Opioids, opioid addiction, and “pill mills” are increasingly in the news. The president recently declared a public health emergency related to the growing opioid addiction crisis.
Within the past year, hundreds of local governments filed lawsuits against opioid manufacturers and distributors. Why? And what does this mean for Americans who legitimately need long-term pain relief?
We answer these questions below. But first, we look into other frequently asked questions about opioids.
- What are opioids?
- How do opioid medications affect our bodies?
- Why do some people become addicted to opioids?
- How did opioid addiction become a national problem?
Once we know the answers to these questions, it is easier to answer the question of why so many governments are filing lawsuits. From there, we consider the possibilities of what the opioid lawsuits may mean for patients who depend upon opioids for long-term pain relief.
What are opioids?
An opioid is any chemical that binds to the body’s natural opioid receptor system. Endogenous opioids are naturally produced by the body. Exogenous opioids come from outside the body.
The opioid receptor system is part of our natural pain control for acute injuries. Our bodies have an opioid receptor system because our bodies naturally produce opioids. Many people have heard of endorphins. Endorphins are endogenous opioid hormones that can create a feeling of euphoria. The word endorphins actually comes from a combination of endo (within) and morphine.
Opioid medications are exogenous opioids – from outside the body. There are three classes of exogenous opioids: Derivatives such as morphine; semi-synthetic such as oxycodone; and fully synthetic such as methadone. All opioids, both endogenous and exogenous, interact with the body’s opioid receptors.
How do opioid medications affect a patient?
Our bodies have different opioid receptors. An opioid that attaches to the mu receptor dulls the sensation of pain. These are the most frequently prescribed opioids because they are the most effective at providing pain relief. These opioids also carry with them the potential for cravings, addiction, and abuse. There are serious and potentially fatal side effects with all exogenous opioids. Never take prescription opioids without physician oversight.
Why do some people become addicted to opioids?
Anyone – any race, gender, and age – can become addicted to drugs, even legal drugs. Many factors impact whether a particular patient is at higher risk of opioid addiction, such as genetics, environment, physical health, mental health, social support, etc. Studies are still being undertaken to gain a better understanding of why one person will become addicted and another will not. But let’s be clear: Even the healthiest, wealthiest, and strongest person can become addicted to opioids.
How did opioid addiction become a national problem?
Opioids have been with us for centuries, with poppies being grown and used in Mesopotamia as early as 3,400 B.C. Archaeologists and historians have found references to opioid use by the Sumerians (whose name for the poppy loosely translated means “joy plant”), Assyrians, and Egyptians. Opioid use continued through time, with ancient Arabs, Greeks, and Romans using opioids as a sedative. Even Hippocrates, the father of medicine, recommended drinking juice from the white poppy to relieve pain, stop bleeding, and treat epidemics.
In our country, Oxycodone was first widely available in 1950 when the FDA approved its use in Percodan. Throughout the 1960s and 1970s, physicians were justifiably concerned about opioid addiction and were conservative with prescribing the medication. But beginning in 1986 and continuing in the following decades, a process occurred that changed the practice of medicine.
Physicians working as Key Opinion Leaders (“KOLs”) for the opioid industry, along with opioid manufacturers and distributors, authored and published numerous medical articles advocating for the use of opioids to treat chronic pain, which would increase sales. The pharmaceutical industry also formed the American Pain Foundation (“APF”), an opioid advocacy group funded almost entirely by opioid manufacturers and distributors. The APF shuttered its doors in 2012 amidst an investigation by the U.S. Senate Finance Committee.
https://www.propublica.org/article/senate-panel-investigates-drug-company-ties-to-pain-groups
One of the opioid industry’s KOLs, who touted opioids for long-term use, later admitted that he “gave innumerable lectures in the late 1980s and ‘90s about addiction that weren’t true.” This doctor explained that the goal given to him by the opioid industry was to “destigmatize” opioids. This physician also stated: “Did I teach about pain management, specifically about opioid therapy, in a way that reflects misinformation? Well, . . . I guess I did.”
Opioid manufacturers and distributors are alleged to have systematically and continuously planted and promoted literature based upon invalid data supporting long-term opioid use. They are also alleged to have attacked any medical literature suggesting that long-term opioid use should be disfavored in an attempt to discredit critics of long-term opioid use.
Why are governments filing lawsuits?
The opioid crisis has financially impacted governments. Cities, counties, and sheriff’s offices are being forced to divert resources to combat the crisis. Law enforcement, emergency medical services, and jail costs have increased because of the pervasive opioid crisis. Petty crimes have increased. Some governments are training their law enforcement personnel to administer a reversal agent to those suffering an opioid overdose. Jails are being filled with opioid addicts who must by law be provided appropriate health care at taxpayer expense.
As opioid addiction awareness increased and physicians realized the inaccuracy of the studies they had been given, those addicted to opioids often found it much more difficult to obtain opioids. This led to an illegal opioid market, which has now grown into an illegal drug market with consequences that make national headlines almost daily. Black tar heroin and synthetic fentanyl are opioids that are being sold illegally by drug dealers throughout the country, compounding problems governments are combatting.
As the illegal market has grown, so has the resolve of state and local governments across the country to file lawsuits seeking recovery of the taxpayer dollars spent to combat this national epidemic. New cases are being filed daily. We expect thousands of government lawsuits to be added in the coming months.
What will the opioid lawsuits mean for patients who need long-term pain relief?
The government lawsuits seek a recovery of costs, but they also request courts to force the opioid manufacturers and distributors to abate the public nuisance they caused. “Abate a public nuisance” is lawyer talk for “you broke it, you fix it.” Nobody has a crystal ball to know whether the government lawsuits will be successful, but if they are, a likely result will be a forced change in behavior by manufacturers and distributors. This may include publishing accurate information regarding how addictive opioids can be, re-educating prescribers and patients, and significantly reducing the number of opioids available.
Fewer patients will have access to opioids. For society, that will be a good thing. But what happens with people who have legitimate and debilitating chronic pain?
The healthcare industry knows that many people suffer excruciating pain. Pain has been called by many in the medical community the “fifth vital sign” (along with temp, pulse, respiration rate, and blood pressure). That idea is now being challenged in the wake of the opioid crisis, with many physicians arguing that pain is a symptom, not a vital sign. Either way, the consensus is that pain is very important, and undertreated pain has consequences that can and usually do dramatically impact a patient’s quality of life.
Nobody wants to deny pain relief to patients who need it. But the healthcare community should be thinking in terms of better and safer medications and alternative treatments for pain. Powerful pain relief does not have to come hand-in-hand with a powerful addiction risk. When the opioid industry is deprived of its approximately $8 billion in annual revenue from these highly addictive pills, perhaps it will commit to researching and developing safer pain relief medications. Hopefully, a national discussion will result regarding the importance of physical therapy and occupational therapy so that patients can have better access to, and broader insurance coverage for, these important treatment options.
Riley & Jackson is representing several county and city governments in opioid litigation.
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