers for both sides of the Opioid litigation have similarly conducted opinion surveys and have shaped their strategies accordingly.

    Settlement prospects
    In conclusion, the success of the Opioid cases will depend upon whether the plaintiffs can muster sufficient legal, political and public relations pressure to force a settlement. That will not likely happen without a perceptibly higher degree of coordination among the plaintiffs and their outside counsel. The plaintiffs should already be discussing and agreeing on what it is that they want the Industry to do (other than pay lots of money). The Industry is not likely (and would be foolish) to settle piecemeal on ad hoc terms.

    In the meantime, the plaintiffs must develop a methodology for reliably estimating the dollar cost to the public of the opioid epidemic. This will be harder for the Opioid plaintiffs than in Tobacco, where there were only five defendants who sold all the cigarettes. Preferably, the plaintiffs should enlist the scientific community to develop a Tobacco-similar statistical model that also controls for costs attributable to addicting non-Opioid-containing drugs, such as methamphetamines, barbiturates and benzodiazepines.

    The defendants, on the other hand, should also decide upon a unified legal, political and public relations strategy. In Tobacco (save Liggett) the largest four defendants had developed very concerted and sophisticated responses on each of these fronts. The Tobacco Industry was not quick, however, in realizing that the essential claims were non-tort-based equity claims where warnings and risk assumption were legally insufficient. Fault was not important in a case for unjust enrichment–only who should pay as between the general public and the Industry whose otherwise legal products caused the epidemic.

    Bottom line, it’s too early to pick winners and losers.

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16. Opioid lawsuits cropping up all over Texas, TLR says ‘enriching’ law firms won’t cure epidemic

    Feb 22, 2018 | SE Texas Record (TX)

    By David Yates

    Joining a nationwide trend, Texas municipals have begun suing the makers of opioids in recent months, alleging drug manufactures knew of the dangers but placed profits above the public good.

    And while no one is really debating that opioid addiction isn’t real or a problem, at least one group is questioning how enriching trial lawyers will cure the epidemic.

    “Whether it is lawsuits against opioid manufacturers or lawsuits against oil companies, public policy should be crafted in the statehouse, not the courthouse,” said Lucy Nashed, communications director for Texans for Lawsuit Reform.

    “Enriching a few plaintiff law firms through a multi-billion dollar tobacco-like settlement does nothing to address the challenges that communities face with opioid addiction.”

    Travis County was one the latest Texas municipals to join the fray, with officials announcing a lawsuit earlier this month and a week after settlement talks commenced for more than 250 opioid lawsuits filed in federal court.

    From all corners of the state, counties such as Dallas, McLennan, El Paso and Hidalgo have filed opioid suits.

    Several East Texas counties, including Bowie, Titus and Upshur, have also brought suits over their own.

    Upshur County was the first in Texas to file an opioid lawsuit, naming more than a dozen pharmaceutical companies as defendants in its Sept. 29 petition.

    In Southeast Texas, Harris County filed an opioid lawsuit in state court back in December, naming Purdue Pharma, Cephalon, Janssen Pharmaceuticals and Allergan as defendants, to name just a few. 

    “The widespread use of opioid drugs is the direct result of a concreted industry scheme that has evolved over the past two decades,” the county’s petition states.

    “In short, these defendants expanded the market for opioids beyond that for which it was originally intended and created a disaster of gargantuan proportions, the likes of which has never been seen in the pharmaceutical industry.”

    The suit alleges drug makers relied on “false science” from their own “product champions” and enlisted “complicit” healthcare providers to help market dangerous opioids to Harris County consumers.

    To aid in the pursuit of the litigation, Harris County enlisted The Gallagher Law Firm in Houston, which also represents Hidalgo County and claims to represent numerous other “cities, counties and municipals” in the effort to recover money spent to treat the opioid epidemic.

    And apparently, there is no shortage of Texas trial lawyers willing to lend their services.

    The Record has reported on several opioid lawsuits being handled by the Baron & Budd law firm in Dallas, which represents municipals across the nation. 

    Famed Houston attorney Mark Lanier, who boasts that his firm “is a pioneer in its involvement in numerous pharmaceutical liability litigations,” is helping to direct both the Dallas County and Tarrant County opioid litigation.

    And last but not least is Jeffrey Simon, a partner with Simon Greenstone Panatier and Bartlett, who claims his Dallas law firm represents more than 40 counties, more than any other in Texas.

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17. The Myth of What’s Driving the Opioid Crisis (Opinion)

    Feb 22, 2018 | Politico Magazine

    By Sally Satel

    As an addiction psychiatrist, I have watched with serious concern as the opioid crisis has escalated in the United States over the past several years, and overdose deaths have skyrocketed. The latest numbers from the Centers for Disease Control and Prevention show fatalities spiraling up to about 42,000 in 2016, almost double the casualties in 2010 and more than five times the 1999 figures. The White House Council of Economic Advisers recently estimated that the opioid crisis cost the nation half a trillion dollars in 2015, based on deaths, criminal justice expenses and productivity losses. Meanwhile, foster care systems are overflowing with children whose parents can’t care for them, coroners’ offices are overwhelmed with bodies and ambulance services are straining small-town budgets. American carnage, indeed.

    I have also watched a false narrative about this crisis blossom into conventional wisdom: The myth that the epidemic is driven by patients becoming addicted to doctor-prescribed opioids, or painkillers like hydrocodone (e.g., Vicodin) and oxycodone (e.g., Percocet). One oft-quoted physician refers to opioid medication as “heroin pills.” This myth is now a media staple and a plank in nationwide litigation against drugmakers. It has also prompted legislation, introduced last spring by Senators John McCain and Kirsten Gillibrand—the Opioid Addiction Prevention Act, which would impose prescriber limits because, as a news release stated, “Opioid addiction and abuse is commonly happening to those being treated for acute pain, such as a broken bone or wisdom tooth extraction.”

    But this narrative misconstrues the facts. The number of prescription opioids in circulation in the United States did increase markedly from the mid-1990s to 2011, and some people became addicted through those prescriptions. But I have studied multiple surveys and reviews of the data, which show that only a minority of people who are prescribed opioids for pain become addicted to them, and those who do become addicted and who die from painkiller overdoses tend to obtain these medications from sources other than their own physicians. Within the past several years, overdose deaths are overwhelmingly attributable not to prescription opioids but to illicit fentanyl and heroin. These “street opioids” have become the engine of the opioid crisis in its current, most lethal form.

    If we are to devise sound solutions to this overdose epidemic, we must understand and acknowledge this truth about its nature.

    For starters, among people who are prescribed opioids by doctors, the rate of addiction is low. According to a 2016 national survey conducted by the Substance Abuse and Mental Health Services Administration, 87.1 million U.S. adults used a prescription opioid—whether prescribed directly by a physician or obtained illegally—sometime during the previous year. Only 1.6 million of them, or about 2 percent, developed a “pain reliever use disorder,” which includes behaviors ranging from overuse to overt addiction. Among patients with intractable, noncancer pain—for example, neurological disorders or musculoskeletal or inflammatory conditions—a review of international medical research by the Cochrane Library, a highly regarded database of systemic clinical reviews, found that treatment with long-term, high-dose opioids produced addiction rates of less than 1 percent. Another team found that abuse and addiction rates within 18 months after the start of treatment ranged from 0.12 percent to 6.1 percent in a database of half a million patients. A 2016 report in the New England Journal of Medicine concluded that in multiple published studies, rates of “carefully diagnosed” addiction to opioid medication averaged less than 8 percent. In a study several years ago, a research teampurposely excluded chronic-pain patients with prior drug abuse and addiction from their data, and found that only 0.19 percent of the patients developed abuse and addiction to opioids.

    Indeed, when patients do become addicted during the course of pain treatment with prescribed opioids, often they simultaneously face other medical problems such as depression, anxiety, other mental health conditions, or current or prior problems with drugs or alcohol. According to SAMHSA’s 2014 National Survey on Drug Use and Health, more than three-fourths of those who misuse pain medication already had used other drugs, including benzodiazepines and inhalants, before they ever misused painkillers. And according to CDC data, at least half of all prescription opioid-related deaths are associated with other drugs, such as benzodiazepines, alcohol and cocaine; combinations that are often deadlier than the component drugs on their own. The physical and mental health issues that drive people to become addicted to drugs in the first place are very much part of America’s opioid crisis and should not be discounted, but it is important to acknowledge the influence of other medical problems and other drugs.

    Just because opioids in the medical context don’t produce high rates of addiction doesn’t mean doctors aren’t overprescribing and doing serious harm. The amount of opioids prescribed per person in 2016, though a bit lower than the previous year, was still considered high by the CDC—more than three times the amount of opioids dispensed in 1999. Some doctors routinely give a month’s supply of opioids for short-term discomfort when only a few days’ worth or even none at all is needed. Research suggests that patients given post-operation opioids don’t end up needing to use most of their prescribed dose.

    In turn, millions of unused pills end up being scavenged from medicine chests, sold or given away by patients themselves, accumulated by dealers and then sold to new users for about $1 per milligram. As more prescribed pills are diverted, opportunities arise for nonpatients to obtain them, abuse them, get addicted to them and die. According to SAMHSA, among people who misused prescription pain relievers in 2013 and 2014, about half said that they obtained those pain relievers from a friend or relative, while only 22 percent said they received the drugs from their doctor. The rest either stole or bought pills from someone they knew, bought from a dealer or “doctor-shopped” (i.e., obtained multiple prescriptions from multiple doctors). So diversion is a serious problem, and most people who abuse or become addicted to opioid pain relievers are not the unwitting pain patients to whom they were prescribed.

    While reining in excessive opioid prescriptions should help limit diversion and, in theory, suppress abuse and addiction among those who consume the diverted supply, it will not be enough to reduce opioid deaths today. In the first decade of the 2000s, the opioid crisis almost seemed to make sense: The volume of prescribed opioids rose in parallel with both prescription overdose deaths and treatment admissions for addiction to prescription opioids. Furthermore, 75 percent of heroin users applying to treatment programs initiated their opioid addiction with pills, so painkillers were seen as the “gateway” to cheap, abundant heroin after their doctors finally cut them off. (“Ask your doctor how prescription pills can lead to heroin abuse,” blared massive billboards from the Partnership for a Drug-Free New Jersey.) If physicians were more restrained in their prescribing, the logic went, fewer of their patients would become addicted, and the pipeline to painkiller addiction and ultimately to heroin would run dry.

    It’s not turning out that way. While the volume of prescriptions has trended down since 2011, total opioid-related deaths have risen. The drivers for the past few years are heroin and, mostly, fentanyl, a synthetic opioid that is 50 times as potent as heroin. Fentanyl has legitimate medical use, but there is also illicit fentanyl, trafficked mostly from China, often via the Dark Web. Fentanyl and heroin (which itself is usually tainted to some extent with the fentanyl) together were present in more than two-thirds of all opioid-related deaths in 2016, according to CDC data. Painkillers were present in a little more than one-third of opioid-related deaths, but a third of those painkiller deaths also included heroin or fentanyl. While deaths from prescription opioids have basically leveled off, when you look at deaths in which prescription opioids plus heroin and fentanyl were present, then the recorded deaths attributed to prescription opioids continue to climb, too. (An especially pernicious element in the mix is counterfeiters with pill presses who sell illicit fentanyl in pill form deceptively labeled as OxyContin and other opioid pain relievers or benzodiazepines.)

    Notably, more current heroin users these days seem to be initiating their opioid trajectory with heroin itself—an estimated 33 percent as of 2015—rather than with opioid painkillers. In the first decade of the 2000s, about 75 to 80 percent of heroin users started using opioids with pills (though not necessarily pain medication prescribed by a doctor for that particular person). It seems that, far more than prescribed opioids, the unpredictability of heroin and the turbocharged lethality of fentanyl have been a prescription for an overdose disaster.

    ***

    Intense efforts to curb prescribing are underway. Pharmacy benefit managers, such as CVS, insurers and health care systems have set limits or reduction goals. State-based prescription drug monitoring programs help doctors and pharmacists identify patients who doctor-shop, ER hop or commit insurance fraud. As of July, 23 states had enacted legislation with some type of limit, guidance or requirement related to opioid prescribing. McCain and Gillibrand’s federal initiative goes even further, to impose a blanket ban on refills of the seven-day allotment for acute pain. And watchdog entities such as the National Committee for Quality Assurance have endorsed a system that compares the number of patients receiving over a certain dose of opioids with the performance rating for a physician.

    A climate of precaution is appropriate, but not if it becomes so chilly that doctors fear prescribing. This summer, a 66-year-old retired orthopedic surgeon who practiced in Northern California—I’ll call her Dr. R—contacted me. For more than 30 years, she had been on methadone, a legitimate opioid pain medication, for an excruciating inflammatory bladder condition called interstitial cystitis. With the methadone, she could function as a surgeon. “It gave me a life. I would not be here today without it,” she told me. But one day in July, her doctor said the methadone had to stop. “She seemed to be worried that she was doing something illegal,” Dr. R told me.

    Dr. R was fortunate. She found another doctor to prescribe methadone. But her experience of nonconsensual withdrawal of opioids is not isolated. Last year, the nonprofit Pain News Network conducted an online surveyamong 3,100 chronic pain patients who had found relief with opioids and had discussed this in online forums. While not necessarily a representative sample of all individuals with chronic pain who are on opioids, the survey was informative: 71 percent of respondents said they are no longer prescribed opioid medication by a doctor or are getting a lower dose; 8 out of 10 said their pain and quality of life are worse; and more than 40 percent said they considered suicide as a way to end their pain. The survey was purposely conducted a few months after the CDC released guidelinesthat many doctors, as well as insurance carriers and state legislatures, have erroneously interpreted as a government mandate to discontinue opioids. In other accounts, patients complain of being interrogated by pharmacists about their doses; sometimes they are even turned away.

    The most tragic consequence is suicide. Thomas F. Kline, an internist in Raleigh, North Carolina, has chronicled 23 of them. His count is surely a harbinger of further patient abandonment to come. Meanwhile, so-called pain refugees—chronic pain patients whose doctors have dropped them—search out physicians to treat them, sometimes traveling more than a hundred miles or relocating. And in a recent Medscape survey, half the doctors who were polled expressed fear of violent reactions if patients were refused the prescription.

    Knowing all this, what should we do about the opioid crisis? First, we must be realistic about who is getting in trouble with opioid pain medications. Contrary to popular belief, it is rarely the people for whom they are prescribed. Most lives do not come undone, let alone end in overdose, after analgesia for a broken leg or a trip to the dentist. There is a subset of patients who are vulnerable to abusing their medication—those with substance use histories or with mental health problems. Ideally, they should inform physicians of their history, and, in turn, their doctors should elicit such information from them.

    Still, given that diverted pills, not prescribed medication taken by patients for pain, are the greater culprit, we cannot rely on doctors or pill control policies alone to be able to fix the opioid crisis. What we need is a demand-side policy. Interventions that seek to reduce the desire to use drugs, be they painkillers or illicit opioids, deserve vastly more political will and federal funding than they have received. Two of the most necessary steps, in my view, are making better use of anti-addiction medications and building a better addiction treatment infrastructure.

    Methadone and buprenorphine are opioid medications for treating addiction that can be prescribed by doctors as a way to wean patients off opioids or to maintain them stably. These medications have been shown to reduce deaths from all causes, including overdose. A third medication, naltrexone, blocks opioids’ effect on the brain, and prevents a patient who tries heroin again from experiencing any effects. In 2016, however, only 41.2 percent of the nation’s treatment facilities offered at least one form of medication, and 2.7 percent offered all three medications, according to a recent review of a national directory published by SAMHSA. We must move beyond the outmoded thinking and inertia that keep clinics from offering these medications.

    Motivated patients also benefit greatly from cognitive behavioral therapy and from the hard work of recovery—healing family rifts, reintegrating into the workforce, creating healthy social connections, finding new modes of fulfillment. This is why treatment centers that offer an array of services, including medical care, family counseling and social services, have a better shot at promoting recovery. That treatment infrastructure must be fortified. The Excellence in Mental Health Act of 2014, a Medicaid-funded project, established more robust health centers in eight states. In 2017, House and Senate bills were introduced to expand the project to 11 more. It’s a promising effort that could be a path to public or private insurance-based community services and an opportunity to set much-needed national practice standards.

    These two priorities are among the 56 recommendations put forth last October by President Donald Trump’s Commission on Combating Drug Addiction and the Opioid Crisis. Indeed, there is no dearth of ideas. In Congress, more than 90 bills aimed at the opioid crisis have been introduced in the 115th session, dozens of hearings have been held and later this month, the House Energy and Commerce Committee will begin holding a week of legislative hearings on measures to fight the opioid crisis. The White House’s 2019 budget seeks $13 billion over two years for the opioid epidemic, and the president recently nominated a “drug czar” to helm the Office of Drug Control Policy, though the candidate has minimal experience in the area.

    As we sort through and further pursue these policies, we need to make good use of what we know about the role that prescription opioids plays in the larger crisis: that the dominant narrative about pain treatment being a major pathway to addiction is wrong, and that an agenda heavily weighted toward pill control is not enough.

    Sally Satel, M.D., is a practicing psychiatrist at a Washington methadone clinic, lecturer at the Yale University School of Medicine and resident scholar at the American Enterprise Institute.
    

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18. Compassion Led Me to Rehab and It Can Help the Country Fight the Opioid Crisis (Opinion)

    Feb 22, 2018 | TIME

    By Mackelmore

    When I was 25, my dad asked me a simple question that ended up changing my life. He asked me if I was happy. At that point, my drug addiction had led me to a place of deep depression and self-hate. I couldn’t get away from the shadow that opioids had cast over my life. My love for making music was gone. My relationships with friends and family were strained at best, and permanently damaged at worst. I spent most of my time in my room with the blinds drawn. The world that I once loved was going on outside without me.

    “Are you happy?” The answer was simple, yet the process to attain this estranged happiness seemed impossible in that moment. It took my dad’s question to make me realize how far gone I really was. That act of love and compassion saved my life. After years of trying to get sober on my own, I went to rehab.

    When I went to treatment, I learned about my disease for the first time. Until then I didn’t know that I had a disease. As the weeks went by, I started acquiring tools to stay sober, one day at a time. When I got out I became immersed in a recovery community that I rely on to this day. Without a group of people who share my experience, I start slipping back into old behavior and start thinking I can do this on my own. My experience time and time again is that I can’t. My parents’ willingness to show up for me and offer me the chance to go to rehab came from a place of love rather than judgement. It’s that kind of compassion our country needs to fight the current opioid crisis.

    There are a lot of misconceptions about addicts and a lot of stigma surrounding addiction. People ask: Why don’t addicts just stop? Why don’t they just give it up? I certainly asked myself those questions when I was addicted, but this is a disease. I had to educate myself about addiction in order to learn compassion for myself. No one wants to be miserable, depressed, suicidal and slowly killing themselves. That’s not a choice that people make; it’s where drugs lead you.

    We’ve been conditioned for so long to think of drug addicts as bad people, that somehow addiction is a moral failing or a personal choice. But the truth is addiction can affect anyone. Almost every family in America has been touched by the disease in some way. Our society is at a crucial point and more people are coming forward and being honest about the disease and how it has impacted their lives. And as we learn more about addiction, the stigma around it is decreasing and giving way to compassion.

    That’s an important step forward, because stigma helps perpetuate the problem. It prevents policy makers and those in power from focusing on treatment and solutions, and instead puts the focus on punishment. Rather than punitive laws that don’t address the root of the problem, we need to provide more tools to help people get their lives back together, get their kids back, get jobs, be happy and be functioning members of society.

    One way to achieve this is to give addicts and their families a platform to share their stories because that’s how we’ll learn compassion for this issue and each other. We have to have these conversations. We have to discuss these stories. We have to discuss the over-incarceration of addicts and the over-prescription of America. We need to mobilize around recovery and restoration, and find ways to get addicts who want help the resources to do so.

    These actions will bring about progress and change how we treat those affected by this disease. Without discussion, it’s too easy to ignore the problem, too easy not to care. If our nation can treat addiction with compassion, I think we’re going to see a beautiful transformation, a reorientation toward recovery.

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19. Bitter Pill

    Feb 21, 2018 | Arkansas Times (AR)

    By David Koon

    Though Lane Huie was 27 years old when he died in a car crash on July 4, 2013, his mother, Darla Huie, never knew her son as a fully functional adult. She could see his potential, of course, as every parent can see the potential in their child. But from the time he was 17 years old, the man he might have been otherwise was always distorted by a crippling, seemingly unbreakable addiction to opioids.

    When he was 17, Lane hurt his hand playing football, a fracture that would take, at most, a month or two to heal for a boy his age. He left the doctor's office with a prescription for the opioid pain reliever hydrocodone. Within a week, his mother said, she saw a change in him, from a happy-go-lucky boy to a person she almost didn't recognize. Within a month, she said, he was hopelessly addicted.

    "We didn't have the skill set to deal with it," Huie said. "We didn't know what we were looking at, and didn't understand the physiology of the drug. Because we'd never been exposed to it, we didn't know. Lane was a happy kid who traveled and had a good time, a very friendly person, excited and exuberant about every day. He went from that to angry and screaming. We had no clue what happened."

    He would remain an addict for the rest of his life, in and out of rehab and in trouble with the law as he tried to keep pace with his habit. Eventually, he turned to heroin.

    Once, after he finished yet another rehab, Huie said she came into his room to find him loading a shotgun to kill himself. She wrestled the gun away. "He was like, 'Mom, I can't,' " Huie recalled. " 'I can't fight this. I don't know who I am. I've fucked up my life. Nobody in our family has ever been to jail. What am I doing? I don't know how to handle this. My brain, I fight it all day. I'll get up and I'll say, I'm not doing this. I'm not going to do it ... . I tell myself, I'm going to have a good day, a great day. I'm going to make them proud. By 3 o'clock, you know how you get a song stuck in your head? It starts playing, Just do it. You did good. Just do it. Do it again. Put yourself out of your misery and go to sleep. ' "

    Lane was making one last, desperate attempt to wean himself off opioids cold turkey, Huie said, when he died. She believes he may have had a seizure behind the wheel, brought on by withdrawal. She uses a metaphor about the last 15 years of her life that would be heartbreakingly beautiful if it wasn't so tragic: that it was as if she spent a decade crawling along in the dust behind her son, begging him to get well, and has spent the five years since she lost him trying to stand.

    "You can't sleep," she said. "You don't have healthy relationships. I would literally have friends wanting me to do things, and the whole time I was thinking, 'What about Lane? Is Lane OK? What's wrong with him? Asking for help. Trying to help him. Going to counseling. Sending him to rehab.' "

    R.J. Looney also knows what it is to fear for an addicted loved one. His son, Zachary, now 29, has been in prison since 2016 on theft charges, which Looney said Zachary committed to support an opioid addiction. After becoming addicted to opioids purchased on the street when he was about 14, the younger Looney progressed from snorting crushed pills to injecting heroin when he was a junior in high school.

    "It just led to the destruction of his teenage years," his father said. "Everything he lived for was just for getting high. ... He stole firearms, chainsaws, window air-conditioning units, debit cards, anything that wasn't nailed down." At one point, Looney said, his son blew through a $2,500 college fund in a single week. Finally, in 2015, after losing his job and unable to find money to feed his habit, he committed a robbery in the parking lot of Little Rock's White Water Tavern. Arrested, convicted and sentenced to five years of probation, he landed in prison last year after violating the terms of his probation.

    With his son scheduled to be released at the end of April, Looney knows the feeling of being trapped between the devil and the deep blue sea: He wants Zach to be free,but knows that once he's released, he may return to his addiction. A wave of recent overdoses and deaths by heroin users in Little Rock is constantly on Looney's mind.

    "Really early, before I go to work, is when the black dog wakes me up and I start thinking about things," he said. "It's always in the back of my mind: the recidivism rates that I've read about. ... I've always said, 'If you love an addict, you'll get to a point where it's about self-preservation, so they don't take you down with them.' They will. You can give up on trust. There's no way I'd ever trust him again, unless it's after years of being clean. But the two emotions you can't give up on are love and hope. That's about all you've got left for them. You always love them. You always hope they'll get better."

    Stories like these are the tip of a looming iceberg the state and nation are only starting to comprehend. America consumes over 80 percent of the global output of prescription opioids, and 99 percent of the world's hydrocodone. According to the Centers for Disease Control and Prevention, Arkansas has the second highest legal opioid prescription rate in the nation: 114.6 prescriptions for every 100 people in the state. Only doctors in Alabama prescribe more opioids. Greene County in Northeast Arkansas has the highest prescription rate in the state, with 122 prescriptions per 100 people. In counties on the other end of the spectrum, the rates are half that. Troublingly, nobody — not addiction specialists at the University of Arkansas for Medical Sciences, nor the state Department of Health, nor the state drug director — can definitively say why there is a difference in prescription rates from county to county.

    What is known, according to the health department's Prescription Drug Monitoring Program, is that doctors and pharmacists in Arkansas legally prescribed and distributed a staggering 235.9 million opioid pills in 2016 alone. Forty-six percent of Arkansans over the age of 18 filled at least one prescription for an opioid drug that year.

    With all those pills floating around, opioid theft for illicit use — what police and policymakers call "diversion" — is rampant. The CDC ranks Arkansas first in the nation when it comes to children aged 12 to 17 who have misused opioids. While opioid-related deaths seem to be edging downward since the introduction of prescription monitoring, opioid overdoses in Arkansas have tripled since 2000.

    Meanwhile, a study released last March of 1.2 million UAMS patient records collected between 2006 and 2015 found that the likelihood of becoming dependent on opioids long term increases by leaps and bounds with every day beyond three that a patient takes the drugs for pain. The study found that patients who were prescribed an 11-day supply of opioid drugs had a 1 in 4 chance of still being on opioids a year later.

    In short, it's clear we have a problem that isn't going to be resolved with thoughts and prayers. Just how to go about solving it, how it got so bad in the first place, and how to pay for a fix is still being debated, but things are moving quickly now. Recent months have seen the Arkansas State Medical Board working on new guidelines to try to rein in prescription rates and problem prescribers, the Attorney General's office announcing it intends to investigate drug manufacturers and bring charges if warranted, and the Association of Arkansas Counties filing a federal lawsuit — and planning to soon file a series of further suits in state courts — against some of the nation's most prominent drug companies and distributors.

    Meanwhile, many chronic pain patients with debilitating injuries are terrified that a crackdown will take away the painkillers they say allow them to lead something approaching a normal life. While efforts such as the state's Prescription Drug Monitoring Program have led to an overall decrease in the amount of "doctor shopping" — hopping from one doctor to another while trying to get opioid prescriptions — and a historic drop in the number of opioid overdoses in the state, state Drug Director Kirk Lane and others the Times spoke with say they believe the worst days of the epidemic are still ahead, as regulatory efforts and stricter prescription guidelines make pharmaceutical drugs like hydrocodone and oxycodone harder to get from doctors and more expensive when diverted to the streets and as prescription opioid abusers turn to much cheaper heroin — some of it laced with the brutally potent synthetic opioid fentanyl.

    Whether those efforts succeed in moving the ball on opioids in a positive direction or not long term, it's clear that the issue is much more complicated than old-fashioned pill mills.

    A plague in a bottle

    Though doctors have known the addictive and often deadly consequences of using opioid drugs since the days when snake oil containing opium and heroin was readily available on drugstore shelves, the last two decades of the 20th century saw a wholesale rethinking of opioids and their addictive properties in the medical community, including the idea that the powerful drugs could be safely prescribed for temporary "acute" pain and chronic pain without fear of addiction. As seen in a number of lawsuits filed across the country over the last 10 years, including the one filed in late 2017 by the counties association, a case can and has been made that much of that rethinking by physicians, and the attendant explosion in opioid prescription rates, corresponds with a decades-long, multimillion-dollar marketing push by pharmaceutical companies beginning in the 1990s, the goal of which appears to have been to convince physicians that no patient need ever be in pain, that opioid painkillers are neither as dangerous or addictive as previous generations believed, and that those drugs could therefore be safely prescribed for pain other than that experienced by late-stage cancer or hospice patients.
    

    The counties association filed suit last December in federal court against several of the biggest makers and distributors of opioid painkillers, including Purdue Pharma, Janssen Pharmaceuticals, McKesson Corp. and others. The lawsuit calls the effort to sell physicians on the idea that opioid medications were safe and nonaddictive a "marketing scheme designed to persuade doctors and patients that opioids can and should be used for chronic pain." It reads like the bleak color commentary on a slow-motion train wreck, laying out the history of how opioids came to be so widely prescribed in Arkansas and America, including claims that drug companies spent millions to downplay the risks of opioid addiction and dependency by using paid "opinion leaders," employing "front groups" masquerading as impartial patient advocates, spending tens of millions of dollars to advertise in medical journals and using drug reps to make the case for shaky concepts such as "pseudoaddiction," the idea that if patients taking opioids were found to be engaging in behaviors indicating addiction, that meant their pain was not well managed and their dosage should be increased. Citing what she called "staggering" statistics, Arkansas Attorney General Leslie Rutledge announced Jan. 24 that her office would bring in extra legalhelp to investigate several yet-to-be-named opioid manufacturers and will potentially bring lawsuits or charges against those firms if warranted.

    The counties association lawsuit points out several of what seem to be damning facts: The named defendants spent over $14 million to advertise their products in medical journals in 2011, triple what they'd spent in 2001, and spent $168 million in 2014 alone to market opioid drugs to doctors through "detailers" — friendly drug company sales reps who visit physicians in their offices — double what they'd spent on opioid detailing in 2000.

    "Manufacturer defendants also identified doctors to serve, for payment, on their speakers' bureaus," the lawsuit goes on to say, "and to attend programs with speakers and meals paid for by Manufacturer defendants." Among other damages, the lawsuit calls for funds specifically to pay for opioid addiction treatment costs in Arkansas in coming years.

    Colin Jorgensen is litigation counsel for the Association of Arkansas Counties Risk Management Services. He said there are obvious parallels between the lawsuits filed against opioid manufacturers and those filed in the past against Big Tobacco, but also significant differences.

    "The parallels are mostly in the legal theory and the misrepresentation in the marketing by the companies," Jorgensen said. "That's what's similar between tobacco and the opioids — the deliberate deceit about the addictive nature of these products, knowing full well the truth. The damages are not exactly the same. We've got a lot more local-level impact this time with the opioid epidemic than with tobacco. ... We need education, prevention and treatment, and all three of those things are extremely expensive, and they're best deployed at the local level." The price tag for that intervention could easily run into the billions of dollars nationwide, Jorgensen said.

    Jorgensen said he believes physicians have been duped about opioids just like patients, but are quickly working to turn things around. "The awareness in the medical profession is shifting dramatically," he said. "I think you're probably going to see a pretty substantial drop-off in the prescription rates and things moving forward. The doctors are in a tough position because they don't necessarily have effective alternative treatment, but they're learning now that [opioid] treatment is ineffective, too."

    Association of Arkansas Counties Executive Director Chris Villines said the financial and social impact on counties and cities in the state is shaping up to be much more costly than that posed by tobacco addiction in the past. "We didn't fill our jails with people using tobacco," he said. "We didn't have to go out and police the street for tobacco users. [Tobacco] really had more of a direct impact on health care than anything. This plague has had an impact all over: the court system, the county hospital, the county jail, policing, law enforcement, coroners, everybody."

    Villines noted that while there is a clear need to curb the prescription opioid rate in the state, slowing the supply does nothing to stop the demand from those addicted to opioids. Like several the Times talked to, Villines fears that attempting to restrict the number of legal prescriptions without a corresponding increase in funding for drug treatment — money that is going to be very hard to find in a cash-strapped state like Arkansas — may well result in a new scourge.

    "Between 2005 and 2009, Mexican heroin [production] increased from 8 metric tons to 50 metric tons," he said. "Almost all of that increase is going straight to those who are getting off of opioids. So if we talk about the solution being, 'Let's cut back the flow of opioids,' we're not helping. We're actually driving addicts more quickly into illegal heroin than we would be if we had a good plan in place to help get them off of opioids."

    Jorgensen said the association plans to file lawsuits somewhat similar to its federal action in state courts this spring. He said the fact that the vast majority of the counties in Arkansas — 70 out of 75 as of this writing — quickly signed on to the forthcoming state lawsuits shows the extent of the problem in both cities and rural areas, and officials' frustration with the issue. The association will also be partnering with the Arkansas Municipal League on the state lawsuits; the municipal league has signed up over 100 cities across the state, including the largest cities, Jorgensen said.

    He and Villines said that in talking to groups around the state, they're seeing that police and leaders understand that it's impossible to arrest their way out of the opioid crisis, and are willing to view opioid addicts as victims of a scheme rather than criminals.

    Though Jorgensen said it's his belief, based on the available evidence, that drug companies set out to get people hooked on dangerous opioid painkillers, he said the lawsuit need only prove the companies knew their drugs were dangerous and addictive and deceptively marketed to prevail. The lawsuit is not about trying to tell doctors how to practice medicine, he said.

    "Ending the deceptive marketing scheme and hopefully enjoining and compelling the companies that produce these pills and the companies that distribute these pills to market them truthfully, that may change the culture among doctors," he said.

    The candyman

    Retired for the past three years, Benton physician Dr. Sam Taggart has long been something of a Paul Revere on the subject of opioids. Both a medical historian (he'll soon publish his second book on the history of the profession in Arkansas) and an early proponent of the idea of "wellness" — the idea that if you eat right, get exercise, stay near an ideal weight, don't smoke and follow other healthy guidelines, the body doesn't need much medicine — he said that the idea of "a pill for everything" has been pushed by the pharmaceutical industry since the turn of the 20th century, starting with vitamins. The result, he said, is that America is a drug culture that has been training its population to look for health in pill form for over 100 years. The problem with that, according to Taggart, is that the pharmaceutical industry is in the market to create customers, not to produce cures.
    

    Since the opioid boom, Taggart believes, the result of that century-long training of American consumers has come home to roost in nearly every Arkansas city and town. "A lot of towns have a candyman," he said. "They have a guy that everybody in town knows: If you need something, you go to this guy. I honestly didn't want to be that person under any circumstances. So I began very early thinking about those kinds of issues and saying, 'How do you keep that from happening?' "

    While it was starting to change by the time he left his practice, thanks in part to the state's Prescription Drug Monitoring Program and other efforts, Taggart said the local "candyman" would often persist for years because those physicians flirt with the edges of the law and Medical Board regulations. "I don't want you to misunderstand me, and please don't misrepresent this: I'm not being judgmental of my fellow physicians, except to say that, in every community, and I believe this is still true ... if you go into the drug-seeking community, there is a network and they know who prescribes drugs," Taggart said. "They know who will do it, they know where they can get it, they know how much they can get."

    Part of being the change he hoped to see in the world was insisting on something that has grown much more common among doctors in recent years: that chronic pain patients in his care be evaluated by a chronic pain management specialist. "If it looked like they had a problem," Taggart said, "something like a severe back problem and there was nothing that could be done, or a severe hip or leg problem and nothing could be done about it, what I would do is start warning them after about three weeks, 'This is not long term. We're not going to do this long term.' I wouldn't write big, long-term prescriptions. I'd say, 'If we decide that this is what you're going to need, I'm going to send you to a chronic pain management specialist,' but with a caveat: 'OK, we'll let them evaluate you. If they think you need this medicine, I'll continue writing the prescription.' "

    During his years in practice, Taggart refused to hear the pharmaceutical companies' sales pitch on opioids. As early as 1983, Taggart said, he stopped seeing "detailers" who asked to come to his office to market drugs. Once, Taggart said, most drug company sales reps were former pharmacists who were informed about medicine and patient care. But during the early 1980s, that changed. "They'd send out pretty young girls, pretty young guys, and they'll send them out with a study that might have six people in it, which is no study at all," Taggart said. "They have direct access. They come right into the doctor's office. They bring food for the whole office staff. They're salesmen. It's sales, is all it is." The sales pitch often worked, Taggart said, because doctors are just suceptable to a friendly face offering direct marketing as anyone else.

    "For a long time, they provided all kinds of freebies," Taggart said. "They would hire physicians to be speakers at meetings: 'We want you to be part of our staff.' That part was ultimately outlawed, I think. I was never part of that. I was never interested in it. I had way too much to do and I wasn't interested in what they had to say. I'd rather get my information from a reasonably objective source."

    Denise Robertson has served as administrator of the health department's Prescription Drug Monitoring Program since it started in 2012. The job has given her a daily view of the flowering of the opioid crisis in Arkansas. Established by Act 304 of 2011, the program collects daily reports from pharmacies, allowing doctors and pharmacists to see with just a few keystrokes whether a patient is engaging in "doctor-shopping" behavior to get more pills from multiple physicians.

    Act 820, passed in the last legislative session, made it mandatory for doctors to consult the drug-monitoring program before writing opioid prescriptions, and for pharmacists to update the registry whenever they fill a prescription. The change from voluntary to mandatory has been controversial, Robertson said, but it is helping to slow the spiraling opioid prescription rate in Arkansas. She noted that since the program was instituted, there has been a 20 percent decrease in prescription opioid overdose deaths in the state. That's the fourth largest decrease nationwide, according to the CDC.

    Robertson said one issue that drives opioid abuse in Arkansas is the fact that Missouri is the only state in the nation without some form of prescription drug monitoring system. The Missouri legislature has made attempts to establishing a system for tracking opioids in their last three sessions, but has failed each time (lacking guidance from the state, St. Louis County and bordering counties finally started their own system, which has helped). Looking at Arkansas county-by-county maps of overdose rates, Robertson said, you can actually see the deadly results of addicts hopping the border into Missouri to doctor shop. "You'll see a lot of that concentrated up there on the border of Missouri," she said. "We have no idea, really, what's going on across that border."

    Drug Director Lane agrees that Missouri's lack of a drug-monitoring program is contributing to the problem in Arkansas. He said the impact of prescription monitoring can be seen in the two states' opioid overdose death rates. "Before we started our program, we ranged about 12 deaths for every 100,000 people," he said. "Missouri tracked right along with us. We were side by side, Missouri and Arkansas. We kicked into our PDMP, and our death rate remains the same today. Based on the current figures, we have around 12.5 people per 100,000. Missouri is at 20 [deaths per 100,000] now. So they have grown. We've maintained."

    Formerly the chief of police in Benton, Lane has seen firsthand the impact of the opioid crisis in the state. He said that prescription opioids go for about a dollar per milligram on the street. "If you have a 10- to 15-pill-a-day habit, you can add up the money there," he said. "It comes from taking from medicine cabinets, stealing or other criminal activity to raise the money and feed the substance abuse disorder. Eventually, you move to heroin because it's cheaper. The supply of heroin is coming into the state very rapidly now."

    Because smugglers have upped supply to meet demand, an amount of injectable heroin to satisfy an opioid habit that would cost thousands of dollars a day goes for about $10 in Arkansas, Lane said.

    Much of the heroin seized in Arkansas in recent years, he said, tests positive for fentanyl, a synthetic opioid that's 50 to 100 times more potent than morphine and that — unlike heroin — can be absorbed through the skin. The drug, normally only used in patch form by late-stage cancer patients, is now being synthesized in cartel labs in Mexico and smuggled into the U.S. in tonnage quantities, sold either alone or mixed into heroin. Because of fentanyl's potency, the fact that it looks identical to heroin and has the ability to pass through the skin, Lane said, the drug has been linked to overdoses across the nation in not only opioid users, but cops, drug dogs and family members who stumbled upon a loved ones' stash.

    "Where heroin will be fatal slowly by slowly depressing the respiratory system," Lane said, "fentanyl acts very quickly. And carfentanil, which we haven't seen in the state yet to my knowledge, is 100 times more potent than fentanyl." Carfentanil, which has popped up in some opioid hotspots around the country, is normally used by veterinarians as a surgical anesthetic for very large animals, including elephants.

    The risk of addicts turning to heroin, the danger of fentanyl and the attendant overdose deaths and needle-related diseases that will result, are why Lane believes the worst days of the crisis in Arkansas are still ahead. It's part of the reason he helped lead the state's effort to make the lifesaving drug Narcan, which can temporarily reverse an opioid overdose and give first responders time to rush a patient to the hospital, available over the counter in the state. First responders have used Narcan to save over 30 overdose victims in Little Rock alone so far this year, including a 17-year-old who overdosed in a bathroom at Little Rock Central High School. Lane said the state has received $3.5 million in grants to provide Narcan to first responders in the state over the next five years. The state's drug takebackprogram — online at artakeback.org — has 194 secure boxes in the state where patients can dispose of their unused narcotic drugs 24 hours a day. Lane said that between the boxes and statewide takeback events — the next one is Saturday, April 28 — the state has collected and destroyed 131 tons of prescription drugs — enough to fully load over three tractor trailer rigs. About a third of the surrendered drugs, Lane said, have been opioids.

    Lane couldn't give a definitive answer as to why the prescribing rates are so high in certain counties. The issue of prescription rates, he said, is multifaceted and the reasons may vary from county to county. "Some Arkansas counties have a lot of retired folks who move here from other states," he said. "Older people have more medical problems than younger people and because of that, they have more medications than younger people. So that may be part of the issue on the prescribing rates. Some of it could be the physicians themselves. ... Some of the problem [may be due to] the older prescribers, who are set in their ways and were trained that opioids were OK in the past. Basically, trying to retrain them and reprogram them to the latest techniques to deal with the opioid epidemic is a big push, not only in Arkansas, but in the U.S."

    One issue as the state moves forward, Lane said, is that Arkansas is in the bottom 10 percent in the nation when it comes to the availability of drug treatment, a problem especially acute in rural areas.

    "Good medically assisted treatment isn't just giving somebody Suboxone or methadone [drugs that mimic opioids but don't cause a high] and letting him walk out the door with a prescription," he said. "Good medical-assisted treatment is the constant monitoring of somebody, urinalysis, and also a piece with peer recovery — not only getting that person clean but maintaining that sobriety and giving them tools." There is also, Lane said, the issue of breaking the stigma of addiction so people can come for help without shame. For a lot of opioid addicts, he said, using is not about getting high; it's just about feeling normal and not getting sick. While that drive can cause addicts to engage in criminal behavior, Lane said that people who have been punished need to have a way back to the community and a sense of worth.

    "We as a society have to understand that and give these people a second chance," Lane said. "It's kind of hard for a longtime cop to say that, but it's a realization of the problem we have and what pushes people into these behaviors. It really takes all of us working together to understand the problem. We created the problem. We can fix it. ... You can't turn addiction off like a light switch. You just can't do it. It takes hard work and support, and it takes a community to solve the problem."

    Dr. Rick Smith chairs the UAMS Department of Psychiatry and serves as director of the hospital's Psychiatric Research Center. He works with patients to break the cycle of opioid addiction every day. "You've got a situation where there are a lot of pills out there. A huge number. Too many pills are out there that are not taken," he said. "There's this diversion phenomena, so the adolescents and young adults get hold of them, and then they end up graduating from pharmaceutical grade opioids to heroin. There used to not be a market in Arkansas for heroin. Heroin would pass through Arkansas on the way to Chicago and other cities up north, but there wasn't enough market to stop here. Now there's plenty of market to stop here because [addicts] can't afford the prescription-grade opioids."

    While it's impossible to determine who will become addicted to opioids and who won't, Smith said there is clearly a genetic susceptibility to opioids in some people linked to their body's activation of opioid receptors in the brain — the golf-tee-like sockets that opioid molecules plug into.

    Educating or reeducating doctors about the danger of the drugs is key, Smith said. In the past, doctors were often misinformed about opioids during their initial training. "The pharmaceutical reps were saying: These drugs aren't dangerous and folks aren't going to get addicted to it if they're having post-surgery or post trauma [pain], which is just not true," Smith said. "I was taught that in my fellowship. I did my fellowship in 1981, and we were taught that if somebody was given a pain medicine after surgery or after trauma, they would almost never get addicted to it."

    Smith said there is a common euphemism for the four categories of doctors who prescribe too many painkillers: those who are dated in their knowledge, those who are duped by their patients into overprescribing, those who are disabled by an addiction to medication themselves, and, the last category, which Smith said is much more rare — doctors who are dishonest and overprescribing for personal gain. "The Prescription Drug Monitoring Program helps sort those out, especially the last group," Smith said, "which is really the responsibility of the DEA and the Medical Board. Reports are sent from the PDMP to the board."

    Helping patients get off long-term opioids must be done slowly and carefully, Smith said. The approach that works best right now is what's called medication-assisted treatment. "The one that we're hoping works and gets widespread use in Arkansas is treatment with Suboxone," he said. "That can be done in a primary care physician's office. They have to have counseling as well as this drug in tapering doses, tapered over a number of weeks. If they're on really high doses of opioids, you have to lower the doses of opioids first, and then get them on Suboxone."

    Asked whether prescribing medical cannabis instead of opioids for pain might help in solving the opioid crisis in the state, Smith said he doesn't believe so. "We know from research that it's a gateway drug," he said. "Adolescents especially will start with marijuana because our society believes that marijuana is harmless or even helpful. So they start using marijuana and they oftentimes graduate to other drugs. It's not always, but it's statistically significant."

    Smith believes the state is moving in the right direction to combat the opioid crisis, taking very aggressive action and instituting programs, like the PDMP, which help stem the tide. "The health department has taken a strong lead, the Arkansas State Medical Board is, the Medical Society is," he said. "Everybody is concerned about the problem, and I don't see anybody really holding back. It's just a very complex problem. We shouldn't and can't blame this on the patients. The patients are suffering. We have to put the patients' best interest first. We can't just ban the drugs. When I had a leg injury, I needed the medicine for a day or two ... There's a battle about: Is this a moral flaw? That's the stigma. No it's not. This is physiological. This is brain physiology — brain and body physiology."

    The fall

    The state Medical Board met Feb. 1 to hear comments on a proposed regulation that would give the board the power to revoke or suspend the medical license of any doctor found to have prescribed "excessive amounts of controlled substances to a patient, including the writing of an excessive number of prescriptions for an addicting or potentially harmful drug." As defined in the proposed rule, "excessive" wouldn't include medications given to patients in hospice, being treated for active cancer, emergency inpatient care or end-of-life care. For the treatment of acute, temporary pain from surgery or an injury, the regulation would define "excessive" as any pain medication prescription written for more than seven days "without detailed, documented medical justification." The board will hold another public comment session on the proposed regulation in April.
    

    As the audience for the meeting filed into the chamber in the Victory Building in downtown Little Rock, it was easy to see which people were there to speak against the proposal — the half-dozen or so, many of them older, who hobbled in on walkers or canes. One man was girdled with an extensive black back brace. One woman in a surgical mask groaned as she lowered herself gingerly into a chair.

    Along with Drug Director Lane — who, citing the UAMS study of addiction rates, advocated for the board to go further and limit opioid prescriptions for acute pain to five days — and Smith and other experts, several patients spoke before the board, saying that opioids had curbed their pain enough that they were able to live fuller lives following a crippling injury. Nearly every patient who spoke said their doctors, fearing repercussions from the Medical Board, had cut back on the amount of opioid medication they would prescribe. Some said they had been cut back to a point where they could no longer function. One patient, on opioids for a back injury for over 20 years, related that without the drugs, he feared he would have to go on permanent disability, close his small business and put his employees out of work. Board members, saying they wouldn't revoke the license of a doctor prescribing long-term opioids for legitimate chronic pain cases, repeatedly encouraged patients who spoke of skittish physicians to have their doctors call the board for reassurance and education about the regulations concerning opioid prescriptions for chronic pain.

    Kelly Jones sat and listened as long as she could bear it, then left the room in tears, saying that the board would do nothing for a person like her. In the hallway, she leaned on a walker and cried as she related her story of living two decades in constant pain. In 1998, while hiding her children's Christmas presents, Jones said, she fell 10 feet from an attic to a concrete carport, rupturing nine disks in her back and neck and crushing an ankle so badly it had to be pieced back together with screws. Since then, bounced from surgeon to specialist, she has been in constant pain that turns to agony without high doses of opioid medication. Bent and wan, an oxygen hose threaded around her head to her nose, Jones said she spends most of her life in bed, the windows of her room heavily curtained because squinting in sunlight givesher headaches, thanks to the neck injury. Like several who spoke, Jones said her doctor has recently cut back her opioid medications, fearing his medical license might be in jeopardy if he continued to prescribe high doses. Dabbing her eyes with a tissue, Jones said she and other chronic pain patients are being punished for the crimes of others.

    "It's like I'm paying for the sins of what other people have done with their medicines," she said. "I can't be there to control what other people do with their medicines. But because they can't control themselves, I'm paying for it. I can't sit in there any longer. I kept asking them, 'Can I please talk? I have to go home and go to bed.' They keep bringing up people from the governor's office to talk. They won't let people talk."

    She knows through being in pain management, she said, that she will never be pain free, but opioids allow her to at least control her pain. She prays for cancer, Jones said, so that at least she can get her medicine and be pain-free again for a little while before she dies. She said the members of the Medical Board will never understand pain like that.

    "I pray to die," she said. "I pray every night to die. My husband actually took the guns out of the house because he was tired of listening to me threaten to do it. ... I'm on scraps of medicine. I can't live my life like this. They don't understand, because unless you have chronic pain, you will not understand what people with chronic pain are talking about. I can't talk anymore. I have to go."

    At that, Jones turned and hobbled away, shuffling, pushing her walker along the carpeted hallway until she rounded the corner and disappeared from view, back to her darkened bedroom somewhere in Arkansas.

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20. Attorney General Fox aims to stop opioid marketing

    Feb 21, 2018 | Fox Montana (MN)

    By Bless Zechman

    Attorney General Tim Fox has sent out his latest effort in combating substance abuse issues in Montana, this time attacking the way makers of opioid can market to their drug

    In December of 20-17, the AG’s office filed a lawsuit against Purdue Pharma, the makers of Oxycontin.
    
    Yesterday, they went a step further and filed a motion for an injunction that would require Purdue to adhere to several limitations, Most notably to stop its opioid marketing campaigns in Montana and begin monitoring programs to keep a watchful eye on prescription patterns. 
    
    "People are still dying, they're still getting addicted, they're having health problems, and so we want to reduce that as much as we can by bringing this motion,” said Fox.

    
    The injunction  would also require the big pharma company to report anomalies in doctor's prescriptions of its drug Oxycontin. This motion is the first of its kind, in that no other state has ever prosecuted against a drug company's ability to market its product.

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21. Sen. Maria Cantwell calls for heavier penalties on drugmakers who fail to keep opioids off the street

    Feb 22, 2018 | Spokesman Review (WA)

    By Rachel Alexander

    Flanked by law enforcement, social service and public health workers, Sen. Maria Cantwell spoke Wednesday in Spokane about the importance of cracking down on prescription opioid manufacturers who let their drugs flood communities.

    “We are fighting back,” she said.

    Cantwell introduced a bill in the Senate last week that would increase the fine for opioid manufacturers who fail to report suspicious drug orders from $10,000 per violation to $100,000 and doubles the maximum penalty to $500,000. She called the current fine a “slap on the wrist” and said it had proven inadequate to stop black market trafficking of prescription drugs.

    “Despite this regulation, large quantities of these pills are flooding our communities,” she said. In Washington, 694 people died of an opioid overdose in 2016, according to the Department of Health.

    Cantwell spoke to half a dozen people currently in treatment at the Spokane Regional Health District.

    One man, who asked that his name not be used because his boss doesn’t know about his history of drug addiction, said he started taking high doses of opioids after he dislocated his shoulder playing football. The injury required surgery and became chronic and his doctor kept writing him refills of painkillers.

    “He was just filling it and filling it,” he said, echoing stories shared by others in treatment.

    Eventually, the man told his doctor he had a problem and got referred to methadone treatment. He’s been there eight years and was able to keep the same corporate job in an industry where he’s worked for 28 years, he said.

    He said he supports Cantwell’s efforts, which he hoped would make it harder for someone in his position to become addicted.

    The city of Everett sued Purdue, the manufacturer of OxyContin, last January, alleging the manufacturer failed to report multiple suspicious sales of the painkiller that were purchased by a trafficking ring in Los Angeles in 2008.

    The lawsuit claims that trafficking ring was directly responsible for drugs coming into Everett, fueling increased taxpayer spending on law enforcement, emergency medical services and treatment.

    That’s one local example of something Cantwell said is happening all over the country.

    The bill, called the Comprehensive Addiction Reform, Education, and Safety Act, also requires the Drug Enforcement Administration to publish an annual report about opioid manufacturers’ record of violations and provides $50 million in funding for specialized DEA units to target heroin traffickers.

    Spokane police Chief Craig Meidl and Spokane County Sheriff Ozzie Knezovich spoke in support of the bill, saying it was needed to keep people from becoming addicted.

    Knezovich recalled meeting in the same room at the Spokane Regional Health District seven years ago with emergency room doctors to talk about making sure powerful painkillers weren’t being diverted.

    “We’re here today because we weren’t successful,” he said.

    Meidl said drug addiction is the biggest driver of property crime in Spokane.

    “We all have a vested interest in the outcome of drug prevention efforts,” he said.

    Cantwell acknowledged that without treatment options and other support for addicts, stemming the flow of pills could drive people to use heroin or other drugs.

    “You need a comprehensive approach,” she said.

    Preventing cuts to Medicaid is an important piece of that, she said, because the government-funded health program pays for so many treatment slots.

    In Spokane, about 730 people are currently receiving treatment at the health district’s methadone clinic through Medicaid, director Julie Albright said.

    Cantwell said she’s hoping to roll the bill into additional opioid treatment and prevention measures being considered in the Senate and ultimately wants to include them in the March budget deal Congress will have to pass.

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Northwest (OR)

22. Portland to sue opioid companies for costs of local havoc

    Feb 21, 2018 | OregonLIve (OR)

    By Brad Schmidt

    The city of Portland will join a national movement by suing drug companies behind America's opioid crisis.

    On Wednesday, the Portland City Council voted 4-0 to file litigation hoping to recoup millions of dollars spent locally each year dealing with the fallout of opioid addiction.

    "This is a much-needed step to help stem the tide of opioid addiction in our community," Portland Mayor Ted Wheeler said.

    Portland will join at least 370 other cities and counties across America suing drug manufacturers or distributors, said Naomi Sheffield, a deputy city attorney. Locally, Multnomah County filed suit against several companies in August while the Clark County Council, in Washington, approved a lawsuit Tuesday.

    Portland plans to argue that drug companies created a public nuisance and acted negligently. Sheffield said the city's damages from opioid addition are "a few million dollars annually."

    In 2016, city firefighters responded to 3,475 overdose calls. Of those, first responders administered Naloxone, which reverses opioid overdoses, about 400 times, Sheffield said. And about half of all drug calls to police are related to opioids.

    "Entities we trust with our health are preying on our pain and leaving a wake of ruin, grief and untold costs to families and communities," Commissioner Chloe Eudaly said.

    City officials have privately identified a list of companies that could be targeted in a lawsuit. But the city did not release those names Wednesday and Sheffield declined to identify the companies when asked by The Oregonian/OregonLive.

    Portland will hire an outside law firm, Baron & Budd, to sue opioid companies. Baron & Budd already represents Portland in a separate suit against chemical-maker Monsanto, and the law firm represents many jurisdictions suing over opioid havoc.

    Portland's lawsuit will be filed locally in federal court. But officials expect it will be transferred to the Northern District of Ohio, where multi-district litigation involving drug companies is being heard.

    "We do have a voice, and collectively our voices have power," Commissioner Nick Fish said.

    Wednesday's meeting also highlighted the personal toll of opioid use.

    Former Portland Commissioner Steve Novick testified about the 2007 death of his brother, Mischa, from an OxyContin overdose. Novick said drug companies -- specifically Purdue Pharma and the wealthy Sackler family behind it -- need to be held accountable.

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23. City of Portland announces it will sue drug industry over opioid crisis

    Feb 21, 2018 | Portland Business Journal (OR)

    By Elizabeth Hayes

    Six months after Multnomah County filed a $250 million lawsuit against Purdue Pharma and other opioid manufacturers, the Portland City Council unanimously decided to also take legal action.

    The City Council today directed the Portland City Attorney to sue opioid manufacturers and distributors to recover the funds it has expended fighting the opioid crisis.

    “Three Oregonians die every week due to prescription opioids, and cities like Portland are on the front lines,” Mayor Ted Wheeler said in a written statement. “Drug manufacturers must be held accountable for their products, and I’m proud of our community for taking a stand against this epidemic.”

    On Tuesday, the Clark County Council in Washington also voted to retain a law firm to sue opioid manufacturers and distributors, adding to growing list of cities and counties that are suing the industry.

    Drug makers recently tried to move Multnomah County’s lawsuit from state circuit court to U.S. District Court, as a precursor to the case being consolidated with 200 similar lawsuits pending in Ohio. U.S. Magistrate Judge John Jelderks, however, sent that lawsuit back to state court.

    The city of Portland plans to file its lawsuit in federal court, where it will likely to transferred to the multi-district litigation in Ohio, the city announced. 

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24. Portland plans to file suit against drug companies for role in city's opioid crisis

    Feb 21, 2018 | KATU On Your Side

    By Staff

    Portland is looking into suing opioid companies as a way to help recoup some of the money spent fighting the city’s opioid crisis.

    City councilors reached a unanimous decision Wednesday to have the Portland City Attorney file a lawsuit against opioid manufacturers and distributors, Mayor Ted Wheeler’s Office said.

    The goal is to recover the city dollars already spent and that will go towards fighting the opioid crisis; everything from the homelessness services for addiction to emergency response programs that handle overdoses.

    “Three Oregonians die every week due to prescription opioids, and cities like Portland are on the front lines,” said Mayor Ted Wheeler. “Drug manufacturers must be held accountable for their products, and I’m proud of our community for taking a stand against this epidemic.”

    Commissioners say the lawsuit would also be a statement “calling for accountability from big pharma.”

    Alongside the funding spent on the crisis, the city mentioned the impact it has on families in our community.

    “Companies that have preyed on people’s suffering in pursuit of their own profit must be held accountable for the wake of devastation they have left across our communities and country,” said Commissioner Chloe Eudaly.

    The lawsuit will be filed in federal court in Oregon, and joins hundreds of similar suits filed on behalf of cities across the nation.

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Northeast (RI)

25. Town joins lawsuit vs. big pharma

    Feb 22, 2018 | The Jamestown Press (RI)

    By Tim Riel

    Drug overdoses have been responsible for 1,679 deaths since May 2011, according to the state Department of Health, which means an average of 21 Rhode Islanders are buried monthly from abuse.

    The biggest culprit are opioids, a class of painkillers that includes OxyContin, Percocet and Vicodin, along with fentanyl, a highly potent pain medication that alone has seen deaths associated with it increase 15-fold since 2009.

    Although the majority of those deaths are in urban areas, like Providence, Woonsocket and Warwick, Jamestown has joined the fight to hold pharmaceutical companies responsible. According to a lawsuit spearheaded by Lt. Gov. Dan McKee in January, at least five companies negligibly overprescribed these dangerous medications: Purdue Pharma, Cephalon, Janssen Pharmaceuticals, Endo Health Solutions and Activis. The town councilors unanimously agreed Tuesday to join nearly two dozen other Rhode Island communities in the lawsuit.

    “We’re not an urban city, but that doesn’t mean we’re not affected,” said Kristine Trocki, council president. “We’ve had losses. And I think it’s important that we address them.”

    “There clearly was a set of offenses,” added Councilman Gene Mihaly. “We need to stand up and say so.”

    According to Town Solicitor Peter Ruggiero, the lawsuit will not cost the town money. Instead, a consortium of law firms across the United States have collaborated to sue these pharmaceutical companies. The legal team will pay expenses for litigation, including filing fees and hiring costs for experts. If the plaintiffs win, the law firms will reimburse themselves and then take a fee from the recovery costs. They will not seek compensation from cities and towns acknowledged in the suit if the pharmaceutical companies win.

    “They’re under the impression this is a zillion-dollar case,” Ruggiero said. “They’re not doing this for free, let’s face it.”

    According to Police Chief Ed Mello, the opioid epidemic has taken a small financial toll on his department. Since overdoses began skyrocketing, Mello has had to train and equip his officer with Narcan, an emergency medication that blocks the effects of opioids.

    “These are the things we can seek recovery for,” Ruggiero said.

    According to McKee, the manufacturing companies pushed highly addictive opioids, falsely representing to doctors that patients only rarely would succumb to drug addiction, while the distributors breached their legal duties to monitor, detect, investigate, refuse and report suspicious orders of prescription opioids.

    “While we bear the burden of this epidemic, multi--billion-dollar companies are turning a profit and ignoring the crisis they caused,” he said. “Until we address the source of this epidemic and force drug makers and distributors to follow the law, our cities and towns will continue to face an uphill battle.”

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Midwest (MI)

26. County joins national lawsuit against opioid manufacturers

    Feb 21, 2018 | Hillsdale Daily News (MI)

    By Corey Murray

    The Hillsdale County Board of Commissioners approved a resolution Feb. 13 approving outside counsel to represent the county in a nation-wide lawsuit against opioid manufacturers.

    The commissioners effectively joined other Michigan counties and municipalities from all over the United States in the nation-wide litigation and will be represented by Weitz & Luxenberg PC and The Sam Bernstein Law Firm PLLC, collectively.

    The firms will be compensated 30 percent of the net sum recovered, if any, during litigation of the suit or settlement.

    Commissioner Bruce Caswell said he believes the case will be settled out of court, given the circumstances of the national opioid epidemic.

    Caswell also voiced his opinion that monies allocated to Hillsdale County from the lawsuit should not be placed in the general fund.

    “I think we need to take this money and use it to solve the opioid problem,” Caswell said. “Many lives have been destroyed by this.”

    With Chairman Mark Wiley’s signature, Hillsdale County became the 22nd county in Michigan to join the growing list of clients represented by these firms. The cities of Detroint, Escanaba, Grand Rapids, Iron Mountain and Lansing are also being represented.

    Caswell said the case will begin in the federal court’s Michigan jurisdiction and eventually be moved to a federal court in Cincinnati, Ohio in a practice that combines federal lawsuits spanning multiple states into one courts jurisdiction for adjudication.

    Although Hillsdale County is not required to spend taxpayer dollars to join the lawsuit, the county may be required to provide statistical information as to how the opioid epidemic has affected the county overall. Another option, according to Caswell, is for the federal courts to adopt a model for all municipalities involved with funding to be split based off a sliding scale presented in the model.

    It is unknown how much, if any, monies may be granted to Hillsdale County in the lawsuit.

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Southeast (AR)

27. Norfork joins opioid lawsuit, Gassville declines

    Feb 22, 2018 | The Baxter Bulletin (AR)

    By Scott Liles

    One Baxter County city recently voted to join a large class-action lawsuit against the manufacturers and distributors of opioid drugs, while another decided that it would not join the same lawsuit.

    The Norfork City Council voted 3-0, with one council member abstaining Tuesday night, to accept a proposal from the Arkansas Municipal League to enjoin the city in the AML’s potential lawsuit against 16 pharmaceutical companies. The Gassville City Council on Tuesday night declined to join the AML’s potential lawsuit, with two council members voting in favor of enjoining the city and four voting against participating.

    The Municipal League — which represents Arkansas cities — is working with the Arkansas Association of Counties — which represent Arkansas counties — to represent local governments in lawsuits about the damage caused by opioid addictions.

    More than 60 Arkansas cities have agreed to participate in the AML’s proposed lawsuit. Baxter County Judge Mickey Pendergrass said that the county agreed in December to join the AAC’s version of the opioid lawsuit.

    Roughly 100 lawsuits against about 70 opioid companies have already been filed nationally by either cities, counties or states, the Arkansas Democrat-Gazette reported in January.

    The AML’s proposed litigation identifies 16 opioid manufacturers or distributors as potential targets: Purdue Pharma LP; Purdue Pharma Inc.; The Purdue Frederick Company, Inc.; Teva Pharmaceuticals USA Inc.; Cephalon Inc.; Johnson & Johnson; Janssen Pharmaceuticals Inc.; Endo Health Solutions Inc.; Endo Pharmaceuticals Inc.; Mallinckrodt PLC; Insys Therapeutics Inc.; Allergan PLC; Actavis Pharma Inc.; McKesson Drug Company; Cardinal Health Inc.; and AmerisouceBergen Corporation.

    In Gassville, council members Naomi Lassen and Anita Seaman voted in favor of the city joining the AML’s lawsuit, while council members Tim McFarland, Rick Peglar, Kayla Holland and Ralph Bird each voted against adding to the city to the lawsuit.

    The AML’s proposed lawsuit was initially presented to the Gassville City Council in January. Council members at that time voted not to join the proposed lawsuit.

    “It’s my understanding that the AML is fast-tracking [the lawsuit],” Gasvville Mayor Jeff Braim said. “I think they’re about to close the class-action, so Gassville will not be a part of it.”

    Norfork’s City Council has six elected positions, but only three council members — Kay Gragg, Phillip Stultz and Don Sappington — were in attendance Tuesday night. Council member Jeremy Mincey was ill, and the city had two open council seats following the death of Eric Stover and the resignation of Nina Brewer.

    Gragg and Stultz both voted for enjoining the city to the AML’s lawsuit, while Sappington abstained. Mayor Lisa Harrison exercised her option to cast a vote, giving the AML proposal the third vote it needed to add Norfork to its list of participating cities.

    In Baxter County, Norfork is the only confirmed municipality so far to join the AML’s proposed lawsuit.

    A resolution for the City of Mountain to join the class-action was discussed in January and February, but ultimately no action was taken on that proposal. The AML proposal is listed on the Cotter City Council’s agenda for tonight’s meeting, and the topic has not been discussed by the city councils of Salesville or Briarcliff. At press time, it was unclear if the issue had been discussed by the Lakeview or Big Flat city councils.

    There were 235.9 million opioid pills sold in Arkansas in 2016, according to data from the federal Centers for Disease Control and Prevention and the National Institutes of Health. Data shows that Arkansas had the highest rate teen prescription drug abuse in 2013, and more than 1,000 people have died from drug overdoses in the state since that year.

    Arkansas has the second-highest opioid prescription rate in the nation, at more than 114 prescriptions for every 100 people, behind only Alabama, according to the Centers for Disease Control and Prevention.

    Perdue Pharma, the pharmaceutical company that manufactures OxyContin, announced on Feb. 9 that it would no longer tout the drug or any other opioids to doctors.

    “We have restructured and significantly reduced our commercial operation and our sales representatives will no longer promote opioids to prescribers,” part of Purdue Pharma’s announcement read.

    A statement issued Jan. 9 by the Healthcare Distribution Alliance, the national trade association representing AmerisourceBergen, Cardinal Health and McKesson, noted that opioid distributors were taking steps to be part of the solution, but were not willing to be scapegoats.

    “Distributors are logistics companies that arrange for the safe and secure storage, transport and delivery of medicines from manufacturers to pharmacies, hospitals, long-term care facilities and others based on prescriptions from licensed physicians. We don’t make medicines, market medicines, prescribe medicines or dispense them to consumers,” John Parker, the senior vice president of the Healthcare Distribution Network. “Given our role, the idea that distributors are solely responsible for the number of opioid prescriptions written defies common sense and lacks understanding of how the pharmaceutical supply chain actually works and how it is regulated.

    “We are ready to have a serious conversation about solving a complex problem and are eager to work with political leaders and all stakeholders in finding forward-looking solutions.”

    New council members appointed at Norfork

    The Norfork City Council filled two vacancies Tuesday, appointing Mark Conley as Ward 1, Position 2 representative and Lyndsey Simpson as Ward 2, Position 2 representative.  Conley will complete the term of the late Eric Stover, while Simpson will complete the term of Nina Brewer, who resigned earlier this year. Both candidates will serve until Dec. 31 and are eligible to seek re-election to the City Council in the General Election on Nov. 6.

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Southwest (NV)

28. North Las Vegas to sue pharmaceutical companies over opioids

    Feb 21, 2018 | Las Vegas Review Journal (NV)

    By Art Marroquin

    The North Las Vegas City Council on Wednesday night voted unanimously to file a civil lawsuit against pharmaceutical drug manufacturers, aimed at recovering money spent on battling opioid addiction through enforcement, medical treatment and social services.

    The City Council hired Las Vegas personal injury law firm Eglet Prince, which has handled similar cases against “some of the largest drug manufacturers in the world,” according to a report by City Attorney Micaela Moore.

    “This hits close,” Councilman Isaac Barron said, adding that his cousin died of opioid addiction.

    More than 100 municipalities nationwide, including Clark County and Reno, have filed similar lawsuits to recover the high cost of prosecuting opioid-related crimes, housing offenders and rehabilitation efforts.

    Robert Eglet, senior partner at Eglet Prince, said that Lyon County is set to consider next week whether to join the lawsuit, while Henderson city officials are negotiating with the law firm.

    “County and city governments and the services they provide their citizens have been strained to the breaking point by this public crisis,” Eglet told the City Council. “The drug companies knew their marketing and the way opioids were prescribed were contrary to the scientific and medical evidence.”

    Eglet said his law firm has budgeted $15 million for the lawsuit. North Las Vegas will not spend any money to file the lawsuit, but Moore said that Eglet Prince will cap contingent fees at 25 percent.

    Moore’s report said that the lawsuit is not expected to conflict with Nevada Attorney General Adam Laxalt’s similar, ongoing multistate investigation.

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Broadcast Media Coverage

29. Eyewitness News at 5am

    Feb 22, 2018 | KYW (CBS)

    By Philadelphia, PA

    Video Link: http://app.criticalmention.com/app/#clip/view/32887648?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f

    Rough Transcript: staying in new jersey camden county taking opioid makers and contributors to court, they announced a big lawsuit yesterday, it targets manufacturers like purdue pharma and rite aide and wall green. county seeking money for drug treatment and toned what it considered, dangerous practices by pharmaceutical industries.

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30. News 12 New Jersey

    Feb 22, 2018 | N12NJ (News 12)

    By New York, NY

    Video Link: http://app.criticalmention.com/app/#clip/view/32887551?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f

    Rough Transcript: camden county is suing the company that manufactures oxycontin. the lawsuit claims purdue pharma tricked doctors into believing opioids could be prescribed without risk of addiction. camden officials cite the costs the county incurred in trying to curb opioidaddiction.

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31. NBC 10 News Today at 6a

    Feb 22, 2018 | WCAU (NBC)

    By Philadelphia, PA

    Video Link: http://app.criticalmention.com/app/#clip/view/32887584?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f

    Rough Transcript: lawmakers in camden county claim the makers of oxycontin are the same as powerful drug cartels. the county said it filed a groundbreaking lawsuit against pharmacies and drug companies including purdue pharma which makes oxycontin and other addictive opioid painkillers. the lawsuit aims to stop opioid distribution and make funding available for treatment, awareness, and educating doctors about the drugs' dangers. >> they should know the devastation they've caused. they knew those pills were addictive. >> if they affected one life, this lawsuit is worth it in my eyes. >> purdue pharma issued a statement saying they could for only 2% of total yoiopioid prescriptions and "vigorousl deny the allegations."

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32. NJTV News With Mary Alice Williams

    Feb 22, 2018 | WNJT (PBS)

    By Philadelphia, PA

    Video Link: http://app.criticalmention.com/app/#clip/view/32887569?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f

    Rough Transcript: the lawsuit filed under racketeering statute said they deceived doctors and the public into believing opioids could be prescribed for long periods of time with little to no risk of addiction. a false premise resulting in billions for purdue pharma and the family and it was adopted by each of the defendants as well as those who acted in concert with them. the lawsuit names no less than 8 drug makers, three distributors and four drugstore retailers, and calls the operation a criminal enterprise. 6:45 AM>> market and ship millions of narcotics throughout the nation. including court cut, new jersey. comeden countyic new jersey. >> reporter: her son's did a -- camden count, new jersey. >> reporter: her son died and she said people struggling with addiction still need help. >> could this help if the lawsuit comseeds? >> i hope -- succeeds? >> i hope. we need beds. >> reporter: the congressman -- the governor chris christie administration filed lawsuits against big parma speaking funny to -- money to pay for addiction treatment and education programs. the company's response to the lawsuit, we deny the allegations and look forward to the opportunity to present our defense. we are troubled by the prediction and opioid abuse crisis. as a campgrounded in science we must balance patient access to fda approved medication while working to solve this challenge. they will fight to end the opioid crisis but camden county wants cash to cover the epidemic's damages. >> you caused this health crisis and the deaths deaths of our loved ones and you must now pay. >> we are so desperate in trying to provide services to our residents and at the same time we have such a lack of funds and support from the federal government. now is the time. >> reporter: the lawsuit was filed in camden county superior court. brenda flanagan, njtv news.

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33. FOX5 News This Morning

    Feb 22, 2018 | KVVU (Fox)

    By Las Vegas, NV

    Video Link: http://app.criticalmention.com/app/#clip/view/32887523?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f

    Rough Transcript: over to north las vegas where city council has hired the eglet prince law firm to file a civil suit to go after big pharma companies that manufacture opioids. the city wants to recover the growing cost of battling opioid addiction through social services, medical treatment and enforcement. north las vegas joins 100 other municipalities who are going after pharmaceutical companies for their marketing and the way they pushed opioids. robert eglet a senior partner in the law firm says north las vegas will not pay a dime in legal fees and that the law firm will cap contingent fees at 25%. robert eglet has a track record of successuly going after big pharacuetical companies. this lawsuit is not expected to create any conflict with an ongoing multi state investigation into the way the big drug companies have promoted opioids over the years.

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34. News15 Today HR 4

    Feb 22, 2018 | KADN (Fox)

    By Lafayette, LA

    Video Link: http://app.criticalmention.com/app/#clip/view/32887537?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f

    Rough Transcript: state attorney general jeff landry has taken the reins of louisiana's lawsuit against opioid manufacturers. landry and governor john bel edwards announcing the move yesterday. the two had been at loggerheads over which office should pursue the suit. the suit accuses pharmaceutical compans of flooding the state with the powerful painkillers while downplaying their highly addictive nature.

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35. Montana This Morning

    Feb 22, 2018 | KPAX (CBS)

    By Missoula, MT

    Video Link: http://app.criticalmention.com/app/#clip/view/32887540?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f

    Rough Transcript: montana attorney general tim fox has filed a motion in district court asking a judge to block purdue pharmaceuticals from marketing the powerful opioid oxycontin in the state. fox's motion asks purdue immediately stop all sales representative promotions of opioidsto prescribers in montana. the motions ask prudue to stop making what he claims are false and misleading claims about the risks of its opioid products...implement a program to monitor orders that may be suspicious...and report to the attorney general's office quarterly. fox's office says this step is necessary after a former purdue sales representative reportedly described a practice where quote: "sales representative encouraged doctors to flag the charts of patients who might be candidates for opioids and asked to review those private patient files with the doctors to discuss putting those patients on purdue's narcotics." "we know that peopl are still begin addicted to opioid based prescription drugs we know that people are still overdosing we believe this is important again that we protect the health of montans as this case goes forward." the new filing is the latest action the state has taken against the oxycontin maker. in december fox's office filed a consumer protection lawsuit against purdue.

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36. WSBT 22 News on Fox

    Feb 22, 2018 | WSBTDT2 (Fox)

    By South Bend, IN

    Video Link: http://app.criticalmention.com/app/#clip/view/32887561?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f
    

    Rough Transcript: st. joseph county is joining a lawsuit against opioid manufacturers and distributors. according to ted booker with our reporting partners at the south bend tribune... county commissioners unanimously voted to join other cities in the lawsuit this week. the lawsuit accuses pharmaceutical companies of deceptive marketing practices. if won... drug companies wil have to reimburse the county for the cost of increased public health and safety services used to combat the opioid epidemic.

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37. FOX 12's 9 O'Clock News on PDX-TV

    Feb 22, 2018 | KPDX (MNT)

    By Portland, OR

    Video Link: http://app.criticalmention.com/app/#clip/view/32887589?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f

    Rough Transcript: clark county has become the latest jurisdiction to announce it's taking legal action against opioid manufacturers. county officials voted yesterday to hire a law firm to sue several pharmaceutical companies. the seattle-based firm of keller rorbach has offices in four states and is also suing the companies on behalf of several other washington jurisdictions -- including king county and the city of tacoma. the firm will be paid only if clark county recovers damages in the suit. officials say since 2014, 91 people have died of opioid- related causes in clark county. meanwhile-- oregon is starting to get a handle on the opioid crisis. in the last few years -- fewer oregonians have died from opioid overdoses -- though thousands still struggle with opioid addiction. meantime -- thousands of other oregonians are struggling with severe pain and rely on opioids to relieve their pain. but right now -- under federal rules -- their pain meds are being cut. ((01:00:00:00 "i'm reall scared. i'm already feeling pain i never felt, and i'm afraid.")) coming up o the 10 o'clock 

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38. KOLR 10 News at 9 on Z

    Feb 22, 2018 | KOZL (Fox)

    By Springfield, MO

    Video  Link: http://app.criticalmention.com/app/#clip/view/32887606?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f

    Rough Transcript: on ozarks tonight, overcoming opioid addiction in the ozarks. we re joined tonight by our own jesse inman who has been doing some important work on the opioid cris here in the ozarks as part of a series airing this month. jesse thanks for being here. now tell us if we haven t had a chance to see your pieces what is the gist of what you ve been investigating. jesse well, i ve really been talking to a lot of people about opioid treatment. we hear a lot about the opioid epidemic itself and how 10:17 PMbad it is especially in our state, but we don t really hear a ton about treatment for people and that s kind of what i ve been honing in on on my three pieces that i ve done this month. brian alright so what are the approaches to the treatment that are most popular? jesse well, for the first piece at i did we really just focused our the brass tax. you know the meat and potatoes. the different medications that you can take. we focused on suboxone, and that s usually used as part of a treatment, not necessarily always just by itself. methadone as well, that was one of the treatments, and there s a couple different clinics here in town. then we focused on inpatient rehab as well and also the dangers of going cold turkey, a lot of misconceptions about that. brian alright, so what are the dangers? jesse with that what i found out from under diction specialist at cox health was that most people think that they can just go cold turkey and everything will be fine, but the problem with that is that it is a very low success rate and folks that may go cold turkey for a few days maybe a week maybe even a month as long as that goes that they could be, you know, an extended period of time, but they end up 10:18 PMrelapsing and going back into those old habits just because they don t have the medication to kind of supplement that or a treatment style to go with it to keep the craving away. brian so how long from the time someone starts treatment does it take for them to have a realistic shot of getting off the drugs? jesse well, it really depends on what they re doing. a lot of things as far as inpatient rehab goes, if you re in you know house i ve heard really varying lengths of time. i ve heard anywhere from ninety to one hundred twenty days, and i ve heard some people are able to go back to functioning outside of an inpatient rehab centers after about thirty days. so a lot of it really depends on the person, and that s the tough part about addiction is it doesn t have a set demographic you know that it goes. it can be anyone and it affects everybody did a little bit differently. brian what are the common reasons someone gets hooked in the first place? jesse 10:19 PMwell a lot of people as far as opioids go like pain pills it can start by just having you know chronic pain or maybe a surgery and they just you know they get a little bit too dependent maybe on some of those pain killers. and then once that tolerance plateaus for some of those pain killers people look elsewhere for the high that they crave, and, unfortunately, that s what a lot of people turn to heroin. brian now the president has labeled opioid addiction a national health cris set top priority for the government and you get a sense from talking to the experts here locally that they have any kind of idea about where policy should go to try to stem the tide of these addictions most effectively? jesse well, i actually talked to attorney general josh holley, and that was for my second piece, and he has a lawsuit right now against three of the largest opioid manufacturers in the country. and the gist with that lawsuit really is just that he says that these large opioid manufacturers are responsible for getting people hooked on these drugs. they ve misconstrued the dangers of these drugs and how addictive they can really be, and this goes back over decades we re talking here, and attorney general holly had said that they used a lot of different things to kind of persuade doctors to persuade patients and it s just really been a trickle down type of effect with that. and so what he s seeking is some compensation from these opioidmanufacturers much in the same way that the tobacco lawsuit in the late ninety s kind of helped get some funding back in for people for tobacco and that you know people who are addicted to tobacco and back in the day and didn t have a good way to get treatment for it so that s really what he s trying to do is get money back into the state for treatment, for job training, really just to get people back on their feet and the entire process and that takes. brian to be continued. jesse inman for us. we appreciate all your great work on this important topic. and folks,

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39. WALB News 10 at 6

    Feb 22, 2018 | WALB (NBC)

    By Albany, GA

    Video Link: http://app.criticalmention.com/app/#clip/view/32887617?token=f6747a35-2cfb-4eae-8b18-e895cefbf30f

    Rough Transcript: cook county commissioners joined the fight against the opioid manufactures and distributors last night. board members unanimously approved a resolution to hire a law firm to help with litigation. at the meeting commissioners agreed the public health epidemic had a big impact on the cook county hospital. they say easy access to opioids led to an overwhelming influx of indigent patients, and ultimately prompted e-r to close. that change goes into effect at the end of the month. studstill law firm out of nashville will help cook county navigate through a class action lawsuit already in place. the contract stipulates the county won't pay any legal fees or out-of-pocket expenses until some recovery is made from the drug manufacturers.

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