Opioid Litigation Daily Media Report - 3/13/18

Commentary and FYIs

1. The War on Opioids Has Become a War on Patients

   Mar 12, 2018 | CATO Institute

   By Jeffrey A. Singer
   
   
   As Anne Fuqua recently pointed out in the Washington Post, non-medical drug users accessing heroin and fentanyl in the underground drug market are not the only victims in the opioid crisis. Many patients whose only relief from a life sentence of torturing pain are also victims. That is because policymakers continue to base their strategies on the misguided and simplistic notion that the opioid overdose crisis impacting the US, Canada, and Europe, is tied to doctors prescribing opioids to their patients in pain.
2. Injectable opioids scarce in hospitals and hospices despite the U.S. being awash in pills

   Mar 13, 2018 | FiercePharma

   By Joseph Keenan
   
   
   Amid the opioid crisis in the U.S., physicians and pharmacists in hospitals and hospices are having increasing difficulty finding injectable painkillers like morphine, hydromorphone (Dilaudid) and fentanyl for easing pain or sedating patients.
3. How America’s prisons are fueling the opioid epidemic

   Mar 13, 2018 | Vox

   By German Lopez
   
   
   For once, Casey is optimistic about his future. After 16 years of struggling with drug addiction, he no longer feels the need to use. He has a steady job doing hazard tree removal for a Fortune 500 energy company. He’s working on getting specialized training for a license to help him land better-paying jobs. He’s even going to the gym.
4. Opioid manufacturers found to be paying physicians for over-prescribing drugs

   Mar 12, 2018 | San Diego Entertainer Magazine (CA)

   By Austin Schoonmaker
   
   
   According to new analysis by CNN and Harvard University, researchers have found that opioid manufacturers are paying physicians large sums of money for prescribing more of their drugs. In 2014 and 2015, thousands of doctors were paid by opioid manufacturers in exchange for consulting, speaking, and prescribing patients these drugs. Hundreds of doctors were paid over six-figures, while others were paid over $25,000 during that time. Doctors who prescribed their patients larger amounts of drugs were said to be more likely to be paid larger sums.
5. Taxes, fees in Andrew Cuomo budget draw criticism

   Mar 12, 2018 | Newsday

   By David M. Schwartz
   
   
   A conservative think tank called on New York State lawmakers Monday to strip $1 billion in tax and fee increases from Gov. Andrew M. Cuomo’s budget.
6. Grassley, Durbin, Kennedy, Feinstein Introduce Opioid Quota Reform Bill to Strengthen DEA’s Ability to Prevent Opioid Diversion and Abuse (Press Release)

   Mar 12, 2018 | US Sen. Chuck Grassley (R-IA)

   In the midst of a prescription opioid, heroin, and fentanyl crisis that is devastating communities of all sizes and in every state, U.S. Sens. Chuck Grassley (R-Iowa), Dick Durbin (D-Ill.), John Kennedy (R-La.) and Dianne Feinstein (D-Calif.), all members of the Senate Judiciary Committee, today introduced the Opioid Quota Reform Act of 2018. This narrow, bipartisan legislation will enhance the Drug Enforcement Administration’s (DEA) existing opioid quota-setting authority by improving transparency and enabling DEA to adjust quotas to prevent opioid diversion and abuse.
7. A bit uneasy about joining lawsuit (Opinion)

   Mar 13, 2018 | Norfolk Daily News (NE)

   By Editorial Board
   
   
   The Madison County commissioners have a decision to make in the near future, and one can make a reasonable argument that they should go ahead and become a part of a class-action lawsuit with other Nebraska counties against opioid producers.

Northeast (NY, CT, PA)

8. Schuyler County is the latest to sue Big Pharma

   Mar 13, 2018 | WETM 18 News (NY)

   By Brooke Taylor
   
   
   Schuyler County is the latest New York county to sue Big Pharma. The county blames the opioid epidemic on their dishonest marketing.
9. Wallingford hires law firm for possible opioid suit

   Mar 12, 2018 | Record-Journal (CT)

   By Matthew Zabierek
   
   
   The town has hired a law firm to help determine whether to bring legal action against opioid manufacturers.
10. Phila. DA sues 10 pharmaceutical companies for their alleged roles in the opioid crisis

    Mar 12, 2018 | The Daily Pennsylvanian (PA)

    By Zachary Zamore
    
    
    The Office of the Philadelphia District Attorney Larry Krasner announced the filing of a lawsuit against ten pharmaceutical companies for their alleged roles in causing the opioid crisis.
11. OPIOID CRISIS: Rush Health, Philadelphia, Clarke County join lawsuit

    Mar 13, 2018 | The Meridian Star (PA)

    By Whitney Downard
    
    
    Rush Health Systems, the city of Philadelphia and Clarke County are among at least six other counties and one other healthcare provider in Mississippi that have filed lawsuits against opioid manufacturers, opioid distributors and pharmacies, citing the increased costs of care and loss of workforce.

Southeast (AL, FL)

12. Cleburne County Commission retains law firm for opioid crisis relief

    Mar 12, 2018 | The Anniston Star (AL)

    By Bill Wilson
    
    
    The Cleburne County Commission voted unanimously Monday night to retain a Montgomery law firm to represent the county in a claim for damages against manufacturers and/or distributors of opioids.
13. County to pursue claims against drug companies

    Mar 12, 2018 | 280 Reporter (AL)

    By Stephen Dawkins
    
    
    Opioids have created an “ever growing crisis” locally and nationally, and Shelby County will pursue potential claims for damages against manufacturers and distributors of the drugs.
14. Osceola County considers suing pharma companies to offset costs of opioid crisis

    Mar 12, 2018 | WFTV 9 ABC (FL)

    By Michael Lopardi
    
    
    Osceola County leaders are ready to take on what could be an unprecedented plan to combat the opioid crisis.

Southwest (TX)

15. In "race to the courthouse," lawyers urge Texas counties to sue over opioids

    Mar 13, 2018 | The Texas Tribune (TX)

    By Marissa Evans
    
    
    Bill Bilyeu started receiving the Powerpoint presentations in October.
16. City Reviewing Proposals As County Moves Forward With Opioid Lawsuit

    Mar 13, 2018 | Rivard Report (TX)

    By Roseanna Garza
    
    
    The City of San Antonio is considering whether to join Bexar County in suing opioid drug manufacturers and distributors that it blames for an addiction epidemic that has been devastating locally.

Midwest (OH)

17. Strongsville may join litigation against makers and distributors of opioids

    Mar 12, 2018 | Cleveland.com (OH)

    By Bill Sandrick
    
    
    The city may join ongoing litigation against drug manufacturers and distributors over the nation's opioid epidemic.

Broadcast Media Coverage

18. Eyewitness News at 5pm

    Mar 12, 2018 | Orlando, FL

    By WFTV (ABC)
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/33529318?token=33fda644-6c45-4291-bf91-a398ca53ffd7
19. The NOW

    Mar 12, 2018 | Cleveland, OH

    By WEWS (ABC)
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/33529341?token=33fda644-6c45-4291-bf91-a398ca53ffd7
20. NewsCenter 5 at Noon

    Mar 12, 2018 | Boston, MA

    By WCVB (ABC)
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/33529345?token=33fda644-6c45-4291-bf91-a398ca53ffd7
21. 18 News Today

    Mar 13, 2018 | Elmira, NY

    By WETM (NBC)
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/33529352?token=33fda644-6c45-4291-bf91-a398ca53ffd7

Commentary and FYIs

1. The War on Opioids Has Become a War on Patients

   Mar 12, 2018 | CATO Institute

   By Jeffrey A. Singer

   As Anne Fuqua recently pointed out in the Washington Post, non-medical drug users accessing heroin and fentanyl in the underground drug market are not the only victims in the opioid crisis. Many patients whose only relief from a life sentence of torturing pain are also victims. That is because policymakers continue to base their strategies on the misguided and simplistic notion that the opioid overdose crisis impacting the US, Canada, and Europe, is tied to doctors prescribing opioids to their patients in pain.

   Unfortunately, political leaders and the media operate in an echo chamber, reinforcing the notion that cutting back on doctors prescribing opioids is the key to reducing overdose deaths. As a result, all 50 states operate Prescription Drug Monitoring Programs that track the prescribing habits of doctors and intimidate them into curtailing the prescription of opioids. Yet multiple studies suggest that PDMPs have no effect on the opioid overdose rate and may be contributing to its increase by driving desperate pain patients to the dangers that await them in the black market.

   Last month Arizona joined the list of 24 states that had put in place limits on the amount and dosage of opioids doctors may prescribe acute and postoperative pain patients. These actions are based on the amateur misinterpretation of the 2016 opioid guidelines put out by the Centers for Disease Control and Prevention and are not evidence-based.

   And the Food and Drug Administration continues to promote the replacement of prescription opioids with abuse-deterrent formulations, despite an abundance of evidence showing this policy only serves to drive non-medical users to heroin and fentanyl while raising health care costs to health systems and patients.

   As prescriptions continue to decrease, overdose deaths continue to increase. This is because as non-medical users get reduced access to usable diverted prescription opioids, they migrate to more dangerous fentanyl and heroin.

   It is simplistic—and thus provides an easy target—for politicians and the media to latch on to the false narrative that greedy pharmaceutical companies teamed up with lazy, poorly-trained doctors, to hook innocent patients on opioids and condemn them to a life of drug addiction. But this has never been the case.

   As Patrick Michaels pointed out about recrudescent opiophobia back in 2004, prescription opioids actually have a low addictive potential and when taken by patients under the guidance of a physician, have a very low overdose potential. Cochrane systematic studies in 2010 and 2012 both found an addiction rate of roughly 1 percent in chronic non-cancer pain patients. And a January 2018 study in BMJ by researchers at Harvard and Johns Hopkins examined 568,000 opioid naïve patients prescribed opioids for acute and postoperative pain from 2008 to 2016 and found a total “misuse” rate (all “misuse” diagnostic codes) of just 0.6 percent. And researchers at the University of North Carolina reported in 2016 on 2.2 million residents of the state who were prescribed opioids, where they found an overdose rate of 0.022 percent.

   Until policymakers disabuse themselves of the false notion that the opioid overdose crisis is a direct result of doctors prescribing opioids to patients in pain, the opioid overdose rate will continue to climb—only the type of opioid from which victims are overdosing will change. We have already seen it move from diverted OxyContin and other prescription opioids to heroin, and from heroin to heroin plus fentanyl. Most recently, fentanyl was the predominant cause of overdoses.

   The “war on opioids” being waged by today’s policymakers is, in effect, a “war on patients in pain.” If policymakers are serious about wanting to reduce overdose deaths, they should look to what has been done in Portugal, and now Norway, and end the war on drugs. If they can’t muster the political will to go that far, then they should at least put the focus on harm reduction measures, such as syringe services programs, medication-assisted treatment, and making the overdose antidote naloxone available over-the-counter.

   Instead of a war on opioids, they should wage a war on deaths.

   Return to headline | Return to top

2. Injectable opioids scarce in hospitals and hospices despite the U.S. being awash in pills

   Mar 13, 2018 | FiercePharma

   By Joseph Keenan

   Amid the opioid crisis in the U.S., physicians and pharmacists in hospitals and hospices are having increasing difficulty finding injectable painkillers like morphine, hydromorphone (Dilaudid) and fentanyl for easing pain or sedating patients.

   Injectable opioids are essential in healthcare environments, and pills are often inappropriate for the same use. 

   Some hospitals, like Penn Presbyterian Medical Center, have reported having to use more expensive alternatives for an extra cost of $30,000 in the past three months, The Philadelphia Inquirer reported. The hospital said three months ago they were getting 20% to 30% less of injectable painkillers than they needed. Those percentages have since increased to 50% to 60% less of the drugs they require.

   The shortage has led the American Society of Health-System Pharmacists, American Society of Anesthesiologists, Institute for Safe Medication Practices and the American Society of Clinical Oncology to urge the Drug Enforcement Administration to temporarily adjust the aggregate production quotas for certain injectable opioid medications in short supply that would allow other manufacturers to provide product until the shortage is resolved.

   “We understand and share the DEA’s concern that these medications need to be well‐managed and used judiciously to help stem the nation’s opioid epidemic,” the organizations wrote. “We fully support and use advances in pain management, such as multimodal analgesia, that enable patients to undergo procedures with fewer opioids and less reliance on opioids after surgery.

   “Nonetheless, injectable opioids remain a crucial component of patient management during and immediately after many operations. With no appropriate opioids available, operations would have to be postponed or cancelled. In some cases, this could prove life‐threatening to the patient.”

   The cause of the shortage stems from manufacturing issues that have been magnified by government regulations aimed at preventing the illegal sale of the addictive drugs.

   Pfizer, a major manufacturer of small syringes and vials of the painkillers, has said some of the products may not be available until July. However, it expects a “full recovery date” for supplies in early 2019, the newspaper reported.

   Return to headline | Return to top

3. How America’s prisons are fueling the opioid epidemic

   Mar 13, 2018 | Vox

   By German Lopez

   For once, Casey is optimistic about his future. After 16 years of struggling with drug addiction, he no longer feels the need to use. He has a steady job doing hazard tree removal for a Fortune 500 energy company. He’s working on getting specialized training for a license to help him land better-paying jobs. He’s even going to the gym.

   But Casey, who asked that I only use his first name for this story, knows this could have turned out very differently. In fact, it had the past few times he was released from prison. Before, he had relapsed as quickly as a matter of days — not only exposing himself to the risk of a deadly overdose but leading to a spiral of drug use that hindered just about every aspect of his life and, often, landed him in prison again.

   The big difference: This time, he got treatment — real treatment — while he was in prison.

   Casey, who’s 36, was one of the beneficiaries of Rhode Island’s relatively new approach to treating opioid addiction in prisons and jails: It now provides the three main medications for opioid addiction to inmates within its facilities, with few strings attached. The three medications — buprenorphine, methadone, and naltrexone — are considered by experts to be the gold standard of care for opioid addiction, with studies showing that they reduce the all-cause mortality rate among opioid addiction patients by half or more and do a far better job of keeping people in treatment than non-medication approaches.

   “If I tried doing it on my own, I would have relapsed,” Casey told me. “I hate saying that, because I’m a mentally strong person — you know, I can go through the ringer. But after six or seven or eight years of doing this to myself, all of a sudden when I get clean [without medication], I just don’t feel 100 percent. I’m stuck at 90.” He said that buprenorphine, which he started taking after he was incarcerated in November, keeps him at 100 percent without using other drugs.

   Rhode Island’s approach is unusual. In an extensive review of state prison policies, I found that almost no state prison system offers these medications to inmates suffering from opioid use disorder. Only two — Rhode Island and New Jersey — reported providing full access to all three kinds of medication. The great majority of states reported not providing any medication at all or allowing only naltrexone, the medication with the least evidence behind its effectiveness.

   In other words, the majority of state prisons don’t offer full access to what experts say is the mainline form of treatment for opioid addiction — and the kind of treatment that has helped Casey get his life back in order.

   Before this, Casey had struggled with addiction for 16 years, starting with OxyContin and progressing to heroin and other substances. In that time, he was arrested four times for drug possession, and he was held in prison for a few weeks or months at a time. He would be “clean,” he said, initially during his release — since he was forced to detox in prison — but within days or weeks, he’d be back to using drugs.

   With buprenorphine treatment that began with his most recent stint in prison, Casey has managed to avoid relapse since he was released in mid-January. “I don’t feel the cravings like I did before,” he said. “It’s really helped me to stay clean.”

   In some ways, Casey is lucky — he survived to this point. Since so few state prisons offer adequate access to treatment, the days and weeks after a person’s release from prison are perhaps the single deadliest time period in the US’s opioid epidemic.

   When an inmate addicted to opioids is released from prison, his chances of a fatal overdose are massively elevated: According to a 2007 study published in The New England Journal of Medicine, former inmates’ risk of a fatal drug overdose is 129 times as high as it is for the general population during the two weeks after release. Other studies have backed this up, putting the increased risk of overdose death in the tens of times or above 100 times.

   “Globally, there is no more high-risk period and no more high-risk population than those leaving incarceration,” Traci Green, a researcher at Brown University in Rhode Island, said. “It’s during those first two weeks and out to four to six weeks that people are at greatest risk of overdose death.”

   Although Rhode Island’s program is still young, a recently released study found that it seems to work as expected — cutting overdose deaths among released inmates by more than half. In Casey’s telling, the program has helped mitigate his risk here as well.

   Yet Rhode Island’s approach remains rare, even in the midst of an opioid crisis that was linked to at least two-thirds of 2016’s record 64,000 drug overdose deaths.

   “We have a population that’s incredibly vulnerable,” Sarah Wakeman, medical director at the Massachusetts General Hospital Substance Use Disorder Initiative, told me. “It’s really inexcusable that we don’t make this available for people who are at such risk of death.”Most state prisons don’t fully offer medications for opioid addiction

   Over the past two months, I reached out to the 50 agencies behind state prison systems, where around 1.3 million people are locked up. I first asked them if they provided any of the three main medications for opioid addiction — buprenorphine, methadone, and naltrexone. If so, I followed up to see if there were any restrictions attached. If necessary, I also verified what states said with news reports, state laws and regulations, and local experts or activists.

   Of the 46 states that sufficiently responded to my initial questions and follow-ups, only two reported full access to all three forms of opioid addiction medications. Hawaii said that it allows, at least in theory, buprenorphine and methadone, although the state clarified that it’s felt little need to widely provide the medications since it hasn’t been hit relatively hard by the opioid crisis. Sixteen states offer only naltrexone. The remaining 27 don’t fully offer anymedication to prisoners with opioid use disorders.

   Generally, states were counted on the map if they offered the medications — with few restrictions — for inmates diagnosed with an opioid use disorder or inmates who were otherwise taking part in treatment.

   For buprenorphine and methadone, that means an inmate with an opioid use disorder should be able to reliably obtain either drug while incarcerated. Both medications work similarly: As opioids themselves, they help stave off withdrawal and cravings, which are two major causes of relapse, without producing the same kind of high that heroin does. This lets a patient focus on other aspects of life without being consumed by a constant desire to use drugs.

   For naltrexone, an inmate should be able to obtain the medication at least shortly before his release, although some state prison systems also provide it during an inmate’s entire incarceration. Generally, naltrexone is primarily used to block the effects of opioids — potentially for up to 28 days with the once-a-month shot Vivitrol — although it can also reduce cravings.

   States were not counted as providing medications on the map if they imposed strict limits on how long an inmate could be on the medications, offered the medications as part of small pilot programs, allowed the medications only for certain groups (such as pregnant women or people who were on medications prior to incarceration), or provided the drugs exclusively for detox or withdrawal management.

   In addition to the states, the federal Bureau of Prisons (BOP) — which takes federal andWashington, DC, inmates — told me that it’s only working on a small program to provide naltrexone to inmates in federal facilities: “Specifically, inmates will begin treatment just prior to transferring to a Residential Reentry Center (RRC) and will continue the treatment for several months in the RRC. The program will begin in Boston and to the extent resources are available and the program is found to be effective, the BOP will look to expand the program.”

   One caveat: The map shows the states that technically allow certain medications, but whether a drug is truly accessible — meaning someone can actually obtain and fill a prescription in prison — is going to vary from state to state and even prison to prison. So the map, as dismal as it already is, likely overstates the level of access to opioid addiction medications in state prison settings.

   The map also doesn’t cover most jails or parole and probation, both of which are sometimes leveraged by authorities to link people to addiction treatment. This is a very large segment of the correctional population — constituting millions of people — but policies in these areas are often guided by individual courts, probation and parole officers, and local officials who run jails, rather than state prison policy.

   But the map is in line with other data. About 58 percent of people in state prison meet the definition for drug dependence or misuse, compared to 5 percent of the general population, according to a 2017 report from the Bureau of Justice Statistics. Yet a 2017 study by Johns Hopkins researchers found that less than 5 percent of people who were referred to opioid use disorder treatment through the justice system received methadone or buprenorphine, compared to nearly 41 percent of people referred through other sources.

   The results ripple through society — exposing people to a higher risk of death and other addiction-related problems, as well as imposing higher social and financial costs on other systems that have to pick up prisons’ slack.How state prison policies can kill people with opioid addiction

   There are two big ways that state policies blocking off opioid addiction medications cause more overdose deaths.

   First, there’s the risk of overdose within prison. Although studies suggest that drug use is actually lower in prison (since it’s simply much harder to obtain drugs), there is still some drug use — which, obviously, carries the risk of overdose and death. But if someone gets treatment for opioid addiction, he’s going to be less likely to use drugs or overdose while incarcerated.

   A bigger concern, though, is the risk of overdose once someone is released from prison — a time period when someone’s risk of death is massively increased.

   “The minute people leave, they’re facing tremendous stressors,” said Wakeman, who’s worked with previously incarcerated populations. “They cross over this threshold of leaving this very artificial environment, going back to their usual environment, and with the incredible stress and burden of having just experienced incarceration and trying to pick up relationships and dealing with barriers with housing and employment and insurance. Not surprisingly, cravings come back, and people often relapse very quickly.”

   Imagine that an inmate is using heroin or already on buprenorphine treatment before he’s incarcerated. Once he’s locked up, he’s forced off the drugs cold turkey. He actually manages to stay drug-free in prison. But then, a few months or years later, he’s released. He’s thrown back into the same environment where he used drugs. He’s perhaps not sure how to reintegrate into society, creating a lot of stress. But he knows how to get in contact with his old drug dealers.

   He does just that — and buys heroin (or, increasingly likely, illicit fentanyl). But since he hasn’t used opioids during all his time in prison, his tolerance is much lower. So when he tries the same dose that he used in the past — or even if he tries to be careful — he’s much more likely to overdose and die.

   Buprenorphine and methadone make this much less likely because, as opioids, they help maintain some level of tolerance as long as someone is on them. And naltrexone blocks the effects of opioids altogether. In case of relapse, either of these features would help — the maintained tolerance will allow someone to take a higher dose of heroin, fentanyl, or other opioids without overdosing, and the blocking effect can stop someone from getting high or overdosing at all.

   And by reducing cravings in the first place, these medications also reduce the chances of relapse overall.

   One thing to keep in mind: Overdose deaths are a tragic proxy for general problems with addiction here, but addiction has many more effects. It destroys people’s careers, drives them to crime, breaks up families, and causes secondary health problems like HIV/AIDS and hepatitis C from reused needles, among many other issues. All of these problems are also made much more likely when people can’t get access to adequate treatment.In Rhode Island, an alternative — and lifesaving — approach

   Rhode Island has shown there is a better way. The state committed serious resources to not only provide all opioid addiction medications in theory, but to make sure they’re accessible to all inmates who need them. And, going further, the system tries to ensure ex-inmates are linked to treatment and continue getting medications as needed after they’re released.

   In 2015, Rhode Island Gov. Gina Raimondo, a Democrat, established a drug overdose task force, bringing in major stakeholders to study and implement the best policies to reverse the opioid crisis. Among the proposals was dramatically improved access to opioid addiction medications in state prisons. Over 2016 and 2017, Rhode Island finally scaled up its prison program.

   “This has really been my vision for the last 20 years,” said Jennifer Clarke, who has been with the state’s Department of Corrections for two decades and has served as medical program director for two years.

   The first evaluation of the system, released in February, reported very promising results: The research letter, published in JAMA Psychiatry, found that in the first six months of 2016, 26 people who were recently released from prison died of a drug overdose. In the first six months of 2017, nine individuals died. This was a drop in mortality of more than 60 percent — far higher than the overall state drop in overdose deaths during the same time period of about 12 percent.

   The study has some serious limitations. It was a small sample size. It only looked at the early results of Rhode Island’s program. There was also a drop in the supplied amount of naloxone, the opioid overdose antidote, among released inmates — which state officials copped to a temporary shift in recording practices — that could have mitigated the benefits of Rhode Island’s program.

   But this is in line with what you would expect from increased access to opioid addiction medications, given that studies show the death rate tends to drop by half or more when patients get access to these drugs.Rhode Island shows how to do this right

   The key to Rhode Island’s success, state officials said, is that it offers all three kinds of opioid addiction medications.

   Casey’s experience speaks to this: He tried to get on methadone in the past, but it just didn’t work very well for him, and he would soon be back to using drugs even while he was on methadone. “I’m not trying to knock methadone at all,” Casey said. “It was just different for me.”

   This isn’t atypical in health care. It’s often true that what works for one patient won’t for another. That’s why it’s important, experts say, to provide as many options as possible — as Rhode Island has done with its in-prison treatment program. Many people may do well on methadone, others may prefer buprenorphine, and yet some may find the best results with naltrexone or even no medications at all.

   “It’s critical to have all three of those components available,” Jody Rich, a researcher in Rhode Island who’s involved with the state’s program, told me.

   Yet the great majority of states that make any medication possible only offer naltrexone, typically for use as an inmate nears release — even though the best data suggests that, if anything, naltrexone is worse than the other medications. A 2017 study in The Lancet that compared buprenorphine and naltrexone, for example, found that while both medications have similar levels of effectiveness once people are on them, people were more than four times more likely to initially drop out of using naltrexone treatment than buprenorphine treatment.

   There’s a straightforward explanation for why buprenorphine performed so much better on the latter count: While buprenorphine requires only partial withdrawal (usually 12 hours to two days of no opioid use), naltrexone requires full detoxification to use (usually three to 10 days). Withdrawal is grueling and, in fact, a major reason for continued opioid use — so it’s no surprise that people would do anything they can to avoid it, even if it means dropping treatment.

   Rhode Island’s data speaks to this. It offers all three forms of medication, and naltrexone is far and away the least popular. According to the recent evaluation, just four inmates in the first six months of 2017 opted for naltrexone. In comparison, 180 took methadone and 119 took buprenorphine.

   “The most important factor about this medication is what you are going to take,” Rich said. “And so the best predictor of which medication someone will take is actually the patient’s preference.”

   Beyond providing all three medications within prison, officials also take steps to ensure inmates can get treatment once they’re released — by following up with them, helping them stay on insurance, and letting them use the same clinic they used in prison if needed. This kind of access is key to the program, Rich said.

   But the US struggles here too. According to a 2016 report by the surgeon general, just 10 percent of Americans with a drug use disorder obtain specialty treatment, in large part due to a lack of supply in care. And other data shows that even when drug addiction treatment is available, fewer than half of facilities offer opioid addiction medications as an option. The lack of access to adequate treatment outside of prisons will need to be addressed along with access inside of prisons to fully address the opioid crisis.

   Skeptics may argue that Rhode Island is a small state where, as a result, this model is uniquely able to work. But this model could be scaled up; it’s just a matter of building more and bigger clinics to cover wider geographical areas and larger populations — not just in prison but outside too. After all, other places, such as Vermont and France, have managed to scale up medication treatment.

   “This is a proof of concept,” Rich explained. “If you can get enough people onto these medications, that will reduce overdose deaths.”Stigma drives prisons’ resistance to offering medications

   Although the Supreme Court has found that prisoners are entitled to proper health care, medical services in prison are far from ideal — as prisons avoid paying too much for even lifesaving interventions to reduce expenses. But my investigation suggests that opioid addiction treatment is in especially bad shape, given that prisons in most states don’t even attempt to look like they offer the standard of care.

   One big reason for the dire circumstances is stigma. Looking at the research in this area, the White House’s opioid epidemic commission concluded in 2017 that “negative attitudes regarding [opioid addiction medications] appeared to be related to negative judgments about drug users in general and heroin users in particular.”

   There are several layers of stigma here. First, there’s the fact that these are prisoners, which simply makes it much harder for people to empathize with them. Of course, many inmates are in prison because of their drug use; for example, about 39 percent of people in state prison for property offenses said that they committed their crimes to get drugs or obtain money to get drugs. Good treatment, then, could actually reduce crime, benefiting not just the inmates but society as a whole. But understanding all of this requires a willingness to empathize with prisoners — which is just not how the US justice system is currently built.

   Then there’s the fact that these people are drug users. For a long time, American society has demonized drug addiction as a moral failure — not the disease that health care groups, including the American Medical Association and American Psychiatric Association, agree it is. This moralization of addiction makes it a lot easier to blame the victim for a drug use disorder, instead of blaming the medical condition itself and focusing on treating it.

   Finally, there’s stigma against buprenorphine and methadone. Since both are opioids, their use to treat opioid addiction is often described as “replacing one opioid with another” or “replacing one addiction with another.” This misunderstands how addiction works — the defining problem of addiction is not opioid or drug use, but rather when opioid or drug use leads to bad social and personal health and safety outcomes. After all, plenty of people use drugs, from medications to caffeine to alcohol, with few issues.

   An example of this stigmatization comes in one of the exceptions that prison systems carve out for opioid addiction medications: pregnant inmates. In my correspondences with state prison systems, they often told me that they’ll allow pregnant inmates to stay on or even start buprenorphine or methadone to avoid withdrawal — even if the rest of the inmate population is not offered either. The reason: Forced withdrawal during pregnancy could hurt or even kill the baby.

   Consider the underlying assumption here: The inmate is to blame for her opioid addiction — even though it’s, by definition, a disease she has little to no control over — so it’s okay if she suffers and even dies. The baby, meanwhile, is obviously innocent, so everything must be done to save it, even if it means using a stigmatized form of addiction treatment.

   “It sheds light on the fact that for all the many reasons you hear people give for why medication treatments either aren’t offered or shouldn’t be offered in prison, at the core of the argument is this notion that people are undeserving of compassionate, patient-centered, and effective treatment,” Wakeman said. “We have lifesaving, effective treatment that we wouldn’t withhold from babies … yet we’re not making it available.”

   There are other issues as well. Prisons don’t have an incentive to care about this problem, since many of the overdoses that happen as a result occur once an inmate is released — out of the prison’s jurisdiction.

   There are also worries about inmates and staff diverting buprenorphine and methadone to illegally sell it to inmates. But Rhode Island said that it cut down on this kind of diversion by better monitoring the administration of these drugs. Better access to treatment could even reduce diversion, since some research shows that many people only resort to illegal means of getting buprenorphine or methadone because they don’t have adequate legal access.

   Prisons also have concerns about the cost. Rhode Island’s program, for one, costs $2 million a year. (Although that’s only about 0.02 percent of the state’s operating budget.)

   But especially given Rhode Island’s success so far, drug policy and public health experts aren’t persuaded by the explanations and excuses for not providing full opioid addiction treatment in prison.

   Prisons “are responsible for [inmates’] health care,” Keith Humphreys, a drug policy expert at Stanford, told me. “If they had high blood pressure, [prisons] wouldn’t be allowed to stop them from getting their blood pressure medication. You’d have to supply that. So if they are addicted to opioids, you should have to supply whatever medication they take for that.”

   Otherwise, he added, the justice system is “potentially sentencing people to their death.”

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4. Opioid manufacturers found to be paying physicians for over-prescribing drugs

   Mar 12, 2018 | San Diego Entertainer Magazine (CA)

   By Austin Schoonmaker

   According to new analysis by CNN and Harvard University, researchers have found that opioid manufacturers are paying physicians large sums of money for prescribing more of their drugs. In 2014 and 2015, thousands of doctors were paid by opioid manufacturers in exchange for consulting, speaking, and prescribing patients these drugs. Hundreds of doctors were paid over six-figures, while others were paid over $25,000 during that time. Doctors who prescribed their patients larger amounts of drugs were said to be more likely to be paid larger sums.

   This revelation is an unsettling glimpse into the world of pharmaceutical companies using their deep pockets to get doctors to move their drugs in large quantities to their patients. Dr. Andrew Kolodny, a senior scientist at the institute for Behavioral Health at Brandeis University, told CNN, “This is the first time we’ve seen this, and it’s really important.” He went on to say, “It smells like doctors being bribed to sell narcotics, and that’s very disturbing.”

   This comes at a time when the nation is continually hit hard by crippling opioid addictions in millions of people. Many believe that the cause of opioid addiction stems from doctors over-prescribing the drugs, but since this research has come to light, it has shown to be a potential reason for physicians over-prescribing. Harvard researchers have said they don’t know whether these payments are used to encourage a company’s drug, or if these pharmaceutical companies are seeking out doctors that already have a high prescription rate for these drugs.

   Michael Barnett, an Assistant Professor of Health Policy and Management at Harvard, told CNN “I don’t know if the money is causing the prescribing or the prescribing led to the money, but in either case, it’s potentially a vicious cycle. It’s cementing the idea for these physicians that prescribing this many opioids is creating value.”

   The study was done by examining several federal government databases, one of which tracks payments that pharmaceutical companies make to doctors, while the other tracks prescriptions that doctors write to patients who are currently enrolled in Medicare. They found that during the 2014-2015 time, over 400,000 wrote a least one prescription for opioids. Digging deeper, they found that a little more than half of those doctors received a payment from these pharmaceutical companies who manufacture opioids.

   Through further analysis of the data, it shows that doctors who were ranked among the top 5 percent of opioid prescribers received twice as much money from these opioid manufacturers. Those who were in the top 1 percent received an average of four times as much money, and the top 10th of the 1 percent received a staggering nine times more than a typical doctor.

   Paying doctors for speaking or consulting is legal, but the practice has been surrounded in controversy for some time. Pharmaceutical companies have long paid physicians for various services, but it is illegal for doctors to prescribe a certain medication in exchange for payments from the manufacturer. Despite this, it is disheartening for many to hear that their physicians could possibly be involved in this, especially considering the high level of trust that many place in them.

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5. Taxes, fees in Andrew Cuomo budget draw criticism

   Mar 12, 2018 | Newsday

   By David M. Schwartz

   A conservative think tank called on New York State lawmakers Monday to strip $1 billion in tax and fee increases from Gov. Andrew M. Cuomo’s budget.

   Reclaim New York’s executive director Brandon Muir said at a news conference in Hauppauge that the proposed budget would increase the cost of living by expanding sales tax collections on online purchases to raise $75 million and instituting a health insurance “windfall profit tax” to raise $140 million and a $127 million tax on opioids.

   “Gov. Cuomo calls these ‘revenue enhancers.’ It sounds like a joke, but people actually have to pay these revenue enhancers to the government,” Muir said outside the H. Lee Dennison building.

   The Cuomo administration defended the new taxes as targeted to specific industries — pharmaceuticals, which it said contributes to the state’s opioid epidemic, and health insurers that are seeing a windfall from federal corporate tax cuts.

   And expansion of online tax collections would level the playing field between brick and mortar stores and online retailers that don’t collect sales tax, said Morris Peters, a spokesman for the state Budget Division.

   “We’re protecting retailers in your neighborhood from being undercut on price by making sure taxes are applied consistently across the board,” Peters said in an email.

   Muir called the proposed opioid tax, “the most disgusting tax” because it would increase the cost of painkillers, while earmarking only a portion of the revenues for drug and alcohol treatment.

   The proposed surcharge — $.02 per milligram prescribed — would be imposed on opioid manufacturers if they are headquartered in New York and, if not, on distributors. Drugstores would be exempt.

   Scott Reif, spokesman for Senate Majority Leader John Flanagan (R-East Northport), said he agreed with Reclaim New York.

   “Hardworking Long Island taxpayers pay more than enough already,” Reif said.

   A vote on the Senate’s budget is likely Wednesday, although the deadline for a final budget is April 1.

   At the news conference, Barry Cowen, owner of a Farmingdale pump manufacturer, criticized the state’s business climate.

   “It’s very difficult being in the worst state in the country,” he said.

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6. Grassley, Durbin, Kennedy, Feinstein Introduce Opioid Quota Reform Bill to Strengthen DEA’s Ability to Prevent Opioid Diversion and Abuse (Press Release)

   Mar 12, 2018 | US Sen. Chuck Grassley (R-IA)

   In the midst of a prescription opioid, heroin, and fentanyl crisis that is devastating communities of all sizes and in every state, U.S. Sens. Chuck Grassley (R-Iowa), Dick Durbin (D-Ill.), John Kennedy (R-La.) and Dianne Feinstein (D-Calif.), all members of the Senate Judiciary Committee, today introduced the Opioid Quota Reform Act of 2018. This narrow, bipartisan legislation will enhance the Drug Enforcement Administration’s (DEA) existing opioid quota-setting authority by improving transparency and enabling DEA to adjust quotas to prevent opioid diversion and abuse.

   DEA is responsible for establishing annual quotas determining the exact amount of each opioid drug that is permitted to be produced in the U.S. every year. DEA approved significant increases in aggregate opioid production quotas between 1993 and 2015, including a 39-fold increase for oxycodone and a 12-fold increase for hydrocodone. Such increases occurred largely because current law directs DEA to only consider certain factors when setting quotas—like past sales and estimated demand—but not other factors such as the impact of such opioid production on diversion, abuse rates, or overdose deaths. As a result, 14 billion opioid doses are put on the market each year—far more than necessary under current medical guidelines and enough for every adult American to have a one month’s prescription of addictive painkillers. 

   Recognizing this problem, Attorney General Jeff Sessions has asked DEA to evaluate whether changes are needed to its production quota process to address the disproportionate volume of opioid prescriptions issued each year in the United States.  

   “The opioid crisis will only be beat back if we use every tool possible to fight against it. This legislation is one of those tools,” said Grassley, chairman of the Senate Judiciary Committee. “Improving transparency in setting opioid quotas is critical to curbing opioid abuse while ensuring those who need opioids to treat illnesses and manage pain will still have lawful access to their medicine. As Chairman of Judiciary Committee and the Narcotics Control Caucus, I care deeply about finding a solution to the opioid epidemic, and this legislation is a step in the right direction.”

   “Every day, more than 100 Americans die from an opioid overdose. While we know that there are legitimate uses for opioid painkillers, we also know that these dangerous pills are being over-produced, over-prescribed, and over-dispensed,” said Durbin. “DEA plays an important gatekeeper role over the volume of opioids that can be produced each year. And while DEA has taken recent steps to lower opioid quotas, their ability to do so is limited. Opioid quota reform is needed so DEA can take important factors like diversion and abuse into account when setting quotas, rather than chasing the downstream consequences of this crisis. And this bipartisan legislation will allow DEA to do just that.  But our work is not done. These quotas should continue to come down, doctors must be more judicious in their prescribing, drug companies must stop misleading the public about their products, and we simply must do more to help those who are currently addicted get treatment.”

   “Drug overdose deaths have nearly tripled since 1999, and the opioid epidemic costs Louisiana alone about $296 million annually. This is unacceptable,” said Kennedy. “If even one of these prescription opioid related overdoses can be prevented by our bill, we are one step closer towards winning the war on drugs.”

   “We have a responsibility to better address the opioid epidemic, which took the lives of more than 42,000 Americans in 2016, by stopping addiction before it starts,” said Feinstein. “I believe this bill strikes the right balance in maintaining access to medications for legitimate medical use and reducing the supply of opioids available to be diverted and abused. I am confident that this bill can help reduce the astonishing number of drug overdose deaths in our country, and am pleased to be a cosponsor.”

   Over the past two years, the opioid quotas have reduced. However, more work must be done to rein in this epidemic, and DEA needs more statutory tools to effectively do its job.

   The bipartisan Durbin-Kennedy Opioid Quota Reform Act of 2018 would:

    

   ·         Direct DEA to consider the additional factors of opioid diversion, abuse, overdose deaths, and public health impacts when establishing annual opioid production quotas, in addition to the existing statutory considerations such as prior-year sales and research needs;

   ·         Require DEA, if it approves any annual increase in opioid quotas, to explain publicly why the public health benefits of the increase outweigh the potential harmful consequences;

   ·         Reveal trends in manufacturer-level quota increases by having DEA report anonymized data to Congress on the number of manufacturers that DEA authorizes to produce opioids each year and how many of those manufacturers’ quotas have increased from the previous year;

   ·         Enable DEA to issue more granular quota levels by removing a current provision that blocks DEA from considering variations in dosage forms when setting quotas; and

   ·         Require DEA to identify strategies to better incorporate data collection and changes in accepted medical practice (such as updated CDC Opioid Prescriber Guidelines) in its quota-setting process.

    

   The Opioid Quota Reform Act of 2018 is supported by the National Association of City and County Health Officials, National Association of Counties, Trust for America’s Health, Safe States Alliance, and National Safety Council.

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7. A bit uneasy about joining lawsuit (Opinion)

   Mar 13, 2018 | Norfolk Daily News (NE)

   By Editorial Board

   The Madison County commissioners have a decision to make in the near future, and one can make a reasonable argument that they should go ahead and become a part of a class-action lawsuit with other Nebraska counties against opioid producers.

   So, why is it that we’re not convinced Madison County should do so?

   An Ogallala law firm recently made a presentation to the county board and shared information about the cost of the ramifications of the opioid epidemic. They estimated Madison County’s cost in 2016 alone was about $4 million.

   Where do the expenses come from? They include the county’s costs in dealing with drug overdoses, abandoned children, treatment for addictions, babies who are born addicted, thefts and crime by those addicted, and prosecution, law enforcement and incarceration costs. It’s a lengthy list of expenses, and not a very palatable one.

   Opioids — which are pain-killers — include oxycontin, percocet and vicodin and many others, along with some street variations. Opioids are effective in reducing pain, but they also can be highly addictive. That’s where the societal problems and costs come into play.

   “The longer you use them, the more you need to use to get the same effect,” one of the lawyers making the presentation said. “The more you need, the higher the risk of addiction there is.”

   In 2016, there were 60,000 Americans who overdosed on opioids. That’s more than the 59,000 Americans who were killed during the entire 19 years of the Vietnam War, the Ogallala lawyers said.

   They also said their firm will not charge the county anything unless the suit is successful. Then the firm will take a percentage of the earnings awarded to the county. That’s a typical arrangement with class-action lawsuits.

   So, with little to risk, why not become part of the lawsuit?

   Our uneasiness stems from whether the manufacturers of the pain-killers are to blame for the addiction-related problems associated with the drugs. What about the black market for opioids that may not be the fault of the pharmaceutical companies? Or what about the physicians who may be too quick to prescribe opioids or refills? And what about the individuals who take them for pain relief and then allow themselves to become addicted?

   In this era of litigiousness, it just seems a bit too easy to always look to someone with deep pockets to blame.

   We won’t be upset if Madison County decides to join the lawsuit, but we’d probably prefer that it doesn’t.

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Northeast (NY, CT, PA)

8. Schuyler County is the latest to sue Big Pharma

   Mar 13, 2018 | WETM 18 News (NY)

   By Brooke Taylor

   Schuyler County is the latest New York county  to sue Big Pharma. The county blames the opioid epidemic on their dishonest marketing. 

   Local lawmakers voted Morning night, to declare the opioid epidemic a "public nuisance," the first step in moving forward with the lawsuit. 

   The Schuyler County Legislature wants reimbursements for the abuse costs, such as social services, treatment, and law enforcement. 

   Elizabeth Grieco was at the public hearing to share her sons battle with the addictive drug. 

   "I found him laying on his bed," Grieco said. "I tried to revive him, call the ambulance, last thing I saw of him was leaving the house with a machine on him to make him breathe." 

   Despite treatments, Grieco says the addiction took over. 

   "He was an addict for 9 years," Grieco said. "He tried to fight it hard, he kept coming back. He has a 7-year-old daughter so he wanted to be clean for her." 

   Steven Getman, Schuler County Attorney, says big pharmaceutical companies have hooked an entire generation, and taxpayers should not have to pay the price. 

   "There's an increasing body of evidence that big pharmaceutical companies have deceptively and fraudulently advertised, manufactured, and marketed opioids, and encouraged doctors to over prescribe," Getman said. 

   Most recently, one head of Big Pharma, Martin Shkreli, was sentenced to 7 years in prison for deceptive marketing and inflating drug prices. 

   Getman said any dollar won by Big Pharma is a dollar that stays in the county government to help fund existing treatment programs. 

   For Grieco, it is a great first step, but she says going after Big Pharma should not be the only focus. 

   "We have treatment centers now, but they aren't doing the job," Grieco said. "They are in there for 6 months and then they are out. They have halfway houses go to afterwards, but they don't pay attention to them. My son was using in a halfway house." 

   Schuyler County is not the only county to sue Big Pharma, at least 16 other counties across the state have also filed suit. 

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9. Wallingford hires law firm for possible opioid suit

   Mar 12, 2018 | Record-Journal (CT)

   By Matthew Zabierek

   The town has hired a law firm to help determine whether to bring legal action against opioid manufacturers.

   Through an interview process, the law department selected Colchester-based Scott & Scott LLP to help investigate the strength of the town’s case against manufacturers over the opioid epidemic. The firm will work on a contingency basis, meaning Scott & Scott will not charge any fees up front, but will collect a substantial part of any settlement.

   Corporation Counsel Janis Small said “the impact of the epidemic on communities includes increased insurance/ healthcare and workers' compensation costs, increase in emergency room responses and an impact on police departments and the criminal justice system” in a memo to the mayor and Town Council in December.

   The law department received a bid waiver from the Town Council in December to interview and select a firm, rather than put the services out to bid. Scott & Scott has represented other Connecticut municipalities in lawsuits against manufacturers, including New Britain and New Haven, Small said.

   “We’re gathering info and then we’re going to meet with (the law firm) and go through the situation for Wallingford and decide how to move forward,” Small said Friday.

   Lawsuits filed by other municipalities focus on the "false and misleading marketing of opioids as an effective and non-addictive treatment for chronic pain," Small said.

   Unlike other Connecticut municipalities, Wallingford provides emergency medical and ambulance services, which has been impacted by the rise in opioid overdoses.

   The lawsuit filed by Scott & Scott on behalf of New Britain named some of the nation’s largest pharmaceutical companies, as defendants, including prescription drug manufacturers Purdue Pharma and Johnson & Johnson. The Hartford Business Journal reported the lawsuit seeks compensation from the manufacturers and wholesale distributors for causing increased costs for social and human services, as well as the enhanced costs for the additional services of police, fire and other first responders.

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10. Phila. DA sues 10 pharmaceutical companies for their alleged roles in the opioid crisis

    Mar 12, 2018 | The Daily Pennsylvanian (PA)

    By Zachary Zamore

    The Office of the Philadelphia District Attorney Larry Krasner announced the filing of a lawsuit against ten pharmaceutical companies for their alleged roles in causing the opioid crisis. 

    The lawsuit, which was filed in Philadelphia's Court of Common Pleas on Feb. 2 according to a press release, seeks financial atonement from multiple pharmaceutical companies for their alleged involvement in creating the opioid crisis. 

    “The time to act is now, which is why I’ve taken this unprecedented action, in parallel with the City of Philadelphia’s suit, to stop these companies from systematically distracting the public from knowing the true dangers of opioid use as they reap billions of dollars in profits,” Krasner said in the press release. 

    Krasner announced the lawsuit on Feb. 15, the same day The Philadelphia Inquirer published an op-ed that he and former Mayor Jim Kenney wrote concerning the failure of the "war on drugs" in the 1980s and 1990s. 

    “No doubt, criminalizing addiction happened in part because the people affected were mainly African-American, Latino and poor,” they wrote. ‘These ‘tough on crime’ policies resulted in Philadelphia having the highest incarceration rate of any large jurisdiction in the country.”

    According to Philly Magazine, the Krasner also announced that he has advised his staff not to seek charges for those arrested for marijuana possession. 

    Philadelphia voters elected Krasner, a former civil rights attorney, to the city's chief law enforcement office in November 2017. 

    With no prior experience as a prosecutor, he ran on a platform of progressive criminal justice reform. He promised to end mass incarceration, replace the cash bail system, and "treat addiction as a medical problem, not a crime." 

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11. OPIOID CRISIS: Rush Health, Philadelphia, Clarke County join lawsuit

    Mar 13, 2018 | The Meridian Star (PA)

    By Whitney Downard

    Rush Health Systems, the city of Philadelphia and Clarke County are among at least six other counties and one other healthcare provider in Mississippi that have filed lawsuits against opioid manufacturers, opioid distributors and pharmacies, citing the increased costs of care and loss of workforce. 

    They join many across the country in face of the inundation of opioid prescriptions and resulting addictions, overdoses and deaths.

     Philadelphia decided to file the suit for two purposes: to show how the opioid epidemic has hurt the community and to deter future generations from opioid use, Mayor James Young said.

     "We want to be at the forefront of getting people to understand how damaging it is to our community," Young said. "If we can minimize the damage and turn the next generation in the right direction we can be stronger in the future."

     Rush Health Systems filed the first case in East Mississippi in the U.S. District Court of Southern Mississippi in December of 2017, followed by Philadelphia and Clarke County in March.

    Young said that if, at the conclusion of the case, funds are distributed, he hoped they'd be put back into the community to prevent future generations from addiction.

    "As a community, you can't deny that it's an issue," Young said. "It's very damaging to our people. It's a scourge to any community."

    Specifically, Young said the presence of opioids and other drugs drained the resources of the community's law enforcement

    "Human lives are at stake... if we incapacitate ourselves with drugs then the community dies," Young said. "Hopefully more will join because we all have the same issue... lives are destroyed because of the use of opioids. That should be a wake-up call."

    All three entities filed complaints alleging public nuisance, fraud, negligence, civil conspiracy, unjust enrichment.

    Rush Health Systems is using attorneys from Frazer PLC, in Nashville, Tennessee; Beggs & Lane, in Pensacola, Florida; and E. Mark Ezell, P.C., in Butler, Alabama. Attorney Patrick McMurtray, of Frazer PLC, also practices in Mississippi.

    "This epidemic and its consequences could have been, and should have been, prevented by the Defendants who control the U.S. drug distribution industry," the complaint said. "These Defendants have profited greatly by allowing the geographic area that RUSH serves to become flooded with prescription opioids."

    The complaint said the drug distribution industry is supposed to check the drug delivery system to prevent theft and misuse by refusing to fill suspicious orders.

    "Defendants thus intentionally and negligently created conditions in which vast amounts of opioids have flowed freely from drug manufacturers to innocent patients who have became (sic) addicted, to opioid abusers and even to illicit drug dealers," the complaint said.

    Defendants in the Rush suit include three classes: McKesson Corporation, Cardinal Health, Inc., AmerisourceBergen Corporation as "Distributor Defendants;" CVS Health Corporation, Walgreens Boots Alliance and  Wal-Mart Stores, Inc. as "Pharmacy Defendants;" and Purdue Pharma L.P., Cephalon, Inc., Teva Pharmaceutical Industries, Ltd., Janssen Pharmaceuticals, Inc., Endo Health Solutions, Inc. and Allergan PLC as "Pharmaceutical Defendants."

    "Each Pharmaceutical Defendant developed a well-funded, sophisticated and deceptive marketing and/or distribution scheme targeted at consumers and physicians," the complaint said, adding that the defendants used deceptive messaging and mislead doctors and patients alike about the risk of addiction.

    As for Distributor Defendants, the complaint said distributors allowed opioids to be lost or stolen in transit, allowing them to be diverted from legitimate medical purposes, and filled orders of unusually large sizes to underpopulated regions.

    "The CDC has reported that people who are dependent on prescription opioid painkillers are 40 times more likely to become dependent on heroin," the complaint said. "The CDC reports that for every opioid-related death, there are on average 10 hospital admissions for abuse, 26 emergency department visits for misuse, 108 people who are dependent on opioids and 733 non-medical users."

    Rush argued that "Defendants' opioid diversion diminishes RUSH's available workforce, decreases productivity, increases poverty and consequently requires greater expenditures by RUSH."

    The complaint called pharmacies the "last line of defense" from drugs being diverted to an illicit market. The complaint argues that pharmacies receive training in recognizing false prescriptions, such as ones written on stolen pads, and warning signs in patients, such as a customer who returns too frequently.

    The complaint recognized that many defendants had settled, been cited or agreed to pay to avoid civil charges in other states or nationally but not in Mississippi.

    Both the City of Philadelphia and Clarke County filed complaints March 7 against the above defendants with the exception of the Pharmacy Defendants. Additional manufacturing defendants include: Johnson & Johnson, Watson Laboratories, Inc., Actavis Pharma, Inc., Insys Therapeutics, Inc. and Mallinckrodt, Plc.

    Both of the complaints for the City of Philadelphia and Clarke County are nearly identical and filed by the same firm, Bossier & Associates, PLLC, of Jackson.

    The complaints said that Mississippi is the fourth highest prescriber of opioids in the country, or "roughly 70 pills for every man, woman and child in Mississippi."

    Philadelphia has a prescribing rate of 147.1 prescriptions for every 100 residents while Clarke County has an estimated 120.9 prescriptions for every 100 residents of the county, according to their respective complaints.

    "The economic burden caused by opioid abuse in the United States is approximately $78.5 billion, including lost productivity and increased social services, health insurance costs, increased criminal justice presence and strain on judicial resources, and substance abuse treatment and rehabilitation," the complaints said. "The City of Philadelphia, Mississippi, (or Clarke County, Mississippi) is being forced to expend City (County) resources combating the opioid epidemic and its cascading effects."

    The complaints discuss how doctors must refocus their efforts, law enforcement tries to stop the tide of criminal enterprises built on the defendants drugs and the citizens of the respective county or city have decreased productivity, which ultimately harms the local economy.

    As insurance providers for their employees, each plaintiff paid for the prescribed opioids for their employees and now has "suffered a loss of productivity as a result of opioid abuse and addiction."

    The complaints use many arguments similar to Rush's complaint, but focus on the impact on their respective municipality.

    "Defendants' deceptive marketing scheme has also detrimentally impacted children in the City of Philadelphia (Clarke County)... there was also an increase in the City's (County's) child protection services in the number of children in foster care driven by parent drug addiction," the complaints said.

    The complaints said the residents in the respective municipality suffered repercussions such as "job loss, loss of custody of children, physical and mental health problems, homelessness and incarceration, which results in instability in communities often already in economic crisis."

    This crisis, the complaints said, increased the demand for services such as hospitals, courts, child services, treatment centers and law enforcement.

    "Defendants knew and should have known about these harms that their deceptive marketing has caused," the complaints said. "While using opioids has taken an enormous toll on the City (County) and its residents, Defendants have realized blockbuster profits."

    Because of the widespread use and abuse of prescription opioids, the complaints said that children and teenagers have been exposed or have access to these opioids, that "even infants have been born addicted to opioids due to prenatal exposure."

    More than 400 similar cases from across the country have been combined in as a multi-district litigation to be presented to Judge Dan Aaron Polster in the Northern District of Ohio. In January, the Rush Health Systems case joined the multi-district litigation. In Mississippi, at least six counties have joined, including Sunflower, Humphreys, Washington, Lawrence, Jefferson Davis and Claiborne.

    Sheila M. Bossier, the attorney for Philadelphia and Clarke County, was unavailable on Monday and couldn't clarify whether the Philadelphia and Clarke County cases would be added to the multi-district litigation. Clarke County supervisors also couldn't be reached.

    Attorneys for Rush Health Systems answered the phone but asked to call back Monday. As of Monday afternoon, no one had called back. A Rush spokesperson said she couldn't discuss the litigation Monday. 

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Southeast (AL, FL)

12. Cleburne County Commission retains law firm for opioid crisis relief

    Mar 12, 2018 | The Anniston Star (AL)

    By Bill Wilson

    The Cleburne County Commission voted unanimously Monday night to retain a Montgomery law firm to represent the county in a claim for damages against manufacturers and/or distributors of opioids.

    Rick Stratton of the Beasley Allen law firm presented an argument to commissioners about how aggressive marketing and distribution has contributed to the current epidemic of opioid use in the state. The law firm, Stratton said, will pursue feasible civil remedies for the county including expenses related to the ongoing costs of dealing with the opioid crisis. The lawyer said the firm will also try to get the responsible parties to fix the problem via education and treatment for the addicted.

    The remainder of this article is under paywall: https://www.annistonstar.com/news/cleburne/cleburne-county-commission-retains-law-firm-for-opioid-crisis-relief/article_05d0c086-2669-11e8-a03c-b7e8753fc1f1.html

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13. County to pursue claims against drug companies

    Mar 12, 2018 | 280 Reporter (AL)

    By Stephen Dawkins

    Opioids have created an “ever growing crisis” locally and nationally, and Shelby County will pursue potential claims for damages against manufacturers and distributors of the drugs.

    The Shelby County Commission approved at its meeting on Monday, March 12, a resolution for the employment of two law firms to pursue claims related to losses suffered by the county and its residents “as a result of the improper and/or illegal manufacture, distribution, marketing and selling of opioids.”

    “We recognize we have overdose deaths,” County Manager Alex Dudchock said. “Our county is not immune to this crisis. We’re having families being affected.”

    The crisis has been fueled by “illegal and improper marketing of opioids,” the resolution states. Dudchock said this would include pharmaceutical companies not giving full disclosure about the drugs’ effects or addictive properties to doctors, who then prescribed them.

    The county wishes to protect residents from “deceptive and unfair marketing practices in the selling and prescribing of opioids, and to modify the behavior of the manufacturers and those distributing opioids illegally and recover a portion of the increasing monetary expenditures being made by Shelby County as it reacts to the ever growing opioid crisis and attempts to heal the broken lives of those left in its wake,” according to the resolution.

    The county’s losses are related to prevention and treatment programs, medical services treating overdoses and death, and associated crime, the resolution states.

    Extensive prevention and education programs are needed to combat the problem, Dudchock said.

    “It will take an extended period of time to help folks,” he said.

    Alabama Attorney General Steve Marshall announced in February that the state had filed suit against companies that manufacture and sell several prescription opioid pain medications.

    The suit claims that the company violated Alabama’s Deceptive Trace Practices Act in the marketing and sale of opioid drugs.

    “Alabama ranks first in the nation for the number of painkiller prescriptions per capita,” Marshall said in a release. “As a result, it is estimated that almost 30,000 of our residents over age 17 are dependent upon heroin and prescription painkillers. Alabama’s drug overdose death rate skyrocketed by 82 percent from 2006 to 2014 and it is believed that many of those deaths were from opioid painkillers and heroin.”

    Shelby County’s resolution follows several weeks’ worth of executive sessions called to discuss the issue, including one such session on March 12 before the Commission voted unanimously to approve the resolution.

    The Commission will employ the Montgomery-based Beasley, Allen, Crow, Methvin, Portis and Miles P.C. and Columbiana-based Ellis, Head, Owens and Justice law firms, with compensation set at 27.5 percent of the net recovery after reimbursement of expenses.

    Expenses will be reimbursed only if there is a recovery in favor of the county, according to the resolution.

    Beasley, Allen, Crow, Methvin, Portis and Miles P.C. is one of the firms retained by Alabama in its lawsuit.

    In other business, the Commission approved the re-appointment of John A. Jones to the Shelby County Board of Equalization for a term ending in June 2021, and the appointment of Jim Martin to the Board of Equalization to fulfill the unexpired term of Jim Latham ending June 2019.

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14. Osceola County considers suing pharma companies to offset costs of opioid crisis

    Mar 12, 2018 | WFTV 9 ABC (FL)

    By Michael Lopardi

    Osceola County leaders are ready to take on what could be an unprecedented plan to combat the opioid crisis.

    Commissioners could soon vote on a proposal that would allow the county to recover some of the costs associated with the problem through lawsuits against pharmaceutical companies.

    The county attorney said it would be another tool to help the county make up some of the money spent dealing with people's addiction problems.

    The ordinance could be a first of its kind in Florida.

    On Monday, commissioners approved a statement of legislative intent. It’s the first step in creating a new ordinance to deal with the abuse of opioids like heroin and painkillers. 

    The county attorney said the proposed rule would allow Osceola County to recover the costs of dealing with widespread addiction, like outfitting law enforcement with the reversal drug Narcan, from entities like drug companies. 

    “I think it's a very proactive position to take and I really think that somebody needs to start to hold the pharmaceutical companies and several other folks accountable for their actions,” said commissioner Thomas Griffin. 

    Griffin runs the transition house, a substance abuse treatment center in St. Cloud.

    “We see more people coming in today because of their opioid addiction than we did last year, and we saw more in 2017 than we saw in 2016,” Griffin said.

    Last November, the county was the first in Florida to file a lawsuit against pharmaceutical companies over the growing addiction problem. 

    The county attorney said new rules could be enforced through fines or the courts. Osceola County leaders said the opioid addiction has cost the county millions of dollars, and it wants help covering those costs.

    The next step is to write the proposed ordinance.

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Southwest (TX)

15. In "race to the courthouse," lawyers urge Texas counties to sue over opioids

    Mar 13, 2018 | The Texas Tribune (TX)

    By Marissa Evans

    Bill Bilyeu started receiving the Powerpoint presentations in October.

    The administrator for Collin County, north of Dallas, found the slides interesting at first, with their charts, numbers and logos from law firms seeking to sue opioid manufacturers on the county’s behalf. But Bilyeu soon grew weary, finding that none of the pitches seemed tailored to the needs of his suburban county, which had 85 drug-related deaths in 2016.

    “It became like a TV commercial where I just don’t pay attention anymore,” Bilyeu said. “I was talking to attorneys and being polite, but now I even tell the secretaries, ‘We don’t have an interest, thank you.’”

    County and city governments across Texas have been the focus of a legal feeding frenzy as law firms vie to represent them in lawsuits against pharmaceutical companies over the nation’s deadly opioid crisis. The firms say the companies oversold the drugs' benefits for treating chronic pain and have downplayed the risk for addiction.

    There were more than 42,000 opioid overdoses in the United States in 2016, according to the Centers for Disease Control and Prevention. Deadly opioid culprits include prescription painkillers such as Hydrocodone; Oxycontin; fentanyl, a synthetic drug; and heroin. While there’s been focus on states like Kentucky, Maine, Ohio and West Virginia for the opioid crisis, 1,107 Texans died from opioids in 2016.

    Lawyers say they want to hold the companies accountable for that epidemic and help governments recoup the cost of combating and treating the opioid crisis in their areas. But the firms might also see the potential for a financial windfall similar to the $15 billion settlement the state won from suing tobacco companies in the 1990s.   

    Currently, individual cases have been absorbed into one multi-district case under a federal judge in Ohio.

    Law firm presentations and informational packets obtained by The Texas Tribune show lawyers urging officials to act quickly. One document describes it as a “race to the courthouse.” Another declares that “inaction is action.”

    The presentations show colorful charts and data from the CDC and the Substance Abuse and Mental Health Services Administration, and links to national media coverage of how opioids have impacted communities. Other documents show law firms pointing to examples of prior cases against some of the pharmaceutical manufacturers and distributors as evidence of success.

    The big selling point in all of them: Get pharma to pay for your troubles. Lawyers are enticing counties to sign on to try to recoup costs for health care, criminal justice, lost productivity and more.

    In October, Upshur County became the first county in the state to sue. The defendants named were a long list of big pharma players: Purdue Pharma, Endo Pharmaceuticals, Pfizer, Janssen Pharmaceuticals, Teva Pharmaceuticals, Allergan, AmerisourceBergen Corporation, Cardinal Health, McKesson Corporation, Abbott Laboratories and Johnson & Johnson.

    Matt Daniel, a partner with Ferrer, Poirot & Wansbrough in Dallas and co-counsel for some of the counties considering lawsuits, said the competition for clients is stiff and that convincing county officials to hire them is no easy task. He is partners in the case with Matt McCarley of the Dallas firm Fears Nachawati, and another firm in Maryland.

    Daniel said he tells officials that pharmaceutical manufacturers and distributors are to blame for the crisis and that taxpayers have had to shoulder the costs of paying for people living with addiction. He also makes sure officials know they won't have to spend anything. 

    So far, Daniel has been hired by Rockwall, Brazos, Stephens, and Kaufman counties.

    “Every lawyer goes to law school saying, ‘I want to help people,’ and in this instance they really are,” Daniel said. “This is an opportunity as a group to say that we can change the world with this.”

    But in conservative Texas, not everyone is on board.

    Lucy Nashed, communications director for powerful business group Texans for Lawsuit Reform, said “regulation through litigation is often not effective” and that the rise in opioid lawsuits is being fueled by lawyers’ quests to find the next tobacco settlement. She said a settlement through the opioids lawsuits does not mean there will be a public policy change and “doesn’t break the cycle of addiction.”

    “The way I see it is that litigation is good for assigning a blame and assigning a consequence for an action,” Nashed said. “But it’s not necessarily good for describing a future solution or coming up with public policy change. It’s only a partial solution to a bigger problem.”

    Attorney General Ken Paxton is leading Texas into a 41-state investigation of companies that manufacture or sell opioids. Last fall, the states served investigative subpoenas or other requests to eight such companies and their affiliates, including some named in Upshur County’s lawsuit.

    During a press conference last week with U.S. Attorney General Jeff Sessions about the opioid crisis, Paxton vowed to continue working on the issue.

    “The opioid crisis demands the attention of federal, state, local and private sector leaders,” Paxton said. “My office will continue to do everything it can to protect Texans from the opioid crisis.”

    Bilyeu said between 10 and 15 firms reached out to him, but the Collin County commissioners have said they don’t plan on suing.

    “I don’t fault any other county for doing it if they can go back and find their expenses,” Bilyeu said. “We don’t run a hospital district, we don’t have direct admission data that says this was what it costs to treat people.”

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16. City Reviewing Proposals As County Moves Forward With Opioid Lawsuit

    Mar 13, 2018 | Rivard Report (TX)

    By Roseanna Garza

    The City of San Antonio is considering whether to join Bexar County in suing opioid drug manufacturers and distributors that it blames for an addiction epidemic that has been devastating locally.

    The City Attorney’s Office is reviewing proposals from area law firms to determine whether to sue, City of San Antonio Public Affairs Manager Thea Setterbo said in an email to the Rivard Report. 

    The City also could decide to use the City Attorney, rather than an outside firm, to take action against opioid manufacturers and distributors, said Councilman Manny Pelaez (D8), adding that the City is being cautious in deciding whether to take legal action.

    “No one should ever take litigation casually,” Pelaez, a labor and employment attorney by trade, told the Rivard Report on Monday. “There is not a ‘one size fits all’ for mass tort litigation. I would rather get it right than get it quick.”

    Last October, County commissioners voted to sue the companies with the provision that any proceeds granted to the County go directly to treatment and research to help area residents who struggle with opioid addiction.

    County Judge Nelson Wolff said during Commissioners Court on Oct. 3, 2017 that filing the lawsuit against the opioid industry is comparable to lawsuits filed against the tobacco industry several years ago, but that opioids addictions are “much more insidious and much more dangerous than smoking.”

    Wolff said “many counties and cities have entered this litigation across the nation,” and that several states, including Texas, have been completing investigations into opioid marketing, sales, and prescriptions. Many of those lawsuits ended in “executives being indicted and charged,” he added.

    Texas Attorney General Ken Paxton joined a coalition of 40 states last year that served investigative subpoenas and other requests to eight companies that either manufacture or distribute prescription opioids.

    There has been broad and consistent support for cities and municipalities interested in pursuing damages from opioid distributors and manufacturers, including the U.S. Department of Justice, which, on Feb. 27, said it will support local officials in hundreds of lawsuits against manufacturers and distributors of powerful opioid painkillers that are fueling the nation’s drug abuse crisis.

    As the County moves forward with support from the DOJ, the City is still working to determine next steps.

    Pelaez explained that in order to file a lawsuit or join existing litigation, the City must decide whether it should proceed “in house” through the city attorney or “farm it out” to an external firm. But first, he said, the City should determine what it has to gain from pursuing the lawsuit.

    “It’s not like this would be zero-cost litigation,” Pelaez said, referring to the legal fees associated with filing and fighting a case, regardless of whether the lawyer is a City employee.

    District Attorney Nico LaHood chose two San Antonio firms to represent Bexar County in the county’s lawsuit: Phipps Anderson Deacon and Watts Guerra.

    Mikal Watts, lawyer with Watts Guerra, said local lawyers are filing lawsuits in both state and federal court on behalf of the County.

    “Opioids are the biggest epidemic in the country right now,” said Watts, who represents 12 other counties in Texas filing lawsuits against opioid manufacturers and distributors. “I wouldn’t have gotten into this if I didn’t think we would be successful.”

    Bexar County leads the state in babies born with drug withdrawal symptoms and has the third-highest per-capita rate of overdose deaths in Texas, with 108 fatal overdoses in 2015.

    “Bexar County has a large volume of different kinds of expenses that it has withstood as a result of the opioid epidemic and we aim to recover those,” Watts said, noting that the County plans to argue it has borne the costs of the crisis through its jail, University Health System, and Center for Health Care Services.

    Watts explained that the lawyers are waiting to see how the remand process goes before committing the County to either federal or state court.

    Pelaez agrees that the City should wait to see what comes of lawsuits filed in other cities and municipalities across the United States, before moving forward with its own lawsuit.

    “Some of these lawsuits may not survive,” Pelaez said, noting that drug manufacturers and distributors have already been fighting back against these types of lawsuits across the country. “There is an advantage [in] waiting to see whether or not they have the ability to withstand the initial challenges.”

    Companies affected by lawsuits in Texas include, but are not limited to, Purdue Pharma, Teva Pharmaceuticals USA, Cephalon, Johnson & Johnson, Janssen Pharmaceutical Company, Allergan, Actavis, Endo Pharmaceuticals, Cardinal Health, McKesson Corporation, AmerisourceBergen Corporation, and all other related entities to these named companies.

    Emails and calls to several companies seeking comments for this article went unanswered Monday.

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Midwest (OH)

17. Strongsville may join litigation against makers and distributors of opioids

    Mar 12, 2018 | Cleveland.com (OH)

    By Bill Sandrick

    The city may join ongoing litigation against drug manufacturers and distributors over the nation's opioid epidemic.

    Under a proposed ordinance, which City Council placed on first reading last week, the city would hire Climaco, Wilcox, Peca & Garofoli Co. LPA, a Cleveland law firm, and Napoli Shkolnik PLLC in New York City, to represent Strongsville in the legal action.

    "This is something we've been looking at," Strongsville Law Director Neal Jamison said. "Manufacturers, distributors and marketers of opioids have created a public nuisance for our community by putting out these highly addictive pain killers, and it has cost the city money and resources."

    Strongsville, if council approves the ordinance, would follow the footsteps of Broadview Heights, which earlier this year hired Climaco Wilcox and Napoli Shkolnik to represent that city in the opioid litigation.

    John Climaco, of Climaco Wilcox, said he filed a suit on behalf of Broadview Heights earlier this month in Cuyahoga County Common Pleas Court. He expects the lawsuit, like other opioid cases, will be moved to federal court.

    U.S. District Judge Dan Polster is president over more than 200 lawsuits - filed by governmental entities in Alabama, California, Illinois, Ohio, Washington and West Virginia - blaming drug manufacturers and distributors for the opioid crisis.

    The lawsuits say that drug makers overstated the benefits and downplayed the risks of using opioids, and that distributors failed to monitor suspicious orders of prescription opiates. Their actions have led to overdose deaths across the country, the lawsuit says.

    The lawsuits ask the courts to make drug manufacturers and distributors pay governments for costs associated with the opioid epidemic and to punish the companies for creating a public nuisance.

    The amount of money governments are seeking has not been determined, but one lawsuit estimated that the opioid crisis has cost them "tens of millions" of dollars. Polster is urging all parties to settle.

    According to the National Institute of Drug Abuse, more than 90 Americans die each day after overdosing on opioids, including prescription pain relievers, heroin and synthetic opioids such as fentanyl.

    But at least one opioid manufacturer has said the lawsuits fail to identify even one physician who prescribed an opioid medication when it was medically unnecessary, or who prescribed such a medication due to misleading marketing or promotional materials.

     Meanwhile, pharmaceutical industry lawyers have stated that the federal government has determined their painkillers are safe and effective when used property.  

    Jamison said opioid overdoses have cost Strongsville's safety forces money in increased emergency runs by paramedics.

    In August, the Strongsville Police Department was one of 130 law enforcement agencies in Ohio that received grant money to create and maintain drug abuse awareness and prevention programs, including D.A.R.E., PALS (Prevention through Alternative Learning Styles), Too Good for Drugs and Stay on Track. Strongsville's grant amount was $32,839.

    "Police Chief (Mark) Fender and the Safety Director (Charles Goss) have set up a special detail to help people who overdose and get them on the right path," Jamison said.

    Strongsville, under its contract with Climaco Wilcox and Napoli Shkolnik, would not pay a legal fee unless it wins a monetary award. The city would give attorneys 10 percent of any amount awarded before the complaint is filed; 20 percent to 25 percent after legal briefings are submitted; 33 percent after a final pretrial, if the lawsuit reaches that point; and 40 percent once a trial begins.

    Other local municipalities, including Parma, Lorain and Elyria, have already filed lawsuits, and those cases have been consolidated in Polster's courtroom. Cleveland and Brunswick filed suits March 6 and last month, respectively.

    Also in February, the state of Ohio sued four opioid distributors, accusing them of unsafe practices. Cuyahoga County filed a suit last year.

    The U.S. Justice Department in early March filed a "statement of interest" in the opioid lawsuits being heard in Cleveland but hasn't decided whether to intervene.

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Broadcast Media Coverage

18. Eyewitness News at 5pm

    Mar 12, 2018 | Orlando, FL

    By WFTV (ABC)

    Video Link: http://app.criticalmention.com/app/#clip/view/33529318?token=33fda644-6c45-4291-bf91-a398ca53ffd7

    Rough Transcript: last november, the county was the first in florida to file a lawsuit against pharmaceutical companies over the growing addiction problem. the county attorney says new rules could be enforced through fines over the courts. osceola says the opioid addiction has cost millions of dollars and it wants help covering the costs.>> the next step is to write this proposed ordinance. we don't have all of the details just yet. the county attorney told me this could be ready for a vote in the next month or two. michael lopardi, channel 9 eyewitness news. >>> orange county leaders are taking unorthodox steps to tackle the opioid crisis. officials teamed up with aspire health to handout the drug narcan to families and people in the holden heights area. officials are calling that a hot zone for overdoses. the county is using money from a federal grant to establish positions and two local hospitals to help haitians with substance abuse after they leave.

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19. The NOW

    Mar 12, 2018 | Cleveland, OH

    By WEWS (ABC)

    Video Link: http://app.criticalmention.com/app/#clip/view/33529341?token=33fda644-6c45-4291-bf91-a398ca53ffd7

    Rough Transcript: we're going to turn to a disturbing story right now. people are dying about 115 a day from opioid overdoses, some doctors are getting rich and the opioid manufacturers are writing the checks. in 2014 and 2015, more than half the doctors that wrote opioid prescriptions to patients were paid by pharmaceutical companies that make them. some got paid six figures to do lectures or consult other doctors. that's nothing new but it is illegal for doctors to prescribe a drug for kickback payments. how would you like to make money by showing off what you know about your community.

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20. NewsCenter 5 at Noon

    Mar 12, 2018 | Boston, MA

    By WCVB (ABC)

    Video Link: http://app.criticalmention.com/app/#clip/view/33529345?token=33fda644-6c45-4291-bf91-a398ca53ffd7

    Rough Transcript: there is a shortage of pain medications at some local hospitals. all this as the state deals with opioid abuse epidemic. pharmacists at hospitals including mgh, tufts, and brigham and women's tell the herald they are struggling to find alternatives to injectable forms of common opiates. that's because of stronger regulations from the dea. the agency is not allowing manufacturers to increase production as a way to curb the opioid crisis. a letter has been sent to the dea requesting more lenient regulations.

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21. 18 News Today

    Mar 13, 2018 | Elmira, NY

    By WETM (NBC)

    Video Link: http://app.criticalmention.com/app/#clip/view/33529352?token=33fda644-6c45-4291-bf91-a398ca53ffd7

    Rough Transcript: schuyler county plans to sue big pharma..for their role in the opioid epidemic.. overdose numbers in the county are increasing.. and local lawmakers blame big pharmaceutical companies...for their dishonest marketing. 18 news reporter brook taylor reports. nat schuyler county plans to sue big pharma.. the county blames their dishonest marketing for the opioid crises... legislators want reimbursement for the abuse cost... between social services..treatment..and law enforcement.. nat elizabeth grieco came to the public hearing.. to share her sons battle with the addictive drug.. greico "i found him laying on his bed.. i tried to revive him..called 6:04 AMthe ambulance..the last thing i seenf him going out of the house was they had a machine on him making him breath..it was just horrible." despite treatments..griecosays the addiction took over... greico "he was an addict for 9 years..he fought it really hard..he kept coming out of rehab. heas a 7 year old daughter so he wanted to be clean for her." schuyler county attorney... steven getman.. says big pharmaceutical companies have hooked an entire generation..and tax payers shouldnt be paying the price.. getman: "there's an increasing body of evidence that big pharmaceutical companies have deceptively manufactured..advertised..and marketed opioids..and encouraged health care providers to over provide." most recently... one head of big pharma..martin shkrelli was sentenced to seven years in prison for deceptive marketing... and inflating drug prices.. getman says any dollar won frombig pharma is a dollar that stays in county government to fund existing treating programs.. for greico..it's a great first step..but she says suing big pharma shouldnt be onl greico "we have treatment centers now....they're in there for 6 months and then out ..half way houses..they don't pay atention..my son using half way house..its not good enough" brooke taylor..18 news.. schuyler county isn't the only new york county to sue big pharma. at least 14 other counties across the state have also filed suit. chemung which, as of 2016, was the new york county with the highest opioid prescription rate, according to data from the centers for disease control has not filed suit.

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