Opioid Litigation Daily Media Report -3/28/18

Commentary and FYIs

1. Cities Vs. States: A Looming Battle For Control Of High-Stakes Opioid Litigation

   Mar 28, 2018 | Forbes

   By Daniel Fisher
   
   
   A public fight between the Tennessee attorney general and counties that have filed separate lawsuits against the opioid industry could be the first of many similar conflicts as state AGs try to assert control over mushrooming litigation over the addiction crisis.
2. Why Trump’s Opioid Plan Will Harm More People Than It Will Save

   Mar 28, 2018 | SELF.com

   By Maia Szalavitz
   
   
   Last week, Trump officially unveiled his aggressive plan to halt the growing opioid crisis in the U.S. In a speech he delivered in New Hampshire (a state with one of the highest rates of drug-overdose deaths in recent years, which Trump once labeled a “drug-infested den”), the president proposed a slew of controversial measures, ranging from slashing opioid prescriptions, to increasing mandatory minimum sentences, to implementing the death penalty for “big” drug dealers, and building the wall he has long pushed for along the Mexico border.
3. Opioid Hysteria Leading to Patient Abandonment

   Mar 28, 2018 | Pain News Network

   By Pat Anson
   
   
   As the overdose crisis has worsened, doctors are under increasing pressure from law enforcement, regulators and insurers to reduce or stop prescribing opioids.
4. Flanders says Whitehouse should return donations linked to drug companies

   Mar 28, 2018 | Providence Journal (RI)

   By Katherine Gregg
   
   
   Republican U.S. Senate candidate Robert Flanders has called on Democrat Sheldon Whitehouse, the two-term incumbent, to return close to $50,000 in contributions from people and groups with ties to the pharmaceutical industry, in light of the lawsuit that 26 Rhode Island cities and towns filed this week against major drug manufacturers.
5. House lawmakers hope to bring opioid legislation to vote before Memorial Day

   Mar 29, 2018 | STAT News

   By Lev Facher
   
   
   A key House committee will hold the last of three major hearings to address the opioid crisis on April 11, and hopes to bring a legislative package to the floor before the House breaks for Memorial Day on May 24, according to GOP aides on Capitol Hill.
6. Blue Cross and Blue Shield dissuades using opioids as primary pain treatment

   Mar 29, 2018 | ModernHealthcare

   By Alex Kacik
   
   
   The Blue Cross and Blue Shield Association has adopted a new standard that opioids should not be the first or second treatment options to manage pain, mirroring guidelines set by the Centers for Disease Control and Prevention.

MDL

7. Judge OKs Drug Distributor Info Sharing In Opioid MDL

   Mar 29, 2018 | Law360

   By Emily Field
   
   
   The Ohio federal judge overseeing the opioid multidistrict litigation on Tuesday signed off on a order proposed by three drug distributors that sharing information about suspicious drug orders in settlement negotiations is immune from federal antitrust law

Northeast (NY, MA, CT, MD)

8. County joins lawsuit against pharmaceutical companies

   Mar 28, 2018 | The Leader-Herald (NY)

   By Brianna O'hara
   
   
   Along with many other counties in New York, Fulton County is taking legal actions against pharmaceutical companies with a lawsuit filed by Simmons Hanly Conroy law firm for the aggressive and fraudulent marketing of prescription opioid painkillers that has allegedly led to the opioid epidemic throughout the country.
9. Warren County considers opioid law, public hearing

   Mar 28, 2018 | Olean Times Herald (NY)

   By Don Lehman
   
   
   Warren County leaders are hoping to declare the opioid crisis a "public nuisance" to assist their efforts to recoup county money spent responding to it.
10. Schenectady explores lawsuit against opioid manufacturers, distributors

    Mar 29, 2018 | The Daily Gazette (NY)

    By Andrew Beam
    
    
    The city is looking to go after opioid manufacturers and distributors.
11. Selectmen Weigh Opioid Suit Against Drug Companies

    Mar 28, 2018 | Cape Cod Chronicle (MA)

    By William F. Galvin
    
    
    Selectmen are weighing whether to participate in a lawsuit against pharmaceutical companies alleged to be behind the opioid epidemic in this country. Town Counsel John Giorgio made a presentation to selectmen on Monday night explaining the town may be able to recover costs incurred to the community from the crisis.
12. Cities’ lawsuit against opioid manufacturer has first court date

    Mar 28, 2018 | Connecticut Post (CT)

    By Rob Ryser
    
    
    Newtown, Southbury and 16 other communities that have teamed up to sue pharmaceutical companies over the opioid abuse crisis will have their first day in court on Thursday.
13. Allegany County joins national opioid lawsuit

    Mar 28, 2018 | WDVM (MD)

    By Staff
    
    
    The Allegany County government has announced it is joining a national opioid lawsuit against drug manufacturers.

Southeast (GA, AR, FL)

14. MACON-BIBB COUNTY FILES LAWSUIT AGAINST OPIOID MANUFACTURERS

    Mar 28, 2018 | WMGT (GA)

    By Staff
    
    
    Macon-Bibb County filed a lawsuit in federal court on Tuesday against several opioid makers and distributors.
15. Woodstock joins class action suit over opioids

    Mar 29, 2018 | Atlanta Journal Constitution (GA)

    By David Ibata
    
    
    The Woodstock City Council has voted to emulate governments ranging from tiny Candler County in southeast Georgia to Fulton and DeKalb counties in metro Atlanta in suing the pharmaceutical industry over opioid painkillers.
16. Arkansas counties and cities file joint lawsuit against opioid drug manufacturers

    Mar 28, 2018 | Newton County Times (AR)

    By Staff
    
    
    In a unified and unprecedented approach against the opioid drug industry, the state of Arkansas, Arkansas counties and Arkansas cities announced that together they have filed a lawsuit in the Circuit Court of Crittenden County.
17. Suncoast governments suing opioid makers and sellers over epidemic

    Mar 28, 2018 | WWSB (FL)

    By Ray Collins
    
    
    Remember when governments around the Gulf of Mexico sued British Petroleum after the oil spill? Something similar is happening now against the companies that make and sell opioids—the pain pills often called the gateway to bigger addictions.

Midwest (MI)

18. Kalamazoo County Commission to join conversation of statewide opioid lawsuit

    Mar 28, 2018 | WWMY (MI)

    By Staff
    
    
    The Kalamazoo County Commission is taking up a proposal to take part in a class action lawsuit in Michigan against opioids.

Broadcast Media Coverage

19. ABC 7 News at 7p

    Mar 28, 2018 | Tampa, FL

    By WWSB (ABC)
    
    
    Video Link 1: http://app.criticalmention.com/app/#clip/view/33899621?token=afbdd945-f057-46b8-8660-6c79a21ae50e Video Link 2: http://app.criticalmention.com/app/#clip/view/33899632?token=afbdd945-f057-46b8-8660-6c79a21ae50e
20. ABC 27 News at Sunrise 5:30am

    Mar 29, 2018 | Tallahassee, FL

    By WTXL (ABC)
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/33899614?token=afbdd945-f057-46b8-8660-6c79a21ae50e
21. CBS 6 News at 6a

    Mar 29, 2018 | Albany, NY

    By WRGB (CBS)
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/33899604?token=afbdd945-f057-46b8-8660-6c79a21ae50e
22. WDVM News at 6:00AM

    Mar 29, 2018 | Washington, DC

    By WDVM (WDVM)
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/33899609?token=afbdd945-f057-46b8-8660-6c79a21ae50e
23. News 2 at 11am

    Mar 28, 2018 | Nashville, TN

    By WKRN (ABC)
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/33899660?token=afbdd945-f057-46b8-8660-6c79a21ae50e
24. Good Day Oregon

    Mar 28, 2018 | Portland, OR

    By KPTV (Fox)
    
    
    Video Link: http://app.criticalmention.com/app/#clip/view/33899664?token=afbdd945-f057-46b8-8660-6c79a21ae50e

Commentary and FYIs

1. Cities Vs. States: A Looming Battle For Control Of High-Stakes Opioid Litigation

   Mar 28, 2018 | Forbes

   By Daniel Fisher

   A public fight between the Tennessee attorney general and counties that have filed separate lawsuits against the opioid industry could be the first of many similar conflicts as state AGs try to assert control over mushrooming litigation over the addiction crisis.

   Tennessee AG Herbert Slatery is seeking to intervene in lawsuits filed by local prosecutors in 14 judicial districts representing 47 counties, saying their lawsuits “impede my ability to prosecute all of the opioid litigation implicating the State's interests.” Slatery, a Republican, also objects to the counties’ use of private lawyers working under contingency-fee contracts, saying the counties had no authority to hire them.

   “Our consistent position has been that all recoveries go to the state and affected areas, not to outside attorneys,” Slatery said in a news release last week.

   The fight illustrates a big potential stumbling block in the drive to negotiate a nationwide settlement of lawsuits against opioid manufacturers, distributors and pharmacies. Hundreds of lawsuits by cities and counties have been consolidated in a federal court in Ohio, where U.S. District Judge Dan Aaron Polster has told the parties he wants to hammer out a settlement that includes significant changes in how the companies do business.

   But there are hundreds more lawsuits pending in state courts beyond the reach of Polster’s multidistrict litigation, and a bipartisan coalition of 41 state AGs is also investigating the industry in possible preparation for their own lawsuits. More than a dozen states have already filed suit — including Ohio, Washington, Missouri and Kentucky. Industry negotiators are unlikely to agree to partial settlements that require them to pay out hundreds of millions or billions of dollars yet leave them vulnerable to continuing lawsuits that could bankrupt them many times over.

   That’s where the state AGs may have some power to bring order to what has become a chaotic tangle of litigation. The law varies from state to state but in most states, cities and counties are considered political subdivisions under the ultimate control of the state and its attorney general.

   After state AGs negotiated the 1998 tobacco settlement, for example, Wayne County in Michigan tried to sue the industry to recover its own smoking-related expenses. But a federal court rejected the suit in 2002, citing an opinion from the Michigan Supreme Court that the state AG had already released the industry from all such claims – even those potentially raised by municipalities -- and the county couldn’t revive them.

   Wayne County sued after the settlement had been signed, of course, while the cities and counties suing opioid manufacturers filed their suits first. And the law is unsettled in many states as to whether and when a state AG can squelch litigation by cities and counties. San Francisco mounted a high-profile, and ultimately successful, battle to overturn the state’s ban on same-sex marriages in which it was opposed by California’s attorney general.

   It would have been absurd if the California attorney general could step in and settle San Francisco’s lawsuit, said Kathleen Morris, an associate professor at Golden Gate University and former deputy city attorney in San Francisco who is researching a paper on the legal interactions between cities and states.

   “I’m not aware of a situation where an AG can walk into a room where a city is already litigating a case and say `I’m your lawyer,’” Morris said.

   Cities and counties, in addition to being political subdivisions, are corporate entities with the authority to sue and be sued, she added.

   “They have their own economic interests as corporations,” she said. “They’ve lost money, and they want it back.”

   Some states also have enshrined “home rule” autonomy for cities and counties in their state constitutions. It requires courts to give even more deference to their legal activities. But state AGs can argue with the opioid litigation that it is a national problem requiring comprehensive solutions, including restrictions on how drugs are distributed and money to pay for treatment centers and other medical services. Doing so on a piecemeal, county-by-county basis would thwart those efforts, some argue.

   Tennessee is “in the best position both to represent the interests of the state and to obtain the best possible monetary recovery for key governmental stakeholders,” Slatery wrote in a March 15 letter to the local district attorneys. “These cases impede my ability to prosecute all of the opioid litigation implicating the State's interests.”

   The Tennessee counties say they’re suing under state statutes that give them specific powers to seek compensation for their own expenses, including the Drug Dealer Protection Act, which allows local hospital districts and other entities to recover the costs associated with drug abuse from anyone who “knowingly participates in the illegal drug market.”

   It’s still a matter of proof whether companies like Purdue Pharma and Cardinal Health fit that description, given each pill they sold was authorized by a doctor’s prescription, but the statute appears to give the counties a powerful independent source of standing to sue.

   The Tennessee AG wants to squelch local litigation so he can give the industry a full release in exchange for funds he can retain at the state level, said J. Gerard Stranch of Branchstetter Stranch & Jennings, who represents the counties. Tennessee participated in a 2007 settlement with Purdue that yielded the state less than $1 million - $400,000 of which was applied to state attorneys’ fees.

   “I would want us gone, we’re going to be the expensive ones,” Stranch said. “If you want to talk settlement to us, we'd love to find creative solutions that don’t bankrupt the company, but there has to be real change and we have to be at the table."

   While no similar battles have flared into public view, they likely will. A state representative in South Carolina, which has sued the industry, commissioned an opinion from its attorney general on whether cities and counties had independent standing to file their own suits.

   His conclusion? It depends. In South Carolina, AG Alan Wilson said, a municipality “must allege infringement of its own proprietary interests or statutory rights,” but that it is entirely possible they can when it comes to opioid-related damages.

   Given this legal landscape, it’s not surprising that plaintiffs attorneys are feverishly compiling all the evidence they can get their hands on of opioid-related hospital charges, drug-treatment program costs and even jail expenses at the local level to bolster the cases of their municipal clients. In the end, this may partly be a case of fighting the last war, in this case against tobacco, in which states obtained multibillion-dollar payments from cigarette manufacturers but little of that flowed down to cities and counties.

   Many local officials viewed the 1998 tobacco settlement as a disappointment because most of the money flowed directly into state treasuries. Of course, the same thing would have happened if the states had simply taxed cigarettes – and they would have avoided the estimated $14 billion in fees to private attorneys that will flow out of the master settlement agreement over its 25-year life. One reason so many cities and counties are suing is their lawyers are telling them this is a way to keep their hands on any money they win.

   States still have another powerful trump card they can play against their cities and towns, however: Legislation. While a state AG may not have the power to commandeer litigation by political subdivisions, the state legislature can.

   Ohio did just that in 2007 to end then-burgeoning litigation against the lead paint industry, passing a law that amended the state’s consumer protection statute to make it harder to win nuisance suits over legal products. Congress did the same thing on a national level when it passed the Product of Lawful Commerce in Arms Act in 2005, prohibiting lawsuits against gun manufacturers over criminal acts involving their products.

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2. Why Trump’s Opioid Plan Will Harm More People Than It Will Save

   Mar 28, 2018 | SELF.com

   By Maia Szalavitz

   Last week, Trump officially unveiled his aggressive plan to halt the growing opioid crisis in the U.S. In a speech he delivered in New Hampshire (a state with one of the highest rates of drug-overdose deaths in recent years, which Trump once labeled a “drug-infested den”), the president proposed a slew of controversial measures, ranging from slashing opioid prescriptions, to increasing mandatory minimum sentences, to implementing the death penalty for “big” drug dealers, and building the wall he has long pushed for along the Mexico border.

   Upon first listen, the proposed agenda comes off like another fear-mongering “Just Say No” campaign. But it’s worse than that: it’s a recipe with the potential to increase overdose deaths, worsen addiction, and harm chronic pain patients. Here’s why it’s (mainly) a prescription for trouble.Trump said that his administration is addressing the issue of overprescribing pain medication—yet he offered very few specifics for how they plan to actually achieve this.

   The Department of Justice is looking “very seriously” into bringing “major” litigation against these drug companies at a federal level, Trump declared in his speech. He added that they will cut nationwide opioid prescriptions by a third over the next three years and “make sure that virtually all prescriptions reimbursed by the federal government follow best practices for prescribing.”

   While all of that sounds like it might help, Trump failed to offer any specific, actionable tactics that his administration will put into effect to achieve these weighty goals. And if recent efforts to slash prescriptions are anything to go by, this move has great potential to make matters worse.

   Doctors are already prescribing opioids less frequently and reducing the average dose they're giving patients, according to recent data looking at opioid prescribing nationwide between 2006 and 2015 from the Centers for Disease Control and Prevention (CDC).

   The most risky prescribing—high-dose opioid prescribing—was down in 86.5 percent of U.S. counties since 2010, according to the CDC data. The number of overall opioid prescriptions, too, has been falling for years. But despite this seemingly reassuring news, opioid overdose deaths in 30 states actually increased between 2010 and 2015, largely because of people switching to illegal drugs (such as heroin and illicit fentanyl).Basically, cutting an existing prescription doesn’t stop an addiction—nor does it do anything to help pain patients get effective care.

   Media coverage of the opioid epidemic has been marred by a false narrative that suggests most addictions start among pain patients who become “accidentally” addicted, when in reality, nearly 75 percent of those who start misusing prescription drugs do not get them directly from doctors.

   People who become newly addicted tend to be teenagers and young adults who obtain the pills from friends or relatives for free or buy from drug dealers or strangers, per 2013 and 2014 data from the National Survey on Drug Use and Health, released this past January. (The survey looked at a nationally representative sample of approximately 67,500 people 12 or older throughout the U.S.) This means that when the pill supply dries up, these groups easily move to street drugs, since they are already familiar with buying them. These drugs, however, are much more likely to cause overdose because the dosage and purity are unknown.

   Trump also called for “great commercials” to scare kids away from drug use by showing them “how bad it is.” But existing data on scare tactics in public service announcements suggests that they simply don’t work on teenagers. (Let’s not forget that Bill Clinton threw a billion dollars into a similar initiative during his presidency that was deemed ineffective in reducing drug use among youth.)

   These days, most overdoses are linked to street fentanyl and similar drugs, which contaminate much of the heroin supply and are much more potent. (From 2014 to 2015 alone, opioid-related death rates increased by nearly 16 percent, and 72 percent of this rise was caused by heroin and illegally-produced synthetic opioids, not prescriptions, according to the CDC.)

   Of course we need to acknowledge the relationship between prescription drug use and illegal drug use: some people do turn to illicit drugs when they can no longer get opioids from a doctor. But we also need to keep in mind that many patients do benefit from these medications. Encouraging doctors to reel in prescribing to those who actually need opioids can do real harm.

   Harrowing stories of pain patients who are being forced off of painkillers and becoming more disabled or even committing suicide are already making headlines. And contrary to media claims, there are few effective alternatives to opioids for certain conditions; and those that exist are often illegal in many parts of the country (think: medical marijuana) or not covered by insurance.As for Trump’s push to invoke the death penalty and harsher minimum sentences for drug dealers? For one, it's immoral. And distinguishing between "users" and "dealers" is not so simple.

   The president remarked that drug dealers "will kill thousands of people during their lifetime" without being punished, and therefore deserve execution.

   But most dealers are not kingpins, just people who are selling drugs to supply their own addictions—and these are the same folks whose lives the plan is presumably intended to save, not end.

   He’s now pushing prosecutors to use existing federal law, which allows the death penalty for high-level traffickers, even if they haven’t killed anyone, according to the Death Penalty Information Center. That being said, the Supreme Court has ruled the death penalty unconstitutional except in cases of murder—and no prior administration has actually used the kingpin statute, the DPIC says. Even at the drug war’s peak, prosecutors recognized the futility of this idea.

   There are also inevitable biases in who would be prosecuted. It’s not going to be big-pharma CEOs or even genuine kingpins being sent to the execution chamber; such people are far too well-protected by lawyers and money and typically too far away from actual product and sales decisions to be proven guilty in any event.

   And given that death penalty cases cost upward of $1.2 million per case, simple accounting means that, realistically, only a tiny number could be pursued. Factor in the decades of appeals that are inevitable to allow due process, and it’s obvious that sentencing a few random people at the bottom of the drug supply chain cannot possibly be a deterrent.

   What about sentencing short of death? Again, the data is clear. Mandatory minimums have not been effective at the state or federal level, which is why there’s now a bipartisan drive to roll them back.There are a few sensible policies buried in Trump’s strategy—namely improving access to safer drug treatments.

   Trump said he will increase access to addiction medications, like methadone and buprenorphine, that have been proven to save lives. (They work by reducing craving and maintaining tolerance—without interfering with functioning—and this reduces both relapse risk and death risk from OD if relapse does occur.)

   Long-term outpatient use of methadone or buprenorphine has been shown to substantially cut the death rate—unlike any other type of treatment. However, his initiative states that for prisoners, he’s going to push access to naltrexone, a drug that unfortunately could make relapse fatal due to the way it reduces tolerance.

   Another research-backed strategy with the power to save lives? Trump’s promise to make the overdose antidote, naloxone (Narcan), more widely available. In one study that looked at 19 communities in Massachusetts that had at least five fatal opioid overdose deaths in each year from 2004 to 2006 found that locations with the greatest participation in naloxone training and distribution programs cut their overdose rates by more than half.

   Massively expanding access to these proven medications and reducing the hoops people have to jump through to get them are the most important steps to take: The data shows this has the potential to cut the problem by at least half.

   Another harm-reduction effort worth advancing in the U.S. (one that unfortunately isn't mentioned in Trump's plan) is providing safe spaces for people to take drugs. Safe Injection Facilities (SIFs) exist in at least 66 cities in 10 countries—and not a single overdose death has ever been documented at one of them. SIFs provide a safe space for people to use drugs in a clean environment, under medical supervision. These locations also link people to treatment. Although you might think “enabling” drug use would keep people from quitting, in fact, harm reduction programs often lure people into treatment, not away from it.There is much uncertainty about which parts of Trump’s plan will actually unfold and how much of it will be accepted and funded by Congress.

   For instance, if new treatment money is added in other iffy contexts proposed by Trump, such as large cuts in Medicaid and imposing additional restrictions, like denying Medicaid access to able-bodied individuals unless they have a job, the net result could actually be less access to treatment than before.

   And so, until we see how this plays out, we can only hope that the administration follows through with the few wise goals Trump offered up—like making safer drug treatments more accessible—and scraps the other stuff.

   But to dramatically curtail overdose death and addiction, for the most part, we have to do the opposite of Trump’s plan.

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3. Opioid Hysteria Leading to Patient Abandonment

   Mar 28, 2018 | Pain News Network

   By Pat Anson

   As the overdose crisis has worsened, doctors are under increasing pressure from law enforcement, regulators and insurers to reduce or stop prescribing opioids.

   A nurse practitioner in the Seattle area – who asked to remain anonymous -- recently told us thatshe was closing her pain clinic because she was afraid of losing her license and going to prison. 

   “This whole thing is making me literally sick to my stomach. I've cried a million tears for my patients already, and I'm just beginning,” she wrote.

   “I will be carefully weaning them all down… or arranging transfer of care to anywhere the patient would like. What a joke that is. There is no one else prescribing effective doses of opioids for chronic pain patients.  If I am to be thrown in prison, it should be for that -- not for keeping them on therapy that enriches their lives."

   Patient abandonment is a growing problem in the pain community. Patients safely prescribed opioids for years are being dropped by doctors – often without weaning or tapering -- after they fail a drug test, miss a pill count, or become disruptive during an appointment. Sometimes they’re dropped for no reason at all.

   Such is the case of Chris Armstrong, a 50-year old Orlando, Florida man severely disabled by multiple sclerosis and trigeminal neuralgia, a chronic pain facial disorder sometimes called the “suicide disease.” For over six years, Armstrong’s pain was treated with relatively high doses of morphine and hydrocodone at Prospira’s National Pain Institute in Winter Park.

   That came to abrupt ending in late December, when Armstrong’s 74-year old mother and caretaker was handed a brief letter during their last visit to the clinic.

   "This letter is to inform you that I will no longer be your physician and will stop providing medical care to you,” wrote Cherian Sajan, MD. “I will continue to provide routine emergency and medical care to you over the next 30 days while you seek another physician.”  

   No explanation was given for Armstrong’s dismissal. Dr. Sajan did not respond to a request for comment.

   “To have the plug pulled just like that,“ says Chris. “There’s nothing in my record that I’ve ever done anything wrong. I was a model patient.”

   “They discharged him and gave no reason,” Valerie Armstrong said.  “They gave us a name of another pain doctor which they scribbled on a piece of torn paper. We went to see him, but after a few visits, (that doctor) told my son he was discharging him as well, as he needs ‘long term care’ which they refuse to provide.”

   At the National Pain Institute, Armstrong says he was prescribed 150 morphine equivalent units (MME) of opioid medication daily. The second doctor reduced that dose to 100 MME – still above the maximum dose of 90 MME recommended by the CDC.  

   Chris has been unable to find a new doctor and believes he’s been red flagged as a patient who needs high doses of opioids. 

   “I went to another one and he said he can’t do anything because his hands are tied because I’ve been ousted by another pain doctor,” he told PNN. “What am I going to do, if no one will see me because of that?”CHRIS ARMSTRONG" id="yui_3_17_2_1_1522273948784_124" style="line-height: 0; text-align: center; position: relative; overflow: hidden; padding-bottom: 299.275px;">

   CHRIS ARMSTRONG

   “I have called every pain clinic in my area and no one will see my son because he has been discharged by the previous pain clinics,” says Valerie. “My son is bed-bound quadriplegic, only travels in a wheelchair and can barely talk or eat from trigeminal neuralgia pain. His health is extremely fragile, and he will surely die if he has to stop his pain medication abruptly. That happened once before and he went to the ER in an ambulance having seizures.”

   Armstrong has only a few days left of his last prescriptions.

   “We need help and we need it now. He only has a few days supply of his pills left and then I'm sure his body will give out from withdrawals,” says Valerie. “My son had never taken any kind of pain medication before going to the National Pain Institute six and a half years ago and now he is physically dependent on them. I have begged and pleaded with them to take him back and even called their corporate headquarters to no avail.”

   There is often little recourse for patients like Chris Armstrong.  Malpractice and patient abandonment laws vary from state to state, but discharging a patient is generally considered legal, as long as it isn’t discriminatory.

   Florida’s Board of Medicine says a “health care practitioner can terminate a patient relationship at any time, but the practitioner may not abandon a patient” and should provide “continuity of care” until a patient can find a new doctor. To fulfill that requirement, the Florida Medical Association recommends that patients be given adequate notice in writing, be provided with medical care for at least 30 days, and be offered assistance in locating another practitioner – which Armstrong’s previous doctors did.

   “There not a lot of strength in the law here,” says Diane Hoffman, a professor of health law at the University of Maryland Carey School of Law. “That makes it very challenging for chronic pain patients. And for physicians, they are trying to find the right place to be. Physicians are very risk averse in terms of the law.”

   If patients have a complaint about a doctor, Hoffman says they should contact their state medical board or their state’s consumer protection office.

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4. Flanders says Whitehouse should return donations linked to drug companies

   Mar 28, 2018 | Providence Journal (RI)

   By Katherine Gregg

   Republican U.S. Senate candidate Robert Flanders has called on Democrat Sheldon Whitehouse, the two-term incumbent, to return close to $50,000 in contributions from people and groups with ties to the pharmaceutical industry, in light of the lawsuit that 26 Rhode Island cities and towns filed this week against major drug manufacturers.

   The lawsuit accuses the drug manufacturers of conspiring to generate enormous profits while spurring the nationwide opioid epidemic.

   Warwick, Cranston, North Providence, Charlestown, Jamestown and a host of other towns filed suit this week in U.S. District Court arguing the AmerisourceBergen Drug Corp., Johnson & Johnson and its subsidiary Janssen Pharmaceuticals, and other drug companies engaged in a racketeering conspiracy by manufacturing and marketing the powerful narcotics at devastating societal costs.

   Flanders, a former Rhode Island Supreme Court justice, issued this statement on Wednesday:

   “Sen. Whitehouse should be ashamed of himself for keeping contributions from Big Pharma companies that are now being sued for their use of deceptive marketing tactics. Not only has he profited from Big Pharma companies, he has also made it harder for the Drug Enforcement Agency to prevent opioid abuse with the passage of his bill that derailed the DEA’s war on painkillers.”

   Flanders keyed his remarks, in part, to contributions that the nonpartisan Center for Responsive Politics says have been made to Whitehouse by PACs affiliated with three defendants: AmerisouceBergen Drug Corp. ($25,000), Cardinal Health ($15,000), and McKesson Corp. ($10,000).

   “Hundreds of Rhode Island families have been destroyed by drugs that are flooding our communities,” Flanders said. “If Sen. Whitehouse doesn’t return or donate every penny he received from these pay-to-play companies, he evidently cares more about lining his pockets than the health and safety of the citizens of Rhode Island.”

   There was no immediate response from Whitehouse to Flanders’ allusion to his stock transactions. But Whitehouse has, in the past, denied that he had a direct role in buying shares in pharmaceutical companies last fall at the same time that Congress was finalizing the 21st Century Cures Act, a major medical-research bill.

   After the stock transactions by Whitehouse and others were brought to light by Politico, his spokeswoman Meaghan McCabe issued this statement: “Trades made in the senator’s account are conducted by a financial advisor without any input from the senator or his family.”

   Whitehouse himself told Politico, “I don’t decide on, neither am I even informed of, trades that are made in my account.”

   In a statement issued Wednesday evening, McCabe did not address Flanders’ call for Whitehouse to return the contributions, but said: “Every decision Senator Whitehouse makes in Congress is guided by one thing: what is best for the people of Rhode Island. ...

   “Since the bill was passed, the DEA has provided Congress with no evidence that the law’s provisions have diminished the agency’s ability to crack down on bad actors. ... The law requires the relevant federal agencies to issue a report on the implementation of the bill. If that report raises concerns, Senator Whitehouse will take them into consideration and work to strike a better balance.”

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5. House lawmakers hope to bring opioid legislation to vote before Memorial Day

   Mar 29, 2018 | STAT News

   By Lev Facher

   A key House committee will hold the last of three major hearings to address the opioid crisis on April 11, and hopes to bring a legislative package to the floor before the House breaks for Memorial Day on May 24, according to GOP aides on Capitol Hill.

   The third hearing of the House Energy & Commerce health subcommittee will focus on insurance coverage, payment issues, and prescription regulations for Medicaid beneficiaries. An initial session focused on enforcement issues and a second discussed public health, treatment, and prevention strategies.

   “Combating the opioid crisis is my top priority as Chairman,” Rep. Greg Walden (R-Ore.), the committee chairman, told STAT in a statement. “It’s part of our bipartisan, comprehensive effort to deliver relief to every American community, which continues to battle this costly epidemic. Time is of the essence and we are working across the aisle to get legislation to the President’s desk as quickly as possible.”

   After passing a spending bill last week, Capitol Hill has mulled how to spend the remaining months before November, with lawmakers keeping an eye on upcoming midterm elections.

   Both chambers are widely expected to pass additional legislation on substance use and recovery issues before campaign season. Such a legislative package would fulfill what lawmakers have long identified as a bipartisan goal — and give legislators from both parties a popular accomplishment to campaign on this fall.

   The bills the committee will discuss at the final hearing next month include requirements for state Medicaid providers to integrate prescription drug monitoring programs into their clinical workflow. The legislation would ensure that pharmacists and providers contracting through Medicaid check a database on a per-patient basis before dispensing a controlled substance.

   It would also compel state Medicaid providers to enforce limits for “at-risk” beneficiaries who have filled opioid prescriptions at multiple pharmacies or otherwise drawn attention from state drug-utilization review programs. While committee aides said limits on providers that can prescribe and pharmacies that can dispense opioids are common under fee-for-service programs, the legislation would ensure they cover all Medicaid beneficiaries, including those utilizing managed care programs.

   Given the legislation’s popularity and expected passage, an array of lawmakers have already introduced competing versions. In two cases, members of Congress have independently beaten the committees with jurisdiction to the punch.

   Sens. Rob Portman (R-Ohio) and Sheldon Whitehouse (D-R.I.) introduced a bill in February called the “CARA 2.0 Act,” billed as a sequel to the Comprehensive Addiction and Recovery Act of 2016. Reps. Tom MacArthur (R-N.J.) and Ann Kuster (D-N.H.), who chair the Bipartisan Heroin Task Force in the House, led an identical version.

   That legislation includes, among other proposals, a three-day limit on first-time opioid prescriptions for acute pain.

   Meanwhile, the Energy & Commerce Committee has continued with a formal and time-intensive hearings process, taking input from public health officials, treatment experts, and recovery advocates.

   Sen. Lamar Alexander (R-Tenn.), who chairs the Senate health committee, has also held a series of hearings specific to potential opioids legislation, and he unveiled snippets of draft bills last week. His committee’s bills would likewise enact stricter requirements on prescriptions, including requiring prescription opioids to be dispensed in short-term “blister packs.”

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6. Blue Cross and Blue Shield dissuades using opioids as primary pain treatment

   Mar 29, 2018 | ModernHealthcare

   By Alex Kacik

   The Blue Cross and Blue Shield Association has adopted a new standard that opioids should not be the first or second treatment options to manage pain, mirroring guidelines set by the Centers for Disease Control and Prevention.

   In most cases, ibuprofen and acetaminophen can treat pain more effectively than opioids, said Dr. Trent Haywood, chief medical officer for BCBSA, which has about 106 million members. It's important that physicians understand that alternatives like medication-assisted treatment exist, which pairs medication with behavioral counseling, he said.

   It's not an absolute decree. In many cases, particularly related to cancer treatment or end-of-life care, opioids may be the best remedy, said Haywood, adding that the association will aid physicians in making the best clinical decision.

   "The opioids are half as effective but two to four times more harmful," he said. "But because of how they are marketed, physicians might think that is not the case."
   
   Opioid marketing campaigns and payment models were partly to blame. Purdue Pharma, which produces OxyContin, reached a $635 million settlement with the federal government in 2007 related to alleged misbranding of OxyContin. South Carolina and other states have made similar claims that Purdue downplayed the addictive nature of the painkillers. 
   
   Physicians used to have performance incentives linked to subjective pain measures that patients indicated on a sliding scale, said John Hamilton, chief clinical outreach officer at Mountainside Treatment Center. There was a lot of pressure to do business as usual, he said. 
   
   "So, they changed the system and looked at things differently," said Hamilton, adding that evidence supports that anti-inflammatory are often more effective than opioids. "The whole subjective measure of pain from sad face to happy face is ludicrous."
   
   Insurers, pharmacies, distributors and providers have restricted the number and size of opioid prescriptions they dole out. Blue Cross and Blue Shield of Michigan recently implemented a new policy that limits opioid prescriptions to 30-day or five-day supplies. Blue Cross and Blue Shield of Massachusetts requires prior authorization for opioid prescriptions for more than 30 days and that doctors and patients co-sign an agreement. Prior to these changes, an analysis from America's Health Insurance Plans revealed that many opioid prescriptions exceeded maximum dosage levels and recommended supply. 
   
   Salt Lake City-based Intermountain Healthcare is looking to cut the number of opioids prescribed for acute pain across its entire system by 40% by the end of this year. Some states are also requiring that physicians participate in training related to opioid prescriptions. 
   
   But physicians worry that reducing the supply could cut off access to patients who need the potent drugs. Also, insurers have been slow to cover alternatives to opioids. Prior authorization for medication-assisted treatment is another big roadblock.
   
   Experts like Sebastian Seiguer, CEO of Emocha Mobile Health, software that helps track medication adherence through video, supported the guidelines implemented by the CDC and BCBSA. 
   
   "All these types of remedies are all trying to cover for one major problem we have—prescribers are hesitant to replace treatment for opioids because they don't know what is happening to the patient when leave the office," he said. "We need ways to monitor and support the patient between visits."
   
   The epidemic has reached unprecedented heights. Twenty-one percent of BCBS commercially insured members filled at least one opioid prescription in 2015, according to a BCBSA study. The report also showed members with an opioid use disorder spiked 493% over seven years.
   
   Research from FAIR Health, an independent not-for-profit that manages the database of privately billed health insurance claims, found that opioid treatment spending increased 1,000% from 2011 to 2015. That was one impetus for Scan Health Plan, which offers a Medicare Advantage plan to about 185,000 members in California, to offer buprenorphine for a $5 copay and boost access to Naloxone. The health plan also has quantity limits and prior authorization requirements for long-term prescriptions as well as a prescriber education program. 
   
   But there is room for improvement and more analysis is necessary, BCBSA's Haywood said. For instance, providers in the Southeast don't prescribe as much medication-assisted treatment than the their peers in the Northeast, despite higher rates of opioid abuse, he said. 
   
   "We want to resolve those particular issues," BCBSA's Haywood said. 
   

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MDL

7. Judge OKs Drug Distributor Info Sharing In Opioid MDL

   Mar 29, 2018 | Law360

   By Emily Field

   The Ohio federal judge overseeing the opioid multidistrict litigation on Tuesday signed off on a order proposed by three drug distributors that sharing information about suspicious drug orders in settlement negotiations is immune from federal antitrust law.

   Three of the distributors, AmerisourceBergen, Cardinal Health Inc. and McKesson Corp., in the MDL have raised concerns that sharing their ways for identifying suspicious orders, which would include certain proprietary and confidential data, could be viewed as violations of U.S. or state antitrust laws, according to the order signed by U.S. District Judge Dan Polster. But the public interest in solving the opioid epidemic and the companies’ interest in identifying ways to prevent fraudulent orders of opioids outweigh any risk of anti-competitive harm, Judge Polster said.
   
   “Moreover, given the parties’ interest in resolving this litigation and preventing further litigation by private parties or state attorneys general, the court finds that negotiating and implementing a settlement that includes information-sharing in furtherance of improvements in monitoring and/or reporting is activity immune from federal antitrust laws,” Judge Polster said.
   
   The order directs the three companies to continue discussing a settlement that includes sharing information on how to identify suspicious orders of opioids, and to share any confidential or proprietary information as necessary.
   
   “We think Judge Polster is guiding this case to global resolution and this is just one step towards that end. This type of transparency is needed," Hunter Shkolnik of Napoli Shkolnik PLLC, a plaintiffs attorney in the MDL, told Law360 on Wednesday.
   
   The trio presented the proposal to Judge Polster on March 23, according to court records.
   
   The MDL encompasses about 300 lawsuits — mostly brought by local governments that claim drugmakers fueled the opioid crisis through reckless sales of opioids — and is still growing.
   
   The U.S. Drug Enforcement Administration has also agreed to share nine years of data on opioid sales, providing the identities of manufacturers and distributors that sold 95 percent of opioids in every state from 2006 through 2014.
   
   The information will include a state-by-state breakdown and will show the “aggregate amount of pills sold and the market shares of each manufacturer and distributor,” according to the status report.
   
   Earlier this month, the judge set a litigation track in the MDL, starting the litigation on an active stage of discovery, motions and bellwether trials to boost the prospects of ongoing settlement talks.
   
   Until that point, the judge had largely blocked the parties, which include drugmakers and distributors, from submitting substantive filings in the case, directing them instead to focus on settlement negotiations.
   
   The judge in a January hearing made waves when he voiced his desire for quickly coming to a settlement that would include drastically cutting down on the number of opioids in circulation.
   
   Attorneys for the drug distributors didn’t immediately respond to requests for comment on Wednesday.
   
   The case is In re: National Prescription Opiate Litigation, case number 1:17-md-02804, in the U.S. District Court for the Northern District of Ohio.
   

   
   

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Northeast (NY, MA, CT, MD)

8. County joins lawsuit against pharmaceutical companies

   Mar 28, 2018 | The Leader-Herald (NY)

   By Brianna O'hara

   Along with many other counties in New York, Fulton County is taking legal actions against pharmaceutical companies with a lawsuit filed by Simmons Hanly Conroy law firm for the aggressive and fraudulent marketing of prescription opioid painkillers that has allegedly led to the opioid epidemic throughout the country.

   According to the news release, the county is seeking relief for millions of dollars spent each year in efforts to stop the opioid epidemic allegedly caused by drug companies’ marketing campaigns that misrepresents the safety and efficacy of long-term opioid use.

   According to the complaint, Fulton County spends millions each year to provide or pay for health care, pharmaceutical care and other necessary services including payments for prescription opium-like painkillers which are manufactured, marketed, promoted, sold, and distributed by the following defendants in the lawsuit: Purdue Pharma L.P.; Purdue Pharma, Inc.; The Purdu Frederick Company, Inc.; Teva Pharmaceuticals USA, Inc.; Cephalon, Inc.; Johnson & Janssen Pharmaceuticals, Inc.; Ortho-McNeil-Janssen Pharmaceuticles, Inc.; Jansen Pharmaceutica, Inc.; Endo Health Solutions Inc.; Endo Pharmaceuticals, Inc.; Insys Therapeutics, Inc.; Dr. Perry Fine; Dr. Scott Fishman; and Dr. Lynn Webster.

   The complaint states that “Opioids provide effective treatment for short-term post-surgical and trauma-related pain, and for palliative and end-of -life care.”

   The complaint continues to say, “with prolonged use, the effectiveness of opioids wanes, requiring increases in doses to achieve pain relief and markedly increasing the risk of significant side effects and addiction.”

   According to the complaint, despite the defendants’ knowledge of the risks of long-term opioid use leading to addiction, the defendants manufactured, promoted and marketed opioids for the management of pain, misleading consumers and medical providers in regards to risks and safety of opioids.

   “Fulton County is the latest to conclude that drug companies must be held responsible for their role in creating the opioid crises in this country,” said Simmons Hanly Conroy Shareholder Paul J. Hanly, Jr., lead counsel for the county in this case. “Together, with county representatives, we will work to get justice for the residents of Fulton County who have suffered profound losses.”

   According to the complaint, heroin-related deaths in Fulton County doubled between 2015 to 2016 , and the number of overdoses more than quadrupled during that time period. In Fulton County, more than 18 residents suffered opioid-related overdoses fatalities between 2003 and 2014. In 2014, there were 94 opioid-related emergency department admissions, a 40.3 percent increase since 2010, and 2017 inpatient hospital admissions. There have also been 157 county residents who were admitted to chemical dependence treatment programs in 2015, and even more in 2016.

   “Fulton County, like many others across the state, is committed to holding drug manufactures and physicians responsible for the misrepresentations and harms to society they have caused,” said Jason Brott, Fulton County attorney. “The pharmaceutical companies named in the complaint ignored the impact that their drugs were having on individuals and families across the country.”

   Other counties within New York also filing similar ongoing litigations include Broome, Duchess, Erie, Greene, Monroe, Orange, Oswego, Schenectady, Seneca, Suffolk, Sullivan, St. Lawrence, Ulster and Wyoming.

   
   

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9. Warren County considers opioid law, public hearing

   Mar 28, 2018 | Olean Times Herald (NY)

   By Don Lehman

   Warren County leaders are hoping to declare the opioid crisis a "public nuisance" to assist their efforts to recoup county money spent responding to it.

   County supervisors this week took the first step to enact a county law as part of the county's litigation against the companies and people that made, marketed and distributed opioid painkillers that have been blamed for starting the opioid addiction epidemic. It claims they "created a public health and safety hazard."

   The public will be given a chance to comment on the issue during a public hearing at the May 18 meeting of the county Board of Supervisors.

   The law, which would specify that the county has incurred costs through police, emergency medical services response, social and public health programs and other services to respond to opioid addiction and assist addicts, calls the issue "one of the greatest challenges facing the county."

   "Manufacturers of prescription opioids and those in the chain of distribution have wrongfully abused the privilege of selling and/or providing medication to our residents and must be held accountable," the proposed law reads.

   The statute would give the county the authority to "recover the costs of governmental functions related to opioids marketed, sold, manufactured, dispensed, prescribed and/or distributed by the responsible party."

   County Attorney Mary Kissane said the law is being sought as part of the process for the county's opioid lawsuit. The litigation was filed late last month in state Supreme Court in Warren County.

   The 260-page lawsuit names 26 defendants, but does not seek a specific amount of damages. It is similar to litigation filed by municipalities around the country seeking damages for their opioid-related costs that have been passed on to taxpayers.

   Kissane said part of the litigation process will include gauging the losses by different county agencies.

   "They are looking into recovering the resources the county spent, looking into damages with each particular agency," Kissane said.

   Prescription painkillers have been blamed for getting many hooked on opioids, resulting in addicts transitioning to illegal heroin and fentanyl, overdosing and committing crimes to support their habit.

   The county board's Legislative & Rules Committee unanimously passed the proposed law on to the full Board of Supervisors. 

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10. Schenectady explores lawsuit against opioid manufacturers, distributors

    Mar 29, 2018 | The Daily Gazette (NY)

    By Andrew Beam

    The city is looking to go after opioid manufacturers and distributors.

    The City Council unanimously approved a resolution Monday for the city to enter into a future lawsuit with the Dreyer Boyajian LLP law firm to try to recoup costs the city suffered due to incidents involving opioid drugs. No lawsuit has been filed yet, and neither the city or the law firm has named possible defendants.

    Mayor Gary McCarthy on Wednesday said the epidemic has put a stress on city police and medical services because of overdoses and other incidents. He said police are usually first to respond to someone overdosing and generally have to call in paramedics. A person is then given Narcan, which helps counteract the effects of an opioid overdose, and taken to the hospital.

    “That’s the best case scenario,” McCarthy said. “A lot of [overdoses] result in fatalities.”

    How much those costs are, though, has yet to be determined, McCarthy said. That will be something they will learn through analyzing the actual impact the crisis has had on the city.

    Don Boyajian said it's a problem facing many municipalities that otherwise could have better programs aimed at preventing, treating and even educating the public about opioid addiction.

    “[Municipalities] have been affected financially. We want to look at various remedies to bring actions to recoup money,” Boyajian said. “Money that is otherwise borne by taxpayers.”

    Schenectady County filed a similar lawsuit last June.

    The county sued more than a dozen pharmaceutical companies, claiming they are responsible for the current epidemic. They said those companies misled doctors into thinking modern opioids were safe. This led doctors to prescribe them to patients for chronic pain, which caused many to become addicted, the suit claims.

    Drugs such as morphine, hydrocodone and oxycodone are considered opioids.

    Boyajian said this lawsuit would be similar. He said the campaign by pharmaceutical companies led to scientists and medical professors to promote the benefits of using opioid drugs for long-term pain management.

    “The problem is not one that just happened overnight,” Boyajian said. “It’s happened over a period of time, and because drug manufacturers sell opioid derivative drugs, they made a concerted effort to expand the market from beyond acute pain management.”

    According to a government report, there were 19,000 deaths in the U.S. in 2014, a number that quadrupled from 15 years earlier. The total number of deaths grew to 25,000 in 2015.

    County officials said there were 55 overdose deaths between 2009 and 2013. The county also reported there were 529 opioid abuse-related hospital admissions in 2014.

    Boyajian said it is unclear where the case would be tried because there could be other municipalities filing similar actions. If that’s the case, he said the lawsuit would be filed in a court centrally located to those municipalities.

    The legal action also is being done at no cost to the city. If the city were to win in any legal action, Boyajian would get a cut. If the city doesn’t win, Boyajian said they wouldn’t be charged at all.

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11. Selectmen Weigh Opioid Suit Against Drug Companies

    Mar 28, 2018 | Cape Cod Chronicle (MA)

    By William F. Galvin

    Selectmen are weighing whether to participate in a lawsuit against pharmaceutical companies alleged to be behind the opioid epidemic in this country. Town Counsel John Giorgio made a presentation to selectmen on Monday night explaining the town may be able to recover costs incurred to the community from the crisis.

    Giorgio presented the background of the litigation being crafted by the Massachusetts Opioid Litigation Attorneys, a consortium of lawyers spearheading the national litigation. He said his firm, KP Law, which represents the town, has signed on to the legal team, coordinating the interests of cities and towns.

    Cities and towns in the state are incurring costs relating to the epidemic, Giorgio said, such public safety and EMS responses to overdoses, use of Narcan, ambulance runs and social services impacts, including the impact of substance abuse and counseling.

    Earlier this month, Police Chief David Guillemette told selectmen, “Our community here reflects the trends across the state. While the number of reported overdoses is fairly steady – 23 in 2015, 21 in 2016 and 25 last year – the number of deaths is declining. Four fatal overdoses were reported in 2015, with one each in 2016 and 2017, and one or two already this year.”

    Town counsel told selectmen the lawsuit is similar to the tobacco litigation and the gas additive lawsuit. He said the law firms involved have experience in such suits and are filing on behalf of individual municipalities.

    “Massachusetts Opioid Litigation Attorneys (MOLA) is a consortium of local and national firms filing suit against the world's largest pharmaceutical manufacturers and distributors to hold them accountable for flooding our communities with opioids, resulting in massive economic damages to Massachusetts cites and town,” a MOLA memo states.

    Giorgio told selectmen there is no cost to the town for the litigation. MOLA will take 25 percent of what is recovered from the litigation and his firm will get a “very small portion.” The litigation will seek to establish liability and damages. The town could place the money from a settlement in a designated fund to help offset the costs to police, fire and EMS services, he said.

    Addressing the serious nature of the opioid crisis, Giorgio said, “I often park at the parking lot (Route 124) to take the bus to Boston in the morning and I am amazed there are young people clearly strung out on something there. I have to be careful going to the bus because there are spent needles. It's a real problem and the costs are mounting relating to this epidemic.”

    Selectman Donald Howell had several questions related to the ability to prove the pharmaceutical companies were at fault. He said gateway drugs such as oxycodone could have come from “grandma's medicine cabinet.” He also questioned how it could be proved the crisis was not caused by knock-off designer drugs.

    The lawsuit is based on over-prescribing of opioids and the intent is not to go after the doctors, Giorgio said. “It's drug companies that pushed oxidation very hard, exceeding the immediate pain relief people were looking for,” he said.

    “They are pushing out an ungodly amount,” Howell concurred.

    Howell wanted to know why the state Attorney General's Office was not leading the litigation as was the case with the tobacco lawsuits. Giorgio responded that unlike the tobacco lawsuits, towns have incurred identifiable costs and will continue to do so. It was pointed out towns did not receive funds from the tobacco lawsuit. States, however, did receive tobacco funds that went into education programs.

    “Manufacturers flooded the market with all these pills, some were prescribed legally and some were not,” Giorgio said. “The fact is they were manufactured for an improper purpose and pushed onto the population. The manufacturers were the cause of the opioid crisis.”

    He said cities and towns would not have to prove that and it would be up to the experts to provide the burden of proof. He said there is a court case in Cleveland that has answered some of the questions.

    Giorgio said he has made this presentation to five of the Cape towns his firm serves and all have signed on to the litigation. He will be making presentations to Martha's Vineyard communities, and the town of Dennis will make a decision on April 10. None of the towns have said they will not participate, Giorgio said.

    Town Administrator Christopher Clark said officials will have to determine if there are any costs to the town and that will take some time and effort. Giorgio said there will be a lot of discovery, but he added one judge has already said he expects to see an out-of-court settlement to avoid the expense of litigation.

    Selectman Julie Kavanagh said this seems to be the better route for the town, adding they do not know if they would get money if the Attorney General's Office pursued it.

    “Why not sue the doctors?” Board of Selectmen Chairman Michael MacAskill inquired. “You can't call the manufacturer and order the pills. I see this as a bunch of lawyers suing deep pockets to get a settlement.”

    “In the end, it's the pills that incurred the costs to the town,” Giorgio said. The pharmaceutical companies train the doctors to dole out the medicines, Kavanagh said. The doctors are following the manufacturers' instructions. At the end of the day, they are making the money and they are responsible for educating the medical profession.

    “I'm confident the pharmaceutical companies started out saying they were more benign and didn't cause addiction,” Howell added.

    Because there were only three board members present, MacAskill urged they not vote on whether to participate in the suit.

    “If I vote tonight, I'd vote no,” he said. The board held off on a vote.

    Giorgio said he could have the MOLA attorneys make a presentation to the board if desired.

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12. Cities’ lawsuit against opioid manufacturer has first court date

    Mar 28, 2018 | Connecticut Post (CT)

    By Rob Ryser

    Newtown, Southbury and 16 other communities that have teamed up to sue pharmaceutical companies over the opioid abuse crisis will have their first day in court on Thursday.

    The municipal coalition, which includes Bridgeport, Oxford and Fairfield, accuses Stamford-based Purdue Pharma and 10 other drug manufacturers of intentionally distributing misleading information about addictive pain-killers such as OxyContin and thereby causing a prescription drug addiction crisis.

    As a result, the cities and towns argue, they “have incurred and will continue to incur substantial economic, administrative and social costs combatting the public nuisance created by defendants’ deceptive marketing campaign,” according to a joint case report filed last week in state Superior Court in Hartford.

    Purdue and other drug manufacturers argue that the municipalities “fail to establish that defendants made false statements or cause the alleged harms; and are preempted by federal law...insofar as they challenge promotion of prescription opioids consistent with FDA-approved indications,” reads the same joint case report.

    A judge will hear from the multitude of attorneys in the case and go over the pretrial schedule during an early- morning hearing on Thursday.

    The lawsuit, which is among scores of legal challenges by states and cities against Big Pharma across the country, is part of varied response in Connecticut to a public health crisis that last year saw a record 1,038 accidental overdose deaths, many due to opioids.

    In Danbury, the City Council recently voted to hire a local law firm to look after its unique interests against pharmaceutical companies. In Ridgefield, the First Selectman says direct talks with Purdue will bring more immediate relief than a drawn-out legal battle.

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13. Allegany County joins national opioid lawsuit

    Mar 28, 2018 | WDVM (MD)

    By Staff

    The Allegany County government has announced it is joining a national opioid lawsuit against drug manufacturers.

    The Poole Law Group, led by A.J. Serafini, is collecting data for the trial that is expected to begin in the Summer of 2019 . Serafini says they've found that Allegany County, the city of Cumberland and the city of Frostburg are some of the hardest hit areas by this crisis nationwide.

    "For every one person walking around in Allegany county, they have more than one opioid prescription. You walk the streets of Cumberland and Frostburg -- all of Allegany county --and you see the devastation that's there. You see the people that have been affected by this," said Serafini.

    The trial is expected to take place in Cleveland, Ohio.

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Southeast (GA, AR, FL)

14. MACON-BIBB COUNTY FILES LAWSUIT AGAINST OPIOID MANUFACTURERS

    Mar 28, 2018 | WMGT (GA)

    By Staff

    Macon-Bibb County filed a lawsuit in federal court on Tuesday against several opioid makers and distributors.

    Last week, the full county commission passed a resolution to move forward with the lawsuit.

    Macon-Bibb County will be represented by Blasingame, Burch, Garrard & Ashley, PC, a law firm in Athens and former Bibb County attorney, Virgil Adams. The Athens law firm is also representing Twiggs County.

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15. Woodstock joins class action suit over opioids

    Mar 29, 2018 | Atlanta Journal Constitution (GA)

    By David Ibata

    The Woodstock City Council has voted to emulate governments ranging from tiny Candler County in southeast Georgia to Fulton and DeKalb counties in metro Atlanta in suing the pharmaceutical industry over opioid painkillers.

    The council voted to participate in an opioid class action lawsuit on March 12 and on March 26, passed a resolution to pursue legal action, saying drugmakers knew of the dangers and addictiveness of opioids, yet “purposefully set out to persuade providers, regulators and patients that their products were safe and effective.”

    Woodstock retained J. Anderson Davis and his law firm Brinson, Askew, Berry, Seigler, Richardson & Davis LLP to represent it. The law firm will bear the costs of litigation and will receive no compensation or reimbursement unless a recovery is realized, according to its retention agreement with the city.

    Hundreds of plaintiffs, mostly county and local governments, are pursuing legal action against drugmakers over the powerful painkillers blamed for thousands of deaths around the country.

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16. Arkansas counties and cities file joint lawsuit against opioid drug manufacturers

    Mar 28, 2018 | Newton County Times (AR)

    By Staff

    In a unified and unprecedented approach against the opioid drug industry, the state of Arkansas, Arkansas counties and Arkansas cities announced that together they have filed a lawsuit in the Circuit Court of Crittenden County.

    This unique litigation approach is unlike any others in the country and will represent 90 percent of Arkansas’s population, with 72 counties and 210 cities participating. It is believed that it will cost billions to stop the Arkansas opioid epidemic and that this money should come from the companies that caused the problem instead of taxpayers.

    “Though other lawsuits have been filed in federal courts across the country, Arkansas is the only state that has united in this fashion,” said Chris Villines, executive director of the Association of Arkansas Counties. “Instead of fighting and competing with each other on critically needed settlement dollars for our cities and counties, all of the cities and counties are working together to do what’s best for Arkansas.”

    The epidemic is real and has ravaged Arkansas families for years. While the U.S. experiences more than 42,000 fatal overdoses a year, Arkansas experiences over 400, a number that has increased nearly 300 percent since 2000 and coincides with opioid sales quadrupling. Additionally, Arkansas ranks second in the nation for ages 12-17 in misuse of opioids (4.67%) behind Alabama, which is also the only other state with a higher opioid prescribing rate than Arkansas, according to the U.S. Centers for Disease Control and Prevention.

    “It is hard to find anyone who hasn’t felt the effects of an opioid addiction from family, friends or even in themselves,” said Kirk Lane, Arkansas State Drug Director. “Though great strides have been made recently to curb the epidemic – especially helping cities fund necessary resources like the opiate antagonist Naloxone (Narcan) – much more could be done to fund ongoing programs for education and prevention.”

    In 2017, there were more opioid prescriptions than people – enough for every man, woman and child to have 80 pills per year. Hospitals and rehabilitation systems cannot keep pace with the influx of victims. The resources of public safety officials are constantly strained to meet the overwhelming needs of opioid-related emergencies. As a result, the state of Arkansas, its counties, cities and taxpayers have funded the enormous societal costs of the opioid epidemic, but have had insufficient revenue to turn the tide of the epidemic.

    “Arkansas’s one-voice approach to this lawsuit is one that gives us a seat at the table,” said Don Zimmerman, executive director of the Arkansas Municipal League. “Neither the state or any county or city is big enough alone; this litigation approach ensures that recovered damages remain in Arkansas.”
    

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17. Suncoast governments suing opioid makers and sellers over epidemic

    Mar 28, 2018 | WWSB (FL)

    By Ray Collins

    Remember when governments around the Gulf of Mexico sued British Petroleum after the oil spill? Something similar is happening now against the companies that make and sell opioids—the pain pills often called the gateway to bigger addictions.

    Sarasota attorney Bill Robertson says the problem is so bad in Sarasota County, the medical examiner needs help with all the extra bodies they're now handling.

    "I know in Sarasota, they asked for $300,000 to increase the budget at the medical examiners office to handle the increased pressure of autopsies, that has a direct correlation," Robertson said. 

    And that's why the City of Sarasota has deputized Robertson to take part in major litigation against both the manufacturer and the distributors of opioid. Distributors are listing annual revenue of $378 billion dollars.

    Some 200 litigants have joined together in a case where billions are at stake.

    "We'll be representing the City of Sarasota in connection to their individual claim against all of these manufacturers and distributors to try to recoup the damages that the city has incurred in the response for first responders--Narcan for examples is $300 a shot, that's the drug that pulls these guys out of the overdoses. So law enforcement, incarceration, any costs the city has incurred in treating opioid overdoses or the epidemic is recoverable in these actions against the manufacturers and distributors," Robertson said. 

    Vice Mayor Liz Alpert is glad the City is trying to stop the flow of the painkiller before it gets in the wrong hands.

    "Absolutely I'm glad the city is trying to chase down the opioid manufacturers because that's the root of the problem and that's where we have to start in order to combat this crisis," Vice Mayor Alpert said. 

    Robertson says the city has spent hundreds of thousands of dollars that could have gone to much better uses.

    "I think for the first time in history these manufacturers will be held accountable, the plaintiffs handling this around the country are some of the best in the world, and they've already filed individual suits previously and gotten verdicts against them on behalf of individuals and so 02 I think there is a great chance for the City of Sarasota as well as other municipalities that have been damaged by this crisis," Robertson said. 

    Robertson must believe he'll be successful on behalf of the City of Sarasota.

    Afterall, he'll only be paid if he wins.

    Manatee County has also filed suit to be part of this multi-district litigation. 

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Midwest (MI)

18. Kalamazoo County Commission to join conversation of statewide opioid lawsuit

    Mar 28, 2018 | WWMY (MI)

    By Staff

    The Kalamazoo County Commission is taking up a proposal to take part in a class action lawsuit in Michigan against opioids.

    During last night's Portage City Council meeting, two members of the Kalamazoo County Commission announced there would be a county-wide discussion next week.

    There are about 50 cities and counties across Michigan suing to hold pharmaceutical companies, distributors and pharmacies accountable for the growing opioid epidemic.

    But County Commissioner Dale Shugars thinks this sets a dangerous precedent.

    "If one believes that the pharmaceutical companies are at the core of this issue, then they ought to look at the doctors, dentists and hospitals, and it's a slippery slope. Who do you blame?” Shugars said.

    The Kalamazoo County Commission is taking up the proposal at a meeting on Tuesday at 4 p.m.

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Broadcast Media Coverage

19. ABC 7 News at 7p

    Mar 28, 2018 | Tampa, FL

    By WWSB (ABC)

    Video Link 1: http://app.criticalmention.com/app/#clip/view/33899621?token=afbdd945-f057-46b8-8660-6c79a21ae50e

    Video Link 2: http://app.criticalmention.com/app/#clip/view/33899632?token=afbdd945-f057-46b8-8660-6c79a21ae50e

    Rough Transcript: we're talking about sarasota's lawsuit ainst the makers of opid pain medication. joining us for more is sarasota's vice mayor liz alpert and attorney bill robertson of kirk pinkerton the firm hired by the city to handle the case. we also asked the pharmaceutical industry to join us tonight. a spokesperson nick mcgee said because of the legal matters the industry could not but they provided us this statement basically describing what the industry is trying to do in terms of the opioid crisis. and quote, that includes those 7:30 PMpolicies include a limit on the supply of the opioid medications to 7 days for acute pain and clear exemptions. mandating prescriber training to assure appropriate treatment of addiction and pain and eliminate coverage mandates that are barriers to keep patients from accessing all forms of addiction treatment. which is i would imagine is good stuff. but does not go nearly far enough to handle the underlying issues that we are talking about tonight. >>guest: i would agree with that. i think the problem is the horse is out o the barn. when you get caught with your hand in the cookie jar. >>alan: i used that line the other night. >>guest:hey got busted for what they were doing. it's not like you can stop it on a dime. because this is going to continue for a number of years. every person addicted, much like an alcoholic, you're always addicted. >>alan: legal case, i know ray referred to the bp oil settlement in his story. but you also have the big settlement involving tobacco. are these similar principles? >>guest: yeah, they are. 7:31 PMi think what happens, there's numbers of lawsus, have been 200 lawsuits filed over the country so far. that will be multiplied by many because each municipality and state has a right to sue and recovery. similar to together, because tobacco, there was 46 states who sued tobacco to recover the costs of smoking-related illnesses. this is the same thing. municipalities and states have the right to recover against big pharma and the distributors for the costs associated with treating the opioid epidemic. from the narcan, which is 300 bucks an injection, to law enforcement to incarceration to hospitalization, to the opioid addicted babies and all the way down the line. so it's something that is similar to that and, what happens, when you have a common issue or a common conduct that gives rise to all these separate lawsuits, they declare what's called a multi-district litigation or mdl. that's been declared in the southern district of ohio. 7:32 PMand what happens is that judge handles all the common issues relative to liability on the part of the parties. and then eachndividual plaintiff has the right to make a claim for its individual damages. so in other words, sarasota's damages are different than sarasota county or city of bradenton or whatever. that's how it's handled. so we sit back and wait until they get done with the common issues until we farm back to here. >>alan: so liz, sarasota is the first community in florida that is joining this lawsuit. obviously the opioid epidemic is ravaging manatee county and i would imagine every major and minor city and town throughout the state. has there been any effort by the city to coordinate efforts with other communities throughout florida? >>guest: we haven't, but i believe your law firm, correct, has been approaching some of the other cities because it would make sense that really all of us get together and say, you know, we need relief from this. you caused this problem, this is what it's costing us, so we 7:33 PMshould be able to recover our damages for what's happening. in addition, individuals who become addicted to this, they would have also grounds for suing the manufacturers for really, it was false advertising, one of the things, you know, telling doctors that they couldn't get addicted. and now of course they're finding out that none of that was true. >>alan: you know, there are a couple questions here. sarasota and the county have done a very good job over the last five years in terms of eliminating pill mills. there was state action on that as well. but there are still pain management practices in sarasota, the city and the county, that are still in business. and they do have a role, i would imagine, but what are the areas, if sarasota won a settlement that you would like to see this money spent on? >>guest: well, obviously i'm one of five commissioners. 7:34 PMbut, you know, if we were able to recover, i'd like to see it go tards offsetting certainly some of the eenses that we have incurred. but i'd also like to see if we couldn't take some of it and put it into some treatment programs or some of the programs that were already supporting, such as the drug treatment and those sorts of things that the center point group that, they're doing rehab and recovery, and try to stop it there. >>alan: you know, i remind people every opportunity i get that florida, the state of florida ranks dead last in the entire nation in terms of funding mental health. which means that when people get into trouble and they need treatment and they need treatment beds, good luck in florida. >>guest: that's a huge issue. i mean, that ties into, as i said, the homeless issue, it 7:35 PMties into the, you know, gun control issue, all of these things are interrelated. and opioid addiction is a big factor. >>alan: but bill, if we're talking about principles and cases similar to the bp case and tobacco, these are cases that take a long time to prosecute. and therefore get, you're lucky to win a settlement or negotiate a settlement, how many years are we talking about here? >>guest: if we had to litigate this case until the end, it might take two to three to five years potentially. but what i expect to do, because of the massive pressure that's going to be borne down on the manufacturersand distributors, there will be a settlement reached and the judge overseeing the mdl has indicated he'd like to get something going by the end of this year. that's pretty optimistic. what i suspect will happen some point over the next year or two will be effort to come up with global settlement which will be distributed to various plaintiffs who filed suit on 7:36 PMsome proportional basis. >>alan: is there any indication yet the pharmaceutical industry is doing anything to change how it markets these drugs or does its business? because i know here also in the statement thai was given, that the industry in general is trying to accelerate the development of non-opioid pain medications. i would imagine that would be good news to a lot of people. >>guest: it should be because that's appropriate for chronic pain. the opioids have place, as i said before, for acute pain for short periodf time, as well as the end of life care. so there's a great place for those things but they have to come up with alternatives. recent studies shown opioids don't do any better for chronic pain than some of the over the counter stuff that's not opioid. thers a place for that but it's not as profitable. they don't have a choe but do something different because they've gotten caught. >>alan: liz, i don't know if you know the answer to this but i'm going to ask you anyway. we're deal with opioid abuse in 7:37 PMa number of different ways. the pharmaceutical industries, the percocets a vicodins and oxycontins, that medication, but also illegal opioids are coming into this country from overseas. so is that a separate, you know, does does that result in separate obstacle that is the city has to deal with in terms of how to defend itself and to get treatment for people who are using that kind of, heroin, fentanyl and so forth? >>guest: well, certainly that is different than this. this lawsuit goes after the pharmaceutical manufacturers, so you have seone you can go after. but when it's illegal, you've got another whole set of issues. and the oxycontin, as i understand it, is similar in character to heroin. and so, if they're not able to get oxycontin, then they're going to heroin, which now is 7:38 PMbeing laced with fentanyl, which is very deadly. so, you know, it makes for even a bigger crisis. >>alan: and of course, bill, what people might want to know when you take a look at other similar cases as we mentioned, bp and the cigarette or the tobacco settlement, what kind of settlement for the city can you hope that you would get one day in terms of monetary amounts? >>guest: you know, we haven't exactly quantity tied our total damages because in this case like bp, we have the right to go back probably five years to collect data on what the costs have been. in addition when you have future damages because it's ongoing, you have the right in these lawsuits to project out future damages as well. so this is a multi-year calculation on what our damagings are. once we get a baseline we are working on, we'll be able to multiply it by the be in of years reasonable to expect. in terms of what that price tag is, i don't know. and i suspect that because of the level of damages that the settlement will be a fraction of what they are because if the pharmaceuticals had to pay the real damages across the country, it would put them out of business. alan: we have to take a quick break and will be back for final thoughts in just a moment. 7:40 PM7:41 PM>>alan: our guests join us for final thoughts. liz, what do you think is the principle here, that the reason why the city was so eager to join this lawsuit and get something out of it? >>guest: well, because i think that it's a way to send a message to the pharmaceutical companies that they've got to change their behavior. 7:42 PMand quit marketing these things for people when they don't need them and then people get addicted. i think the thing i would like people to take away from this is that we need to fight this on all fronts. and the state needs to step up and give more funding for mental health, for substance abuse and all of these issues. and this is a way for us to maybe recover our costs and get some money for that. >>alan: bill if you were to boil down what the drug companies are doing that is really the worst behavior in this whole affair, what would that be? >>guest: it's the big marketing scam they came up with to convince doctors that it's okay to prescribe for chronic pain and as i said, statistically people get addicted 56% chance that they will if they take it over long period of time which might be two weeks, three weeks. so it's gotten people hooked and the deaths are up. so the profits are way up. and unfortunately, even the fines, purdue pled guilty and fined $300 million. that's a slap on the wrist with the revenues they have on annual basis. it doesn't do anything to them. until the fda and others have fined them, but until they get hit in the pocketbook and stop the behavior, that's where they're going to hear it. i guess my takeaway would be, those of us who take on the cause on contingency fee basis are going to send them a message and stop the behavior. until then, they're not going to stop.

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20. ABC 27 News at Sunrise 5:30am

    Mar 29, 2018 | Tallahassee, FL

    By WTXL (ABC)

    Video Link: http://app.criticalmention.com/app/#clip/view/33899614?token=afbdd945-f057-46b8-8660-6c79a21ae50e
    

    Rough Transcript: the opioid crisis continues to sweep the nation, and another south georgia government is preparing a legal battle to fight the epidemic. dougherty county commissioners plan to file a lawsuit against the pharmaceutical industry and pill abusers. earlier this week, county commissioners heard from five different georgia law firms. each want to represent the county in it's quest of seeking financial damages. "chris cohilas, chairman, dougherty county commission: "i think it is an important issue that has to be addressed, both legally and also through a community oriented approach. i think you have to start discussions with your medical providers, as well as law enforcement, and sort of infiltrate the issue from all sides.

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21. CBS 6 News at 6a

    Mar 29, 2018 | Albany, NY

    By WRGB (CBS)

    Video Link: http://app.criticalmention.com/app/#clip/view/33899604?token=afbdd945-f057-46b8-8660-6c79a21ae50e

    Rough Transcript: in schenectady county the gazette reports the city is looking to go after opioid manufacturer and distributors. the city council approved a resolution for the city to enter into a future lawsuit to try to recoupe costs it suffered due to incidents involving open yoads. no lawsuit has been filed and neither the city or the law firm has named possible defendants.

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22. WDVM News at 6:00AM

    Mar 29, 2018 | Washington, DC

    By WDVM (WDVM)

    Video Link: http://app.criticalmention.com/app/#clip/view/33899609?token=afbdd945-f057-46b8-8660-6c79a21ae50e

    Rough Transcript: the allegany county government has announced it is joing a national opioid lawsuit against drug manufacturers. the poole law group, led by a-j serafini is collecting data for the trial that is expected to begin in the summer of 20-19. serafini says they've found that allegany county, cumberland and frostburg are some of the hardest hit areas in the nation by this crisis. "for every one person walking around in allegany county, they have more than one opioid streets of cumberland and frostburg, all of allegany county, and you see the devastation that's there. you see the people that have been affected by this." ross: the trial is expected to take place in cleveland, ohio.

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23. News 2 at 11am

    Mar 28, 2018 | Nashville, TN

    By WKRN (ABC)

    Video Link: http://app.criticalmention.com/app/#clip/view/33899660?token=afbdd945-f057-46b8-8660-6c79a21ae50e

    Rough Transcript: montgomery county is now suing several pharmaceutical companies claiming they're responsible for the opioid epidemic. it says they "aggresively advertised" and persuaded doctors to prescribe opioids to paients. the lawsuit also says the crisis has put a financial burden on the county and asks for money to pay for medical care.. treatment... and law enforcement. more than a dozen companies are named in the lawsuit. nikki: and coming up at 11-45. former nashville judge and current lawyer kevin sharp joins us as our newsmaker to discus several opioid lawsuits against big pharmacompanies.

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24. Good Day Oregon

    Mar 28, 2018 | Portland, OR

    By KPTV (Fox)

    Video Link: http://app.criticalmention.com/app/#clip/view/33899664?token=afbdd945-f057-46b8-8660-6c79a21ae50e

    Rough Transcript: governor kate brown signed 2 ne bills substance abuse nonprofit and the new legislation aimed a fighting oregon opioid crisis with concrete addiction recover plan by july 2020 as well as focusing on measures to combat existing opioid problem. governor brown said new laws ar the first step in a long road t transfer working into a recover state. this all comes as clark county signing onto a massive lawsuit against the pharmaceutical industry. the county joining 400 jurisdictions nationwide with drug manufacturers and wholesalers to federal court. the lawsuit says largely to blame for widespread opioid addictions by knowingly giving false information to doctors an patients regarding opioid prescription safety. clark county and others looking to recover the public cost opioid at you-opioid abuse has drained from the communities.

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