Two American counties in Ohio and four pharmaceutical companies were able to reach settlement in a landmark lawsuit involving liability for the nation’s opioid epidemic on October 21, paving the way for a far-reaching agreement on more than 2,400 similar claims, consolidated into multidistrict litigation, that are still pending in the US. The $260 million settlement was reached with McKesson Corp., AmerisourceBergen, Cardinal Health and Teva Pharmaceuticals just hours before the trial was set to begin in the first federal lawsuit related to the opioid era.
According to US Drug Enforcement Administration (DEA) data, drug companies dispersed 267,109,356 oxycodone and hydrocodone pills between 2006 and 2012 in Cuyahoga County, Ohio alone, an equivalent of 29 pills per person per year. The settlement will give the counties of Summit and Cuyahoga badly needed funding and anti-addiction medication to stave off the crisis that continues to impact the country. But it may also guide the next rounds of negotiations as the drug companies and governments continue efforts to resolve the remaining claims in a global settlement.
The origins of the opioid epidemic
Opioids are a class of medications that include heroin, fentanyl (a synthetic opioid) and prescription painkillers such as oxycodone, hydrocodone, codeine and morphine. Many believe that the opioid epidemic began in the US in the late 1990s, when pharmaceutical companies reassured the medical community that patients would not become addicted to prescription opioid pain relievers such as oxycodone and hydrocodone, and healthcare providers began to prescribe them with greater frequency, leading to a huge increase in the use of opioid painkillers in recent years.
Some experts maintain that the roots of the opioid epidemic actually go back to the early 1980s, when acute pain was frequently treated with opioids and propoxyphene was the second-most dispensed drug in the US. Overreliance on opioid medications is often characteristic of a health care system that incentivises quick, simple answers to complex physical and mental health concerns. One Institute of Medicine report attributed the rise in chronic pain prevalence during the 1990s to:
- Greater patient expectations for pain relief;
- More musculoskeletal disorders associated with an ageing population;
- Increased obesity rates;
- Improved survival rates after injury and cancer;
- More frequent and increasingly complex surgical procedures.
When properly managed, short-term medical use of opioid pain relievers—taken for a few days following minor surgery, for example—rarely leads to an opioid use disorder or addiction. But longer-term use of opioids (several times a day for several weeks or more) can lead to dependence, tolerance, and in some cases, addiction.
In 2017, more than 47,000 Americans died from opioid overdoses and that same year, an estimated 1.7 million people in the US were believed to be suffering from substance use disorders related to prescription opioids, according to the National Institute on Drug Abuse. NIDA estimates that about 80% of those who now use heroin formerly abused prescription opioids, and about 4% to 6% of those who abuse prescription opioids will transition to heroin.
Pain pill database says drug companies saturated US with billions of painkillers
According to the Automation of Reports and Consolidated Orders System (ARCOS), a pain pill database maintained by the DEA that was recently made public by the Washington Post, just six companies distributed three-quarters of the opioids sold in the US between 2006 and 2012: AmerisourceBergen, Cardinal Health, CVS, McKesson, Wal-Mart and Walgreens, with McKesson controlling 18.4%, the biggest share of the market. Three manufacturers produced about 88% of the opioids during that time: Actavis Pharma, Endo Pharmaceuticals unit Par Pharmaceutical, and Mallinckrodt subsidiary SpecGx. These companies allegedly inundated the country with 76 billion opioid capsules in just six years, resulting in almost 100,000 deaths.
During that time, the highest death rates related to opioids were in rural communities in West Virginia, Kentucky and Virginia, where fatalities were triple America’s national rate. But no section of the country has avoided the opioid epidemic, and many think the blame lies with the pharmaceutical industry, which allegedly increased the volume of painkillers distributed from 8.4 billion in 2006 to 12.6 billion in 2012, an increase of 51%.
What has the opioid epidemic done to the US economy?
According to the National Institute on Drug Abuse (NIH), more than 130 US citizens die from opioid overdoses every day, and the misuse of and addiction to opioids such as prescription painkillers, heroin and synthetic opioids like fentanyl costs the country $78.5 billion annually in healthcare, lost productivity and addiction treatment programmes.
A study released in October by the Society of Actuaries found that the opioid crisis will cost the US economy at least $631 billion, the biggest costs from unrealised lifetime earnings of those killed by the painkillers and healthcare expenditures that are expected to reach between $172 billion and $214 billion in 2019 alone for those with opioid-related disorders.
Other economic losses were related to costs associated with the criminal justice system, child and family assistance programmes, and lower workforce participation rates due to incarceration for drug-related offenses. Nearly 400,000 people in the US died from overdoses involving prescription or illicit opioids from 1999 to 2017, according to the researchers.