Nicole Saphier, MD: Oklahoma opioid verdict – A physician's take on judge's $572 million decision
{{#rendered}} {{/rendered}}The ruling by Cleveland County District Judge Thad Balkman marks the first in the realm of a pharmaceutical company’s maleficence and its contributing role in our national opioid epidemic.
Other companies such as Purdue Pharma and Treva Pharmaceuticals were originally named in the Oklahoma lawsuit. However, they settled out of court and thus avoided the bench trial for $270 million and $85 million respectively.
OKLAHOMA JUDGE RULES AGAINST JOHNSON & JOHNSON, ORDERS $572M PAYMENT
{{#rendered}} {{/rendered}}Although the judgment may have been higher for Johnson & Johnson had it settled out of court or opted for a jury trial rather than a bench trial, $572 million is still a hefty fine for a company with less than a 1 percent share of the opioid market.
“The defendants engaged in false and misleading marketing of both their drugs and opioids generally, and the law makes clear that such conduct is more than enough to serve as the act or omission necessary to establish the first element of Oklahoma's public nuisance law,” Balkman wrote in his ruling.
Johnson & Johnson has already declared that it will appeal Balkman’s decision. The company claims that the state failed to present evidence that the company’s products or actions caused a public nuisance.
{{#rendered}} {{/rendered}}“This judgment is a misapplication of public nuisance law that has already been rejected by judges in other states,” said Michael Ullmann, executive vice president and general counsel for Johnson & Johnson.
The ruling is unique because the district attorney sued on behalf of the community at large as an abatement plan to reverse the effects of downplaying the significance of opioids.
The verdict in this case will likely set precedent for thousands of pending lawsuits in various districts throughout the country.
{{#rendered}} {{/rendered}}However, I question if the judgment against Johnson & Johnson for a “public nuisance” is an outlandish stretch of a criminal charge. Historically “public nuisance” crimes have been used to settle property disputes and various other civil complaints.
I will let the legal authorities sort through the minutia of whether this constitutes the crime in the appeals process. But as a medical doctor I have my own concerns regarding the emerging lawsuits.
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If we look back to the way this crisis began, it started with a combination of deceptive pharmaceutical marketing schemes and limited government oversight. This was all happening while the government was pushing for patient satisfaction as a metric in medical care.
{{#rendered}} {{/rendered}}Is it at all a surprise that the distribution of opioids spiraled out of control? Suddenly, our campaign for better pain control morphed into a war on drugs.
Fast forward to today. I am wary about what’s happening on the legal front. I wonder whether these lawsuits represent a government money-grab utilizing pharmaceutical companies as a scapegoat for the crisis we are in.
And I wonder if those suffering from the devastation of addiction will even have any financial compensation when this is all over. Will they have the resources they need to afford the hefty price tag that comes with a lifetime of addiction treatment?
{{#rendered}} {{/rendered}}The medical profession has come together as the epidemic has grown to swiftly insist on opioid prescription limits, narrow usage recommendations, education programs and centralized opioid registries. All these things restrict the role physicians once played in misappropriation of opioids.
The Centers for Disease Control and Prevention recently announced that opioid overdose deaths appear to have declined last year for the first time in nearly three decades, with nearly 68,000 reported deaths in 2018 compared with more than 70,000 in 2017.
This modest improvement was driven by a reduction of deaths from prescription painkillers and was likely a result of the tactics used to rein in misuse of legal forms of opioids. But deaths that involve fentanyl, a much more powerful opioid found in street drugs and shipped into the U.S. from China or smuggled from Mexico, are still rising.
{{#rendered}} {{/rendered}}What do these lawsuits against the pharmaceutical companies do for the more than 11 million Americans already addicted to opioids?
Combatting opioid addiction is complex and will require tight border security to stop the importation of illegal opioids, along with large sums of money to treat those already addicted.
The nearly $1 billion Oklahoma would collect from the three companies if Monday’s ruling is upheld on appeal is roughly what it would cost the state to provide care to people in the state impacted by the opioid crisis for just over one year, assuming 100 percent of the money is used for addiction treatment.
{{#rendered}} {{/rendered}}As a physician, I want to know what becomes of those people after the proverbial well runs dry and they are still in need of care.
An addict is an addict for life. Although these patients may no longer have a physical dependence on opioids after one year of treatment, they will require lifelong monitoring and therapy to ensure success.
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{{#rendered}} {{/rendered}}The filing of lawsuits holding manufacturers accountable for irresponsible use of a product is a sticky battle and has fallen by the wayside regarding gun manufacturers and their role in gun-related violence.
However, as happened in the past with tobacco, opioids were being distributed inappropriately with misleading marketing tactics based on faulty research, yet under the large umbrella of legality.
The Oklahoma trial marks the first of what could be thousands of lawsuits against opioid drug companies and their distributors – including doctors and pharmacists.
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Monday’s judgment is a glimpse of more to come as our nation continues to face an opioid crisis that has not only claimed more than 400,000 American lives but has also cost the U.S. over $1 trillion since 2001 and may cost another $500 billion or more over the next few years.
Perhaps it would behoove us all to refocus from the minutia of the individual lawsuits and instead form a plan, collectively with pharmaceutical companies, to ensure that as a nation we are combating the opioid epidemic – not in a piecemeal fashion, but together.
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