Posted On: June 9, 2014 by Patrick A. Malone

Counties Sue Drug Companies for Increased Narcotic Abuse

Long ignored, the national problem of prescription narcotic drug overuse and abuse finally gained prominence last year. Now, an eye-opening lawsuit has been filed against pharmaceutical manufacturers by local government.

Last month, as reported by the Los Angeles Times, the California counties of Orange and Santa Clara sued Actavis, Endo Health Solutions Inc., Johnson & Johnson's Janssen Pharmaceuticals, Purdue Pharma and Teva Pharmaceutical Industries' Cephalon Inc. for causing the national prescription drug epidemic. The lawsuit accused these five global companies of a “campaign of deception” to boost sales of powerful painkillers, such as OxyContin.

We’ve blogged about efforts by the Centers for Disease Control and Prevention (CDC) and the FDA to enlighten people about the narcotic epidemic, and about databases such as ProPublica’s Prescriber Checkup, which tracks practitioners’ prescribing habits.

Painkillers, according to The Times, are involved in more than 16,000 U.S. deaths annually, more than the number of fatal traffic accidents.

This isn’t the first time a drug company has been charged with hiding the facts about dangerous drugs — in 2007 Purdue agreed to pay $635 million to settle criminal and civil charges by the federal government and several states because it knowingly minimized the risk of addiction in order to persuade doctors to prescribe OxyContin.

But the California counties also are accusing drug makers of violating state laws against false advertising, unfair business practices and creating a public nuisance. Both counties, one in the southern part of the state, the other in the north, have suffered high numbers of overdose deaths, emergency room visits and increasing medical costs related to prescription narcotics. The lawsuit says, essentially, “enough.”

As The Times said, the action harkens back to when tobacco companies were brought to account for their deceptive, dangerous promotional activities. The counties charge the drug companies with fattening their coffers by manipulating doctors into believing that the benefits of narcotic painkillers outweighed their risks, despite "a wealth of scientific evidence to the contrary."

They also charge that the companies encourage patients to request painkillers from their doctors to treat common conditions such as headaches, arthritis and back pain whose proper treatment generally is not strong narcotics, but other interventions, including less risky meds, such as ibuprofen, acetaminophen or aspirin.

The lawsuit says that the widespread prescribing of narcotics has created "a population of addicts," and has prompted a resurgence in the use of heroin because it produces a high similar to opiate-based painkillers, but it’s less expensive.

The suit’s charge of "deceptive marketing and conspiratorial behavior," refers to the use of leading physicians — known within the companies as "key opinion leaders" — to proselytize among their peers. Allegedly, the companies recruited and paid them to give speeches and write policy papers.

So we’re not ready to give prescribers a complete pass, but it is more difficult for them to ascertain the truth when some manufacturers have a reputation for influencing clinical trial studies and withholding information about a variety of drugs.

The suit also claims that drug makers used fake patient advocacy organizations to promote narcotic painkillers. It was their "marketing — and not any medical breakthrough — that rationalized prescribing opioids for chronic pain and opened the floodgates of opioid use and abuse," it says.

The lawsuit was filed on behalf of all of California, and seeks compensation for the damages allegedly caused by the drugs. It also wants a court order forcing the drug companies to forfeit revenue based on the contested marketing campaign.

Robert Fellmeth, an attorney, law school professor and former deputy district attorney who was an expert witness in the tobacco litigation, also helped write the unfair business practices law. He told The Times that the counties’ case is exactly what the statute was designed for.

"California is suffering disproportionately from this problem, so it is appropriate for this state to take up this hammer," he said.

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