Drug giant Purdue Pharmaceuticals has agreed to pay $270 million to settle a lawsuit with the state of Oklahoma, which sued the opioid manufacturer, among others, for contributing to thousands of overdoses, deaths and a public health crisis.
The settlement, announced Tuesday, could symbolize a promising legal victory for several states that have filed their own lawsuits against opioid manufacturers and distributors. States including Massachusetts and Ohio are watching this and calculating how it might build a precedent for their own legal arguments.
A trial is still scheduled to begin May 28 for the other defendants named in Oklahoma’s lawsuit, including Johnson & Johnson and Teva Pharmaceuticals, a spokesman for state Attorney General Mike Hunter confirmed.
“This agreement is only the first step in our ultimate goal of ending this nightmarish epidemic,” Hunter said in a released statement. “In the coming weeks, the team and I will continue preparing for the trial 24/7, where we intend to hold the other defendants in this case accountable for their role in creating the worst public health crisis our state and nation has ever seen.”
As part of the settlement, Purdue Pharma announced it would help establish the National Center for Addiction Studies at Oklahoma State University to research and develop treatment and policy initiatives.
“Purdue has a long history of working to address the problem of prescription opioid abuse and diversion,” Craig Landau, CEO of Purdue Pharma, said in a released statement.
Johnson & Johnson and Teva Pharmaceuticals did not respond to the PBS NewsHour’s requests for comment about the lawsuit.
Nationwide, more than 700,000 people fatally overdosed on drugs between 1999 and 2017, according to federal data. In 2017 alone, more than 70,200 Americans died from drug overdose, and more than two-thirds of those deaths were linked to opioids, with a growing proportion of those deaths tied to heroin and fentanyl.
The White House estimated in 2017 that the economic toll of the opioid crisis amounted to $504 billion, or nearly 3 percent of GDP. Experts say more must be done to prevent opioid misuse, such as physicians reducing unnecessarily high dosages and long durations of opioid prescriptions, but also the government expanding access to treatment and making it more affordable.
Here’s what we know about whether Tuesday’s settlement could help the nation turn a corner on its struggle with opioids.
What does the lawsuit say?
In 2017, the State of Oklahoma filed a lawsuit against 13 major pharmaceutical entities for damages linked to the opioid crisis. In the original petition, the state said Purdue Pharma’s sales of Oxycontin alone rose from $48 million in 1996 to $3 billion by 2009.
“The State is entitled to recover Defendants’ ill-gotten gains,” the court document said.
For every 100 Oklahomans, an estimated 101.7 opioid prescriptions were written in 2015, according to the National Institute on Drug Abuse. That amounted to nearly 4 million prescriptions that year. In 2016, Oklahomans fatally overdosed on opioids at a rate of 11.6 deaths per 100,000 people — nationwide, that rate was roughly 13 deaths per 100,000 people.
“Oklahoma is one of the hardest hit states,” said Andrew Kolodny, who co-directs opioid policy research at the Heller School for Social Policy and Management at Brandeis University and served as an expert witness in Oklahoma’s lawsuit. “There has been a tremendous loss of life.”
These deadly consequences didn’t happen overnight. Drug companies’ pervasive marketing tactics influenced conversations not only between patients and doctors, but medical school students and instructors, said Adriane Fugh-Berman with the Department of Pharmacology and Physiology at Georgetown University Medical Center and a paid expert witness in Oklahoma’s lawsuit.
“After a while, industry-generated narrative becomes conventional wisdom,” Fugh-Berman said.
One tactic that opioid manufacturers used to protect sales was the rebranding of substance use disorder as pseudo addiction — that patients who took opioid medication and later developed symptoms of addiction should be treated with more opioids.
Fugh-Berman cautioned that while fewer doctors are writing opioid prescriptions than they had been in recent years, “it is nowhere near a reasonable level,” and that opioid marketing continues to lead doctors to guide patients toward the drugs.
How significant is this moment?
This lawsuit “is just the beginning,” said Kathleen Sebelius, who served as health secretary during the Obama administration and now co-chairs of the Aspen Health Strategy Group, which studied the opioid crisis so far and how to reduce overdoses and deaths. She said she “hasn’t seen anything quite like this since the tobacco litigation” of the 1990s.
With Oklahoma’s Purdue settlement in hand, Sebelius said other state attorneys general have a template to follow. They also have an empathetic public.
“Everyone knows somebody who has been impacted or affected by this crisis,” she said.
But not everyone is convinced this latest legal development will result in meaningful change.
It is unlikely these lawsuits will reduce harm, curb corporate misbehavior or improve public health, said Leo Beletsky, law and health professor at Northeastern University and University of California-San Diego, who also directs the Health in Justice Action Lab. He compared Purdue’s settlement to tobacco industry settlements from the 1990s, saying these agreements “are not structured to meaningfully improve access to treatment or take other measures to reduce overdose deaths.”
“The amount and structure of the settlement enables the state to do a victory lap, while allowing the pharmaceutical giant to walk away with a slap on the wrist,” Beletsky said.
What else does the nation need to reduce overdoses and deaths and expand treatment access?
One out of nine Americans with a substance-use disorder receive treatment, and that’s simply not good enough, said Beth Connolly, who directs Pew Charitable Trust’s Substance Use Prevention and Treatment Initiative and formerly served as commissioner for New Jersey’s Department of Human Services.
An increasing number of U.S. deaths is linked to opioids, despite efforts to ramp up public awareness and government intervention, the latest federal data suggests. Is the nation on track to reduce overdoses and deaths? “Not right now,” Connolly said in a written statement to the NewsHour.
In the short-term, she said the nation must expand access to naloxone, an antidote that reverses the effects of opioid overdose. Long-term recovery must be prioritized, and that means lowering stigma and quickly connecting people to treatment “through emergency departments, law enforcement, or any other avenue they may take.”
To make headway against the opioid epidemic, people need to understand “there are no silver bullets,” said Michael Botticelli, who directs the Grayken Center for Addiction at Boston Medical Center and formerly directed the White House Office of National Drug Control Policy under the Obama administration.
He echoed the call for better access to harm reduction tools, such as naloxone, and affordable medication-assisted treatment. The companies that Botticelli said “created this problem” can help do that.
“They made billions and billions in profit, often in the pain and suffering of many people and families and communities,” Botticelli said. “They have a responsibility to be legally and financially responsible for this epidemic.”