As opioid drug-case settlement advances, fentanyl deaths spike in D.C. area

fentanylillustration-300x99Just as attorneys generals for more than a dozen states inch toward a multibillion-dollar settlement with a drug maker faulted for its big role in the start of the opioid abuse and drug overdose crisis, that health menace is taking a new, deadly turn in the region around the nation’s capital.

In Washington, D.C., Maryland, and Virginia, officials report they are grappling with spiking overdose deaths, numbering in the hundreds, and blamed on the rise of fentanyl. It is a synthetic, prescription painkiller developed to assist late-stage cancer patients. It packs a wallop. And Big Pharma companies pushed for its wider use with aggressive marketing and sales campaign that landed some drug executives in jail.

The excessive promotion of fentanyl also led to its illegal manufacture, notably in chemical factories in China. Its increasing abuse, along with other opioids, also opened the door to big problems with illicit drugs.

Experts have warned for some time about the dangers posed by fentanyl. Those who use drugs may be tempted to mix it with other substances. But the painkiller is so powerful in even tiny amounts that dosage is difficult for trained health personnel to deal with, much less for it to be close to safe in street dealing. As the Washington Post reported:

“In the District [of Columbia], the city’s medical examiner identified fentanyl in 95% of the 87 overdose deaths through March this year, a number that has risen steadily in recent years; 281 overdose deaths in 2019 and 411 in 2020. Black residents, who make up 46% of the city according to census data, have been disproportionately affected. More than four out of five people who die of overdoses in the city are black, according to data from city officials. The Arlington County Sheriff’s Office tweeted recently that the trend has worsened in the past two weeks because of a reportedly bad batch of fentanyl that has led to at least 15 fatal overdoses in the region, including six in Arlington alone. Alexandria has already recorded 59 fatal and nonfatal overdoses through June 30, which is on pace to break last year’s high of 104.

“Emily Bentley, Alexandria’s opioid response coordinator, attributes the recent spike to dealers lacing substances with the cheaper, more addictive fentanyl. She noted that unsuspecting marijuana users may be taking drugs laced with the synthetic opioid, broadening the types of drug users who could be impacted. ‘We need to reach an audience we’ve never targeted before,’ she said. Police reports in Montgomery County, Maryland’s largest county, show that fatal opioid overdoses are up 33%, and nonfatal overdoses are up 57% this year as of the end of June, compared with the same period in 2020. Montgomery County Assistant Chief of Police Dinesh Patil said that 98% of the county’s fatal overdoses involve fentanyl. ‘It’s Russian roulette,’ Patil said. ‘This is not experimental. This is life and death.’”

Taking precautions

Officials throughout the region have stepped up their outreach, including in known abuse areas, to warn users of all kinds of illicit substances about their serious risk with fentanyl, the newspaper reported. In some areas, they are giving out fentanyl test strips. They also are trying to increase the distribution to potentially affected users supplies of naloxone, the drug known by its brand name Narcan. It treats overdoses and can prevent fatalities.

Federal experts estimate that the opioid crisis, in a disastrous decade that saw it become a leading public health nightmare, killed roughly 500,000 Americans. It has caused major disruption in communities across the country, with prescription painkillers, their synthetic versions, and illicit drugs addicting and debilitating countless numbers of people and causing more than $1 trillion in estimated economic damage.

Doctors, nurses, hospitals, Big Pharma, insurers and many others in U.S. health care share responsibility for fostering the deadly abuse of these potent drugs, over which thousands of state, county, and other local governments, as well as Indian tribes, have sued the nation’s big-name drug makers, asserting they are responsible for the opioid mess. The cases were consolidated in the hands of a federal judge in Cleveland, who has sought, as occurred with Big Tobacco lawsuits decades ago, to strike a “global” settlement.

A bankruptcy deal gathers support

The efforts to strike such an accord have taken their own legal twist, as Purdue Pharmaceutical, the firm founded and run by the plutocratic Sackler clan, sidestepped the federal court, and sought its own deal in a federal bankruptcy action. This move has infuriated the governmental claimants, dividing them as to whether Purdue and the Sacklers will evade justice and pay less in bankruptcy.

Complex litigation is never easy to keep along a smooth legal path in the best circumstances. But Purdue’s divisive legal strategy has riven plaintiffs, particularly along partisan lines, with Democratic attorneys general from blue states opposing a proposed Sackler settlement and GOP officials supporting it. Now, as the New York Times and other media organizations have reported of the legal bickering over terms:

“Fifteen states have reached an agreement with Purdue Pharma, the maker of the prescription painkiller OxyContin, that would pave the way toward a settlement of at least $4.5 billion and resolve thousands of opioid cases. The states decided … to drop their opposition to Purdue’s bankruptcy reorganization plan, in exchange for a release of millions of documents and an additional $50 million from members of the Sackler family, the company’s owners. The agreement was contained in a late-night filing by a mediator in U.S. Bankruptcy Court in White Plains, N.Y. The settlement extracts concessions that will be added to a comprehensive proposal now being voted on by more than 3,000 plaintiffs, including cities, counties, tribes and states, who sought to hold Purdue and its owners responsible for their role in the opioid epidemic …

“Nearly two years ago, the Sacklers proposed paying $3 billion in cash to settle rapidly increasing litigation. Both the company and family members had resisted releasing the full trove of documents, including hundreds of thousands of work emails and communications with lawyers, reaching back 20 years. According to [the new and latest court] filing, Purdue and the Sacklers will now release some 33 million documents. The Sacklers’ contribution to a deal has risen to $4.5 billion, plus an additional $225 million in a civil settlement with the federal Department of Justice, for which they admit no wrongdoing. Purdue Pharma will distribute $500 million as soon as the company emerges from bankruptcy.”

Thousands of creditors still must vote to approve the Sackler settlement. But it is gaining support from lawyers and politicians involved in the case against the family and their company, because governments say they sorely need sums to deal with the opioid crisis. It has worsened during the coronavirus pandemic, as too many of the isolated, lonely, and unemployed have abused opioids and have been cut off from personal support networks, professional mental health care, and drug treatment, especially getting naxolone to avert fatal overdoses.

In my practice, I see not only the harms that patients suffer while seeking medical services, but also the damage that can be inflicted on them by dangerous drugs, notably Big Pharma’s prescription products.

The Washington Post report on increasing overdose deaths involving fentanyl focuses in part on youthful drug users. They start by believing their youth makes them indestructible. They tell grownups in their lives that they are street savvy and have acquired magically protective wisdom about illicit drugs. They are, after all, mostly just using marijuana and little more. Alas, criminals who peddle grass seek to differentiate themselves by selling marijuana they say is more intoxicating — because it has been laced with tiny but fatal amounts of fentanyl.

We have much work to do, not only to bring to justice — yes, including in the civil justice system through lawsuits — those who need to be held accountable for fostering the opioid abuse and drug overdose crisis. We also need to jump on this health threat and smash it down. We cannot stand by as more loved ones, friends, colleagues, and acquaintances are addicted, debilitated, and dying due to opioids and illicit street drugs.

Illustration credit: fentanyl overdose warning from the Imperial Calcasieu Human Services Authority of Louisiana.
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