Suboxone Tooth Decay MDL – Status Update

Cleveland, OHIn recent years, Suboxone, a critical medication used to treat opioid addiction, has come under fire for its unintended side effects—specifically, severe tooth decay. While the drug has helped millions overcome opioid dependence, patients across the country have filed dangerous drug lawsuits claiming that Suboxone caused serious dental problems, leading to painful and costly procedures as well as social isolation for some individuals. These claims have been consolidated in an ongoing multidistrict litigation (MDL) in the Northern District of Ohio, where patients are suing the manufacturers of Suboxone for failing to warn about the risk of tooth decay. 

The Ohio MDL, known formally as  Suboxone (Buprenorphine/Naloxone) Film Products Liability Litigation, is a pivotal case that may shape the future of pharmaceutical litigation, particularly when it comes to the obligation to warn about lesser-known but potentially devastating side effects. With hundreds of cases consolidated under the MDL, the outcome of this litigation is highly anticipated by both legal professionals and patients alike.

Suboxone and tooth decay: an overview

Suboxone combines buprenorphine, a partial opioid agonist, with naloxone, an opioid antagonist. It is administered sublingually, meaning patients place a dissolvable film under their tongue or take a tablet that dissolves in the mouth. This method increases the drug’s effectiveness in treating opioid addiction but also leaves the teeth and gums exposed to the medication for extended periods.

One of the significant side effects reported by long-term Suboxone users is xerostomia, or dry mouth, which can lead to a sharp increase in dental decay. Without sufficient saliva to neutralize acids and protect teeth, users experience rapid tooth deterioration, including cavities, gum disease, and in some cases, tooth loss.

Patients in the Ohio MDL allege that they were not adequately warned about this risk. Many claim that despite adhering to regular dental hygiene practices, their dental health deteriorated rapidly while on Suboxone. As a result, they have had to undergo extensive dental work, including fillings, root canals, extractions, and in severe cases, full dental implants. These lawsuits have raised important questions about the duty of pharmaceutical companies to disclose all known risks associated with their products.

The legal basis for the Ohio MDL

The Suboxone MDL was established to centralize lawsuits from across the country, allowing for more efficient pretrial proceedings and consistency in legal rulings. The primary defendants in these cases are Reckitt Benckiser Pharmaceuticals, Indivior, and other companies involved in manufacturing and distributing Suboxone.

The legal arguments center on two main points:

• Failure to Warn: Plaintiffs argue that the manufacturers of Suboxone knew or should have known about the risk of severe tooth decay but failed to provide adequate warnings to both patients and healthcare providers. Failure to warn could amount to negligence if it can be shown that the lack of warning caused harm to the patient; and
• Defective Design: Some plaintiffs also claim that the design of Suboxone, particularly its sublingual administration, is inherently flawed and contributes to dental decay.

Status of the MDL

As of October 5, 2024, a U.S. Federal Court in Ohio held an in-person status conference regarding the Suboxone multidistrict litigation. Among the items discussed in this conference were plaintiff information about their Suboxone use, subsequent injuries, and treatments. This information and additional data will be shared and discussed at the next conference on November 21, 2024. Discovery is well underway, with both sides exchanging documents, depositions, and expert reports.

The court has not yet scheduled a bellwether trial, which would serve as a test case for how juries might respond to the evidence presented. Bellwether trials are a common strategy in MDL cases, helping both parties gauge the strengths and weaknesses of their arguments before a broader series of trials or settlement discussions take place.

While no official settlement talks have been publicly disclosed, MDLs often lead to large-scale settlements when both sides see the potential for lengthy, costly trials. If the plaintiffs succeed in demonstrating that Suboxone manufacturers were negligent in warning about the dental risks, it is possible that the defendants will seek to settle with the plaintiffs to avoid the unpredictability of a jury verdict.

Potential impact of the Ohio MDL

The Suboxone MDL in Ohio could set an important legal precedent for pharmaceutical companies and their duty to disclose side effects. If the plaintiffs succeed, it may encourage further lawsuits from patients who experience lesser-known side effects from other medications. Additionally, pharmaceutical companies may be forced to take a more cautious approach to disclosures in drug labeling, ensuring that even relatively minor side effects are prominently mentioned.

For healthcare providers, this litigation highlights the importance of informed consent. Physicians prescribing Suboxone or similar medications should be aware of the potential for dental issues and advise their patients accordingly. Failure to do so could result in claims of medical malpractice, particularly if a patient suffers severe dental damage without having been adequately warned.

Moving forward: what to expect

The Suboxone MDL is still in its early stages, with discovery and pretrial motions expected to continue into 2025. Depending on how the bellwether trials unfold, the litigation could result in either a series of jury verdicts or a global settlement for the plaintiffs.

Ultimately, the MDL represents an important test case for how courts will handle claims that focus on side effects that, while not life-threatening, can have severe consequences for a patient’s quality of life.