The Multnomah County Board of Commissioners Thursday declared the oversupply of prescription opioids a public nuisance, a vote that lays the groundwork for the county to file suit against companies and individuals it believes contribute to an epidemic of opioid addiction and overdose death.
"When people make and push a product that destroys people's lives, we need to hold them accountable," said Chair Deborah Kafoury.
County Attorney Jenny Madkour said she expects the county, in collaboration with Portland attorney Nick Kahl and Alabama-based Wiggins, Childs, Pantazis, Fisher & Goldfarb, to file suit as early as next week.
Commissioner Sharon Meieran, an emergency room physician, has led the charge.
“I am proud to be able to approach the epidemic on a macro scale, and with my colleagues take the first step at Multnomah County in holding those who caused the epidemic accountable,” Commissioner Meieran said.
Opioid abuse has exploded in the two decades since OxyContin, the nation’s best selling pain killer, came on the market. The rise in sales of the drug paralleled the rise in drug treatment admissions and overdose deaths, according to data from the National Vital Statistics System, Drug Enforcement Agency and Substance Abuse and Mental Health Services Administration.
From pill to needle
A former high school science teacher named Michael told the board Thursday that he got hooked on the OxyContin after doctors wrote him a prescription in the 1990s. Soon he was lifting pills from the school. After he was caught and fired, he lost his family, landed on the street and turned to heroin.
Tiffany, a mother of three, sent her kids to live with her parents while she battles addiction to opioids. What began as an addiction to prescription pills cost her up to $180 a day. That prompted her to turn to heroin, an addiction just one-tenth the cost.
Haven Wheelock, who manages the syringe exchange program for Outside In, described the ripple effect of the oversupply of legally prescribed opioid drugs. More than half of heroin users they interview say they transitioned from costly prescription pills.
Consider:
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Oregon doctors prescribe about 280 million opioid pills each year, enough to provide 73 pills to every resident, including more than 222,000 Oregonians under age 5.
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The oversupply of prescription pills has earned Oregon fourth place in the nation for prescription of long-lasting opioids such as OxyContin.
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Four out of five heroin users first abused prescription painkillers.
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224 Oregonians died of an opioid overdose in 2014, up nearly four times from a decade earlier.
The county has taken steps for years to prevent, reduce the harm of, and treat opioid addiction, sponsoring educational campaigns on safe prescription levels and alternative forms of pain management, supporting a robust needle-exchange program and supplying providers, families and addicts with the overdose-reversal drug Naloxone.
“But these efforts cost money, and this money drains precious resources from the county. Each dollar spent on opioid addiction is a dollar less spent on maternal child health, on school-based health centers, on homeless services,” Commissioner Meieran said. “There was a clear path by which large pharmaceutical companies, particularly Purdue Pharma, got us here. And it’s time to take action.”
A bill of goods
Until the 1980s, doctors rarely prescribed opioids to treat chronic pain, fearing the drugs too addictive for anything other than treatment for late-stage cancer. But in 1980, a doctor in Massachusetts published a one-paragraph letter to the editor in the New England Journal of Medicine, declaring the risk of addiction virtually nonexistent in hospitalized patients receiving opioids. Six years later another pair of doctors published a case report observing that 36 patients who received opioids did not become addicted. They concluded that opioids posed little risk of addiction for people without a history of drug abuse, and did not cause harm.
Those articles were widely cited in support of broader prescription of opioids, when, in 1996, Purdue Pharma introduced OxyContin. The company billed the opioid as a superior time-release pain medication with a less than 1 percent chance of addiction. and marketed the drug to doctors as a safe long-term option for people suffering non-cancer-related chronic pain. The company more than doubled its salesforce, promoted the drug with everything from fishing hats to plush toys, according to research published in the The American Journal of Public Health.
Use of OxyContin to treat non-cancer-related pain increased nearly tenfold in the following five years, boosting sales from $48 million to more than $1 billion and making it the most often-prescribed brand name opioid pain medication in the country, researchers found.
Then in 2007, Purdue and three executives pleaded guilty to misbranding the drug and defrauding physicians. It settled a civil suit filed by 26 states, including Oregon, for $600 million and agreed to take steps to control the off-label use of the drug.
But that didn’t stop the overuse or addiction of OxyContin. Nearly 15,000 Americans died from painkiller overdoses the next year, more than those caused by heroin and cocaine combined, and triple the number just a decade earlier. In 2012, the United States Senate Committee on Finance launched an investigation into Purdue and other opioid drug makers’ ties to medical groups and allegations of continued misbranding of the drugs. The findings were never made public.
Legal Challenges Mount
Meanwhile state and local governments sought to stem the epidemic through legal action. In 2014, Santa Clara and Orange counties in California filed suit against Purdue Pharma, Teva Pharmaceutical Industries, Janssen Pharmaceuticals, Endo Health Solutions, and Actavi, alleging false advertising in the marketing of narcotic pain medication to treat non-cancer chronic pain, and alleging the oversupply was creating a public nuisance. (The case is still pending, although one of the five defendants settled this year for $1.6 million).
Mississippi announced in 2015 that it would file a similar suit, just as the family behind Purdue Pharma for the first time made Forbes list of America’s richest families, with an estimated wealth of $14 billion made largely from its signature drug OxyContin, the magazine report.
In 2016, Suffolk County in New York filed a lawsuit of its own, and was subsequently joined by six other New York counties.
Lawsuits have since been piling up. The city of Everett, Washington filed suit against Purdue in January, alleging that, “Purdue collected, tracked, and monitored extensive data evidencing the illegal trafficking of OxyContin, including the dissemination of alarming quantities of pills.” But it “intentionally, recklessly, and/or negligently failed to disclose such data to enforcement authorities or stop the flow of OxyContin into the black market.”
Cabell County, West Virginia filed suit against wholesalers in March, alleging companies such as Walgreens and Rite Aid fueled a public nuisance of opioid addiction by allowing the distribution of suspicious quantities of pills. The Cherokee Nation filed suit against wholesalers in April.
The State of Ohio filed suit against Purdue and other makers of opioids in May alleging the companies overstated the benefits, understated the risks of addiction, and targeted vulnerable patients. Oklahoma and Missouri filed suits against the manufacturers in June. and St. Clair County, Illinois filed suit against the manufacturers earlier this month.
Multnomah County could join the ranks as early as next week.
“What we’re looking for is accountability from the corporate defendants, who are really profiteers without conscience, they have destroyed lives,” said James Rice, the county attorney who will lead the charge. “Make no mistake about it: this is David versus Goliath. We’re dealing with people on the other side who have tremendous resources. But it would be wrong to stand pat and do nothing.”
