The Opioid Crisis—Who is Responsible?

Santa Clara, CA While cities, counties and states nationwide are filing opioid lawsuits, those defendants--that include big Pharma, manufacturers, distributors and pharmacy chains-- maintain that they cannot be held responsible for what happens to pain pills once they travel down the supply chain. And is anyone taking into account people in pain?

For instance, in the state of Wisconsin, 28 counties claim in federal lawsuits that "nefarious and deceptive" marketing campaigns from pharmaceutical companies are responsible for the nation's opioid overdose epidemic. The lawsuits against Purdue Pharma, Johnson & Johnson, Endo Health Solutions, Inc. and subsidiaries of the companies allege that local governments' health and law enforcement services "have been strained to the breaking point" because of widespread opioid abuse. (Wisconsin taxpayers aren't footing the bill. Rather, those law firms representing the counties are covering the costs.)

If states like Wisconsin prevail, where will that leave about 76 million Americans over the age of 20 who currently endure pain that lasts more than 24 hours? Critics of these lawsuits say they directly risk the value that opioid medications bring to the millions of patients who live with pain. And chronic pain can lead to other health problems that include severe depression, as well as adverse impacts on the cardiovascular, immune, and musculoskeletal systems. Further, there are financial consequences. People who suffer from chronic pain miss work more often, and are less productive at work.

Of course, many patients have become addicted to opioids through no fault of their own. Perhaps they were involved in a car crash, were prescribed opioids for pain and then cut off, sometimes abruptly. Some patients turn to street drugs. And some politicians are blaming them for the epidemic. (Shouldn’t they have learned from Nancy Regan’s “Just Say NO” campaign how successful it is to blame addicts for their disease and where that leads?)

Attorney Ken Feinberg (he oversaw claims administration after 9/11, the BP oil spill, the Boston Marathon bombing and the Volkswagen emissions scandal) told fortune.com that a few factors make it hard to assign blame to the opioid epidemic: Pain meds are lawful drugs, approved and regulated by the federal government, so litigation is brought against companies who appear to be complying with the law; and there are “a whole lot of intermediaries in the distribution process. And he points out that, “Even if the litigation is successful, what will you do with this money?” He says giving it to surviving victims may be problematic, given their addictions. As for paying for the nation’s epidemic, “I don’t think there’s enough money to cover it,” he said.

Pharmaceutical companies, including Purdue Pharma L.P., Janssen Pharmaceuticals Inc. and Allergan PLC, say they've complied with the FDA’s requirements to warn the public about potential risks that come with using their drugs, The Oklahoman reported.

McKesson is the nation’s largest distributor of pharmaceuticals, including opioid drugs. In July 2016, the International Brotherhood of Teamsters and stockholder in the company cited McKesson’s “role in fueling the prescription opioid epidemic” at its annual shareholder meeting. Jennifer Nelson, a spokesperson for McKesson, told The Atlantic that the opioid, heroin, and fentanyl epidemic is “complicated” and “not to be laid at the feet of distributors.”

But the Pulitzer-prize writer Eric Eyre revealed in the Charleston Gazette-Mail that in 2007 and 2008 drug distributors shipped almost 9 million hydrocodone pills to one pharmacy in the town of Kermit, West Virginia, population 392. “In six years, drug wholesalers showered the state with 780 million hydrocodone and oxycodone pills, while 1,728 West Virginians fatally overdosed on those two painkillers,” Eyre wrote. He found that in 2007 alone McKesson sent 3,289,900 doses of hydrocodone into Mingo County, West Virginia, whose population at the time was 26,679.

The Wellness Center in Williamson, West Virginia was shut down in 2010 after a federal raid exposed it as a moneymaking machine, raking in more $4.5m a year. Doctors frequently did not even see the patients they were handing out prescriptions for, and soon the word was out: you could pick up opioid prescriptions at the clinic--it had its own pharmacy—for cash without consultation.

West Virginia is attempting to fight back. Its lawsuit alleges that “a veritable rogue’s gallery of pill-pushing doctors and pharmacies” grew rich on the back of patients who sought medical treatment only to have their lives wrecked by addiction. Some drug distributors in June agreed to pay West Virginia millions of dollars and some of the physicians and pharmacists involved have been jailed and stripped of their medical licenses. As attorney Ken Feinberg opined, where will the money go?

Lawyers for big pharma and distributors, unscrupulous doctors and clinics, argue that the fault lies with the addicts. But if doctors and pharmacies weren’t feeding the addiction, who knows how many lives could have been saved.