On September 27, 2017 I presented before the Wyoming County Attorney’s Association on the opioid crisis and the impact same was having on Wyoming.  The opioid crisis is  the worst public health crisis of our generation; far outpacing smoking.

Since 2015 approximately 25 states, counties and municipalities have filed lawsuits against the Opioid manufacturers alleging deceptive and fraudulent advertising.

The marketing blitz has worked extremely well (for the pharma co’s) as the numbers reflect:  more than 140 people die every day from an opioid drug overdose.

Withdrawal symptoms have been described in the medical literature  as being far worse than often the underlying pain that was being treated in the first place.  Young people have posted online videos of the traumatic withdrawals they have gone through, and they are absolutely heart breaking.  (See video here).

Remarkably, my impression has been that most public officials at the local level do not appreciate the true impact this epidemic is having in our communities.

President Trump announced on August 10, 2017 that he would be declaring the opioid epidemic a National Emergency yet, to date, he still has yet to do so.

Moreover, just yesterday, the Washington Post and 60 Minutes reported that Todd Marino, nominated for the country’s “drug czar”, received enormous amounts of campaign money from the pharmaceutical industry and sponsored legislation that hindered the Drug Enforcement Agency from being able to adequately and aggressively go after the opioid manufacturers.  See more here.   (While writing this article, Marino withdrew himself from consideration for drug czar, no doubt in light of the Washington Post and 60 minutes piece).

What does all this mean?  That the fight against the opioid manufacturers must be brought by the public, through their AG’s, their county attorneys, city attorneys or private lawyers.

Litigation against the manufacturers will be, and has been, extremely expensive.  The issues are complex and all consuming for most private firms; much less for small county attorney offices.  But the private sector is prepared to help, and can do so by fronting costs and expenses to counties and municipalities and taking on the stress of the litigation.

Wyoming and Colorado has yet to have a single county or municipality join in the recovery. Having grown up in Colorado and now living in Wyoming, it was of particular interest to me to see which counties in each state were the hardest hit by the opioid crisis.

According to the NY Times, the following represents the hardest hit counties in Wyoming in descending order:

  1.  Fremont
  2. Uinta
  3. Carbon
  4. Natrona
  5. Niobrara
  6. Laramie
  7. Goshen

The hardest hit counties in Colorado in descending order:

  1. Las Animas
  2. Pueblo
  3. El Paso
  4. Mesa
  5. Crowley
  6. Bent
  7. Lincoln

Absent counties fending for themselves, the likelihood of any recovery at the county level is extremely small.  Counties should not pass up the opportunity to join forces with qualified litigation firms in an effort to replinish much needed resources to combat this epidemic.

At my firm, we have joined forces with other prominent firms across the country to take on the opioid manufacturers the way in which they deserve to be battled.

 

opiate abuse

In a startling new study by the Boston Medical Center that will surely help the numerous counties and states persecuting opioid manufactures and distributors for the nationwide addiction epidemic, it was shown that one in twelve doctors was paid personally by an opioid manufacturer in a effort to promote their products. [Read the full study HERE.]

Most payments mostly consisted of paying for a doctor’s meal (93% of cases) or speaking fee (63%), where they speak at a conference to talk about a drug. The study showed that even if a doctor was paid a small amount, it lead to a higher narcotic prescription rate. Opioid manufacturers paid 68,177 doctors in some capacity for a total of $46 million spent. 83% of the money was spent on only 700 doctors.

Furthermore, the states hit hardest by the crisis also were the state where the most payments were made. Ohio, Indiana, and Pennsylvania, and New Jersey, which are some of the states hit hardest by the crisis, all are some of the states where doctors have received the most money in an effort to promote opioid use.

Names of both the physicians themselves and the pharmaceutical companies were not used in the report’s findings.

The data collected is from August of 2013 to December of 2015.  A 2013 law required all pharmaceutical companies to disclose any money given to doctors for the purpose of marketing. Without this regulation, the analysis could not have been done.

Scott Hadland, the study’s author, states that opioids are unique in that “…they are one of the only medications in the U.S. in 2017 where there are active public health efforts to reduce the prescribing of.” The revelation that the smallest of these payments has such a large effect is particularly disturbing, Hadland additionally mentions.

Fentanyl is one such drug that was peddled by doctors to the public. Of the $46 million total, $21 million was used to push this narcotic onto doctors and, by extension, their patients. It is usually meant to treat pain in cancer and patients that are near death. However, due to its strength, it is a drug that causes a large amount of overdose deaths, especially when it is combined with heroin. Many addicts turn to heroin because it is stronger and cheaper than prescription painkillers.

While a causal link has been found, more research must be done to determine the true extent these payments had on the epidemic. Hopefully, this is done sooner than later; 2017 is likely to have a record number of overdoses.

opiate abuse

Experts are urging the president to declare a state of emergency due to the severity of the national opioid epidemic.

President Trump campaigned on a promise of stopping the nation-wide crisis, which killed 33,000 people in 2015 alone. More Americans are addicted to painkillers and heroin than tobacco, a truly startling statistic. As he said in his inaugural address: “ drugs (opioids) have stolen too many lives and robbed our country of so much unrealized potential”. The death toll is climbing. 142 people die from an opioid overdose everyday. Regardless of partisanship, Washington saw it was time to take action.

After Trump took office in January, he created the President’s Commission to Combat Drug Addiction and the Opioid Crisis. Chris Christie, the current governor of New Jersey and former Republican presidential candidate, is its leader. He believes that the issue is serious enough that the president should declare a state of emergency. Doing so would benefit legislative outlooks and raise public awareness of the crisis. Christie wants to “awaken every American to this simple fact: If this scourge has not found you or your family yet, without bold action by everyone, it soon will”. The commission aims to put pressure on Congress in an effort to refocus funding toward helping those affected by the epidemic. They suggest this effort should take shape in the following ways, among others:

  • Adding a breadth of drug rehabilitation options under Medicaid
  • Encouraging the creation of non-opioid pain medications
  • Increasing protection under “Good Samaritan” laws to protect those reporting overdoses and other opioid-related injuries

They also recommend the president could use the bully pulpit, a method used to capture the attention and communicate broadly with the people, to raise awareness and bring solutions to light.

Opioid addiction has been an increasing issue in United States since the mid-1990s. When pharmaceutical companies introduced slow-release, “addiction-proof” drugs, doctors started prescribing them at higher rates, as they were reluctant before to give painkillers to their patients after the morphine crisis several decades earlier. Clearly, the new opioids were not “addiction-proof”; if they are crushed, they give off an even stronger high. This discovery in conjunction with doctor shopping, fake prescriptions, and gross overprescribing has landed the country in the state it is in today.

Licit opioid abuse is a gateway to heroin abuse. Combining the two nearly always leads to an overdose.

Hopefully, President Trump will heed the warning from his commission and declare a state of emergency to combat the crisis at the national level.

For a more in-depth look, read the Washington Post article on the state of emergency HERE.

The US has been hit very hard by the recent opioid crisis. Deaths from opioid-related overdose have quadrupled since 2003, with 33,000 deaths in the nation last year alone. But nowhere in the US has been affected as drastically as Indian Country. To paint a picture, Native American high school students abuse OxyContin at twice the national average. The Cherokee Nation, which, is represented by 14 counties in northeastern Oklahoma, is taking a stand by filling a lawsuit against the US’s top pharmaceutical distributors, following in the footsteps of Ohio and Mississippi, among other states (read about it here). There have been 350 overdose-related deaths in these Oklahoma counties between 2003 and 2015. Cherokee officials knew it was time to take action.

The numbers regarding opioid prevalence in the Cherokee Nation speak for themselves:

  • 845,000,000 million milligrams worth of drugs were distributed to the 14 counties in 2015
  • This means that every opioid addict in the area had roughly 360 to 720 pills
  • 6 percent of American Indian 12th graders have tried heroin, twice the national average

Attorneys representing the Cherokee Nation hope that their lawsuit accomplishes two objectives. Number one, it will compensate those affected by the opioid crisis, as much as a lawsuit can. Financial penalties from these companies will go toward law enforcement costs and reimbursing the child welfare service, which has had to cope with the influx of addicted babies. The money currently being spent by the state could be going towards other families without these issues.

Secondly, the Cherokee Nation’s attorneys hope that the lawsuit will change the behavior of the pharmaceutical distributors named as defendants. These include:

  • Walmart
  • CVS Pharmacies
  • Walgreens

As well as the nation’s three largest distributors:

  • AmerisourceBergen
  • McKesson
  • Cardinal Health

Plaintiffs allege that the named defendants did not take the necessary steps to stop their drugs from getting into the hands of the black market. For example, they turned a blind eye to doctor shopping and filling multiple opioid prescriptions at once, both of which violate the Controlled Substances Act. Distributors should, under the act, file any suspicious activities, such as these, with the federal government. The Cherokee Nation’s attorneys state that the crisis boils down to the simple problem of market oversaturation. There are more drugs, ones that should be rare and difficult to get in the first place, in the market than there should be. They have ignored known issues in their supply chain to get to this point.

Defendants, however, contest that they have done nothing wrong. As Courtney Tobin, a spokesperson for Cardinal Health, puts it:

Cardinal Health is confident that the facts and the law are on our side, and we intend to vigorously defend ourselves,” Tobin wrote. “We believe these lawsuits do not advance the hard work needed to solve the opioid abuse crisis – an epidemic driven by addiction, demand and the diversion of medications for illegitimate use.

All of the defendants who could be reached for comment by The Rolling Stone felt similarly about the case.

The suit was filed in tribal court on April 20th, 2017. While the defense will likely ask the judge to move jurisdiction to a federal court, a tribal court will allow plaintiffs to get access to corporate records sooner.

Like the rest of the country, Wyoming’s Indian population has been hit hard by the opioid epidemic. State officials are sensitive to the issue and have been working to address it. For example, in Fremont County, drop boxes for unneeded drugs can now be found at clinics and city halls. These have been added to combat the spike in opioid overdoses over the last several years and decades.

Fremont County has a large Native American population at 20% and is home to the Wind River Reservation. Learn move about the drop boxes and other initiatives [HERE].

Regardless of the trials outcome, we at the Ochs Law Firm hope for relief and will join the fight for all of those affected by the epidemic in the Cherokee Nation and Wyoming.