Over the past 20 years, nearly 500,000 American lives have been lost to the Opioid Epidemic due to prescription painkillers such as Oxycontin and other illicit substances sold on the street. As recently as Monday, April 11, 2022, the popular pharmacy chain Walgreens is being prosecuted by the state of Florida for the “fraud and addiction that the company should have noticed and acted upon.”

Florida’s prosecutor Jim Webster says the company of roughly 9,000 storefronts, 820 of which located in Florida, was knowingly dispensing medications that were actively killing people. Records show that from May of 2006 to June of 2021 in Florida alone, Walgreens distributed approximately 4.3 billion Opioid pills. Between the years 1999-2020, more than 39,000 Florida residents died from Opioid use. According to Webster, 1 in 4 of these cases was traced to Walgreens’ sale and suspicious circumstances: fake prescriptions, questionable physicians, and unnecessary amounts of pills for any singular patient.

Walgreens’ attorney, Steve Derringer, claims that the real issue lies with the pharmaceutical companies not being entirely forthright and truthful about the addictiveness of Opioids, not that of the individual pharmacy chains like Walgreens.

Walgreens Is The Last To Budge

This is hardly the first lawsuit regarding Opioids and the pharmacies responsible for distributing them in Florida. So far, the state has reached nearly $878 million dollars in settlements: CVS Health Corp agreed to pay the highest so far at $484 million, with Teva Pharmaceuticals Industries Ltd next at $195 million, and Allergan PLC paying upwards of $134 million. This case follows that of the nationwide deal where Purdue Pharma’s owners, the Sackler family, agreed to pay $6 billion in settlements. Considering the estimated total cost of both civil and criminal penalties tied to OxyContin’s parent company since 2007 is roughly $45 billion, the contributions from the family responsible hardly makes a dent in the national deficit. Florida alone has spent nearly $14 billion over the last two decades in various Opioid-related costs, from criminal justice and drug rehabilitation reform to saving infants born with an Opioid addiction.

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Taking place in New Port Richey, Florida, just north of Tampa, the trial is slated to last anywhere from 3-8 weeks. Walgreens, the largest pharmacy chain in the country, is the last stake in this multi-pronged Opioid prosecution campaign. In the opening statement on Monday, Florida’s Attorney General, Ashley Moody said her department wants the store chain to be held responsible “for its role in helping create and fuel the deadly Opioid crisis devastating Florida families and draining taxpayer-funded resources.”

Following the relative success of the settlements with other big pharmacy brands, Webster, in his opening remarks claims:

Walgreens was the last line of defense in improperly distributing Opioids. The evidence will show that millions of times, Walgreens ignored its duty to investigate suspicious prescriptions. Instead, it filled them as quickly as possible.

Who Is Really Responsible?

Due to the number of players and stakeholders and general scope of the Opioid Epidemic, it is tough to determine who and what deserves the largest number of pointed fingers. Many families who have lost loved ones to the addictive power of prescription painkillers blame the Sackler family and their intentional negligence to inform physicians and pharmacies of the inherent danger in medications such as OxyContin. Others point to the drug counters across the country and wonder why no one questioned the increasing amount of Opioid prescriptions running through their systems while still others don’t understand how doctors could be so obtrusively unaware of the devastating side effects.

Regardless of the outcome, the issue proceeds. The scariest part of the Opioid crisis is the fact that an addiction can start from a prescribed medication if the individual is not cautious and aware. If you or someone you love is struggling with an addiction to painkillers, or any other substance, remember you are not alone and there are resources to help you.

As for the judicial trials, only time will tell.

The post Florida Vs Pharmacies: Fueling The Opioid Crisis? appeared first on Addiction Center.

Johnson & Johnson, alongside 3 major pharmaceutical distributors, have agreed to pay nearly $26 billion to settle thousands of Opioid-related lawsuits on Friday. These lawsuits claimed that their business practices helped fuel and maintain the deadly Opioid epidemic that has claimed over 500,000 American lives since 1999. Of the $26 billion in payouts, Johnson & Johnson agreed to pay $5 billion, and AmerisourceBergen, Cardinal Health, and McKesson will pay $6.1 billion, $6 billion, and $7.4 billion, respectively.

Forty-six states and nearly 90% of eligible local governments signed onto the deal, which the drug wholesalers agreed was enough to move forward with a “comprehensive agreement to settle the vast majority of the Opioid lawsuits,” according to their joint statement. By signing the deal, these localities and states have agreed to drop any present Opioid lawsuits against the companies and not pursue any future action against them. During the settlement, none of the companies acknowledged any wrongdoing for manufacturing and distributing large quantities of prescription medication and continue to deny attributing to the Opioid crisis with their aggressive drug marketing throughout the years.

What The Settlement Will Fund

Of the $26 billion, 85% of the payments will go to addiction prevention, treatment, and health care services. These payments will provide thousands of communities across the US with nearly $20 billion over the next 18 years. Examples of what communities can use this money for include creating public education programs, increasing the number of drug counselors and social workers in municipal courts, and paying for addiction treatment medicine used in correctional facilities.

There will be people alive next year because of the programs and services we will be able to fund because of these settlement proceeds.

Currently, there are no separate funds from the settlement dedicated to compensating the individual victims of the Opioid crisis. The hope is that these payments will help rebuild communities devastated by the Opioid crisis and prevent them from being flooded with high-risk medication in the future through newly-funded monitoring systems. The money is issued to start reaching communities in early April and will continue flowing for the next two decades.

Opioids In America

This settlement comes at a troubling point of the Opioid crisis as many who have developed an Opioid use disorder have switched to using Fentanyl, a synthetic Opioid 50 times stronger than Heroin. According to the Centers for Disease Control and Prevention (CDC), nearly 100,000 lives are lost a year to drug overdoses. The Opioid epidemic is not a new phenomenon by any means, and over the past 2 years, the number of annual overdose deaths have spiked by 50%. The introduction of Fentanyl into the illegal drug market, individuals turning to drugs during the pandemic, and a number of treatment facilities shutting their doors contributed to this spike in overdose deaths.

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Many have accused pharmaceutical companies of creating and maintaining America’s Opioid crisis. Looking to expand the use of prescription Painkillers beyond malignant pain, many pharmaceutical companies marketed Opioids as less addictive or non-addictive in comparison to Morphine and with no dangerous side effects. Doctors, convinced of these claims, began prescribing these drugs and saw no repercussions to patients taking them. This growth in the prescribing of Opioids directly pushed the distribution of Opioids to elevated levels today.

Johnson & Johnson’s History With Opioids

The CDC describes 3 waves of the Opioid epidemic, with the first wave beginning in the 1990s as the rate of prescribing Opioids increased exponentially. In 1994, the Johnson & Johnson company created a strain of poppy to be used to manufacture and distribute large amounts of Opioids. The company made this specific strain in anticipation of future demand for Oxycodone which led to its future partnership with Purdue Pharma as their supplier. Johnson & Johnson additionally supplied 60% of all active ingredients for Opioids manufactured and sold in the US for years to come.

For over a decade, Johnson & Johnson ran marketing campaigns that assured all Opioids as safe for everyday pain. Since the company was the largest supplier of Opioid active ingredients, boosting the Opioid market positively impacted business. In 2001, the company continued to market the drugs as having a low risk of abuse and misuse, even after its medical advisory team and the FDA warned against it.

Johnson & Johnson has since stopped selling Opioids and has agreed not to resume. In contrast, the other 3 distribution companies have agreed to provide data to a clearinghouse, or middleman, to track when prescription drugs enter the black market.

What Lawsuits Brought To The Surface

While the 4 companies claim no wrongdoing in their settlement, surrounding lawsuits brought some troubling practices and actions to the public’s attention. One case revealed that drug wholesalers continued to distribute vast amounts of prescription pills to small, rural communities despite the heavy indication that the drugs, like OxyContin, were dispersed and sold across the black market. The amount of prescription medicine flooding these communities was often disproportionate to the local population.

In a separate lawsuit, an email shared between AmerisourceBergen executives revealed the use of language like “pillbillies” and “hillbilly Heroin” to describe those addicted to Opioids and to refer to OxyContin. These lawsuits, and subsequent lawsuits, highlight the questionable actions of these companies at the height of the crisis.

While the $26 billion settlement serves as a much-needed financial boost for communities to fund addiction prevention and treatment services, the damage done by Opioids throughout the nation will take years to mitigate. Opioid-related lawsuits focused on pharmacy chains that sold egregious amounts of prescription pills directly to consumers continue in other state and federal courts.

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This week, the Centers for Disease Control and Prevention (CDC) presented a set of recommendations for Opioid prescriptions. These new guidelines are the first revisions made to the organization’s 2016 suggestions which stopped many with chronic pain from getting the relief they needed. 

The Opioid Epidemic And The CDC

For over 3 decades, the US has been experiencing a serious public health crisis known as the Opioid epidemic. In the 1990s, pharmaceutical companies, insurers, and pain specialists endorsed Opioid pain relievers as being less addictive and safe to use for common ailments. The marketing of drugs like OxyContin led to an increase in prescriptions being written for issues like backaches and arthritis. 

As a result, US overdose deaths rose drastically. From 1999 to 2017, Opioid-related overdose deaths increased almost sixfold. While local and federal governments attempted to restrict prescriptions, the crisis continued. Those who had already become addicted to Opioids turned to Heroin or Fentanyl when they couldn’t get a prescription. In fact, studies have shown that 80% of people who have used Heroin first used prescription Opioids. 

The CDC released a set of guidelines in 2016 aimed at decreasing the number of Opioids being prescribed. The organization urged physicians to explore other treatment options before turning to Opioids. Other medications and non-drug therapies were recommended as alternatives. If doctors chose to prescribe painkillers for acute pain, the CDC proposed a 3-day limit for prescriptions and that doctors prescribe the lowest possible effective dose. These guidelines also applied to treating chronic pain. Despite being voluntary, doctors and local governments implemented these recommendations. 

An Unintended Consequence

Although these guidelines ultimately contributed to a decrease in Opioid prescriptions being written, they were largely opposed due to their effect on a specific group. Many doctors across the US feared there would be criminal or civil consequences if they did not follow them. Doctors became very hesitant to prescribe Opioids and quickly tapered patients off of their prescriptions. This greatly affected many chronic pain patients who rely on doses higher than the 90 milligram ceiling of Morphine listed in the 2016 guidelines. 

Studies have shown that rapid tapering patients off of Opioids can lead to harmful outcomes. One particular study of 100,00 chronic pain patients found there was 68% increase in overdose deaths for patients experiencing tapering compared to those who were not. For the tapered group, there was also a spike in mental health conditions. Chronic pain patients were also more likely to turn to substances like Heroin and Fentanyl to self-medicate their pain after being tapered off their medications. Suicide can also be an outcome of tapering. It has been reported that up to 30% of Opioid overdoses could be suicides. 

The rigid interpretation of the CDC’s 2016 guidelines also affected those who were struggling with a substance use disorder (SUD). Many doctors developed a one strike policy. This meant that if a patient tested positive for an illicit substance, they were not given further treatment. 

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CDC Proposes New Guidelines

Several organizations spoke out against the original 2016 guidelines. In 2019, the US Food and Drug Administration issued a warning about the dangers that can come from suddenly tapering patients off of Opioids. The American Medical Association recommended that doctors immediately suspend the CDC’s guidelines in 2020. In response, the CDC acknowledged that their suggestions had been misinterpreted and misused. Concerned about the reports of people with chronic pain being denied relief, the CDC began to work on revisions to their 2016 guidelines. This time, their recommendations were drafted with no input from drugmakers. 

The new guidelines, released on Thursday, are aimed at balancing the necessary use of Opioids for severe pain and protecting other patients against harmful risks. The 12 recommendations proposed in the 229 page document changes the “one-size fits all approach” to Opioid prescriptions. Doctors are being urged to look at each patient’s situation and assess the risk and benefits prescribing Opioids. Overall, the CDC still believes that non-Opioid therapies should be attempted before prescribing Opioids for pain. At the same time, they removed the 90 milligram ceiling of morphine for chronic pain patients and the 3 day limit for acute pain. 

While the document warns of addiction, depressed breathing, and effects to mental status, they have noted that they serve a very important medical purpose. Relieving pain from traumatic injuries, such as burns and crushed bones, were listed. In these cases, it is recommended that immediate release pills be used rather than long-acting. The CDC also stated that these guidelines do not apply to those with cancer, sickle cell, and end of life or palliative care. 

The CDC also noted that patients who come in and test positive for illicit substances could have untreated pain or a substance use disorder. The new guidelines recommend that doctors offer treatment, counseling, and careful tapering when necessary. In doing so, they can assist patients in improving their quality of life. 

These recommendations are currently available on the Federal register. For 60 days, the public can make comments on the proposed guidelines. The CDC will then review these comments and will likely release a final issue by the end of the year. 

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On Thursday, a federal judge overturned a nearly $4.5 billion bankruptcy settlement that granted immunity to the Sackler family from civil lawsuits linked to their company Purdue Pharmaceuticals, the manufacturer of OxyContin. According to NPR, the settlement also included hundreds of individuals, companies, and other organizations vying for a “clean legal slate.” The judge, Colleen McMahon of the US District Court for the Southern District of New York, stated in a written opinion on Thursday that the New York bankruptcy court that approved the settlement back in September did not have the authority to shield the Sackler family from future Opioid-related lawsuits.

The settlement was first approved by Judge Robert Drain of the US Bankruptcy Court in White Plains, New York. It settled that the owners of Purdue Pharma, members of the Sackler family, would renounce their ownership of the company and must pay back billions of their fortune to address the deadly Opioid epidemic. In addition, the Purdue company would be dissolved and re-emerge as Knoa Pharma which would still produce OxyContin and other drugs. By doing so, however, the family and related parties would be absolved from any liability related to the Purdue company.

What Are Opioids?

Opioids are a class of drugs that are derived from or mimic Opium, which is a chemical that occurs naturally in poppy seeds and plants. Opioids activate receptors in the brain and depress the central nervous system. When these receptors are activated, they release “feel-good” chemicals known as endorphins. Due to their intensely calming effects, Opioids have tremendously high rates of abuse which, in many cases, leads to dependence or addiction. This class of drugs includes the illicit drug Heroin, synthetic Opioids such as Fentanyl, and pain relievers available legally through physicians, such as Oxycodone or OxyContin, Codeine, Morphine, and many others.

Prescription Opioids, when used appropriately under a health care provider’s direction, can provide effective pain relief for mild to chronic health conditions. However, just because an Opioid is prescribed by a doctor, that doesn’t mean that the rate of addiction is any lower. Between the high rates of prescription and the addictive qualities of the drug, Opioids have gripped the nation in a deadly health crisis.

Purdue Pharma’s Involvement With The Opioid Crisis

The Sackler family has long been accused of fueling the nation’s Opioid crisis, tracing back to the 90s. Purdue Pharma’s aggressive and misleading advertisements of OxyContin neglected to disclose its highly addictive nature. The company and family members have denied these allegations.

Trusting the pharmaceutical company at its word, healthcare providers began prescribing OxyContin at higher rates leading to widespread misuse of both prescription and non-prescription Opioids. By 2006, there were 215,917,663 Opioid prescriptions in the US. This number translates to a prescribing rate of 72.4 prescriptions per 100 people. By 2020, this rate has dropped to 43.3.

In September 2019, the Purdue company filed for bankruptcy in the face of nearly 3,000 lawsuits accusing the company of contributing to the public health crisis that has claimed more than half a million American lives since 1999. In 2019, of the nearly 71,000 drug overdose deaths, 70.6% involved Opioids.

While the company formerly denied its involvement in the Opioid epidemic, in November 2020, Purdue Pharma pleaded guilty to 3 criminal charges, formally taking responsibility for its misconduct. This ruling angered many critics as they believed it still protected individuals, like the members of the Sackler family, from the consequences of their involvement.

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What To Expect Now

Hours after the bankruptcy settlement was decided, the Purdue company stated that it would appeal the decision, and the case may reach the US Supreme Court. According to Purdue Chairman Steve Miller, this decision to overturn the bankruptcy settlement will delay, or even end, the ability of communities to receive compensation to abate the Opioid crisis. While the Purdue Pharma bankruptcy plan may be on hold as legalities persist, the Opioid epidemic continues regardless of settlements and negotiations.

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The ruling of a 2019 Opioid case against Johnson & Johnson was overturned by the Oklahoma Supreme Court on Tuesday. The original case was the first of its kind to go to trial and found that the pharmaceutical company played a major role in the state’s Opioid overdose deaths. In a 5 to 1 outcome, the Supreme Court determined that the original $465 million verdict incorrectly applied the state’s public nuisance law. 

Just last week, a California state judge determined that J&J and 3 other drug companies are not responsible for the state’s Opioid crisis. Like the Oklahoma ruling, the California case did not believe a public nuisance was provable in this situation. Currently, there are about 3,000 lawsuits with similar public nuisance claims against drug manufacturers, distributors, and pharmacies. 

What Are Opioids?

Opioids are a class of drugs that are derived from the poppy plant. These substances can relieve feelings of pain by affecting receptors in the brain and body. While Opioids like Heroin and Fentanyl are illicit in the US, some Opioids, such as Oxycodone and Hydrocodone, can be obtained legally through prescriptions. These substances, even when prescribed by a medical professional, have a high potential for misuse and addiction which can lead to fatal outcomes. Individuals who become addicted to Opioids after using a prescription may turn to more dangerous but easier to obtain substances, like Heroin, as an alternative. 

Since 1999, there have been over 760,000 Opioid related deaths in the US. In 2019 alone, 70,630 people in the US died as a result of an Opioid overdose. Oklahoma specifically experienced the loss of more than 4,600 citizens to Opioid overdose deaths from 2007 to 2017. Nationwide and locally, fatalities due to Opioids are considered to be a major public health, social, and economic crisis. 

Johnson & Johnson’s Involvement In The Opioid Crisis

The Opioid crisis, also known as the Opioid epidemic, began in 1995 when the US Food and Drug Administration (FDA) approved a pain medication developed by Purdue Pharma. This substance, called OxyContin, was marketed as being effective in controlling  pain while having a low potential for abuse due to its controlled release formula. Pharmaceutical companies began pushing sales of OxyContin to distributors which led to an increase in Opioid prescriptions in the US. Rapidly, the substance started to be misused by people all over the country. By 2003, 2.8 million people were using OxyContin for non-medical use. 

In the 2019 Oklahoma Johnson & Johnson case, the state provided evidence of the company’s contributions to the Opioid epidemic. This evidence argued that the drug manufacturer targeted high prescribing doctors, women, and veterans and misrepresented OxyContin as being safe to use for every day pain. Additionally, it was presented that J&J created a mutant strain of poppy which allowed them to manufacture Opioids, as well as supply about 60% of the active ingredients for Opioids made in the US. Because Johnson & Johnson was supplying ingredients to other companies, the state claimed that for 15 years the company campaigned the sale of Opioids, even those manufactured by other companies. 

Based on this evidence, Oklahoma declared that Johnson & Johnson’s actions fall under the state’s public nuisance law which was instituted in 1910. A public nuisance is defined as conduct that interferes with the rights of the public. Oklahoma’s law specifically says, “A public nuisance is one which affects an entire community or neighborhood, or any considerable number of persons, although the extent of the annoyance or damage inflicted upon the individuals may be unequal.” 

Oklahoma Supreme Court’s Decision

The Supreme Court’s reversal, as stated in the opinion written by Justice R. Winchester, determined that the 2019 ruling took the public nuisance law too far by extending it to manufacturing, marketing, and prescription Opioid sales. Winchester went on to say that Johnson & Johnson, and companies in general, cannot be liable for how their products are used by patients after they have been sold. They found this to be especially true as there are multiple levels of distribution. Manufacturers sell to distributors and wholesalers who then supply to pharmacies, hospitals, and doctors. It is at this point that Johnson & Johnson’s products are prescribed to patients. 

The lawful use of Opioids for treating pain, such as cancer related pain, was also cited as being a reason the public nuisance verdict was overturned. Additionally, Johnson & Johnson stopped marketing Opioids in 2015 and completely stopped selling them after a 2021 New York lawsuit. This case resulted in a $230 million settlement and the agreement to end nationwide sale of Opioids. Despite this settlement, the company does not admit liability or wrongdoing. 

Although the 2019 case was overturned, the Supreme court does not want to minimize the suffering that Opioids have caused many Oklahoma citizens. Johnson & Johnson also acknowledges the tragedy caused by the misuse of Opioids in the past 2+ decades but agrees with the court’s decision. The company has said that they support the overturning of what they called a misguided and unprecedented attempt to expand public nuisance laws. 

“We recognize the Opioid crisis is a tremendously complex public health issue, and we have deep sympathy for everyone affected. The company’s actions relating to the marketing and promotion of these important pain medications were appropriate and responsible,” Johnson & Johnson said in response to the ruling and on their involvement with Opioid epidemic. 

Because public nuisance laws are different depending on the state, it is not known whether this overturned case and the California ruling will inform the many similar cases against drug manufacturers. Earlier this year, Johnson & Johnson, along with 2 other companies, agreed to pay a $26 billion settlement. Currently, 42 states, 4 territories, and Washington D.C. have signed to this agreement. It is possible that the overturning of the 2019 Oklahoma verdict could convince states that are on the fence into signing on to this settlement. 

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Xavier Becerra, the Secretary of Health and Human Services (HHS), has indicated that the war on drugs may be in the midst of a shift (and so too the Biden administration’s drug policy); late last month, Becerra told NPR that as far as harm reduction strategies concerned with mitigating damage from drug abuse go, “We are willing to go places where our opinions and our tendencies have not allowed us to go [before].”

Becerra’s willingness may be the result of desperate times calling for desperate measures; according to the Centers for Disease Control and Prevention (CDC), there were 96,779 overdose deaths during the 12-month period ending in March of 2021. Addiction, often a disease of despair, was provided an opportunity to flourish during the pandemic given the multitude of layoffs and abundance of time spent at home; reporting on the subject, the Associated Press shared that, “pandemic restrictions isolated those with drug addictions and made treatment harder to get.” Furthermore, the proliferation of Synthetic Opioids — along with the legacy of deceptive marketing practices by drug companies, which often masked the addictive and dangerous nature of Opioids — has put the country in a position where new approaches may be well-warranted.

The aforementioned harm reduction strategies include, according to NPR, “clean needle exchange programs designed to slow the spread of diseases such as HIV/AIDS and hepatitis among drug users” as well as “fentanyl test strips to help active drug users identify contaminated street drugs.” In Becerra’s own words, “We are literally trying to give users a lifeline.”

Perhaps most controversially, in his remarks Becerra seemed to open the door to so-called “safe consumption sites.” These are locations where illicit drugs can be taken in a way that is regulated and supervised. Safe consumption sites have been operating in Europe for roughly 30 years; they are largely verboten in the US, despite evidence that they can effectively reach marginalized populations and facilitate health and recovery.

Earlier this year, Rhode Island became the first state to pass legislation to allow safe consumption sites. According to Vice News, at the kind of sites now legal in Rhode Island, “people can use drugs, with oversight from medical professionals trained to administer medicines like naloxone…users can also meet with case workers to connect them with services like housing and job training.” The description of the site sounds in line with Biden administration drug policy aims as stated by the American Rescue Plan Act passed earlier this year, which earmarked millions to “support community based overdose prevention programs, syringe service programs, and other harm reduction services.”

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Pushback To Biden Admin Policies And Recommendations

Though Becerra seemed to signal a willingness to give safe consumption sites a shot in more places than Rhode Island, telling NPR that “We’re not going to say ‘but you can’t do these other type of supervised consumption programs that you think work or that evidence shows work,’” HHS immediately distanced itself from the sentiment; an agency spokesperson said in a later statement that, “HHS does not have a position on supervised consumption sites,” elaborating that, “The issue is a matter of ongoing litigation. The Secretary was simply stressing that HHS supports various forms of harm reduction for people who use drugs.”

The Biden administration has faced friction in the face of its drug policies from without as well as from within; a coalition of groups including Human Rights Watch, the American Civil Liberties Union, and the National Council on Alcoholism and Drug Dependence recently addressed a joint letter to President Biden, congressional leadership, and administration officials including Becerra.

The letter accuses the Biden administration and its drug policies of “[leaning] on law enforcement, not evidence-based public health solutions, to solve the overdose epidemic,” going on to say that “it is time to center a public health approach rooted in expanding access to harm reduction and treatment instead of the same ineffective approach of arrest and incarceration.”

Making direct reference to the Biden administration’s recent drug policy recommendations to Congress, which called for “fentanyl-related substances” to be forever designated Schedule I under the Controlled Substances Act, the advocacy and watchdog groups declared that “there is simply no evidence that classwide scheduling or increased enforcement works to reduce illicit drug supply or rates of overdose and addiction.”

Stigma Persists As Supreme Court Defers

Data concerning how well scheduling a substance works to stop abuse of that substance is mixed. Scheduling a substance certainly might help contribute to the already-present stigma that surrounds addiction — potentially portraying drug users as dangerous or immoral people. President Biden has previously pushed back against the characterization of drug users in this manner, and has called for policies that prioritize rehabilitation over punishment.

Most Americans believe that the taboo around drug use and addiction is alive and well. According to a survey conducted earlier this year by Fors Marsh Group, more than two-thirds of Americans think that people who receive treatment for substance use disorders are generally regarded poorly as a result.

Furthermore, 7 in 10 Americans in recovery indicated they didn’t believe they would be hired if they talked about struggling with addiction or substance abuse in a job interview; 93% of respondents, meanwhile, “said it’s important for employers to support substance use recovery programs for their employees.”

The American public seems to want recovery-related resources made available to individuals affected by addiction. The Biden administration’s drug policies may have the same goal; only time will tell if they will end up being a closer match to Becerra’s harm-reduction rhetoric or to the punitive, law-and-order image painted by advocacy and watchdog groups.

For now, it doesn’t appear that recovery-related resources — at least in the form of safe consumption sites — will get any help from the Supreme Court. The Supreme Court of the United States chose not to complete a case review that might have allowed a supervised injection site which could work to prevent overdoses to operate. Therefore, the ruling of a lower court will stand; the nonprofit’s operators will continue to look for a way around the so-called “crack house statute” that has been used to shutter and prevent safe consumption sites for decades — a statute that, ironically, in its enforcement against these sites may itself be leading to more activity inside of actual crack houses.

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Two Ohio counties, Lake and Trumbull, filed a lawsuit in 2018 against CVS, Walgreens, Walmart, and Giant Engle for their part in the Opioid epidemic; after delay, the federal trial of the 4 pharmacies began October 4th.

In his opening remarks, Mark Lanier — attorney for the 2 Ohio counties — declared major pharmacies had “dispensed like a vending machine,” elaborating that the massive companies had failed to adequately train and hire pharmacists and had not prevented the shockingly high quantities of addictive medications they were distributing from ending up on the black market.

The Washington Post reports that, over the course of 8 years, pharmacies in Lake and Trumbull counties filled enough Painkiller prescriptions to, “provide about a dozen doses to each man, woman and child who lived there every 12 months.”

Attorney for Walgreens Casper Stoffelmayr put the blame on drug makers, defending the pharmacies on trial by saying that it was manufacturers who, “tricked doctors into writing way too many pills” and that “Pharmacists… don’t tell doctors what to prescribe.”

While it may be true that pharmacists don’t tell doctors what to prescribe, large pharmaceutical retailers like CVS and Walgreens do appear to be ignoring doctors’ instructions around safe dosing levels and requesting refills even when they’re not needed; additionally, evidence shows these companies are severely overworking their staff in ways that can be disastrous to both employees and patients alike.

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Pharmacies Are “Understaffed And Chaotic”

The New York Times last year published a bombshell report that found many pharmacists’ workplaces — including those of companies like CVS and Walgreens, pharmacies now on trial — to be “understaffed and chaotic.”

Per the Times, pharmacists “struggle to fill prescriptions, give flu shots, tend the drive-through, answer phones, work the register, counsel patients and call doctors and insurance companies… all the while racing to meet corporate performance metrics.” Some pharmacists have even reported developing kidney conditions from denying themselves trips to the bathroom.

One pharmacist, writing to their state pharmacy board, highlighted how harmful working conditions like these are to patients, proclaiming that, “I am a danger to the public working for CVS.” Another said that, “Mistakes are going to be made and the patients are going to be the ones suffering.”

The Times’ report chronicled several such mistakes, many made by the pharmacies now on trial, which have included a teenage girl getting blood pressure medicine instead of her normal asthma treatment as well as an Illinois man who went to the ER after administering to his eyes medicine he thought was eye drops; the man incorrectly received ear drops instead.

Perhaps even more worryingly, the American Psychiatric Association (APA) has voiced concerns about CVS; the APA claims that the pharmaceutical retailer regularly disregards instructions from doctors in order to dispense to patients more medication than has been medically recommended.

One physician shared a troubling account also reported by others — that his office receives more refill requests from pharmacies than the prescriptions themselves actually merit; the Times attributed these extraneous and erroneous refill requests to both “automated systems designed in part to increase sales” and “pharmacists… who said they faced pressure to reach quotas.”

Opioid Lawsuits Have Cost Billions

Ohio’s Lake and Trumbull counties are far from the only counties affected by the fallout of large pharmaceutical retailers’ decisions to prioritize profit over patient and pharmacist safety. In 2019, after Lake and Trumbull’s lawsuit was filed but before the trial began, the Tampa Bay Times reported that “hundreds of millions [of Opioids] streamed through grocery stores and chain pharmacies like CVS and Walgreens,” emphasizing 1 Walgreens — located in a city of less than 3,000 people — that “received an average 74,706 pills per month.”

That’s more than 25 pills per resident per month.

Florida has acted as a major source of Opioids for entire nation; Dave Aronberg, a former member of the Florida State Senate, declared that Florida “became the pill suppliers for the rest of the country,” after pharmacies, including pharmacies now on trial, dispensed such disproportionately high numbers of Opioids.

In July of this year, America’s top 3 drug distributors and Johnson & Johnson agreed to pay $26 billion to settle thousands of lawsuits concerning the Opioid crisis; none of the companies admitted to any wrongdoing. In August, pharmaceutical retailer Rite Aid settled with Lake and Trumbull counties — the same counties now squaring off against CVS, Walgreens, Walmart, and Giant Engle in court.

According to Reuters, Rite Aid settled “just over a month before the case was set to go to trial,” and parties involved, “did not reveal the terms of the deal.”

The current pharmacy trial will likely last for weeks — and the stakes are huge. According to NPR, “If the companies are found liable, federal Judge Dan Polster will later determine the amount of damages to be paid.” Per NPR, those damages could be extensive: “If the companies lose this fight, they wouldn’t just have to pay for drug treatment. They could eventually be required to compensate governments all over the U.S. for everything from larger foster care programs to a wide array of costs.”

There’s certainly no shortage of costs associated with the devastation of the Opioid epidemic and its architects; overdoses involving Opioids killed an average of 191 Americans every day last year.

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Despite opposition from the Department of Justice and attorneys general from 9 states and the District of Columbia, federal Judge Robert Drain ruled on Wednesday that members of the Sackler family, the former owners of pharmaceutical giant Purdue Pharma, are immune from lawsuits over their role in the Opioid epidemic.

The decision, which was part of a larger bankruptcy settlement hammered out behind closed doors over the last few years, was delivered somewhat begrudgingly by Judge Drain. Drain stated that it was a, “bitter result,” going on to say that despite his ruling, his opinion is that, “at least some of the Sackler parties have liability” when it comes to their role in the destruction wrought by OxyContin and other Opioids.

Approximately $4.3 billion will be paid out by members of the Sackler family as part of the settlement, though the family did not admit to any wrongdoing and refused to apologize for their role in the Opioid epidemic. The money will go to, “communities and people in need” according to a website launched by members of the Sackler family, who have also forfeited their ownership of Purdue Pharma as part of the deal.

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The Sacklers’ History Of Criminality

Members of the Sackler family had good reason to fear lawsuits over their wrongdoing; their company has pleaded guilty to criminal charges on 2 separate occasions in regard to irresponsible branding and distribution of Opioid drugs.

On the first occasion in 2007, the parent company of Purdue Company as well as 3 top executives pleaded guilty to intentionally deceptive marketing practices that minimized the side effects and abuse potential of Oxycontin. Purdue Pharma pleaded guilty again in 2020. According to Rachael A. Honig, First Assistant US Attorney for the District of New Jersey, the company admitted culpability in, “[marketing] and [selling] its dangerous [Opioid] products to healthcare providers, even though it had reason to believe those providers were diverting them to abusers.”

The misdeeds of the Sackler family have previously led to public outcry. Protesters have repeatedly participated in demonstrations that highlight the Sackler family’s role in the Opioid epidemic and object to the ties that the family, worth several billions of dollars, has to many high-profile universities and institutions. Specifically, activists asked that Harvard University and the Guggenheim Museum, both of which have received donations from the Sacklers, refuse any future funding from the family.

One student characterized the demonstrations by saying that, “It reminded me of stories of protesters laying down in Wall Street during the Aids epidemic. These institutions all have dirty hands.”

Washington State Attorney General Vows To Fight Decision

It’s possible that members of the Sackler family may still see legal consequences for their role in the Opioid epidemic, as none other than Washington state Attorney General Bob Ferguson has vowed to fight against the decision granting them immunity from Opioid lawsuits.

“This order lets the Sacklers off the hook by granting them permanent immunity from lawsuits in exchange for a fraction of the profits they made from the [Opioid] epidemic — and sends a message that billionaires operate by a different set of rules than everybody else,” said AG Ferguson, who went on to declare that the ruling is, “insulting to victims of the [Opioid] epidemic who had no voice in these proceedings — and must be appealed.”

It’s not the first time that AG Ferguson has gone up against a pharmaceutical company. Ferguson previously notched a courtroom victory against Johnson & Johnson after successfully suing for the release of thousands of documents detailing the drug company’s Opioid dealings.

Of his ongoing legal efforts, AG Ferguson said that “We are aggressively litigating all of our [Opioid] cases, and we are keeping these multinational corporations and their army of lawyers on their heels.”

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The steady rise of Americans addicted to prescription Opioids have concerned health officials, with 130 fatal overdoses occurring each day according to a Harvard article. Approximately 70% of Opioid deaths involve Opioid analgesics or prescription Opioids, which has called many to reconsider prescription Opioid distributions and policies. Attorney generals in 7 states declared a $26 billion settlement with Johnson & Johnson and 3 other large drug distributors in response to Opioid lawsuits.

The main companies, Cardinal Health McKesson Corp and AmerisourceBergen, have to pay $21 billion over 18 years, while Johnson & Johnson would pay $5 billion over 9 years ($3.7 billion in 3 years) if approved. Fourteen states have been very instrumental in proposing the settlement, advocating for families impacted by the Opioid epidemic.

Settlement Encourages Accountability For An Epidemic

The proposal aims to lower the ongoing effects of America’s Opioid crisis. By placing responsibility on targeted distributors and companies, many hope to lower the hundreds of both fatal and non fatal Opioid overdoses that occur each day. According to a press release from New York Attorney General Letitia James, 4,000 entities have filed lawsuits in federal and state courts against McKesson, Cardinal Health, AmerisourceBergen, and Johnson & Johnson. Cardinal Health, McKesson, and AmerisourceBergen have distributed Opioids, while Johnson & Johnson has been targeted as a manufacturer of Opioids.

Johnson & Johnson must agree to stop funding third parties for the promotion of Opioids and halt their Opioid sales. According to CNN, Michael Ullmann executive vice president of Johnson & Johnson stated, “We recognize the Opioid crisis is a tremendously complex public health issue, and we have deep sympathy for everyone affected.” He continued, “This settlement will directly support state and local efforts to make meaningful progress in addressing the Opioid crisis in the United States.”   

The agreement calls for these companies to be accountable for their shipments of Opioids, as the other 3 companies must account for their shipments as well as the shipments of other distributors. The result would be a $23 billion in mitigation efforts to get treatment for those most impacted by their Opioid distribution and manufacturing. States like New York will get, “up to $1.25 billion for fund prevention,” which includes both treatment and recovery programs.

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Settlement And Hope For Change 

These companies can help families of those affected by getting them treatment or other types of support. They must also report and halt processing of any suspicious orders, according to CNN, gatekeeping other companies’ attempts to distribute them. Such an act mirrors an earlier settlement with tobacco in the 1990s, the Purdue Pharma and Mallinckrodt Pharmaceuticals, and a prior settlement between the state of New York and Johnson & Johnson in June of 2021. Reuters.com also states a trial against the three remaining defendants, Endo International Plc, Teva Pharmaceutical Industries Ltd, and AbbVie Inc Allergen department, is currently underway in state court.

Complications from Opioid analgesic dependence and abuse have resulted in increased abuse of illicit Opioids like Heroin and Fentanyl. The National Institute on Drug Abuse cites, “Of those who began abusing Opioids in the 2000s, 75% reported that their first Opioid was a prescription drug.” Furthermore, recent Opioid-related overdoses have increased due to combining them with Cocaine and/or Methamphetamine. Opioid-related deaths have increased with the onset and spread of COVID-19, with a U.S. News source stating, “the economic losses of grief, anxiety, and social isolation are leading to increased substance use.” Because of this, many who have abused substances in isolation were more likely to overdose. 

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