500 Cities, Counties and Tribes Sue Owners of Oxycontin Manufacturer

Much of the Trump/Pence.GOP agenda has been aimed at slashing regulations that protect the public and creating a new Gilded Age where the wealthy are allowed to make fortunes at the expense of the larger populace and avoid accountability.  Among some of the most greed driven are the pharmaceutical companies which charge obscenely high prices to Americans for drugs that cost a small fraction of the US cost in Europe, Canada and elsewhere.  Previous post have looked at the greed of the manufacturer of PrEP that protects against HIV infection.  The other huge scandal involves the manufactures of opioids who made billions while misleading doctors and fueling the national opiod crisis.  Among such companies are the manufacturers of Oxycontin who have amassed a fortune at the cost and lives of many Americans.  The owners of that company now face a massive lawsuit to hold them responsible.  Here are highlights from The Guardian:

A group made up of more than 500 cities, counties and Native American tribes across the United States has filed a massive lawsuit accusing members of the Sackler family, who own the maker of the opioid painkiller OxyContin, of helping to create “the worst drug crisis in American history”.

The lawsuit represents communities in 26 states and eight tribes and accuses Sackler family members of knowingly breaking laws in order to enrich themselves to the tune of billions of dollars, while hundreds of thousands of Americans died.

“Eight people in a single family made the choices that caused much of the opioid epidemic,” the lawsuit, filed earlier this week in federal court in the southern district of New York, states.

The same eight members of the family had recently been added to a small number of lawsuits that are underway against a string of opioid-makers, including the Connecticut-based pharmaceutical company the Sacklers wholly-own, Purdue Pharma, but they have not been sued as individuals on anything like this scale before.

“This nation is facing an unprecedented opioid addiction epidemic that was initiated and perpetuated by the Sackler Defendants for their own financial gain, to the detriment of each of the Plaintiffs and their residents. The ‘Sackler Defendants’ include Richard Sackler, Beverly Sackler, David Sackler, Ilene Sackler Lefcourt, Jonathan Sackler, Kathe Sackler, Mortimer DA Sackler, and Theresa Sackler,” this week’s lawsuit states.

Court documents accuse the eight family members of purposely playing down the dangers of the prescription painkiller OxyContin, which is more potent than heroin or morphine. They are accused of deceiving doctors and patients and directing sales and marketing techniques that drove huge over-prescribing and ever stronger doses for many patients who should never have been prescribed the pills in the first place.

“The defendants’ actions caused and continue to cause the public health epidemic…caused deaths, serious injuries, and a severe disruption to public peace, order and safety, it is ongoing and it is producing permanent and long-lasting damage,” the court documents allege.

The lawsuit filed in New York on 18 March is extraordinary because it focuses almost entirely on the individual Sacklers.

Richard and Jonathan Sackler are sons of the late Raymond Sackler, one of the founding brothers of Purdue. Beverly is Raymond’s widow and David his grandson.

Ilene, Kathe and Mortimer David Alfons are children of the late Mortimer Sackler, another of the founding brothers of Purdue, and Theresa is his widow.

The only other defendants named in the lawsuit are the family trust connected to Raymond Sackler’s branch of the family and Rhodes Pharmaceuticals, a company owned by the Sacklers that produces generic opioid painkillers.

Other cases focus mostly on Purdue and other well known pharmaceutical giants involved in opioid production, such as Johnson & Johnson and Allergan.

Drug overdoses now kill more than 72,000 people in the US a year, according to government figures from the Centers for Disease Control and Prevention, and 49,000 of those are caused by opioids.

Purdue’s business has attracted a wave of lawsuits alleging deception about the safety of OxyContin, which the company had admitted misbranding in a 2007 criminal case.

Purdue has not ruled out filing for bankruptcy, which would cause a hiatus in the civil cases brought against it, but also indicates it could be short of the kind of funds that would be needed for a massive settlement or a fine at trial in the cases against it, to compensate communities for the cost of the crisis.

But a victory in the latest lawsuit against the Sacklers would give the plaintiffs access to the Sacklers’ personal fortune.

One can only hope the lawsuit is successful.

People Over 50 Are the Fastest-Growing Group of Cannabis Users

Illustration: George Wylesol for the Guardian.

The push to decriminalize marijuana and expand its medical uses is sweeping the country - even in Virginia.  I support decriminalization since, having been a teen in the 1960's, I am no stranger to marijuana and, in my view, the claim that it is a "gateway drug" is bullshit (pardon my "French"). If someone is trying to lose themselves in drugs, the real solution is decent mental health care that addresses the underlying issues.  Moreover, in my experience, the marijuana laws (especially in Virginia) seem to be aimed at criminalizing blacks with a goal of disenfranchising them.  Hence why the Virginia Republican Party is killing decriminalization efforts in this year's session of the Virginia General Assembly. With the Virginia GOP not being able to win a statewide election in a decade, the desperation to minimize "those people" on the voter rolls has reached new levels of desperation. As a piece in The Guardian indirectly notes, however, the GOP may be about to hit a brick fall in its efforts to retain this tool for criminalizing blacks.  The fastest growing cohort of marijuana users is the older 50 crowd, a key GOP demographic.  Here are article highlights (note the drop in opioid usage where marijuana has been decriminalized): 

As attitudes towards cannabis shift, the fastest-growing group of users is over 50 – and marijuana’s popularity among seniors is beginning to change the American experience of old age.

Why are more seniors getting high? It might make more sense to ask: “Why not?” As adults reach retirement, they age out of drug tests and have far more time on their hands. Some feel liberated to abandon long-held proprieties.

Elegant vape pens and other attractive, discreet products have helped de stigmatize the drug among older Americans. “Legalization seems to make non-users seem a little less scared of it, and perhaps less judgmental,” says Jo, a 56-year-old cannabis user who preferred not to use her real name.

The seniors using cannabis today aren’t your parents’ grandparents. The generation that camped out at Woodstock is now in its seventies. They’ve been around grass long enough to realize it’s not going to kill them, and are more open to the possibility it will come with health benefits.

Seniors’ affinity for weed is beginning to ripple across the US healthcare system. A 2016 study found that in states with access to medical marijuana, those using Medicare part D – a benefit primarily for seniors – received fewer prescriptions for other drugs to treat depression, anxiety, pain, and other chronic issues.

[P]roven or not, a number of seniors evidently prefer it to the medications they would otherwise be taking. A study published last year in in the Journal of the American Medical Association found opioid prescriptions for Medicare part D recipients dropped 14% after a state legalized medical marijuana – a hopeful sign amid the opioids crisis.

While some doctors have expressed concerns about seniors self-medicating with weed, virtually everyone agrees the public health consequences of opioids are far worse. And the most serious health concerns associated with marijuana, such as impaired brain development, tend to affect younger people.

For the industry, seniors’ newfound interest in cannabis is a business opportunity. The Colorado edibles company Wana Brands, among many others, sells cannabis products reminiscent of medicines familiar to seniors. Wana sells extended release capsules as well as products with different ratios of THC and CBD, which intoxicate users to different degrees and can have a variety of effects on ailments.

For someone who hasn’t seen a joint in 40 years, the modern dispensary can be a dizzying experience replete with dozens of products – topicals (lotions), tinctures, sprays – all promising to help you feel better, but also to get you stoned. Whether or not marijuana helps seniors to alleviate their conditions, many may enjoy a sense of control over their own wellbeing. Meanwhile, dispensaries in California and elsewhere cater to older clientele with discounts and shuttle busses.

It hasn’t escaped the pharmaceutical industry that marijuana could soon be seen as a viable replacement for many of its products. Perhaps someday soon it will be normal for seniors to pass their last decades in a cannabis-induced haze.

For those who support decriminalization, there's an easy step to take: vote Democrat in every race possible in November 2019 and flip control of the General Assembly from the GOP. 

The Opioid Crisis: Holding Pharmaceutical Companies Responsible

Tiny Vinton, Ohio, where massive amounts of opioids were shipped.

Much has been said about who is to blame for the opioid crisis impacting America, especially portions of rural America.  Some would blame the users, others would blame physicians, others blame economic distress, but, in my view, the real villains are the pharmaceutical companies, who like gun manufacturers, care nothing about the consequences of their product.  Rather their sole focus is seller ever larger quantities and to make more and more money.  Part of this effort includes wining and dining physicians and other prescribers and pushing them to prescribe more and more product.  Part of it is advertising campaigns to encourage patients to ask their doctors for prescriptions.  Yet another part is turning a blind eye to what even in passing would be insane quantities of opioids being shipped to small communities. Now, as the Washington Post reports, localities and states are seeking to hold pharmaceutical companies for the damage their products and their negligence have done.  Here are article highlights:

Vinton Ohio — The opioid epidemic has affected nearly every aspect of life in Vinton County. Teachers buy shoes for students whose addicted parents send them to school in footwear held together with tape. Overdose deaths have surged. Foster care is overwhelmed. The jail is bursting at the seams.

The expenses related to caring for the children of drug abusers and locking up drug offenders here eat up about 25 percent of the Ohio county’s $4 million annual budget, a hole that it can’t plug. Now, Vinton officials think someone should help foot the bill: Big Pharma.

“It almost feels like Vinton County was preyed upon,” said Lily Niple, who got addicted to prescription opioids here but managed to push through, having been clean for more than two years. “It’s like a huge exploitation of the people here. And it was negligent. Just complete disregard for the future.”

[T]he biggest fight against the opioid epidemic is being waged in a federal courthouse in Cleveland, where hundreds of lawsuits brought by cities, counties, Native American tribes and unions have been brought together into one case with a scope that rivals anything seen in the U.S. legal system. Vinton County and hundreds of other municipalities across the nation are suing companies that manufactured and distributed powerful painkillers and others up and down the supply chain, arguing that they knowingly peddled massive amounts of a highly addictive product that set in motion a public health crisis. The plaintiffs argue that the vast network of opioid businesses should pay for the damage the drugs wrought.

“This is probably the most complex piece of litigation in the history of our country,” said Paul J. Hanly Jr., one of the lead plaintiffs lawyers.

The consolidated case is being compared to the one that led to hundreds of millions of dollars in settlements against tobacco companies and restricted the sale and marketing of cigarettes. Some of the same tobacco lawyers are now working on the opioids trial.

Plaintiffs are making different, but similar, claims and suing various companies in the drug pipeline. Some allege the drug companies created a public nuisance with their products. Others argue that deceptive marketing led to an epidemic. Some say state consumer protection laws were violated. Some of the lawyers allege that the distribution system, which includes wholesalers and distributors of powerful narcotics, amounted to a criminal enterprise. A small group is suing pharmacy benefit managers. Some are suing pharmacies. One lawyer is suing on behalf of children born to mothers who were addicted to opioids.

The Justice Department filed a motion this past week requesting that it be allowed to participate in settlement discussions as a friend of the court. Attorney General Jeff Sessions said the department would seek repayment for the cost of the drug crisis because the federal government has borne substantial expenses. The sheer number of defendants in the case — more than a dozen — also is staggering and unprecedented. And they could start pointing fingers at one another. They include the manufacturers Purdue Pharma and Janssen Pharmaceuticals, the distributors AmerisourceBergen, McKesson and Cardinal Health and pharmacy benefit managers such as Express Scripts. The litigation comes as people at all levels of government have identified opioid abuse as a major public health — and societal — woe, one that thus far has defied solution. And in many ways, lawyers and legal experts say, the opioid lawsuit is different and far larger in scope than efforts such as the action against Big Tobacco.

The opioid epidemic kills hundreds of people each day, akin to the 1918 flu pandemic. The judge overseeing the case, Dan Aaron Polster of the Northern District of Ohio, said during a January hearing that this scourge was man-made and that lawyers need to reach a resolution quickly, because approximately 150 people are dying each day.

 The White House Council of Economic Advisers estimates that the economic cost of the opioid crisis was $504 billion just in 2015, or 2.8 percent of that year’s gross domestic product. Altarum, a nonprofit organization that studies health care, estimates the opioid crisis cost the country more than $1 trillion from 2001 to 2017. Mark Chalos, a lawyer who represents communities in Tennessee and some unions, said the toll is tremendous, “a preventable catastrophe . . . made entirely by an industry that operates in plain view.” [Judge] Polster is taking a unique tack — he is not interested in litigation for the sake of litigation. Instead, he wants to help solve the crisis and do something to “dramatically reduce the quantity” of opioids being disseminated, manufactured and distributed, he said in a January hearing. He also wants to ensure the drugs are being used properly. It is not the first time that some of the companies have been pursued in the courts. In 2003, Hanly sued Purdue Pharma, which makes the powerful synthetic opioid painkiller OxyContin. The company paid out $600 million, and three executives pleaded guilty to criminal charges that they misled doctors, regulators and patients. But the epidemic raged on. The judge also put a protective order on what lawyers say is likely the linchpin of the case: information from a database kept by the Drug Enforcement Administration that monitors the flow of prescription painkillers from manufacturer to distribution point.

After initially resisting, the DEA said it would disclose some of the data, including identifying the manufacturers and distributors that sold 95 percent of the opioids in each state from 2006 to 2014. Lawyers say the full set of data could provide a road map for the crisis, perhaps showing a correlation between where the drugs flooded and where people died. . . . . but some information that has been released and analyzed is staggering: In two instances, millions of pills were shipped to pharmacies in tiny West Virginia towns.

In Vinton County, where 13,000 people live among the rolling hills and creeks, an average of 113.5 doses of opioids were dispensed per resident here in 2012, according to state data.

Despite what Republicans will bloviate, industries cannot be trusted to regulate themselves.  They have only one true god:  money.  Who gets hurt or dies as a consequence all too often is nowhere in the equation.  The quantities of opioids shipped to tiny Vinton, Ohio,  make it clear that manufacturers and suppliers knew something was seriously wrong, but did nothing.  All they cared about was profit.   The GOP effort to create a new Gilded Age is witnessing the same kind of abuses that ultimately were reined in during the first decades of the 20th Century.  It seems Republicans learned nothing. 

America's Flawed Health Care System Fuels the Opioid Epidemic

I will be honest right up front.  I fully support a single payer health care system that would put healthcare insurance companies as we know them out of business.  Having done legal work for a hospital system and physicians in the past, the former, like health insurers, care only on maximizing profits despite advertisements to the contrary, while the latter are largely restricted in the practices by what health insurers will pay.  Prescribing a pill to mask the symptom is so much cheaper than addressing the true under lying cause.  And, of course, the insurers care nothing about a preventative approach to medicine.  Put all of this in the context of the opioid crisis in America and there's a reason why other advanced industrialized nations are not experiencing a similar crisis: they have universal health care systems that take an entirely different approach to health care.  America's health care system is literally killing tens of thousands of citizens.  A piece in the Washington Post looks at this reality - something that neither Trump or Congressional Republicans will admit, much less address.  Here are article highlights:

For the second year in a row, life expectancy in the United States has dropped.

It is not hard to understand why: In 2016, there was a 21 percent rise in the number of deaths caused by drug overdoses, with opioids causing two-thirds of them. Last year, the opioid epidemic killed 42,000 people, more than died of AIDS in any year at the height of the crisis.

“We should take it very seriously,” Bob Anderson, chief of the Mortality Statistics Branch at the National Center for Health Statistics, told my colleagues Lenny Bernstein and Christopher Ingraham. “If you look at the other developed countries in the world, they’re not seeing this kind of thing. Life expectancy is going up.”

In other words: In no other developed country are people taking and dying from opioids at the rates they are in the United States. We have about 4 percent of the world's population but about 27 percent of the world's drug-overdose deaths.

What explains the discrepancy?  The U.S. medical system.

Americans are prescribed opioids significantly more often than their counterparts in other countries. In the United States, 50,000 opioid doses are taken daily per every million residents. That is nearly 40 percent higher than the rate in Germany and Canada, and double the rate in Austria and Denmark. It is four times higher than in Britain, and six times higher than in France and Portugal.

That is in large part a result of our health insurance structure. Unlike countries that provide universal health care funded by state taxes, the United States has a mostly privatized system of care. And experts say insurers are much more likely to pay for a pill than physical therapy or repeat treatments. “Most insurance, especially for poor people, won't pay for anything but a pill,” Judith Feinberg of the West Virginia University School of Medicine told the BBC.  . . . . the best thing is physical therapy, but no one will pay for that. So doctors get very ready to pull out the prescription pad. . . . . . As a result, Americans were being prescribed opioids. Often, they were given several more pills than they could be expected to use, to avoid repeat visits. 

[D]octors in the United States are much more likely to provide painkillers than are doctors in other countries. One comparative study found that Japanese doctors treated acute pain with opioids about half the time. In the United States, the number was 97 percent of the time.

There are other culprits, too. The United States is one of only two countries that allow prescription drug companies to advertise on television. (The other is New Zealand.) The companies do advertise, a lot. In 2016, pharmaceutical companies spent $6.4 billion on advertising. Experts say, too, that U.S. medical schools have not done enough to educate students on pain management, addiction and opioid use and abuse.

Drug companies also try to woo physicians with gifts. Some companies host fancy dinners, and others sponsor conferences and junkets. In 2016, for example, OxyContin maker Purdue Pharma spent $7 million on gifts to doctors and teaching hospitals. . . . .  In the same period, the company doubled its sales force, distributing coupons so doctors could offer patients 30-day supplies of OxyContin and other highly addictive drugs. In those six years, prescriptions for OxyContin jumped from 670,000 to more than 6 million.

That alarmed at least one public-health group, which ran a 2009 bulletin titled, “The Promotion and Marketing of OxyContin: Commercial Triumph, Public Health Tragedy.”  By then, it was too late.

Big Pharma - Drug Dealers in Lab Coats

Last weekend the Washington Post and “60 Minutes” did a major public service and reported that pharmaceutical lobbyists had manipulated Congress to hamstring the Drug Enforcement Administration.  Just as frightening, Donald Trump intended to name big Pharma's point man in Congress to be his new drug czar until the scathing coverage derailed that effort and Pennsylvania Republican Tom Marino, withdrew his name from consideration.  The crisis of deaths from opioids is a prime example of why strict government regulation is needed because sadly in too many corporate board rooms the only thing that matters is money - even when it comes from actions that lead to needless deaths. Rather than rail against petty anti dealers and increase the arrests on users of small amounts of marijuana, Trump and the ever despicable Jeff Sessions need to go after big Pharma which not only has become a merchant of death but also overcharges everyday Americans on virtually a daily basis.  A column in the New York Times looks at the underlying cause for the opioid crisis.  Here are highlights:

For decades, America has waged an ineffective war on drug pushers and drug lords, from Bronx street corners to Medellin, Colombia, regarding them as among the most contemptible specimens of humanity.

One reason our efforts have failed is we ignored the biggest drug pushers of all: American pharmaceutical companies.

Our policy was: You get 15 people hooked on opioids, and you’re a thug who deserves to rot in hell; you get 150,000 people hooked, and you’re a marketing genius who deserves a huge bonus.

Big Pharma should be writhing in embarrassment this week after The Washington Post and “60 Minutes” reported that pharmaceutical lobbyists had manipulated Congress to hamstring the Drug Enforcement Administration. But the abuse goes far beyond that: The industry systematically manipulated the entire country for 25 years, and its executives are responsible for many of the 64,000 deaths of Americans last year from drugs — more than the number of Americans who died in the Vietnam and Iraq wars combined.

The opioid crisis unfolded because greedy people — Latin drug lords and American pharma executives alike — lost their humanity when they saw the astounding profits that could be made.

Today, 75 percent of people with opioid addictions began with prescription painkillers. The slide starts not on a street corner, but in a doctor’s office.

That’s because pharmaceutical companies in the 1990s sought to promote opioid painkillers as new blockbuster drugs. Company executives accused doctors of often undertreating pain (there was something to this, but pharma executives contrived to turn it into a crisis that they could monetize). The companies backed front organizations like the American Pain Foundation, which purported to speak on behalf of suffering patients.

The opioid promoters hailed opioids as “safe and effective,” and they particularly encouraged opioids for returning veterans — one reason so many veterans have suffered addictions.

Drug companies employed roughly the same strategy as street-corner pushers: Get somebody hooked and business will take care of itself. So last year, Americans received 236 million opioid prescriptions — that’s about one bottle for every adult.

[T]he Sackler family, owner of the company that makes OxyContin, joined Forbes’s list of richest American families in 2015, with $14 billion.

It’s maddening that the public narrative is still often about an opioid crisis fueled by the personal weakness and irresponsibility of users. No, it’s fueled primarily by the greed and irresponsibility of drug lords — including the kind who inhabit executive suites. The Washington Post quoted a former D.E.A. official as referring to pharmaceutical company representatives as “drug dealers in lab coats.”

Our pattern of opioid addiction points to a tragedy, driven by the greed of some of America’s leading companies and business executives, systematically manipulating doctors and patients and killing people on a scale that terrorists could never dream of.

There’s a lot of talk in the Trump administration about lifting regulations to free up the dynamism of corporations. Really? You want to see the consequences of unfettered pharma? Go visit a cemetery.