Who's to blame for drug overdoses?

Chuck Norris

As prescription and illicit opioid overdose deaths continue to rise in the United States, lawsuits against makers and distributors of the painkillers are also growing rapidly. According to an Associated Press report, health officials estimate that nearly 48,000 overdose deaths in the U.S. in 2017 involved some type of opioid.

The drumbeat for accountability for this crisis – now beating for more than a decade – just got a whole lot louder. Recent court cases are starting to generate attention-grabbing headlines. Purdue Pharma, the maker of OxyContin – and one of the pharmaceutical companies accused of fueling the nation's deadly opioid crisis – is currently embroiled in a case brought forward by the Massachusetts attorney general's office. The suit from Massachusetts is said to be one of more than 1,000 by state and local governments pending against Purdue and a major piece in what Jan Hoffman of the New York Times recently called "one of the most complicated and gargantuan legal battles in American history."

What is putting Purdue Pharma in the spotlight is the release of previously secret redacted passages from a court document filed in the Massachusetts suit. They suggest that Purdue Pharma made a calculated move to capitalize on a crisis they helped create by making moves to expand its business model into what company documents referred to as an "attractive market" – the treatment of opioid addiction.

According to STAT News, in internal correspondence (now public), beginning in 2014, Purdue Pharma executives discussed the sale of opioids and the treatment of opioid addiction are "naturally linked" and the company's prospective expansion across "the pain and addiction spectrum," according to sections of the Massachusetts lawsuit. In addition, it is alleged that Purdue went to extreme lengths to boost OxyContin sales and spruce up the drug's reputation in the face of increased regulation and growing public awareness of its addictive nature.

While most of the lawsuits name multiple additional defendants, including other drug manufacturers, distributors and pharmacies, the Massachusetts case focuses solely on Purdue. The company has characterized the suit as an attempt to publicly "vilify" Purdue and its founders.

At the same time, eyes will soon be on the first trial in another state: The State of Oklahoma v. Purdue Pharma is currently scheduled to start in late May. Meanwhile, hundreds of other lawsuits filed against Purdue by states, cities, counties and tribes are consolidating in one pending case in federal court in Ohio.

Also in the news is a related study published in JAMA Network Open, presenting what the New York Times calls "some of the strongest evidence yet of the connection between the marketing of opioids to doctors and the nation's addiction epidemic."

The report found that counties where opioid manufacturers offered a large number of gifts and payments to doctors had more overdose deaths involving the drugs than counties where direct-to-physician marketing was less aggressive. As reported by the Times, the industry spent about $40 million promoting opioid medications to nearly 68,000 doctors from 2013 through 2015, including paying for meals, trips and consulting fees. Researchers found that for every three additional payments that companies made to doctors per 100,000 people in a county, overdose deaths involving prescription opioids a year later were 18 percent higher there. According to the report, even as the opioid epidemic was killing more and more Americans, such marketing practices remained widespread.

A statement by the American Academy of Family Physicians recently criticized the report, citing "many unknown variables that prevent drawing a direct causal link between pharmaceutical marketing and opioid-related deaths."

What is clear is that these court cases, disputes and calls for reform are sure to persist, remaining contentious and difficult to resolve for some time to come. You have to wonder: When it is all over, what will victory over the opioid epidemic look like?

For a clue, it might be worth looking at smoking, a not unsimilar public health crisis that many consider to be mostly solved.

As pointed out by Kenneth E. Warner, professor emeritus of public health at the University of Michigan, in a think piece in the Conversation, it is hard to deny the extraordinary victories against smoking. Since the 1964 surgeon general's report on smoking and health, adult smoking prevalence has dropped by two-thirds, from 43 percent to 14 percent. The decrease among young people is even more substantial. Since smoking peaked among high school seniors 20 years ago, its prevalence has plummeted by nearly 80 percent. Yet, even at current levels, smoking remains our nation's most avoidable cause of disability and premature death.

According to Warner, 1 in 7 adults are still tobacco smokers. Smoking kills nearly 500,000 Americans every year, a number that far exceeds the sum total of all deaths caused by opioid and other drugs, alcohol, motor vehicle injuries, homicide, suicide, HIV/AIDS and fires.

Halting the opioid epidemic and restoring control to the nation's public health agenda will be no easy feat in a world where history so often repeats itself.

Write to Chuck Norris with your questions about health and fitness. Follow Chuck Norris through his official social media sites, on Twitter @chucknorris and Facebook's "Official Chuck Norris Page." He blogs at ChuckNorrisNews.blogspot.com.