Opioid Litigation Daily Media Report - 3/19/18

President Trump Opioid Plan

1. White House tweaks plan to seek death penalty as part of opioid response

   Mar 18, 2018 | Politico

   By Dan Diamond
   
   
   President Donald Trump’s plan to fight the opioid epidemic will call for the death penalty in some cases, White House officials said Sunday, scaling back the administration’s plan to punish drug dealers.
2. What to know about Donald Trump’s visit to New Hampshire on Monday

   Mar 18, 2018 | Boston.com

   By Nik DeCosta-Klipa
   
   
   President Donald Trump is returning to New Hampshire this week, and there should be plenty to talk about.

Commentary and FYIs

3. Q&A: Holding drugmakers accountable for the opioid crisis

   Mar 18, 2018 | Associated Press

   By Matthew Perrone
   
   
   Hundreds of communities in the U.S. are suing the makers and distributors of opioid painkillers, arguing that the companies should help pay the enormous costs of the deadliest drug epidemic in U.S. history.
4. Philly Litigator Rips Opioid Defense Attys At Conference

   Mar 16, 2018 | Law360

   By Dan Packel
   
   
   A veteran Philadelphia plaintiff's attorney who is representing the city in litigation against drugmakers over the opioid crisis suggested that attention should be paid to the drug manufacturers' lawyers, at a forum on legal responses to the crisis on Friday.
5. Taking on the big drug companies (Opinion)

   Mar 17, 2018 | Marshfield Mail (MS)

   By Sen. Claire McCaskill
   
   
   All across Missouri, in my town hall meetings or at the grocery store, I’ve heard story after story from families struggling with rising healthcare costs. Whether it’s unexpected emergency room bills, rapidly increasing prescription drug prices or insurance premiums going up, Missouri families are getting squeezed.
6. People are dying because we misunderstand how those with addiction think (Opinion)

   Mar 16, 2018 | Vox

   By Brendan de Kennessey
   
   
   The American opioid epidemic claimed 42,300 lives in 2016 alone. While the public policy challenge is daunting, the problem isn’t that we lack any effective treatment options. The data shows that we could save many lives by expanding medication-assisted treatments and adopting harm reduction policies like needle exchange programs. Yet neither of these policies has been widely embraced.
7. Hundreds of millions in state opioid cash left unspent

   Mar 19, 2018 | Politico

   By Rachana Pradhan & Brianna Ehley
   
   
   Congress sent states hundreds of millions of dollars to fight an opioid crisis claiming more than 100 lives a day — money they've largely been unable to spend after a year.
8. Opioid shortages leave US hospitals scrambling

   Mar 19, 2018 | CNN

   By Pauline Bartolone
   
   
   Even as opioids flood American communities and fuel widespread addiction, hospitals are facing a dangerous shortage of the powerful painkillers for patients in acute pain, according to doctors, pharmacists and a coalition of health groups.
9. Can Taxing Pain Pills Alleviate the Opioid Epidemic?

   Mar 19, 2018 | Governing

   By Mattie Quinn
   
   
   The opioid epidemic, which killed 64,000 Americans in 2016, is making governments resort to unprecedented policies for saving lives and preventing addiction in the first place.
10. Docs more likely to prescribe opioids after pharma pay, study finds

    Mar 16, 2018 | BioPharmaDive

    By Meg Bryant
    
    
    Doctors who receive even one payment from a pharmaceutical company for a brand name drug are five times more prone to prescribe that drug over an alternative treatment, including generics, according to a new CareDash study. The likelihood rises to 14.5% when the payment involves a specific opioid drug.

Southeast (FL, SC, MS, VA, WV)

11. Broward County Files Federal Lawsuit Against Opioid Drug Manufacturers

    Mar 16, 2018 | WUSF (FL)

    By Caitlin Switalski
    
    
    Broward County filed a new lawsuit in federal court Monday against manufacturers of opioid drugs.
12. Lancaster County sues drug distributors after rise in overdose deaths

    Mar 18, 2018 | The Herald (SC)

    By Hannah Smoot
    
    
    Lancaster County saw a 400 percent increase in drug overdose deaths in 2017. Now the county plans to do something about that.
13. Starkville to consider joining opioid litigation

    Mar 17, 2018 | The Dispatch (MS)

    By Alex Holloway
    
    
    The Starkville Board of Aldermen will consider allowing the city to join as plaintiffs in litigation targeting opioid manufacturer and distribution companies when they meet on Tuesday.
14. Dickenson County files $30 million suit against drug makers, others

    Mar 16, 2018 | The Roanoke Times (VA)

    By Luanne Rife
    
    
    Dickenson County this week filed a $30 million lawsuit against the makers of painkillers and the companies that distribute them and oversee prescription benefit plans.
15. Milton joins into lawsuit against drug manufacturers

    Mar 16, 2018 | WSAZ (WV)

    By Staff
    
    
    Another West Virginia city is filing a lawsuit against drug manufacturers and opioid distributors.

Midwest (WI, MI, OH)

16. Menominee Latest Tribe To Sue Pharma Cos. Over Opioids

    Mar 15, 2018 | Law360

    By Adam Lidgett
    
    
    The Menominee Indian Tribe of Wisconsin on Thursday became the latest Native American tribe to file suit against major drugmakers and distributors over the opioid epidemic, accusing a host of companies of making billions off the crisis.
17. Menominee Tribe sues opioid manufacturers

    Mar 16, 2018 | WLUK (WI)

    By Staff
    
    
    The Menominee Tribe is suing major companies that manufacture and distribute opioid drugs.
18. Traverse City To Consider Joining Opioid Lawsuit

    Mar 19, 2018 | The Ticker (MI)

    By Beth Milligan
    
    
    Traverse City commissioners will consider joining their counterparts in Grand Traverse and Leelanau counties in suing drug manufacturers over costs related to the opioid epidemic as part of a federal class-action lawsuit.
19. Columbiana County files lawsuit against opioid manufacturers, distributors

    Mar 17, 2018 | The Vindicator (OH)

    By Justin Wier
    
    
    The Columbiana County commissioners have filed a federal lawsuit against several drug companies and distributors in an attempt to fight the opioid epidemic and recoup costs resulting from the crisis. The 173-page lawsuit claims manufacturers “aggressively pushed highly addictive, dangerous opioids, falsely representing to doctors that patients would only rarely succumb to drug addiction,” and that distributors “intentionally and/or unlawfully breached their legal duties ... to ... report suspicious orders of prescription opioids.”

Northeast (NY)

20. Washington County may sue opioid manufacturers

    Mar 18, 2018 | Olean Times Herald (NY)

    By Kathleen Moore
    
    
    Washington County may join the brewing lawsuit against opioid manufacturers.
21. Ulster County joins lawsuit vs. pharma companies over opioids

    Mar 16, 2018 | Daily Freeman News (NY)

    By Staff
    
    
    Ulster County has joined the legal battle against pharmaceutical companies that counties say were dishonest about the effects of long-term opioid use.

Southwest (TX)

22. Cooke County gets green light for legal fight in opioid crisis

    Mar 16, 2018 | Gainsville Daily Register (TX)

    By Megan Gray-Gatfield
    
    
    Cooke County Judge Jason Brinkley said the county was recently given the green light to proceed with its lawsuit against the pharmaceutical industry in an effort to recuperate monies spent related to opioid use.

Broadcast Media Coverage

23. Black Hills Fox News

    Mar 19, 2018 | Rapid City, SD

    By KEVNLD (Fox)
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/33677138?token=4d1be804-a22a-4528-a58b-58ab30e1dde1
24. ABC 17 News This Morning

    Mar 19, 2018 | Columbia, MO

    By KQFXLD (Fox)
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/33677271?token=4d1be804-a22a-4528-a58b-58ab30e1dde1
25. Eyewitness News This Morning Sunday at 6:00am

    Mar 18, 2018 | Orlando, FL

    By WFTV (ABC)
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/33677645?token=4d1be804-a22a-4528-a58b-58ab30e1dde1
26. Kentucky Newsmakers

    Mar 19, 2018 | Lexington, KY

    By WKYT (CBS)
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/33677679?token=4d1be804-a22a-4528-a58b-58ab30e1dde1
27. WSAZ NewsChannel 3 Saturday Morning

    Mar 17, 2018 | Charleston, WV

    By WSAZ (NBC)
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/33677685?token=4d1be804-a22a-4528-a58b-58ab30e1dde1
28. WJCL News at 7PM

    Mar 19, 2018 | Savannah, GA

    By WJCL (ABC)
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/33677688?token=4d1be804-a22a-4528-a58b-58ab30e1dde1
29. KTBS 3 News

    Mar 16, 2018 | Shreveport, LA

    By KTBS (ABC)
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/33677700?token=4d1be804-a22a-4528-a58b-58ab30e1dde1
30. Eyewitness News More Local at 8:00 AM

    Mar 16, 2018 | Rockford, IL

    By WQRF (Fox)
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/33677705?token=4d1be804-a22a-4528-a58b-58ab30e1dde1
31. Fox13 News- Good Day Utah 7AM

    Mar 16, 2018 | Salt Lake City, UT

    By KSTU (Fox)
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/33678211?token=4d1be804-a22a-4528-a58b-58ab30e1dde1

President Trump Opioid Plan

1. White House tweaks plan to seek death penalty as part of opioid response

   Mar 18, 2018 | Politico

   By Dan Diamond

   President Donald Trump’s plan to fight the opioid epidemic will call for the death penalty in some cases, White House officials said Sunday, scaling back the administration’s plan to punish drug dealers.

   “The Department of Justice will seek the death penalty against drug traffickers when appropriate under current law,” said Andrew Bremberg, the White House’s director of the Domestic Policy Council. White House officials referred follow-up questions to DOJ.

   An earlier version of the plan, obtained by POLITICO last week, would have called for the death penalty in some cases involving drug dealers, too.

   Trump will announce his opioid plan on his visit to New Hampshire on Monday. POLITICO first reported on Thursday that the White House was finalizing its opioid plan, which includes a mix of administration actions and initiatives that would require new funds or laws from Congress.

   There were more than 64,000 drug overdose deaths in 2016, mostly involving opioids, according to the most recent federal mortality data. The CDC this month reported that emergency rooms recorded a 30 percent spike in opioid overdoses last summer, indicating that the devastating crisis is worsening.

   The administration says its plan will reduce opioid prescriptions by one-third within three years and that the initiative will fulfill Trump's campaign promise to "stop opioid abuse."

   The plan involves three major components, said White House counselor Kellyanne Conway: education and prevention; law enforcement and interdiction; and treatment and recovery efforts.

   “The opioid crisis is viewed by us at the White House as a nonpartisan problem searching for bipartisan solutions,” Conway said.

   However, the White House did take a shot at the Obama administration for its role in allowing illicit drugs to spread, arguing that it insufficiently prosecuted traffickers. “The prior administration did not prioritize enforcing the laws related to drugs. I think that’s been directly attributable to the rise and increase of fentanyl and the resulting overdose deaths,” a senior White House official said.

   The Trump administration will call on Congress to make it easier to invoke the mandatory minimum sentence for drug traffickers who knowingly distribute illegal opioids that can be lethal, like fentanyl.

   Multiple congressional committees also are preparing their own responses to the opioid epidemic, with the House Energy and Commerce Committee slated to review 25 bills this week. That’s raised questions about whether the Trump administration and congressional lawmakers are coordinating their work, with lawmakers occasionally scheduling competing announcements.

   “We [have] been talking to Congress about various bills and their upcoming hearings,” a White House official told POLITICO. “As they move from the hearing to the markup stage, we will get even more involved.”

   The White House is also backing new health ideas, such as calling for 75 percent of opioid prescriptions reimbursed by government health programs like Medicare and Medicaid to be issued by using “best practices” within three years. That would be scaled up to 95 percent of prescriptions in five years. A White House official said that the goal would be to use guidelines identified by the CDC as best practices.

   It also will call on Congress to formally repeal a rule barring Medicaid payments to residential treatment for opioid addiction at large facilities, which could cost tens of billions of dollars. The Trump administration also will encourage states to adopt a prescription drug monitoring database that health care providers can access nationwide to flag patients seeking out numerous opioid prescriptions.

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2. What to know about Donald Trump’s visit to New Hampshire on Monday

   Mar 18, 2018 | Boston.com

   By Nik DeCosta-Klipa

   President Donald Trump is returning to New Hampshire this week, and there should be plenty to talk about.

   Trump is scheduled to make two stops in the state Monday as he rolls out his long-promised — and potentially very controversial — plan to address the opioid crisis. The visit is slated to be the Republican president’s first appearance in New Hampshire, the state where he won his first primary, since the eve of the 2016 election. It’s Trump’s first visit to the Granite State since he privately called it a “drug-infested den.”

   Here’s everything you need to know about Trump’s visit:The logistics:

   As the Concord Monitor reported last week, Trump plans to make two official stops Monday afternoon in Manchester, the state’s largest city.

   According to the Monitor, the president is first “expected to make a policy announcement on opioids” during an event at Manchester Community College. He will then visit the Manchester Central Fire Station to get an up-close look at Safe Station, a “first-of-its-kind program” in which people battling drug or alcohol addiction can safely seek help at one of the city’s 10 fire stations without fear of arrest.

   Trump praised the Safe Station program last October.

   A senior White House official told CNN that First Lady Melania Trump will also make the trip, adding that the issue of opioids is “really the only policy issue the two of them have tackled together.”What to expect:

   White House advisor Kellyanne Conway told WMUR on Sunday that Trump will use the New Hampshire visit to announce his long-awaited plan to address the country’s opioid epidemic. Conway said the plan will emphasize “three main fronts: prevention and education, treatment and recovery, and law enforcement and interdiction.”

   According to NBC News, the plan includes tougher punishments for drug dealers, including the potential use of the death penalty. Politico first reported last week that the White House was finalizing a plan calling for the death penalty to be used in “certain cases” when opioid dealing and trafficking (including fentanyl-related) is directly responsible for death.

   Trump has recently and repeatedly floated the idea that drug dealers should pay “the ultimate penalty.”

   “You kill 5,000 people with drugs because you’re smuggling them in and you are making a lot of money and people are dying. And they don’t even put you in jail,” he said at a political rally in Pennsylvania earlier this month. “That’s why we have a problem, folks. I don’t think we should play games.”

   Critics say there is no evidence that executing drug dealers would effectively address the opioid crisis and that the policy could actually make it more difficult to imprison traffickers. Sen. Ed Markey called it an “extreme” proposal that would “perpetuate a harmful stigma associated with opioid use disorders and divert attention from meaningful conversations and progress on expanding access to treatment, recovery, and other public health initiatives that are critical to saving lives.”

   “Patients and families suffering in this opioid crisis don’t need toughness, they need treatment,” the Massachusetts Democrat said in a statement last week.

   Conway told WMUR that a single proposal shouldn’t distract from the rest of the plan, which reportedly lays out how the Trump administration thinks the $6 billion recently appropriated by Congress to address the drug crisis should be spent.The backdrop

   New Hampshire is one of the state’s hit hardest by opioid addiction.

   According to the Centers for Disease Control and Prevention, the state ranked third in the nation — behind only West Virginia and, barely, Ohio — for the most overall drug overdose deaths. It also ranked first in the rate of deaths related specifically to synthetic opioids, such a fentanyl. In a University of New Hampshire poll last year, 53 percent of residents said that drugs were the biggest problem facing the state. It the first time in the poll’s history a single issue has been cited as the most important problem by a majority of respondents.

   But while New Hampshire seems an appropriate place for Trump to announce his new opioid plan, the president has recently been at odds with local elected officials when it comes to the issue.

   Trump was highly criticized by Republican Gov. Chris Sununu and the state’s Democratic Congressional delegation last fall after he reportedly called New Hampshire a “drug-infested den” in a phone call with the president of Mexico, as well as for the administration’s lack of action on the nationwide epidemic.

   Sununu’s office told WMUR on Friday that the governor plans to meet Trump upon his arrival and hopes the president will support changing the way the government distributes money to states to combat the opioid crisis, so that particularly affected states, like New Hampshire, can receive more funding.

   “Gov. Sununu hopes the president will acknowledge that states impacted the most by the opioid crisis should receive assistance proportionate to the size of the problem, enabling New Hampshire to tackle this crisis head-on,” spokesman Benjamin Vihstadt said in a statement.

   Following Trump’s State of the Union in January, Sen. Jeanne Shaheen said she appreciated Trump’s continued attention on the opioid issue, but added that “words are not enough.”

   “The President must finally begin fulfilling his promise to deliver treatment resources,” Shaheen said in a statement at the time. “Over the past year, President Trump has only devoted lip service to respond to the opioid epidemic.”

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Commentary and FYIs

3. Q&A: Holding drugmakers accountable for the opioid crisis

   Mar 18, 2018 | Associated Press

   By Matthew Perrone

   Hundreds of communities in the U.S. are suing the makers and distributors of opioid painkillers, arguing that the companies should help pay the enormous costs of the deadliest drug epidemic in U.S. history.

   Since 2000, more than 340,000 Americans have died from overdoses of opioids, which include prescription painkillers and illegal drugs like heroin. The financial toll has been estimated at $500 billion in 2015, according to the latest White House figures, which include deaths, health care, lost productivity and criminal justice costs.

   But can the drug industry be legally compelled to help pay for the damage?

   Rebecca Haffajee, a lawyer and professor of public health at the University of Michigan, answered questions about past cases against opioid drugmakers and the latest lawsuits.

   Q: Why didn’t early lawsuits filed against opioid drugmakers have much success?

   A: The earlier lawsuits were typically brought by individuals and were vulnerable to a number of defenses from the manufacturers. The companies could argue that individuals misused the prescription drugs or prescribers weren’t providing adequate medical advice about the products. Companies also argued that they were marketing and selling their products in accordance with Food and Drug Administration rules for these FDA-approved products.

   Many of those cases were dismissed. Sometimes the individuals bringing the suits simply ran out of resources to pay for the litigation.

   Q: Why are these newer lawsuits different?

   A: Governments are bringing these more recent lawsuits, and they are alleging harms to their overall social systems that (acknowledge) misuse was happening, but regardless, are trying to hold companies accountable.

   The idea is that these companies must have known, based on their own records and information, that the mass selling and distribution of opioids had gone beyond their appropriate medical use. The defense that people misused these drugs doesn’t hold as much weight in these cases.

   Q: People have compared this litigation to the lawsuits against Big Tobacco in the 1990s that resulted in a nearly $250 billion financial settlement for state governments. What are some of the differences?

   A: Part of the idea with tobacco was to get this product off the market altogether. With opioids we don’t want that. We want to be limiting the amount of opioids prescribed and misused, but we recognize these are FDA-approved products that have a medical use and can be appropriate and effective, particularly for acute pain. The idea here is to try and thread the needle and allow appropriate use, but rid the market of inappropriate use.

   Q: Beyond a financial settlement, many government officials say they want to change how this industry does business. Is that likely to happen?

   A: That certainly can be a byproduct of the litigation, changing marketing practices and behavior. If it’s a penalty that’s big enough, it could have a deterrent effect.

   Some of the recent settlements we’ve seen with drug distributors and manufacturers have required that they report certain information or refrain from certain conduct going forward.

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4. Philly Litigator Rips Opioid Defense Attys At Conference

   Mar 16, 2018 | Law360

   By Dan Packel

   A veteran Philadelphia plaintiff's attorney who is representing the city in litigation against drugmakers over the opioid crisis suggested that attention should be paid to the drug manufacturers' lawyers, at a forum on legal responses to the crisis on Friday.

   Speaking at the University of Pennsylvania Law School, Stephen Sheller of Sheller PC specifically called out former New York mayor and federal prosecutor Rudy Giuliani, whose consulting firm represented OxyContin maker Purdue Pharma LP during a criminal investigation in 2007. Sheller was one of several litigators and state prosecutors who spoke at the event.
   
   Best known for his battles with Johnson & Johnson in the long-running fight over the company’s antipsychotic medication Risperdal, Sheller identified attorneys as an overlooked target in the growing effort to impose accountability on those who enabled the opioid public health emergency.
   
   “Originally, they would have gone to jail, the Sacklers,” Sheller said of the family that owns Purdue. “So they hired the Giuliani firm, so they didn’t go to jail.”
   
   “The law firms involved, that has to be looked at in the context of this whole opioid problem,” he continued.
   
   Sheller is one of a team of attorneys representing the Philadelphia mayor's and district attorney's offices in two separate suits against Purdue and others. But he was not the first lawyer at the event to place a bull's-eye on Purdue, which has been named in a growing number of civil suits brought by states and municipalities around the country.
   
   Bridget Brennan, a special narcotics prosecutor for New York City, noted the extreme difficulties in again bringing criminal charges against the company, pointing to the $637 million fine Purdue already paid in a 2007 misbranding case and statute-of-limitations issues.
   
   But Brennan said she would be thrilled if she, or others, could come up with a sound legal theory to hold manufacturers criminally liable. Brennan pointed to a landmark criminal prosecution she brought against a doctor who ran a “pill mill” out of his Queens office. She said an appeals court in December upheld two manslaughter convictions in the case. 
   
   “Our manslaughter case in New York City was the first of its kind, and it created really good law,” she said.
   
   Also on hand were attorneys general from both Delaware and Georgia. Delaware Attorney General Matthew Denn noted that his state had also launched a civil suit against opioid manufacturers. Georgia Attorney General Chris Carr, meanwhile, praised President Donald Trump’s recent pronouncements — which have included bombastic comments about the death penalty for drug dealers — for attracting attention to the issue.
   
   “When a president — this president or any president — brings an issue to the forefront, it’s a good thing. And I want to commend the administration for how often they have focused on the issue,” he said. “Now, the comment about the death penalty, be that as it may, I do think it shows an understanding of the frustration and passion I hear and Matt hears around this issue.”
   
   Conference organizer Claire Finkelstein, the director of Penn’s Center for Ethics and the Rule of Law, noted that a number of the drug companies named as defendants in opioid litigation declined invitations to attend the event, as did their defense attorneys.
   

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5. Taking on the big drug companies (Opinion)

   Mar 17, 2018 | Marshfield Mail (MS)

   By Sen. Claire McCaskill

   All across Missouri, in my town hall meetings or at the grocery store, I’ve heard story after story from families struggling with rising healthcare costs. Whether it’s unexpected emergency room bills, rapidly increasing prescription drug prices or insurance premiums going up, Missouri families are getting squeezed.

   But every time you turn on the TV, you’re flooded with drug company commercials for often-obscure prescription drugs. You’ve seen the ads — the two bathtubs, the endless litany of side effects — but did you also know that you’re paying for them?

   That’s right — Missouri taxpayers are subsidizing the billions of dollars drug companies spend on advertising, all while these companies jack up the costs of the drugs you may need.

   This isn’t normal. The United States is one of only two countries in the world that allows this direct-to-consumer drug advertising. And the other is New Zealand.

   In 2015 alone, taxpayers subsidized $6 billion in fully tax-deductible prescription drug advertising in the United States. Nearly all of the top 10 pharmaceutical companies spent more on sales and marketing than they spent on research and development. And I think Missourians are tired of paying for it.

   It’s clear the big drug companies have a lot of friends and influence in Washington. But I didn’t go to Congress to make friends — I came here to fight for Missourians. And that’s why I’ve introduced legislation to repeal this corporate tax break.

   This isn’t the only fight I’ve taken on against the big drug companies. After spearheading the only bipartisan Congressional investigation into the egregious price spikes for certain prescription drugs, I fought through partisan gridlock to pass a law that will prevent these price hikes by speeding up the approval process for cheaper, generic alternatives.

   I’m also holding opioid  manufacturers’ feet to the fire for their role in fueling the opioid epidemic that’s ravaging our communities. Through my investigation, we’ve exposed fraud, improper sales practices and efforts to push back on prescription limits.

   And it’s not just drug companies I’m going after. We’re seeing a troubling trend of insurance companies denying coverage for visits to the emergency room, leaving families with debt even when they have insurance coverage. Parents are being asked to self-diagnose a medical emergency or risk getting saddled with enormous bills if insurance companies decline coverage. I’m working to protect Missourians who are harmed by this dangerous and wrongheaded practice.

   There’s no doubt the rising cost of Missourians’ healthcare is not an easy issue to address, one with a tangle of causes and symptoms with a tough diagnosis. But I’m not interested in picking the easy fights. I’m interested in the hard ones, the ones where every small victory means one more child with insurance coverage, or one more family able to pay their bill.

   So I’m going to keep doing what I know how to do best: fight on behalf of Missourians.

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6. People are dying because we misunderstand how those with addiction think (Opinion)

   Mar 16, 2018 | Vox

   By Brendan de Kennessey

   The American opioid epidemic claimed 42,300 lives in 2016 alone. While the public policy challenge is daunting, the problem isn’t that we lack any effective treatment options. The data shows that we could save many lives by expanding medication-assisted treatments and adopting harm reduction policies like needle exchange programs. Yet neither of these policies has been widely embraced.

   Why? Because these treatments are seen as indulging an addict’s weakness rather than “curing” it. Methadone and buprenorphine, the most effective medication-assisted treatments, are “crutches,” in the words of felony treatment court judge Frank Gulotta Jr.; they are “just substituting one opioid for another,” according to former Health and Human Services Secretary Tom Price.

   And as county Commissioner Rodney Fish voted to block a needle exchange program in Lawrence County, Indiana, he quoted the Bible: “If my people ... shall humble themselves … and turn from their wicked ways; then will I hear from heaven, and will forgive their sin.”

   Most of us have been trained to use more forgiving language when talking about addiction. We call it a disease. We say that people with addiction should be helped, not blamed. But deep down, many of us still have trouble avoiding the thought that they could stop using if they just tried harder.

   Surely I would do better in their situation, we think to ourselves. We may not endorse the idea — we may think it is flat-out wrong — but there’s a part of us that can’t help but see addiction as a symptom of weak character and bad judgment.

   Latent or explicit, the view of addiction as a moral failure is doing real damage. The stigma against addiction is “the single biggest reason America is failing in its response to the opioid epidemic,” Vox’s German Lopez concluded after a year of reporting on the crisis. To overcome this stigma, we need to first understand it. Why is it so easy to see addiction as a sign of flawed character.

   We tend to view addiction as a moral failure because we are in the grip of a simple but misleading answer to one of the oldest questions of philosophy: Do people always do what they think is best? In other words, do our actions always reflect our beliefs and values? When someone with addiction chooses to take drugs, does this show us what she truly cares about — or might something more complicated be going on?

   These questions are not merely academic: Lives depend on where we come down. The stigma against addiction owes its stubborn tenacity to a specific, and flawed, philosophical view of the mind, a misconception so seductive that it ensnared Socrates in the fifth century BC.

   Do our actions always reflect our preferences?

   In a dialogue called the Protagoras, Plato describes a debate between Socrates and a popular teacher named (wait for it) Protagoras. At one point their discussion turns to the topic of what the Greeks called akrasia: acting against one’s best judgment.

   Akrasia is a fancy name for an all-too-common experience. I know I should go to the gym, but I watch Netflix instead. You know you’ll enjoy dinner more if you stop eating the bottomless chips, but you keep munching nevertheless.

   This disconnect between judgment and action is made all the more vivid by addiction. Here’s the testimony of one person with addiction, reported in Maia Szalavitz’s book Unbroken Brain: “I can remember many, many times driving down to the projects telling myself, ‘You don’t want to do this! You don’t want to do this!’ But I’d do it anyway.”

   As pervasive as the experience of akrasia is, Socrates thought it didn’t make sense. I may think I value exercise more than TV, but, assuming no one is pressuring me, my behavior reveals that when it comes down to it, I, in fact, care more about catching up on Black Mirror. As Socrates puts it: “No one who knows or believes there is something else better than what he is doing, something possible, will go on doing what he had been doing when he could be doing what is better.”

   Now, you might be thinking: Socrates clearly never went to a restaurant with unlimited chips. But he has a point. To figure out what a person’s true priorities are, we usually look to the choices they make. (“Actions speak louder than words.”) When a person binges on TV, munches chips, or gets high despite the consequences, Socrates would infer that they must care more about indulging now than about avoiding those consequences — whatever they may say to the contrary.

   (He isn’t alone: Both the behaviorism movement in 20th-century psychology and the “revealed preference” doctrine in economics are based on the idea that you can best learn what people desire by looking at what they do.)

   So for Socrates, there’s no such thing as acting against one’s best judgment: There’s only bad judgment. He draws an analogy with optical illusions. Like a child who thinks her thumb is bigger than the moon, we overestimate the value of nearby pleasures and underestimate the severity of their faraway consequences.

   Through this Socratic lens, it’s hard not to see addiction as a failure. Imagine a father, addicted to heroin, who misses picking up his children from school because he’s shooting up at home. In Socrates’s view, the father must be doing what he believes to be best. But how could the father possibly think that?

   I see two possibilities. As Socrates’s illusion analogy suggests, the father could be grievously mistaken about the consequences of his actions. Perhaps he has convinced himself that his kids can get home on their own, or that he’ll be able to pick them up while high. But if the father has seen the damaging effects of his behavior time and again — as happens often to long-term addicts — it becomes harder to see how he is not complicit in this illusion. If he really believes his choice will be harmless, he must be willfully, and condemnably, self-deceived.

   Which leads us to the second, even more damning possibility: Perhaps the father knows the consequences shooting up will have on his children, but he doesn’t care. If his choice cannot be ascribed to ignorance, it must reveal his preferences: The father must care more about getting high than he cares about his children’s well-being.

    If Socrates’s model of the mind is right, these are the only available explanations for addictive behavior: The person must have bad judgment, bad priorities, or some combination of the two.

    Our philosophy of addiction shapes our treatment of it — whether we realize it or not

    It’s not exactly a sympathetic picture. But I suspect it underlies much of our thinking about addiction. Consider the popular idea that someone with addiction has to hit “rock bottom” before she can begin true recovery. In the Socratic view, this makes perfect sense. If addiction is due to a failure to appreciate the bad consequences of getting high, then the best route to recovery might be for the person to experience firsthand how bad those consequences really are. A straight dose of the harshest reality might be the only cure for the addict’s self-deceived beliefs and shortsighted preferences.

    We could give a similar Socratic rationale for punishing drug possession with decades in jail: If we make the consequences of using bad enough, people with addiction will finally realize that it’s better to be sober, the thought goes. Once again, we are correcting their flawed judgment and priorities, albeit with a heavy hand.

    Socrates’s view also makes sense of our reluctance to adopt medication-assisted treatment and needle exchange programs. These methods might temporarily mitigate the damage caused by addiction, but on the Socratic view, they leave the underlying problem untouched.

    By giving out clean needles or substituting methadone for heroin, we may prevent some deaths in the short term, but we won’t change the skewed priorities that caused the addictive behavior in the first place. Worse, we may “enable” someone’s bad judgment by shielding her from the worst effects of her actions. In the long run, the only way to save addicts from themselves is to make it harder, not easier, to pursue the lifestyle they so clearly prefer.

    Is Socrates right? Or can we find a better, more sympathetic way of thinking about addiction?

    To see things differently, we need to question the fundamental picture of the mind on which Socrates’s view rests. It is natural to think of the mind as a unified whole and identify ourselves with that whole. But this monolithic view of the mind leads to the Socratic view of addiction. Whatever I choose must be what my mind wants most, and so what I want most. The key to escaping the Socratic view, then, is to realize that the mind has different parts — and that some parts of my mind are more me than others.

    The “self” is not a single, unitary thing

   This “divided mind” view has become popular in both philosophy and psychology over the past 50 years. In psychology, we see it in the rise of “dual process” theories of the mind, the most famous of which comes from Nobel laureate Daniel Kahneman, who divides the mind into a part that makes judgments quickly, intuitively, and unconsciously (“System I”) and a part that thinks more slowly, rationally, and consciously (“System II”).

    More pertinent for our purposes is research on what University of Michigan neuroscientist Kent Berridge calls the “wanting system,” which regulates our cravings for things like food, sex, and drugs using signals based in the neurotransmitter dopamine. The wanting system has powerful control over behavior, and its cravings are insensitive to long-term consequences.

    Berridge’s research indicates that addictive drugs can “hijack” the wanting system, manipulating dopamine directly to generate cravings that are far stronger than those the rest of us experience. The result is that the conscious part of a person’s mind might want one thing (say, to pick his kids up from school) but be overruled by the wanting system’s desire for something else (to get high).

    You might be hoping for me to draw you a picture of the brain with “The Self” outlined in thick black ink: a country with its own sovereign territory. Things aren’t quite that simple. Though some parts of the brain (prefrontal cortex) appear to be Selfier than others (cerebellum), conscious and unconscious processes are too deeply intertwined for us to expect to find a clean neurobiological break between them.

    The question of how to find the self in the mind is more a philosophical question than a neurobiological one. Even if we had a high-definition map of every neural firing in your brain, we would still have to take a stand on what in this flurry of electrical activity constitutes you.

    Over the past half-century, philosophers have turned to this question with new vigor, trying to make sense of the idea that some of a person’s desires (to get sober and care for her children) represent what she cares about — her true self — in a way that other desires (to get high) do not.

    The desires that represent my true self are, on different theories, the desires that I want myself to have (Harry Frankfurt), the desires that align with my judgments of what is valuable (Gary Watson), the desires that cohere with my stable life plans (Michael Bratman), or the desires that are supported by rational deliberation (Susan Wolf).

    More important than the differences between these views is one critical similarity: These philosophers are united in rejecting the Socratic view. None of them thinks that what I really want is just a matter of what desire wins out over my behavior. To see what my true self wants, we should look not to my actions but to my reflective judgments about the kind of person I want to be and the life I want to lead.

    Putting these two strains of thought together, we can see the heroin-addicted father in a different light. As the father decides whether to shoot up or go pick up his kids, two parts of his mind are battling for control: the part that wants heroin more than anything else, and the part that cares far more about his kids. But the father is not a mere bystander in this conflict: He is a participant in it. The father is fighting on the side of the part that cares about his children.

    Drugs that reduce cravings don’t “enable” addiction. They give people with addiction an ally.

   I would go further and say that the father is the part of his mind that cares more about his children. For if we asked him to tell us what, on reflection, he really cares about, he would say that he wants to get sober and take care of his kids. And in this case, words speak louder than actions.

    When the desire for heroin unfortunately wins out, that doesn’t mean that the father cares more about getting high than he cares about his children. It means that he lost the struggle: His behavior is being controlled by a part of his mind that is not his true self.

    This is the possibility Socrates failed to recognize: A person might judge one thing to be best and yet do another. The plight of addiction is that of having a powerful part of your mind push you relentlessly and automatically toward behaviors you do not actually want to do. An addicted person behaves the way she does not because she has bad judgment or skewed priorities, but because she is blocked from acting on her true values by her supercharged “wanting system.”

    I don’t mean to suggest that no one ever endorses the choice to do drugs. Indeed, as the philosopher Hanna Pickard has argued, addictive behavior is often initiated and maintained by the purposes it serves in someone’s life, often as self-medication for physical or psychological trauma. Nor am I saying that addictive behavior is compulsive, irresistible, or completely out of the person’s control. After all, many people manage to recover from addiction without the help of medication or even clinical intervention.

    The messy truth about addiction is that it lies somewhere in between choice and compulsion. Addictive cravings work in much the same way as the cravings that everyone experiences — for Netflix or chips, say. They do not simply take over one’s muscles like an internal puppeteer. Instead, they pull one’s choices toward the craved object, like a psychological kind of gravity.

    But as Berridge’s research suggests, the neurochemical effects of addictive drugs make the cravings addicts experience far, far stronger than those the rest of us have to contend with in our daily lives. It may not be impossible to resist these cravings, but it is extraordinarily difficult. And given how hard it is to resist cravings of normal strength — just think of those bottomless chips — we should not blame someone with addiction for failing to overcome her neurobiologically enhanced cravings.

    This is why addiction is not a moral failure. The addicted person need not be shortsighted or selfish; she may have the very same priorities as anyone else. Nor need she be any worse at self-control than the rest of us are. She is just faced with cravings that are far harder to resist.

    

   Seeing addiction this way also helps us think more clearly about treatment. Emphasizing the bad consequences of using, whether by pushing someone to rock bottom or by threatening her with prison, is ineffective because the part of the mind that drives addiction can overpower thoughts about consequences.

    The problem is not that a person with addiction does not understand the consequences of her actions, but that she is unable to use this understanding to control her behavior. Thus, we should not be worried about “enabling” her addiction by protecting her from its worst effects — for example, by providing her with clean needles.

    The paradigm shift is most dramatic for medication-assisted treatment. While the Socratic view paints these treatments as crutches that leave the basic problem unaddressed, the divided mind view shows this to be wrongheaded. If the source of addiction is overly strong automatic cravings, then the most direct way to treat addiction would be to weaken or satiate these cravings in a non-damaging way.

    And that is exactly what methadone and buprenorphine do. By satiating the wanting system’s cravings, these medications put the addicted person back in the driver’s seat, allowing her to control her life again.

    Plato himself eventually came to understand that the mind was more divided than his teacher thought. While he always used Socrates as his star character, Plato began to strike out on his own in later work. And so it is revealing that in one of his later dialogues, the Phaedrus, Plato takes a different view. The soul, Plato writes, is like a chariot.

    The charioteer, Reason, tries his best to guide the chariot along the road of virtue. But his horse, Appetite, is stubborn, “deaf as a post” and may gallop off the road at any moment. “Chariot-driving in our case,” Plato concludes, “is inevitably a painfully difficult business.” If we take that to heart, maybe we will start giving the addicted what they need to get their lives back under control.

    Brendan de Kenessey is a fellow in residence at the Edmond J. Safra Center for Ethics at Harvard University. This fall, he will join the faculty of the philosophy department at the University of Toronto.

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7. Hundreds of millions in state opioid cash left unspent

   Mar 19, 2018 | Politico

   By Rachana Pradhan & Brianna Ehley

   Congress sent states hundreds of millions of dollars to fight an opioid crisis claiming more than 100 lives a day — money they've largely been unable to spend after a year.

   Mixed signals from the Trump administration on how to use the money and state challenges ramping up their efforts have left untouched more than three-quarters of the $500 million Congress set aside under the 21st Century Cures Act in late 2016.

   As President Donald Trump heads to hard-hit New Hampshire today to tout his plan to combat the crisis, the slow drip of dollars into communities hit hard by addiction has put state officials in a bind and frustrated addiction experts and some treatment organizations.

   “This is a total failure,” said Andrew Kolodny, former chief medical officer at Phoenix House and now a Brandeis University researcher, likening the situation to food and water “stuck in an airport somewhere, while people are starving to death.”

   The grants for opioid addiction and prevention efforts were part of a $1 billion commitment over two years authorized in the Cures Act, which then-President Barack Obama signed just before leaving office.

   But state officials were quickly caught in a dilemma: They were happy to receive new money, but it was guaranteed for only two years, making it difficult to get long-term commitments from health care providers and others to build programs and hire a workforce.

   Many of those trying to expand access to medication-assisted treatment, buy overdose reversal drugs and bolster recovery programs say they were hamstrung in their efforts to solve a magnifying public health emergency with a short-term program. They’re calling on Congress for a longer-term financial commitment.

   "One-time money really changes the parameters of what you think you can fund," said Katie Marks, project director for the Kentucky Opioid Response Effort, where officials will receive $21 million in grants over two years. "Some of these programs are going to take a fair amount of development before they can sustain themselves."

   Congress is set to release the second $500 million tranche of aid soon, and weighing whether to extend the grants beyond two years while making other changes, according to aides in both parties.

   The funding is valuable to boost certain types of programs, but doesn’t come close to paying for aggressive treatment for those suffering from addiction, said Robin Parsons of the Fairbanks Alcohol and Drug Addiction Treatment Center in Indianapolis.

   “This isn’t going to go away in a couple years,” Parsons, the hospital’s chief clinical officer, said of the epidemic.

   Regina LaBelle, who served as chief of staff at the Office of National Drug Control Policy during the Obama administration, likens the states' challenge to “flying a plane while you’re building it ... They have to build infrastructure at the same time they have to get money out the door.”

   Many projects are just getting off the ground, even though the first year of the program ends April 30 — with officials expecting to request the money be carried over into the new year.

   Kentucky officials had spent nearly $2 million as of early this month, Marks said. They began finalizing contracts for roughly 30 projects in July, she said.

   "It has been a challenge with that many contracts, and using a state procurement process and partnering with community agencies," said Allen Brenzel, clinical director for the Kentucky Department for Behavioral Health, Developmental and Intellectual Disabilities.

   Other states found workarounds to spend it faster. California legislators gave their health department new authority to quickly roll out contracts using the nearly $45 million the state will get annually, most of it to increase the use of medication-assisted treatment. The programs were up and running by last fall.

   Progress has been slower elsewhere.

   In New Hampshire, which had the nation's third-highest drug overdose fatality rate in 2016, a five-member council must approve state contracts exceeding $25,000. The first two grants weren't approved until late January.

   "We don't want to spend 18 months building programs that sunset when the funding ends," said Julia Frew, who oversees a Dartmouth-Hitchcock Medical Center effort that got $2.8 million to expand medication-assisted treatment for pregnant women. "We're trying to think of sustainability as we go."

   In Indiana, which received about $11 million the first year, concerns about future funding led Aspire Indiana to not move ahead with a proposed expansion of residential substance abuse services, according to Matt Brooks, president of the Indiana Council of Community Mental Health Centers.

   There is no guarantee that SAMHSA grant funding will continue in the future," said Brooks.

   Federal officials say such spending delays are normal for new programs. The first four months of the state opioids grants were dedicated to setting up infrastructure, followed by a half year focused on delivering services, SAMHSA spokesperson Chris Garrett said. He said that states have spent just under a quarter of the $500 million Congress appropriated so far.

   But the start-up experience has underscored the need for greater clarity from the federal government. Last year, Ex-HHS Secretary Tom Price sent mixed signals about how much funding states would receive in round two and what it might be spent on. That rattled state officials, who worried that changes halfway through would require them to reapply and potentially delay projects.

   Congress and SAMHSA also went back and forth about whether to change the funding formula— it is based on a combination of population and total drug deaths, which left small states like West Virginia and New Hampshire with proportionately less money than big states that had lower mortality rates.

   "We had to kind of wait for the green light that the second-year funding would be allocated to the same priorities," said Kentucky's Brenzel.

   State officials are now awaiting the second round of funding and hoping for more after that.

   "My No. 1 ask" would be for them to continue the program as is, said Marlies Perez, chief of the California Department of Health Care Services Substance Use Disorder Compliance Division. "For them to come up with a whole new system? That would definitely add delays."

   Some in Congress are nonetheless examining possible tweaks. Sen. Tammy Baldwin (D-Wis.) and others have proposed broadening the funding targets to address additional substance use issues like methamphetamine, which has plagued her state.

   Other lawmakers, from states with the highest drug-related death rates, are pushing for more money, faster.

   "How do we deal with small communities that don't have two nickels to rub up against each other to file a grant application?" said GOP Rep. David McKinley, whose home state of West Virginia has the highest overdose mortality rate in the country. "How can we streamline this so that it does get out?"

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8. Opioid shortages leave US hospitals scrambling

   Mar 19, 2018 | CNN

   By Pauline Bartolone

   Even as opioids flood American communities and fuel widespread addiction, hospitals are facing a dangerous shortage of the powerful painkillers for patients in acute pain, according to doctors, pharmacists and a coalition of health groups.

   The shortage, though more significant in some places than others, has left many hospitals and surgical centers scrambling to find enough injectable morphine, Dilaudid and fentanyl -- drugs needed for patients undergoing surgery, fighting cancer or suffering traumatic injuries. The shortfall, which has intensified since last summer, was triggered by manufacturing setbacks and a government effort to reduce addiction by restricting drug production.

   As a result, hospital pharmacists are working long hours to find alternatives, forcing nurses to administer second-choice drugs or deliver standard drugs differently. That raises the risk of mistakes -- and already has led to at least a few instances in which patients received potentially harmful doses, according to the nonprofit Institute for Safe Medication Practices, which works with health care providers to promote patient safety.

   In the institute's survey of hospital pharmacists last year, one provider reported that a patient received five times the appropriate amount of morphine when a smaller-dose vial was out of stock. In another case, a patient was mistakenly given too much sufentanil, which is about 10 times more powerful than fentanyl, which was the ideal medication for that situation.

   In response to the shortages, doctors in states as far-flung as California, Illinois and Alabama are improvising the best they can. Some patients are receiving less potent medications like acetaminophen or muscle relaxants as hospitals direct their scant supplies to higher-priority cases. Others patients are languishing in pain because preferred, more powerful medications aren't available, or because they have to wait for substitute oral drugs to kick in.

   The American Society of Anesthesiologists confirmed that some elective surgeries, which can include gall bladder removal and hernia repair, have been postponed.

   In a Feb. 27 letter to the U.S. Drug Enforcement Administration, a coalition of professional medical groups -- including the American Hospital Association, the American Society of Clinical Oncology and the American Society of Health-System Pharmacists -- said the shortages "increase the risk of medical errors" and are "potentially life threatening."

   In addition, "having diminished supply of these critical drugs, or no supply at all, can cause suboptimal pain control or sedation for patients," the group wrote.

   The shortages involve pre-filled syringes of these drugs, as well as small ampules and vials of liquid medication that can be added to bags of intravenous fluids.

   Drug shortages are common, especially of certain injectable drugs, because few companies make them. But experts say opioid shortages carry a higher risk than other medications.

   Giving the wrong dose of morphine, for example, "can lead to severe harm or fatalities," explained Mike Ganio, a medication safety expert at the American Society of Health-System Pharmacists.

   Calculating dosages can be difficult and seemingly small mistakes by pharmacists, doctors or nurses can make a big difference, experts said.

   Marchelle Vernell, a nurse at St. Louis University Hospital in Missouri, said it would be easy for medical mistakes to occur during a shortage. For instance, in a fast-paced environment, a nurse could forget to program an electronic pump for the appropriate dose when given a mix of intravenous fluids and medication to which she was unaccustomed.

   "The system has been set up safely for the drugs and the care processes that we ordinarily use," said Dr. Beverly Philip, Vice President for Scientific Affairs at the American Society of Anesthesiologists. "You change those drugs, and you change those care processes, and the safety that we had built in is just not there anymore."

   Chicago-based Marti Smith, a nurse and spokeswoman for the National Nurses United union, offered an example.

   "If your drug comes in a prefilled syringe and at one milligram, and you need to give one milligram, it's easy," she said. "But if you have to pull it out of a 25 milligram vial, you know, it's not that we're not smart enough to figure it out, it just adds another layer of possible error."

   During the last major opioid shortage in 2010, two patients died from overdoses when a more powerful opioid was mistakenly prescribed, according to the institute. Other patients had to be revived after receiving inaccurate doses.

   The shortage of the three medications, which is being tracked by the FDA, became critical last year as a result of manufacturing problems at Pfizer, which controls at least 60 percent of the market of injectable opioids, said Erin Fox, a drug shortage expert at the University of Utah.

   A Pfizer spokesman, Steve Danehy, said its shortage started in June 2017 when the company cut back production while upgrading its plant in McPherson, Kansas. The company is not currently distributing pre-filled syringes "to ensure patient safety," it said, because of problems with a third-party supplier it declined to name.

   That followed a February 2017 report by the U.S. Food and Drug Administration that found significant violations at the McPherson plant. The agency cited "visible particulates" floating in the liquid medications and a "significant loss of control in your manufacturing process [that] represents a severe risk of harm to patients." Pfizer said, however, that the FDA report wasn't the impetus for the factory upgrades.

   Other liquid opioid manufacturers, including West-Ward Pharmaceuticals and Fresenius Kabi, are deluged with backorders, Fox said. Importing these heavily regulated narcotics from other countries is unprecedented and unlikely, she added, in part because it would require federal approval.

   At the same time, in an attempt to reduce the misuse of opioid painkillers, the Drug Enforcement Administration called for a 25 percent reduction of all opioid manufacturing last year, and an additional 20 percent this year.

   "DEA must balance the production of what is needed for legitimate use against the production of an excessive amount of these potentially harmful substances," the agency said in August.

   When the coalition of health groups penned its letter to the DEA last month, it asked the agency to loosen the restrictions for liquid opioids to ease the strain on hospitals.

   The shortages are not being felt evenly across all hospitals. Dr. Melissa Dillmon, medical oncologist at the Harbin Clinic in Rome, Georgia, said that by shopping around for other suppliers and using pill forms of the painkillers, her cancer patients are getting the pain relief they need.

   Dr. Shalini Shah, the head of pain medicine at the University of California-Irvine health system, pulled together a team of 20 people in January to figure out how to meet patients' needs. The group meets for an hour twice a week.

   The group has established workarounds, such as giving tablet forms of the opioids to patients who can swallow, using local anesthetics like nerve blocks and substituting opiates with acetaminophen, ketamine and muscle relaxants.

   "We essentially have to ration to patients that are most vulnerable," Shah said.

   Two other California hospital systems, Kaiser Permanente and Dignity Health in Sacramento, confirmed they're experiencing shortages, and that staff are being judicious with their supplies and using alternative medications when necessary.

   At Helen Keller Hospital's emergency department in Sheffield, Alabama, earlier this month, a 20 year-old showed up with second-degree burns. Dr. Hamad Husainy said he didn't have what he needed to keep her out of pain.

   Sometime in January, the hospital ran out of dilaudid, a drug seven times more potent than morphine, and has been low on other injectable opioids, he said.

   Because Husainy's patient was a former opioid user, she had a higher tolerance to the drugs. She needed something strong like dilaudid to keep her out of pain during a two-hour ride to a burn center, he said.

   "It really posed a problem," said Husainy, who was certain she was in pain even after giving her several doses of the less potent morphine. "We did what we could, the best that we could," he said.

   Vernell, the St. Louis nurse, said some trauma patients have had to wait 30 minutes before getting pain relief because of the shortages.

   "That's too long," said Vernell, a former intensive care nurse who now works in radiology.

   Dr. Howie Mell, an emergency physician in Chicago, said his large hospital system, which he declined to name, hasn't had dilaudid since January. Morphine is being set aside for patients who need surgery, he said, and the facility has about a week's supply of fentanyl.

   Mell, who is also a spokesman for the American College of Emergency Physicians, said some emergency departments are considering using nitrous oxide, or "laughing gas" to manage patient pain, he said.

   When Mell first heard about the shortage six months ago, he thought a nationwide scarcity of the widely-used drugs would force policymakers to "come up with a solution" before it became dire.

   "But they didn't," he said.

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9. Can Taxing Pain Pills Alleviate the Opioid Epidemic?

   Mar 19, 2018 | Governing

   By Mattie Quinn

   The opioid epidemic, which killed 64,000 Americans in 2016, is making governments resort to unprecedented policies for saving lives and preventing addiction in the first place.

   First it was the expanded access of naloxone, the overdose-reversing drug now available in many schools and pharmacies and often carried by first responders. On Monday, President Trump is set to announce new policies to fight the opioid crisis, including the death penalty for some drug dealers. Meanwhile, several states might tax drug manufacturers for the opioids they produce.

   “350 million opioid pain pills came into Kentucky last year. Drug companies get billions, our state gets nothing, and communities are devastated,” says Kentucky state Rep. James Kay, who sponsored an opioid tax bill.

   Bills are also circulating in Minnesota, New Jersey, New York, Tennessee and West Virginia. They vary on tax amounts, how the law would be enforced and how the money would be used. Some propose putting the new revenue toward expanded treatment options. Others would use it for funding public schools or adding to the General Fund.

   But even among supporters of taxing opioids, there are still a lot of questions: How could they prevent the tax from being passed on to consumers? Would it hurt patients who need pain pills? And could a tax actually reduce the number of overdoses and drug users?

   “To prevent cancer, you tax cigarettes to get people to stop buying and smoking. But do we want to tax people’s medical treatment? That’s trickier,” says Richard  Auxier, research associate for the Urban-Brookings Tax Policy Center.

   Because legal opioids aren’t a consumer good that can be bought over the counter, it’s unclear if this tax would slow prescriptions in the same way a cigarette or soda tax is supposed to deter people from consuming those things.

   “We can keep saving people [with] naloxone, but until we start talking about how [opioids] get dispensed, we’re going to keep having this problem. And the drug companies have to be a part of the solution,” says Minnesota state Rep. Dave Baker, a Republican who supports the tax.

   In Baker's state, the bill calls for sending opioid manufacturers a quarterly tax bill based on how many pills were prescribed. Lower-dose opioids like codeine would be taxed less than stronger opioids like oxycodone.

   “I do believe a significant tax would cut back on the supply," says Kay, the Kentucky representative.

   It's no secret, though, that pharmaceutical companies spend a lot of money lobbying against laws that could hurt their bottom line. For instance, despite bipartisan anger over soaring drug prices, the industry successfully campaigned against two ballot measures in the last couple of years that would have regulated drug prices in California and Ohio.

   Indeed, in Kentucky, Rep. Kay admits that getting the opioid tax bill to pass the Senate will be a challenge because pharmaceutical interests have stepped up their lobbying “three-fold” since it picked up steam. However, he is encouraged by the bipartisan nature of the proposals.

   These opioid tax proposals come at a time when more than 300 states, cities and counties are suing opioid drug manufacturers and distributors for their role in the opioid crisis. Most of them are seeking monetary damages for the cost of fighting the epidemic.

   “We want to make the people who created this epidemic pay, and I empathize with that," says Auxier, the researcher. "But I just don’t know how that will work [with opioid taxes]."

   Instead of passing an opioid tax now, Auxier advises states to first increase funding for substance abuse treatment and mental health care -- and then experiment with how a tax could supplement that cost. It might be more helpful to think of it like a gas tax, he says: as a tool for revenue rather than changing behavior.

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10. Docs more likely to prescribe opioids after pharma pay, study finds

    Mar 16, 2018 | BioPharmaDive

    By Meg Bryant

    Dive Brief:Doctors who receive even one payment from a pharmaceutical company for a brand name drug are five times more prone to prescribe that drug over an alternative treatment, including generics, according to a new CareDash study. The likelihood rises to 14.5% when the payment involves a specific opioid drug.From 2014 to 2016, drug companies paid doctors a total of $6.2 billion for services like promotional talks, royalties/licenses and consulting.Opioid manufacturers paid physicians more than $43 million, with Insys Therapeutics and Purdue Pharma L.P. doling out $16 million and $11.5 million, respectively, over the two-year period.Dive Insight:

    Prescription drugs accounted for 17% to 20% of all U.S. healthcare spend in 2015, and invoice spending on medications is expected to reach $580 billion to $610 billion by 2021, the report says.

    The top two drugs for which doctors received payments — Xarelto and Invokana, with $76.5 million and $55.9 million, respectively — are both made by Johnson & Johnson's Janssen Pharmaceutica NV. AbbVie Inc.'s Humira was number three, with payments totaling $53 million.

    More than 74,000 payments totaling $16 million were tied to Insys’ fentanyl drug Subsys between 2014 and 2016. Doctors in Arizona, California, Florida, New York, Ohio and Texas took more payments for opioids than those in other states—with New York claiming the most per provider at $1,014.93.

    In general, family practice physicians were most likely to prescribe a brand name drug after receiving payment from the manufacturer, followed by internal medicine, psychiatry and cardiology.

    “This analysis pulls back the curtain on the influence pharmaceutical companies may have on a patient’s course of treatment and allows patients to make more informed healthcare choices,” Ted Chan, founder and CEO of CareDash, said in a statement. “Patients have the right to know about their doctors’ motivations, any potential conflicts of interest, and should be aware of the connection between the marketing practices of pharmaceutical manufacturers and the drugs they are prescribed by their physician.”

    Drug companies have been coming under fire for their role in the opioid crisis, in part because of aggressive marketing. In late February, the Department of Justice announced plans to file a statement of interest in a multi-district action for hundreds of opioid-related lawsuits. Days later, President Donald Trump suggested a federal lawsuit against opioid makers could be in the offing.

    In February, New York filed a lawsuit against Insys, alleging it recklessly pitched Subsys to a wider patient population, downplayed the drug’s addiction risk, bribed doctors to prescribe it and lied to insurers to avoid prior authorizations.

    And just this week, a tribe in Oklahoma sued 26 drugmakers, accusing them of intentionally misrepresenting the risks and benefits of addictive painkillers. The Ponca tribe is seeking a jury trial and an injunction barring drug companies and distributors from using “unfair or deceptive practices.” 

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Southeast (FL, SC, MS, VA, WV)

11. Broward County Files Federal Lawsuit Against Opioid Drug Manufacturers

    Mar 16, 2018 | WUSF (FL)

    By Caitlin Switalski

    Broward County filed a new lawsuit in federal court Monday against manufacturers of opioid drugs.

    Walmart, Walgreens, the McKesson Corp. and CVS Health are just some of the drug makers and distributors Broward County is suing.  \

    Others include Johnson & Johnson, Cardinal Health Inc., Health Mart Systems, Mallinckrodt, Amerisourcebergen Corp., as well as Endo Janssen, Purdue, Cephalon and Teva Pharmaceuticals. 
    

    The county accused the companies in the complaint of violating rhe Racketeer Influenced and and Corrupt Organizations Act, as well as the Florida Deceptive And Unfair Trade Practices Act, and others.  

    Citing the opioid crisis as the reasoning for the suit, the county is also alleging other federal laws were violated by making and distributing opioid drugs like Fentanyl and OxyContin. 
    

    In Broward County alone, there were more than 580 deaths due to opioid overdoses in 2017, which breaks down to more than 11 a week.
    

    Broward County announced in the lawsuit that officials are seeking a jury trial.

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12. Lancaster County sues drug distributors after rise in overdose deaths

    Mar 18, 2018 | The Herald (SC)

    By Hannah Smoot

    Lancaster County saw a 400 percent increase in drug overdose deaths in 2017. Now the county plans to do something about that.

    Lancaster County filed a federal lawsuit March 7, alleging that three major drug companies should have noticed – and stopped – “suspicious” orders of opioids in South Carolina.

    The three companies are Amerisourcebergen Drug Corporation, Cardinal Health and McKesson Corporation. They account for 85 percent to 90 percent of wholesale drug distribution in the United States, according to the Lancaster County suit.

    The Lancaster County Coroner’s Office reported 25 overdose deaths in the county in 2017. Of those deaths, 18 involved the potent opiate fentanyl, which is about 50 times stronger than heroin.

    Lancaster County saw only five overdose deaths in 2016.

    Charles Whetstone, the lead attorney representing Lancaster County in the suit, said his firm has reached out to many counties. He said it is representing three other South Carolina counties – Horry, Dillon and Marion counties – in similar suits.

    John Weaver, Lancaster County attorney, said the week before the County Council discussed the possibility of the lawsuit, three residents died from drug overdoses.

    “I think it’s unquestioned that the use of those opioid drugs has gone beyond usefulness into excessiveness,” he said. “I think there are counties and municipalities in the state, including Lancaster County, that have seen the effects of excessive opioid prescriptions.

    “And the more counties and municipalities that get on the bandwagon to apply pressure, the better off our citizens and the whole nation will be if there is some restriction placed on it,” Weaver said.

    The county is suing the drug companies for damages it says it incurred through spending on services including law enforcement, prosecutions, emergency response services, public utilities and property damage.

    “There are drugs out there who provide dangerous conditions, not only for the deceased of course, but for the EMS and the coroner,” Weaver said.

    Representatives from Healthcare Distribution Alliance, the national trade association that represents all three drug companies, said in a statement that distributors already report every single order to the Drug Enforcement Administration.

    “The misuse and abuse of prescription opioids is a complex public health challenge that requires a collaborative and systemic response that engages all stakeholders,” said the statement from John Parker, senior vice president at Healthcare Distribution Alliance.

    “Given our role, the idea that distributors are responsible for the number of opioid prescriptions written defies common sense and lacks understanding of how the pharmaceutical supply chain actually works and is regulated,” Parker said. “Those bringing lawsuits would be better served addressing the root causes, rather than trying to redirect blame through litigation.”

    Weaver said it’s too early to say if the county will win any money. But he said if it did, the money would likely be put toward educational training and the safety of public safety personnel.

    “It’s somewhat of an uphill battle,” he said.

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13. Starkville to consider joining opioid litigation

    Mar 17, 2018 | The Dispatch (MS)

    By Alex Holloway

    The Starkville Board of Aldermen will consider allowing the city to join as plaintiffs in litigation targeting opioid manufacturer and distribution companies when they meet on Tuesday. 

    The litigation, which is an item under the mayor's business portion of Tuesday's meeting agenda, came up for discussion during a Friday work session at city hall after law firm Smith, Bobinger and Smith approached the city about joining as a plaintiff. 

    Columbus attorney Corky Smith, speaking to The Dispatch, said the crux of the litigation is that opioid drug manufacturers didn't properly warn people about the dangers of their products. Those companies, he said were aware of the dangers -- especially in how addictive opioid medications can be. 

    "They used deceptive business practices to get a highly addictive product on the market that they knew would get customers for life, but didn't tell them about the dangers of the product," Smith said. "You can't have someone make informed consent on a product if they don't know the dangers they can cause. If you've known the dangers, you've got a duty to tell people. Everything stems from there." 

    Smith said multiple companies all over the country are defendants in the litigation, including Purdue Pharma, which manufactures the original version of OxyContin. 

    Mayor Lynn Spruill said Smith, Bobinger and Smith were the first firm to approach the city about joining the litigation, though several firms have unsuccessfully approached the Oktibbeha County Board of Supervisors with similar requests. 

    "They were asking us to join the opioid litigation," she said. "There's nothing required of us, other than to agree to be one of the plaintiffs." 

    Opioids are a class of drug with the primary purpose of reducing pain. Legal opioids can be prescribed by medical providers and include drugs such as hydrocodone, oxycodone, codeine and fentanyl. Illegal opioids include drugs like heroin and variants of fentanyl and other synthetic substances. 

    Smith said the group has already entered into contracts with Columbus, George County and Green County, and is awaiting considerations from several additional entities. 

    He said the suit would be part of a multi-district litigation case, which means it will be compiled with similar cases from across the country in federal court in the Northern District of Ohio. He said that will allow a consistent decision on the cases, rather than courts across the United States rendering different decisions on different cases. 

    The case, Smith said, will target the manufacturing and distribution companies that control the flow of opioids, and not pharmacies and doctors. 

    "It's not local doctors," he said. "It's not local pharmacies. In fact, a lot of the times, the doctors and pharmacies were, for lack of a better term, duped the same way the public was." 

    Smith said claims can vary from entity to entity, depending on their unique situation, and it will take time to determine the potential for damages in Starkville. However, he said there are likely to be some commonalities for cities and counties, such as increased law enforcement costs. 

    "A lot of the costs are recognizable through different levels of damages," he said. "You have increased police costs, increased court costs. You've got a number of programs that are publicly funded that help treat or respond to things as a result of this crisis." 

    Spruill compared the opioid litigation to litigation against tobacco companies that generated billions of dollars in settlement money. 

    City attorney Chris Latimer, speaking during Friday's work session said joining may be worth considering. 

    "It's worth a shot," he said. "I can't say there's any kind of guaranteed potential for recovery, but it's just, as the mayor said, the cigarette litigation -- we didn't know if that was going to go anywhere or not and it ended up being a really big deal." 

    Latimer said the city wouldn't take on any expenses, in the event to joining the litigation. If the litigation doesn't generate any recovery, the city wouldn't have to pay any fees, and if the recovery is less than expenses for the suit, the city wouldn't owe any fees.

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14. Dickenson County files $30 million suit against drug makers, others

    Mar 16, 2018 | The Roanoke Times (VA)

    By Luanne Rife

    Dickenson County this week filed a $30 million lawsuit against the makers of painkillers and the companies that distribute them and oversee prescription benefit plans.

    The lawsuit filed in the county’s circuit court mirrors actions by local governments across the nation. A similar lawsuit seeking $100 million was also filed Wednesday by the city of Alexandria, according to The Washington Post.

    The Dickenson suit claims that pharmaceutical manufacturers, distributors and benefits managers “profit enormously from the movement of opioid products,” while the county has had to “allocate substantial taxpayer dollars, resources, staff, energy and time to address the damage the opioid scourge has left in its wake and to address its many casualties.”

    The lawsuit claims that Purdue Pharma and other opioid makers misrepresented the addictive qualities of pain pills, but that their "lies would matter not, if the drugs themselves were not distributed. And no drug would reach any community were it not on a PBM [pharmacy benefit manager] formulary, which specifies which drugs will be covered and, in turn, paid for by private or public insurers."

    The county blames prescription drugs for causing overdose deaths of its residents, and pointed out that unlike other parts of the state, heroin and fentanyl are not the source of its problems.

    But the lawsuit erred in claiming that in a county of 16,000 people, 465 of them died in 2016 from overdoses. The figure actually represents the statewide number of prescription opioid deaths, according to the Virginia Department of Health.

    Six of the deaths were Dickenson residents, which still places the county’s per capita mortality rate among the highest in the state.

    In 2016, the health department also reported 803 heroin and fentanyl overdose deaths, along with more than 10,000 emergency room visits for heroin and opioid overdoses.
    

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15. Milton joins into lawsuit against drug manufacturers

    Mar 16, 2018 | WSAZ (WV)

    By Staff

    Another West Virginia city is filing a lawsuit against drug manufacturers and opioid distributors.

    On Friday, the city of Milton announced that they filed a lawsuit against the manufacturers and distributors of opioids responsible for flooding the market with pills. They say those pills have spawned a nationwide crisis.

    The city says these distributors provided false and misleading information to doctors and patients about the safety and efficacy of prescription opioids for the last 20 years.

    Milton Mayor Tom Canterbury released a statement:

    "It has become too easy to become an addict in the State of West Virginia. Opioids are too readily available from Physicians and the quantities prescribed to individuals are unbelievable. The result of addiction in our community is becoming a health hazard to innocent children who are finding used needles in areas that should be safe for them such as playgrounds and ball fields. Families are being torn apart and grandparent and great-grandparents are raising children whose parents have chosen drugs over their own children. I won't even mention the loss of life. In the City of Milton, it has become a priority to clean up our city, however this is an ongoing battle and we need to enlist the help of those who control manufactures and distributors."

    The lawsuit is seeking damages to remedy the impact of the opioid crisis on the city of Milton. The city says their police, fire and emergency service workers are routinely responding to opioid related health crisis's including overdoses.

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Midwest (WI, MI, OH)

16. Menominee Latest Tribe To Sue Pharma Cos. Over Opioids

    Mar 15, 2018 | Law360

    By Adam Lidgett

    The Menominee Indian Tribe of Wisconsin on Thursday became the latest Native American tribe to file suit against major drugmakers and distributors over the opioid epidemic, accusing a host of companies of making billions off the crisis.

    The tribe filed a complaint in Wisconsin federal court against various companies — including Purdue Pharma LP, McKesson Corp., AmerisourceBergen Corp., Janssen Pharmaceuticals Inc. and others — saying the defendant companies have made the crisis worse and have minimized or hid opioid abuse risks. Drug companies have been facing a slew of cases over the opioid epidemic from states, individuals and Native American tribes, with a large number of cases involving the crisis being part of multidistrict litigation in Ohio federal court.

    “Instead of acting with reasonable care and in compliance with their legal duties, the defendants intentionally flooded the market with opioids and pocketed billions of dollars in the process,” the complaint said. “Defendants also flooded the market with false statements designed to persuade both doctors and patients that prescription opioids posed a low risk of addiction. Those claims were false.”

    The tribe said that as it has seen the number of parents addicted to opioids rise, so the cost of child welfare and foster care has as well. Additionally, the tribe said its health services have been inundated, as its health insurance is self-funded.

    Other issues that have sprung up have included an increase in the burial expenses for those who have died of opioid use and a higher crime rate and rate of mental health incidents, the complaint said. The tribe said that the opioid industry should have done something to prevent all those costs and issues.

    The Menominee Tribe’s complaint is just one of a number of similar suits from tribes. Earlier this month, a coalition of Washington-based tribes — including the Port Gamble S’Klallam tribe, the Suquamish tribe and the Jamestown S’Klallam tribe — filed a similar suit.

    Timothy Q. Purdon, an attorney for the Menominee Tribe, told Law360 on Thursday that he expects the case to be conditionally transferred to the Ohio MDL. He added that the tribe is the fifth tribe his firm has filed a suit on behalf of, and that the suit says both the manufacturers and distributors of opioids have engaged in unlawful conduct that has exacerbated the problem of opioid addiction on the reservation.

    “We are dedicated to doing our part as a distributor to mitigate the diversion of these drugs without interfering with clinical decisions made by doctors, who interact directly with patients and decide what treatments are most appropriate for their care,” AmerisourceBergen said in a statement. “Beyond our reporting and immediate halting of tens of thousands of potentially suspicious orders, we refuse service to customers we deem as a diversion risk and provide daily reports to the DEA that detail the quantity, type, and the receiving pharmacy of every single order of these products that we distribute.”

    Jessica Castles Smith, a Janssen spokesperson, said in a statement that the company was committed to an “ongoing dialogue and to doing our part to find ways to address this crisis.”

    “Our actions in the marketing and promotion of these medicines were appropriate and responsible,” the statement said. “The labels for our prescription opioid pain medicines provide information about their risks and benefits, and the allegations made against our company are baseless and unsubstantiated. In fact, our medications have some of the lowest rates of abuse among this class of medications.”

    Purdue said in its own statement that it was troubled by the crisis and wanted to work to solve it.

    “Although our products account for less than 2 percent of the total opioid prescriptions, as a company, we’ve distributed the CDC Guideline for Prescribing Opioids for Chronic Pain, developed three of the first four FDA-approved opioid medications with abuse-deterrent properties and partner with law enforcement to ensure access to naloxone,” Purdue said. “We vigorously deny these allegations and look forward to the opportunity to present our defense.”

    John Parker, senior vice president of the Healthcare Distribution Alliance — a trade association whose members include McKesson and others — said in a statement that the “misuse and abuse of prescription opioids is a complex public health challenge that requires a collaborative and systemic response that engages all stakeholders.”

    “Given our role, the idea that distributors are responsible for the number of opioid prescriptions written defies common sense and lacks understanding of how the pharmaceutical supply chain actually works and is regulated,” Parker said. “Those bringing lawsuits would be better served addressing the root causes, rather than trying to redirect blame through litigation.”

    The tribe is represented by Richard B. Allyn, Tara D. Sutton, Holly Dolejsi, Shira T. Shapiro, Sarah E. Friedricks, Brendan V. Johnson and Timothy Q. Purdon of Robins Kaplan LLP.

    Counsel information for the defendants was not immediately available on Thursday.

    The case is the Menominee Indian Tribe of Wisconsin v. Purdue Pharma LP et al., case number 1:18-cv-00414, in the U.S. District Court for the Eastern District of Wisconsin.

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17. Menominee Tribe sues opioid manufacturers

    Mar 16, 2018 | WLUK (WI)

    By Staff

    The Menominee Tribe is suing major companies that manufacture and distribute opioid drugs.

    “Menominee continues to endure the most catastrophic effects of this opioid epidemic. We need to hold these manufacturers and distributors accountable," Menominee Tribal Chairman Douglas Cox said in a news release. 
    

    The tribe is going after pharmaceutical companies including Purdue Pharma L.P., Teva Pharmaceutical Industries Ltd., and Allergan PLC, and distributors McKesson Corp., Cardinal Health Inc., and AmerisourceBergen Corp.

    They're accused of marketing prescriptions in a way that hides or minimizes the risk of addiction, as well as failing to abide by the laws that are meant to prevent abuse of prescribed drugs.

    Other Wisconsin counties have filed similar lawsuits against the makers of prescription painkillers.

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18. Traverse City To Consider Joining Opioid Lawsuit

    Mar 19, 2018 | The Ticker (MI)

    By Beth Milligan

    Traverse City commissioners will consider joining their counterparts in Grand Traverse and Leelanau counties in suing drug manufacturers over costs related to the opioid epidemic as part of a federal class-action lawsuit.

    Traverse City commissioners will consider joining their counterparts in Grand Traverse and Leelanau counties in suing drug manufacturers over costs related to the opioid epidemic as part of a federal class-action lawsuit.

    Commissioners will meet at 7pm tonight (Monday) to vote on retaining a legal team comprised of local, state and national attorneys – including Traverse City-based Smith Johnson, Farmington Hills’ Bernstein Law Firm, and New York City’s Weitz & Luxenberg – in a lawsuit against pharmaceutical manufacturers, distributors, and retailers. The lawsuit alleges that the targeted companies aggressively pushed the sale of highly addictive narcotic drugs like OxyContin, Vicodin, methadone, codeine, morphine, and fentanyl to consumers despite knowing the dangers they posed. A skyrocketing number of national opioid prescriptions – which quadrupled between 1999 and 2013 – directly led to the heroin epidemic, with four out of five heroin users starting out on prescription opioids, according to the lawsuit.

    Grand Traverse and Leelanau counties are already participants in the class-action case along with numerous other Michigan municipalities. Traverse City will consider joining under the same terms as those communities, paying no upfront legal fees but sharing 30 percent of the recovered damages with attorneys if the lawsuit is successful.

    Ahead of tonight’s vote, city commissioners met last week with Grand Traverse County Deputy Civil Counsel Christopher Forsyth to learn more about the lawsuit as well as the impact the opioid epidemic has had locally. There have been 31 overdose deaths in Grand Traverse County in the past three years, according to Forsyth – with opioids responsible for more deaths locally than car accidents and the same number of deaths as caused by firearms. Data provided to commissioners by Weitz & Luxenberg show that for every 10,000 residents of Grand Traverse County in 2015, 10,698 opioid prescriptions were written – with prescriptions increasing 33 percent since 2009. Local enforcement agencies continue to receive “several calls weekly for overdose situations,” according to Forsyth.

    “We’ve learned that one, all opioids are addictive, and they do not discriminate,” Forsyth said. “They don’t discriminate between the young and the old, the rich and the poor. They affect everybody. They will eventually lead to heroin. Once that (prescription) runs out, once you can’t doctor shop anymore, you will turn to the black market – and that will lead you to heroin.”

    The lawsuit seeks to recover costs for local communities caused by the opioid epidemic, including increased costs for emergency room visits, treatment programs, addiction and mental health counseling, law enforcement response and training, court cases, and child protective services. Each community participating in the lawsuit will provide its own estimate of damages. According to the National Institute on Drug Abuse, opioid misuse costs $78.5 billion annually in healthcare costs, lost productivity, addiction treatment, and criminal justice intervention. The lawsuit alleges pharmaceutical companies are responsible for bearing those costs because starting in the late 1990s, they falsely “reassured the medical community that patients would not become addicted to prescription opioid pain relievers, and healthcare providers began to prescribe them at greater rates,” according to Weitz & Luxenberg. “This subsequently led to widespread diversion and misuse of these medications…(and) opioid overdose rates began to increase.”

    The law firm provided as one example Purdue Pharma’s introduction of OxyContin in 1996; an aggressive marketing campaign for the drug caused its sales to swell from $48 million in 1996 to almost $1.1 billion in 2000, making it a leading drug of abuse in the country by 2004. OxyContin sales reps were trained to promote the drug in the “non-malignant pain market,” to encourage primary-care physicians to prescribe the drug liberally, and to state the risk of addiction for patients was less than one percent, according to attorneys. Such strategies were common practice across the industry for numerous addictive opioids, with patients prescribed potent medications for symptoms as common as headaches, arthritis, and back pain, the lawsuit alleges.

    During commissioners’ meeting with Forsyth, numerous residents spoke during public comment about the opioid epidemic’s effect on their lives. Traverse City East Middle School teacher Jody Mackey told commissioners three of her former students died from opioid overdoses in 2017, and said she personally intervened to prevent medical practitioners from prescribing opioids to her children following a childbirth and dental procedure, respectively. “My concern is that I’m still seeing even in my own life evidence that we’re still way overprescribing in this community,” she said. “If we don’t stop prescribing this amount...we’re getting people that have no other reason to become a drug addict other than they have a health incident, we’re getting people hooked on drugs. And it’s kids, too.”

    Several of Mackey’s digital media students produced a documentary on the local epidemic called Predator & Prey: Opioids’ Savage Effect On Our Community. The 18-minute film will screen for free at the State Theatre on Sunday, April 15 at 11:30am, followed by a panel of speakers who will discuss addiction. Mackey encouraged city commissioners to see and promote the film, as well as to use their position in the city “to leverage some talks with the medical community” about opioids and the rate at which they are prescribed locally.

    Commissioners affirmed their interest in exploring options beyond joining the federal class-action lawsuit to address opioid addiction in the community. The board discussed the possibility of reinstating a drug interdiction officer position within the Traverse City Police Department; such an officer would specialize in illegal drug interception and reach out to local hotels and other locations where drugs commonly appear to train staff on how to recognize drug activity. Commissioner Michele Howard also said she wanted to see the city play a more proactive role in the Grand Traverse Drug Free Coalition and ramp up educational programming and campaigns, such as promoting Good Samaritan laws that allow individuals to report drug overdoses without risk of being arrested. Howard said joining with other municipalities in a lawsuit against pharmaceutical companies was “a great idea,” but emphasized the city needed a multi-pronged approach to address the opioid epidemic.

    “I think we have a role that we can play to take action, and maybe some of that would be through budgetary means,” Howard said. “I’d like to see us get involved a step deeper.”

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19. Columbiana County files lawsuit against opioid manufacturers, distributors

    Mar 17, 2018 | The Vindicator (OH)

    By Justin Wier

    The Columbiana County commissioners have filed a federal lawsuit against several drug companies and distributors in an attempt to fight the opioid epidemic and recoup costs resulting from the crisis. The 173-page lawsuit claims manufacturers “aggressively pushed highly addictive, dangerous opioids, falsely representing to doctors that patients would only rarely succumb to drug addiction,” and that distributors “intentionally and/or unlawfully breached their legal duties ... to ... report suspicious orders of prescription opioids.”

    The commissioners announced their plans to file the lawsuit last year. The matter will likely be transferred into a centralized action that includes more than 200 lawsuits filed by state and local governments against opioid manufacturers and distributors.

    Judge Dan A. Polster, of U.S. District Court in Cleveland, presides over the multi-district litigation.

    Judge Polster has told reporters that in addition to money, he wants a potential settlement to include real solutions to help stop the opioid epidemic.

    Columbiana’s action includes claims that the manufacturers and distributors have created a public nuisance, violated the Racketeer-Influenced and Corrupt Organizations act and the Ohio corrupt practices act and engaged in deceptive trade practices.

    It alleges that the manufacturers and distributors, “trivialized and failed to disclose the risks of long-term opioid use,” which contributed to the epidemic.

    The complaint asks the judge to prevent the manufacturers and distributors from engaging in unfair or deceptive practices and to order them to compensate Columbiana County for costs associated with fighting the opioid epidemic.

    In December, Trumbull County filed a similar action in Trumbull County Common Pleas Court. Ohio Attorney General Mike De-Wine also sued the five largest manufacturers of opioids in May.

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Northeast (NY)

20. Washington County may sue opioid manufacturers

    Mar 18, 2018 | Olean Times Herald (NY)

    By Kathleen Moore

    Washington County may join the brewing lawsuit against opioid manufacturers.

    The Board of Supervisors will meet in executive session with two law firms on March 21. The closed-door sessions will be interviews with each firm to determine whether the county wants to hire either one.

    Both law firms have a number of clients from the area, including Warren and Saratoga counties.

    If Washington County joins, there would be no immediate cash cost. The law firms are taking on the case with the deal that they will be paid a percentage of the eventual judgment, if there is one.

    The county would have to collect records proving that rampant opioid addiction has been costly, in law enforcement calls, jail time, medical care and social services assistance.

    “You’ll have to assemble the records. There’s the cost — it’s a time cost,” said County Attorney Roger Wickes. “The theory of the case is, by prescribing and marketing the things the way they have, it’s cost the county a lot of money. You’ve got to prove damages.”

    Damages could even include the cost of cans of Narcan issued to law enforcement and others to help save the lives of addicts who overdose.

    Supervisors have been asking about the lawsuit, Wickes said. So he listened to presentations by both of the major local law firms involved. He decided the case is worth considering.

    “It’s worth looking into,” he said. “No lawyer can say it’s a winner. You never know what can happen. Is it worth exploring? Yes.”

    He expects that any lawsuit from Washington County would eventually get merged with hundreds of similar lawsuits around the country.

    “It will probably get combined into one massive case,” he said.

    That will be heard in one court, likely not in New York state, he said.

    Given all that, the case could be years away from resolution.

    But Washington County is coming into it “relatively late,” he said, and the supervisors might decide soon to join the case. They would have to vote on hiring a law firm and starting a lawsuit.

    All supervisors have been asked to attend the meetings on March 21, which are not open to the public because they will discuss legal strategies. A vote on the matter will be held in public.

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21. Ulster County joins lawsuit vs. pharma companies over opioids

    Mar 16, 2018 | Daily Freeman News (NY)

    By Staff

    Ulster County has joined the legal battle against pharmaceutical companies that counties say were dishonest about the effects of long-term opioid use.

    Ulster’s lawsuit was filed Thursday by the law firm Simmons Hanly Conroy, which also is representing Dutchess, Greene, Orange and Sullivan counties.

    The suit alleges the defendant companies “sought to create a false perception in the minds of physicians, patients, health care providers and health care payors that using opioids to treat chronic pain was safe for most patients and that the drugs’ benefits outweighed the risks.”

    Ulster County Executive Michael Hein said his county has witnessed the devastating effects of opioid abuse first hand.

    “If you stood in my shoes and been to funerals and held mothers and fathers in your arms because they are putting their child in the ground, then you would know fully that what is happening here with opioids, and the next progression that moves onto heroin that is directly tied to this kind of tragedy,” Hein said. “It is specifically and a direct result of large pharmaceutical companies turning a blind eye to science and to what they knew was going to be the end result of flooding the market with a huge amount of opioid-based pain medication.”

    Earlier this week, Ulster County Health Commissioner Dr. Carol Smith said the county’s recent reduced ranking in what are known as “health outcomes” was largely attributable to a surge in opioid-related deaths.

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Southwest (TX)

22. Cooke County gets green light for legal fight in opioid crisis

    Mar 16, 2018 | Gainsville Daily Register (TX)

    By Megan Gray-Gatfield

    Cooke County Judge Jason Brinkley said the county was recently given the green light to proceed with its lawsuit against the pharmaceutical industry in an effort to recuperate monies spent related to opioid use.

    The Dallas-based firm of Simon Greenstone Panatier Bartlett, PC says pharmaceutical manufacturers, marketers and distributors are to blame for building what is now an opioid epidemic across the nation.

    “This county, unfortunately, is not immune to the opioid epidemic,” said Jeffrey Simon, a founding shareholder of Simon Greenstone Panatier Bartlett, PC. “We, as a country, are in the grips of the largest drug epidemic in our history. There are two things about this epidemic that are different from every other drug epidemic that proceeded it. The first, is its size. It’s exponentially larger than any other drug epidemic we’ve ever had. And secondly, it’s American made. It wasn’t created or promoted by a South American drug cartel, but rather by some of the largest drug companies in the world.”

    Brinkley said the county was approached by “four or five” law firms last year before members of the commissioners’ court approved hiring Simon Greenstone Panatier Bartlett in November.

    “They represent, I think, the greatest number of counties in the state of Texas,” Brinkley said of lawsuits that are being filed statewide against the pharmaceutical industry.

    No tax dollars have been spent on the litigation, he said, adding that the county had to receive approval from the state comptroller to enter into a contingency fee agreement with the firm. The comptroller approved the agreement this month.

    “It’s all covered if we recover anything as a county,” Brinkley said. “Anything is obviously better than nothing, but it also is to hold the drug manufacturers accountable and make sure that they step up to the plate for something that obviously is not just a drug manufacturer issue.”

    He said the epidemic goes beyond the pharmaceutical industry, but they need to be held accountable for what they have contributed to the issue.

    Opioids such as hydrocodone, oxycodone and morphine, prescribed by doctors to treat moderate to severe pain, can be addictive and dangerous, officials said.

    In October, United States Health and Human Services Secretary Eric D. Hargan declared a nationwide public health emergency regarding the opioid crisis, as requested by President Donald Trump.

    Each day, 116 people die in the U.S. from opioid-related drug overdoses, according to the HHS.

    Officials claim prescription opioids are a gateway to heroin, which is also considered an opioid.

    Nearly 80 percent of heroin users reported misusing prescription opioids prior to heroin, information from the federal government states.

    Brinkley said he has met with County Attorney Ed Zielinski and District Attorney John Warren to discuss the impact opioids have on the area.

    “I think it’s very evident that it’s (opioid use) impacted Cooke County in multiple different ways. Not only from a criminal justice standpoint but also on the medical standpoint,” he said.

    Brinkley said a portion of the calls for Cooke County Emergency Medical Services are for people who have overdosed on opioids.

    In 2017, CCEMS responded to five opioid-related disorders, according to information provided by Cooke County EMS Director Kevin Grant.

    Simon Greenstone Panatier Bartlett have a team who will take on analyzing how much of the taxpayers’ money the county has spent over the years related to opioids before filing the case, according to Brinkley.

    “The taxpayers have spent money on this whether they realize it or not over the years,” he said. “If we could recoup even a fraction of that, I think it would be beneficial.”

    Brinkley said he suspects the litigation will take “a long time.”

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Broadcast Media Coverage

23. Black Hills Fox News

    Mar 19, 2018 | Rapid City, SD

    By KEVNLD (Fox)

    Video Link: http://app.criticalmention.com/app/#clip/view/33677138?token=4d1be804-a22a-4528-a58b-58ab30e1dde1

    Rough Transcript: south dakota attorney general marty jackley has filed a lawsuitagainstseveralprescr iptiondrugmanufacturers for deceptively marketing opioidmedications. jackleyfiled the civil complaint dated wednesday in state crt against purdue pharma, endo health solutions and janssen pharmaceuticals. the lawsuit alleges the drug companies broke state deceptive trade and medicaid fraud laws and created a public nuisance by spreading false information about the risks and benefits of opioid medications. jackley says pharmaceutical companies "knowingly and deceptively" hurt consumers and must be held accountable. the lawsuit says the state is seeking damages, civil penalties and an end to any current "unlawful promotion of opioids." the state says nearly 600,000 opioidprescriptions were written in south dakota last year.

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24. ABC 17 News This Morning

    Mar 19, 2018 | Columbia, MO

    By KQFXLD (Fox)

    Video Link: http://app.criticalmention.com/app/#clip/view/33677271?token=4d1be804-a22a-4528-a58b-58ab30e1dde1

    Rough Transcript: later today, we'll learn more about president trump's plans to combat the country's opioid epidemic. his proposal includes seeking the death penalty for some drug dealers. it also includes a task force that wll focus on opioid manufacturers and distributors. the white house also hopes to cut opioidprescriptions by a third over the next three years. president trum will be speaking in new hampshire. budget talks are firing up again with another federal shutdown deadline coming this week. congress has until midnight this fridayto agree to a 1-point-3 trillion dollar spending bill. like usual, there are a number of topics slowing down budget talks. this time- abortion, immigration and a massive rail project in the northeast are causing issues. a current proposal would see a budget increase for the pentagon, as well as more infrastructure and opioids cris funding.

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25. Eyewitness News This Morning Sunday at 6:00am

    Mar 18, 2018 | Orlando, FL

    By WFTV (ABC)

    Video Link: http://app.criticalmention.com/app/#clip/view/33677645?token=4d1be804-a22a-4528-a58b-58ab30e1dde1

    Rough Transcript: 

    osceola county is ready to take what could be an unprecedented step to fight the opioid cris. commissioners could soon vote on a proposal that would allow the county to recover some of the money associated with the problem. it is reported that the county is already suing pharmaceutical companies over these costs. >> the motion carries. >> osceola county commissioners approved a statement of legislative intent. the first step in creating a new ordinance to deal with the abusive opioids like heroin and painkillers. the county attorney told me the 6:46 AMproposed county would allow osceola to recover the cost of dealing with widespread addiction like outfitting law enforcement with the reversal drug narcan from enties like drug companies. and while commissioners did not discuss the topic, thomas griffin had a lot to say. >> i think it is a very proactive position to take. i think somebody needs to start to hold the pharmaceutical companies and other folks accountable for their actions. >> griffin runs a transition house, a substance abuse treatment center in st. cloud. >> we have seen more people coming in today because of opioid addiction. we saw more in 17 then we did in 16. >> 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 a fine or the court. osceola says the opioid addiction has cost millions of dollars and they want help covering the cost. channel 9, eyewitness news. >> the next step is to write the proposed ordinance. the county attorney says they could be ready for a vote by next month or may. >>> orange county leaders are taking some unorthodox steps to tackle the opioid cris. earlier this year, officials teamed up with aspire health to hand out the drug narcan to families in holden heights and also motels along south orange blossom trail. they call that area a hot zone for overdoses. the county is using money from the federal grant to establish positions that two hospitals to help patients with substance abuse after they leave.
    

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26. Kentucky Newsmakers

    Mar 19, 2018 | Lexington, KY

    By WKYT (CBS)

    Video Link: http://app.criticalmention.com/app/#clip/view/33677679?token=4d1be804-a22a-4528-a58b-58ab30e1dde1

    Rough Transcript: attorney general andy beshear with us today. welcome back to "kentuck newsmakers." >> thank you for having me, bill. >> you have aggressively suedpharmaceutical companies and distributors i think there have been four lawsuits. you won also a court ruling saying that you don't need the governor's permission to take action and to hire outside counsel to do that. do you think your efforts can really dial back kentucky's opioid addiction crisis? >> well, our opioid addiction, our addiction cris is the challenge of our times. we lose four kentuckians every single day to a fatal overdose. as you know i saw that firsthand on a downtown street here in lexington pulling an overdose man from a car. but it's also the single greatest threat to our families. more children in foster 6:02 AMchair or kindship care than ever before. it's truly ripping us apart at the seams. and i am committed to holding these multinational drug companies that made billions fueling this epidemic sending 1200 opioids during a six year period into floyd county for every man, woman and child, 1200. but nerve raising a red flag. never taking responsibility, never stopping that flood. they made billions. those distributors that we sued some of them made over $30 billion just in the last quarter alone. but while they count their billions, they don't put a single dollar into our communities to help us repair and dig out. >> do you accuse those companies of willfully addicting kentuckians? >> i accuse those companies of knowing how dangerous these drugs are and, especially for these distributors knowing that there is absolutely no reason for mccommitteeson so send 18 million pills into 6:03 AMan eastern kentucky county of 38,000. knowing how dangerous those drugs are but just taking the money and letting those drugs enter into those communities. and we see the devastation and it's time that these companies take responsibility. because they won't on their own, i'm committed to dragging them into a kentucky court where they have to answer to our families. >> if kentucky wins money from drug makers or distributorses are as they did in west virginia, i think $15 million, $16 million over there in one ruling, where would that money go? >> well, we have supported a bill that has both some democratic and some republican sponsors right now that would require every dollar that we would secure in these opioid lawsuits to go to addressing the addiction crisis. it can go to enforcement, prevention, treatment, recovery, but at the end of the day this is blood money. this is blood money. these companies have made profits off of our misery. anything we recover needs to go back and address the addiction and the widespread devastation and no matter 6:04 AMwhat we recover it's never going to bring back somebody's son or daughter that they've lost. but it might just prevent that next child from being lost. >> do you think if there is a when and there's punitive action that then will prevent the companies from continuing to do as you accuse them of? >> that's certainly my hope. we have seen our pressure already causing some positive changes. last year, one of the companies we sued pulled opana e.r. and purdue pharma are cutting their entire marketing force that was out there trying to convince doctors to previbe -- prescribe their drugs. we're seeing some changes but not enough. we still see far too many opioids flooding into counties and being prescribed to people that shouldn't be taking them. >> opioids are for end of life care primarily. and the fact that some people are getting them just for headaches shows we still have a long way to go. >> well, we have so many people fighting addiction. justice secretary tilley says something has to be done because too many people are just simply being warehoused, they're being sent to prison and not really getting the treatment they need. he says kentucky will flat runout of prison beds by may of 2019, that's next year, unless something gives. do you support his efforts to reclassify some crimes, including drug possession and maybe even increasing the threshold for the felony thefts and this sort of thing to alleviate that issue.

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27. WSAZ NewsChannel 3 Saturday Morning

    Mar 17, 2018 | Charleston, WV

    By WSAZ (NBC)

    Video Link: http://app.criticalmention.com/app/#clip/view/33677685?token=4d1be804-a22a-4528-a58b-58ab30e1dde1

    Rough Transcript: another city in west virginia is filing a lawsuit against drug manufacturers and opioid distributors. the city of milton says they've now filed suit. they say these companies are responsible for flooding the market with pills. milton mayor tom canterbury says addiction has become a health hazard to innocent children. clay county.. the town of gilbert.. and smithers have all filed similar lawsuits. ohio leaders say they are significantly increasing the number of agents in the state fighting the opioid epidemic.

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28. WJCL News at 7PM

    Mar 19, 2018 | Savannah, GA

    By WJCL (ABC)

    Video Link: http://app.criticalmention.com/app/#clip/view/33677688?token=4d1be804-a22a-4528-a58b-58ab30e1dde1

    Rough Transcript: the fight against the nationwide opioid cris --- áisá ramping up in chatham county. the county now suing the makers of opioids. the county áisá suinga group of manufacturers and distributors -- including "purdue pharma' and "johnso and johnson" they claim they misrepresented their products and their addictive nature -- causing economic hardships. it was filed by attorney mark tate -- who is seeking damages to cover the costs of dealing with the epidemic, going back 20 years. he says the damages could run into the tens of millions of dollars. tate also filed similar suits for bacon county -- brunswick -- and richmond hill. wjcl's parent company -- "hearst television" -- is par of an on-going initiative to fight the nationwide opioid cris.

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29. KTBS 3 News

    Mar 16, 2018 | Shreveport, LA

    By KTBS (ABC)

    Video Link: http://app.criticalmention.com/app/#clip/view/33677700?token=4d1be804-a22a-4528-a58b-58ab30e1dde1

    Rough Transcript: i'm jamie ostrof local governments are taking the fight against the opioid epidemic to court bossier parish became the first parish in louisiana to file a federal lsuit against opioidmanufacturers and distributors. this was back in december and now hat lawsuit has been moved up to ohio. that's where similar suits against drug companies are being consolidated the bossier parish attorney says the opioid act epidemic transcends all walks of life and costing taxpayers now. they want the money back. what the evidence is revealing is that there was a mass marketing campaign by these manufacturers to dupe pharmacists physicians and two prescribing this medication for almost every medical ailment we've had a need for a drug court. it has taxed both our law enforcement are parish jails are health systes to millions of dollars. the orleans parish sherif also filed a similar lawsuitand webster jeferson davis and beauregarde parishes are working on suits of their own.

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30. Eyewitness News More Local at 8:00 AM

    Mar 16, 2018 | Rockford, IL

    By WQRF (Fox)

    Video Link: http://app.criticalmention.com/app/#clip/view/33677705?token=4d1be804-a22a-4528-a58b-58ab30e1dde1

    Rough Transcript: the city of rockford and winnebago county announce they're suing more than 20 opioid manufacturers and distributers. it's a response to the ongoing opioid cris. they claim the companies they're suing failed to report over- prescriptions... and continue to ship mass quanties of opioids to local pharmacies without following proper procedure.

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31. Fox13 News- Good Day Utah 7AM

    Mar 16, 2018 | Salt Lake City, UT

    By KSTU (Fox)

    Video Link: http://app.criticalmention.com/app/#clip/view/33678211?token=4d1be804-a22a-4528-a58b-58ab30e1dde1

    Rough Transcript: it's a legal challenge states are taking on, suing drug manufacturers for their role in the opioid crisis, the summit county attorney said drug makers began to flood the market with pain dillers two decades ago without accountability. >> there are careers ruined families destroyed and babies born addicted. a >> according to the utah department of health, 30 people die every month in utah due tod heroin or opioid overdose.

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