After a year of drug document subpoenas, interviews, and fact finding,
the City of Chicago filed a lawsuit Monday against five pharmaceutical companies alleging that they deceptively
marketed opioid painkillers like Percocet and OxyContin for chronic pain
management, even though the companies knew the drugs were ineffective at
treating chronic pain and carried a high risk of addiction.
The deceptive marketing practices have
caused health problems in Chicago, the city alleged in a release, stating that opioid misuse resulted in 1,080 emergency
room visits in Chicago in 2009. The city seeks to end deceptive marketing
practices and seeks punitive damages. The city claims that
the City’s Health Insurance plan “has reimbursed claims for approximately $9.5
million on these drugs since 2008.”
Chicago’s lawsuit has implications far
beyond the city limits. If the allegations are true, they get at one root cause
of the growing rates of addiction and death from opioid painkillers and heroin
in the United States. Drug overdose deaths, the majority of which are caused by
prescription painkillers, have more tripled since 1990, according to the CDC, and in 2010, prescription opioid painkillers caused
16,651 overdose deaths in the U.S.
In the 122-page complaint filed in Cook County Circuit
Court on Monday, the City of Chicago argues that the shift in medical use of
opioid painkillers was the direct result of deliberately misleading marketing
from pharmaceutical companies. (Earlier this month, two counties in California filed a similar suit.) According to the complaint, “in 2010, 254 million
prescriptions for opioids were filled in the U.S.” (By comparison, in 2009,
there were 44 million prescriptions filled for the anti-depressant, Xanax.) It also reports that
“20 percent of doctors visits resulted in the prescription of an opioid.”
According to the press release, this accounted for a quadrupling of sales for
these drugs from 1999 to 2010.
The complaint argues that the five companies named in
the suit—Purdue Pharma L.P., Cephalon, Inc., Janssen Pharmaceuticals, Inc.,
Endo Health Solutions Inc. and Actavis plc—led to a huge market ($8 billion in
revenues in 2010) for these drugs by telling doctors (incorrectly) that they
were effective for chronic pain management, which now accounts for roughly 87%
of the opioid prescriptions given out in this country.
“They knew—and had known for years—that
opioids were too addictive and too debilitating for long-term use for chronic
non-cancer pain,” the complaint reads. “In order to expand the market for
opioids and realize blockbuster profits, Defendants needed to create a
sea-change in medical and public perception that would permit the use of
opioids for long periods of time to treat more common aches and pains, like
lower back pain, arthritis, and headaches.”
Purdue Pharma declined to comment. Teva, which owns
Cephalon, Janssen, Endo, and Actavis could not be immediately reached for
comment.
How did we get here? The recreational use of opioid
painkillers began with a sea-change in the way doctors prescribed prescription
painkillers, experts say. According to the CDC, there has been a tenfold
increase in medical use of opioid painkillers for the treatment of pain since
1990.
This began, says Dr Jason Jerry, a psychiatrist and
addiction expert at the Cleveland Clinic, with a cultural shift in the 1990’s
in the medical community’s attitude toward pain and pain medication. Prior to
that point, he says, most doctors wouldn’t have considered using prescription
painkillers for problems like low back pain. “They were for end-stage cancer
pain or patients who had recently undergone surgery,” he says, adding, “the
marketing practices in the pharmaceutical industry shifted the culture of
medicine to the point that there was a fifth vital sign in medicine: pain.”
The rise in use of prescription painkillers has also
led to a resurgence in heroin use. A recent analysis from JAMA Psychiatry showed that prescription drug abuse has become a
gateway for heroin use. In the 1960s, 80% of heroin users (who were mostly
young city dwellers) initiated heroin first, but in recent years, as users have
become older and more suburban; 75% of heroin users started using heroin after
getting into opioid painkillers first.
Chicago’s lawsuit, if it succeeds, may mark a turning
point in the epidemic of opioid abuse.
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