Politics /

There is little justice amid America’s spiralling opioid crisis. Drug companies get rich, addicts die. For the devastated families left behind, there’s scant hope of recourse, just an unending blame-game defined by a single question: who led their loved one down this brutal path? Tens-of-thousands wrestle with it every day; but now, mercifully, an answer – and a little compensation – may be coming their way. 

Late August saw a watershed court reckoning in Oklahoma – Johnson & Johnson (J&J), a multinational drugmaker, was ordered to pay $572m for its role in the opioid epidemic. The penalty fell far short of the $17bn prosecutors had demanded, but it has, at last, put on record at state-level Big Pharma’s culpability in the crisis. “[The drugs epidemic] has ravaged the state of Oklahoma,” said presiding judge Thad Balkman, “it must be abated immediately”.

Though J&J will doubtlessly appeal, the ruling marks a successful opening salvo from those seeking justice in the courts. Nearly 2,000 counties, cities, unions, hospitals and Native American tribes have filed lawsuits against drug companies. The breadth of the litigation speaks to the crisis’s scale – opioids have been linked to over 400,000 deaths since 1999, and will likely kill upwards of half a million over the next decade. 

The epidemic’s roots lie in the advertising campaigns of pharma firms a quarter-century ago. Aggressive marketing tactics put profits above patients, testimony in the Oklahoma case heard, with deliberate efforts to underplay the risk of painkiller addiction. Overpromotion to doctors “to influence their prescribing behaviour” was rife, with language like ‘pseudoaddiction’ used to assuage fears that patients may be dangerously hooked on pills. Close financial links to pain management advocacy groups were also commonplace, with large drugmakers effectively funding ‘undertreatment awareness’ campaigns.  

Of those in the firing line, Purdue Pharma is perhaps most widely blamed for the opioid crisis. Fiercely marketed as a safer pain treatment in the mid-‘90s, their OxyContin medication is regarded as a starting point of the epidemic. Mesmerised by growing sales, Purdue’s client base – pharmacies and hospitals – peddled more and more of the drug, helping the company’s owner, the Sackler family, amass their $13bn fortune. The firm’s legal clout is formidable, but Oklahoma’s landmark ruling has helped sketch Purdue’s plaintiffs a roadmap to victory, law experts say. 

“[The J&J verdict] is very reassuring to the many [parties] suing opioid makers… and it is, correspondingly, very disturbing for those who made and sold opioids to the American public,” said Stanford Law Professors Michelle Mello and Nora Freeman Engstrom. “[It shows that] judges and juries may be willing to pin blame not just on Purdue, the maker of OxyContin, but on others who played an arguably less central role in fuelling this public health crisis”.

Taking heed of the J&J decision, the Sacklers have reportedly backed a plan to resolve all outstanding lawsuits. The scheme would involve Purdue’s voluntary bankruptcy and payouts of up to $12bn. But not all are content with the proposals. The Sacklers’ personal $3bn contribution, a fraction of their total worth, is an insult to the families whose misery they account for, critics say. Opponents are also unhappy that at least half of the compensation is believed to be in the form of free drugs – including OxyContin – which will be valued at retail prices, minimising the settlement’s overall monetary worth.

It is also unclear how much of a forward focus the restorative action will have. Insiders suggest there’s no provision for new addiction treatment centres, painkiller alternatives, or offering Purdue’s own expensive anti-addiction drugs. Cash for these is unlikely to come through conventional channels – the stigma of addiction limits the political incentives for intervention – so must be sought in court, campaigners say.

“It is imperative that as we move forward, we make it a priority to get people access to high-quality, evidence-based treatment just as people with other chronic diseases receive,” said Gary Mendell, founder of Shatterproof, an addiction charity. “Equally important is the need to invest in educating the public around substance use disorders to end the stigma and discrimination that surrounds it”.

Education must spread beyond the public, into the hospitals and pharmacies where pain medication has been too readily dispensed. Federal initiatives to improve prescribing practice and retrain medical staff misled by pharma firms would be worthwhile. The Food and Drug Administration (FDA), the national body which approved OxyContin, must also face up to its role in the crisis. Even now the regulator seems to be complicit in the epidemic, with the chair of its opioid unit identifying the group’s “direct impact” on mortality rates.

That’s no doubt part of a wider issue: the commercial incentives woven into America’s health-care system. To tackle those would require unparalleled political impetus, which, regrettably, is unlikely to materialise anytime soon. For the time being, those left bereft by the opioid epidemic must put their faith in the courts. Legal action alone can’t abate the crisis, but it’s a good place to start.