Big Pharma's avoidable role in the man-made opioid epidemic

Big Pharma's avoidable role in the man-made opioid epidemic
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When the boss calls you into his office, it’s always a big deal. And so it was in the fall of 2001, when I was a 30-year-old assistant attorney general in the economic crime division. The boss — Attorney General Bob Butterworth — handed me a magazine article about people with sports and workplace injuries who became addicted to a new painkiller, OxyContin, manufactured by Purdue Pharma. Butterworth was concerned that Purdue Pharma was marketing OxyContin deceptively and too aggressively, leading to overprescribing, addiction and, in many cases, death.
 
Today, with numerous states and local jurisdictions suing Purdue Pharma and others in the pharmaceutical industry for their role in creating America’s opioid epidemic, it’s important to remember how we got here.
 
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OxyContin, which is essentially a higher dose of the powerful opioid oxycodone with a time-release coating, first hit the U.S. market in 1996. Just five years later, sales exceeded a billion dollars a year, as OxyContin became the most frequently prescribed brand-name narcotic in the United States for treating moderate to severe pain. 
 
 
Whether OxyContin was superior to its competition in pain relief was questionable. What was more certain was its unprecedented marketing campaign for a powerful schedule II narcotic.
 
Doctors were offered all-expenses-paid trips to pain management seminars at golfing resorts; a “speakers bureau” paid physicians to spread the word about the benefits of the drug; and swag such as OxyContin-branded stuffed animals, fishing hats, coffee mugs (with the slogan “The One to Start With”), Swiss Army knives and music CDs featuring a cover photo of two dancing seniors above the words, “Swing in the Right Direction with OxyContin.”
 
When Purdue Pharma in 2001 learned that we began investigating its marketing practices, the company hired a lobbyist who had run Butterworth’s successful campaign for attorney general and later served as his chief of staff. 
 
The Purdue Pharma lobbyist acknowledged the rising number of OxyContin addicts who overcame the time-release coating by crushing the pills or dissolving them in liquid, but denied the company’s responsibility. 
 
Known for his integrity and soft-spoken leadership, Butterworth insisted we press on with the investigation. In 2002, I was elected to the state Senate and left the attorney general’s office.  
 
Months later, a settlement was reached with Purdue Pharma that required the company to pay Florida millions to establish a much-needed Prescription Drug Monitoring Program (PDMP) to reduce “doctor shopping” and over-utilization of the drug by tracking the prescribing and dispensing of controlled substances. Among other things, the company also agreed to change its marketing practices and pulled its egregiously potent 160 mg pill from the U.S. market.
 
Unfortunately, most of the Purdue Pharma settlement money expired when the conservative Florida legislature repeatedly blocked implementation of the PDMP because of concerns over patient privacy and “big government.” The next decade saw Florida become the opioid supplier for the rest of the country, as caravans of addicts and aspiring pill peddlers flooded Florida’s booming, unregulated pain clinic industry. 
 
In 2007, Purdue Pharma and three executives pleaded guilty in federal court to misleading regulators, doctors and patients about OxyContin’s risk of addiction and its potential for abuse. The company agreed to pay $600 million in fines, and the executives agreed to pay $34.5 million and serve 400 hours of community service, although they were spared prison. 
 
Purdue Pharma’s scrutiny may have been greater had it not shelled out big bucks since 2002 to a familiar face: Rudy Giuliani. According to The New York Times, one of Giuliani’s missions “was the job of convincing public officials that they could trust Purdue because they could trust him."
 
In 2011, with more pain clinics than McDonalds in Florida, and with opioid overdoses causing seven deaths a day, newly elected Florida Attorney General Pam Bondi convinced a reluctant legislature to finally take action.  
 
With new laws, stronger enforcement and the long-overdue implementation of the PDMP, Florida would experience a sudden drop in opioid overdose deaths, only to see OxyContin and oxycodone replaced by deadly fentanyl-laced heroin as the drug of choice for addicts. Today, 14 people die each day in Florida from opioid overdoses. 
 
Having survived state investigations and federal prosecutions, Purdue Pharma and its cohorts may now be facing their toughest opponent of all: civil trial lawyers. 
 
Echoing the litigation that led to the $246 billion settlement with Big Tobacco in 1998, the plaintiffs have hired outside counsel on a contingency fee basis to seek billions to reimburse the public costs of addiction caused by the drug manufacturers and distributors. 
 
Hundreds of different lawsuits have been consolidated in federal court because they all share common allegations, such as whether opioid manufacturers overstated the benefits and downplayed the risks of the drugs, and whether drug distributors turned a blind eye to the suspiciously enormous orders of the drugs by providers.   
 
Drug companies are accustomed to winning lawsuits filed by families of overdose victims because the users are usually seen as responsible for their addiction.  This time, however, the plaintiffs are governments that can’t be blamed for misusing pills, yet still have suffered severe financial loss. 
 
When the definitive history of America’s opioid epidemic is written, it will be a tale of corporate malfeasance, professional greed, political apathy and regulatory failure. This crisis was both avoidable and preventable. It was purely man-made and years in the making. And now a federal court will decide whether this is when many of those responsible are forced to pay up. 
 
Dave Aronberg is the State Attorney for Palm Beach County, Fla.