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Explainer: Why a US court ruling could be a turning point in one of the country's worst-ever drug epidemics

A landmark ruling against Johnson & Johnson was made in Oklahoma yesterday.

5mg pills of Oxycodone, one of the drugs involved in the US opioid crisis
5mg pills of Oxycodone, one of the drugs involved in the US opioid crisis
Image: Keith Srakocic/PA Images

YESTERDAY, A JUDGE in the US state of Oklahoma ordered healthcare giant Johnson & Johnson to pay $572 million (€515 million) for its role in driving the state’s opioid addiction epidemic.

The landmark ruling, the first against a company for the ongoing crisis in the US, found that the company had deceptively promoted addictive painkillers to doctors in the state.

Judge Thad Balkman determined that the company’s actions “compromised the health and safety of thousands of Oklahomans” and ordered the company to fund an ‘abatement plan’ for care for addicts, families and communities ravaged by the crisis.

His ruling could set a precedent for similar lawsuits throughout the US taken by those affected by the epidemic.

But what is the opioid crisis? How have Johnson & Johnson contributed to it? And why was yesterday’s ruling so important?

Spike in overdose deaths

In recent years, the US has seen a spike in the number of people addicted to opioids, a group of drugs which include prescription painkillers, heroin, and synthetic drugs such as fentanyl.

The crisis began in the early 2010s, and is mostly rooted in the overprescription of Oxycontin and other legal painkillers, which has led to more than two million people becoming addicted.

Experts largely blame US pharmaceutical companies – like Johnson & Johnson – who played down the risks of opioid painkillers over the years, leading healthcare providers to prescribe them at higher rates.

The increase in prescriptions eventually led to widespread misuse of prescription and non-prescription opioids, before it became clear that the drugs were highly addictive.

Drug overdose deaths rose, particularly those related to the use of synthetic opioids, and increases were seen among both men and women, in all races and among adults of nearly all ages.

Pop icon Prince and rocker Tom Petty are among the high-profile victims of the epidemic.

president-trump-signs-anti-opioid-bill-washington US President Donald Trump signs a bipartisan bill to stop the flow of opioids into the country last year Source: Sachs Ron/CNP/ABACA/PA Images

Last year, a study found that the percentage of deaths attributed to opioids in the US increased by 292% from 2001 to 2016, with one in every 65 deaths related to opioid use by 2016.

Opioid overdoses accounted for more than 42,000 deaths that year, the highest on record, with an estimated 40% of deaths involving a prescription opioid.

US President Donald Trump later declared the problem a national public health emergency, and gave new funds were to communities to fight addiction and the social impact of the epidemic.

In a positive development, it emerged last month that drug overdoses declined by 5.1% in the US in 2018, the first time the figure had dropped in two decades.

However, some 2,000 lawsuits had already been launched by states, cities and Native American territories across the country against those seen to be responsible for the crisis.

‘Public nuisance’ ruling

The case against Johnson & Johnson and its subsidiary Janssen, like hundreds of others, accused manufacturers of deceptive marketing and distributors of over-supplying prescription painkillers, despite them knowing about the risks of addiction.

Oklahoma claimed the state had been burdened with increased costs on healthcare, criminal justice and law enforcement, particularly relating to prescriptions of its drugs Nucynta and Duragesic.

Before the case went to trial, Purdue Pharma – maker of the painkiller OxyContin – agreed to pay the state $270 million, while Israeli pharmaceutical giant Teva agreed to pay the state $85 million.

However, Johnson & Johnson denied the charges against it and the trial opened in May, with prosecutors seeking $17 billion in damages for an abatement program to be spread over 30 years. 

The company was found to have contributed to a “public nuisance” yesterday.

opioid-lawsuit-oklahoma Judge Thad Balkman announces his decision in Oklahoma yesterday Source: Sue Ogrocki/PA Images

“The defendants Janssen and Johnson & Johnson’s misleading marketing and promotion of opioids created a nuisance,” Judge Thad Balkman said in his ruling.

He determined that Johnson & Johnson had promoted its drugs by telling doctors and patients that pain was not being treated enough and that “there was a low risk of abuse and a low danger” in the drugs themselves.

He said:

The defendants used the phrase ‘pseudoaddiction’ to convince doctors that patients who exhibited signs of addiction… were not actually suffering from addiction, but from the undertreatment of pain.

He also said the company consciously downplayed the risks it knew were present in the drugs, pointing to the 2007 $600 million fine in a Virginia trial of Purdue Pharma for misleading the health industry and the public about the addictive properties of Oxycontin.

In the aftermath of the ruling, Johnson & Johnson said it would appeal the decision. 

“Janssen did not cause the opioid crisis in Oklahoma, and neither the facts nor the law support this outcome,” Johnson & Johnson executive vice president Michael Ullmann said.

More lawsuits forthcoming

The company was the first to go to trial over the crisis, and the case against it is seen as an important benchmark for thousands of possible criminal and civil suits over the distribution of highly addictive painkillers like oxycodone and hydrocodone.

The lawsuits are being compared to the 1998 cases against tobacco companies, which ended in a 46-state settlement estimated at $250 billion in annual payments over the first 25 years of it being in force.

ny-cuomo-must-support-overdose-prevention Protesters rally outside the office of New York Governor Andrew Cuomo's office in 2018 Source: SIPA USA/PA Images

Many cases are being rolled into a case that will go to trial in October in the state of Ohio, which will most likely set the basis for potentially billions of dollars in settlements across the country.

Dozens of local and state governments across the country have also already reached settlements with opioid manufacturers and distributors to address their problems.

The ruling against Johnson & Johnson will see cash will go towards care for a generation of addicts, families and communities affected by the opioid crisis.

Even in its rejection of the court’s findings, the company acknowledged the importance of the ruling.

“The unprecedented award for the state’s ‘abatement plan’ has sweeping ramifications for many industries and bears no relation to the company’s medicines or conduct,” Ullmann said.

By setting a precedent, billions of much-needed dollars could go towards fighting the crisis.

But it remains to be seen whether other states follow suit in finding Big Pharma responsible for the worst drug epidemic ever seen in the US.

With reporting from - © AFP 2019.

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