OPIOID OVERDOSE

The scope of the opioid painkiller problem cannot be underestimated. According to a report by the U.S. Centers for Disease Control and Prevention (CDC) in 2010, doctors wrote enough prescriptions for hydrocodone to give every American adult a one-month supply.

The situation has worsened considerably in the last seven years as well. Doctors and healthcare providers wrote nearly a quarter of a billion opioid prescriptions in 2013 in the United States.

Prescription opioids can be prescribed by doctors to treat moderate to severe pain, but can also have serious risks and side effects. This class of drugs is highly addictive and known to be one of the most overprescribed in the U.S., despite all the trouble the drugs have caused.

From 2000 to 2015 more than half a million people died from drug overdoses. Now, over 90 Americans die every day from an opioid overdose. Prescription opioids are a driving factor in the 15-year increase in opioid overdose deaths. Ohio is among the states hardest hit by the epidemic.

Joe Lyon is a highly-rated medical malpractice attorney with experience in injuries due to prescription error.

Mr. Lyon has represented plaintiffs nationwide in a wide variety of medical negligence, wrongful death and Cincinnati opioid painkiller injury claims.  

Types of Opioid Painkillers

Sales of prescribed opioid painkillers, including oxycodone and hydrocodone almost quadrupled in the U.S. between 1999 and 2015, according to the U.S. Centers for Disease Control and Prevention (CDC), contributing to a 400 percent increase in deaths from prescription opioids in that same period.

Almost 2 million Americans either abused or were dependent on prescription opioid painkillers in 2014, according to the CDC. Common types of dangerous painkillers include:

•    Oxycodone (OxyContin)
•    Hydrocodone (Vicodin)
•    Morphine
•    Methadone
•    Fentanyl

Fentanyl Deaths Rising Nationwide

Fentanyl, a synthetic opioid painkiller, is up to 50 times more potent than heroin and 100 times more powerful than morphine. This drug has caused an immense rise in addiction and death in many states, including Ohio. Although fentanyl is often illegally made and distributed, it can be prescribed by doctors to treat acute pain in patients. There are two kinds of fentanyl:

1.    Pharmaceutical fentanyl—primarily prescribed to manage acute and chronic pain.
2.    Non-pharmaceutical fentanyl—Illicitly manufactured, and often mixed with heroin to increase the drug’s effect.

The death rates from synthetic opioids, including drugs like tramadol and fentanyl increased by over 72 percent from 2014 to 2015. Opioid injury and death rates increased across all demographics and numerous states including Ohio where the death rate more than doubled.

Deaths from dangerous prescription opioids have more than quadrupled since 1999. The epidemic in addiction has prompted many hospitals and clinics to control the drugs more closely, though the problem persists. In 2013, the U.S. Department of Veteran Affairs (VA) rolled out an Opioid Safety Initiative and significantly cut the number of opioids it prescribed.

Drug Marketing & Addiction

The National Institutes of Health identified drug companies’ marketing tactics as a major contributor to the nation’s opioid abuse problem. Despite a lack of scientific evidence that opioid use is beneficial for long-term pain management, the amount of prescribed opioids in the United States is astounding.

In 2014, nearly two million Americans either abused or were dependent on prescription opioid pain relievers. As many as one in four patients receiving long-term opioid treatment struggles with opioid addiction. Once addicted, it can be nearly impossible to stop. Taking too many prescription opioids can stop a person’s breathing and lead to death.

Drug overdose deaths and opioid-involved deaths continue to increase in the United States. The majority of drug overdose deaths (about 60 percent) involve an opioid. The crisis has been named a top priority by the U.S. Food and Drug Administration (FDA) Commissioner.

Doctors Overprescribing Dangerous Drugs

While tens of thousands of Americans die from prescription opioid overdoses each year, opioid manufacturers are making sure that the more opioids a doctor prescribes, the more money they can make. Individual doctors can earn huge amounts of money in speaking fees and promotion tactics, and may compromise what’s in the best interest of America’s vulnerable patients.

A Harvard analysis of data from 2014 and 2015 show about 811,000 prescriptions written for Medicare patients. Of those, nearly half of doctors wrote at least one prescription for opioids. Around 54 percent of those doctors, accounting for more than 200,000 physicians, received a payment from opioid pharmaceutical companies.

The relationship between opioid prescription and profit has become obvious. Doctors in the top one percent of opioid prescribers receive about four times as much money from drug makers as the typical doctor. Opioid manufacturers, including OxyContin maker Purdue Pharma, have paid millions of dollars to advocacy groups and doctors, many of whom promoted the use of the painkillers, according to a U.S. Senate report.

Addiction Treatment & Insurance Claims

Opioid addiction requires extensive treatment, and when insurance companies fail to cover patients and claims are denied, the addicted are forced out and left to their own devices. There is a mental health and drug crisis in the U.S., and in 2017 alone, around 47,000 Americans died by suicide and 70,000 from drug overdoses.

How can insurance companies deny coverage? The Mental Health Parity and Addiction Equity Act requires insurers to provide coverage for mental health and medical treatments. But insurers are still denying claims, and limiting coverage.

Americans are now taking action against insurance companies when they recognize unlawful or unethical treatment. In one high-profile case of late, a plaintiff took United Behavioral Health, a unit of UnitedHealth Group, to court when they declined to cover a longer stay at an addiction treatment center, and he later died of an overdose. Even though his addiction specialist wanted him to stay at the center, the insurance would not cover him.

Addiction treatment and mental health claims have long been denied or limited by insurers and claimants are fighting back with legal action. Families are seeing their loved ones die or overdose because insurance companies fail to cover treatment.

Before the case mentioned above, United Behavioral Health was already the target of a class action lawsuit alleging that it improperly denied coverage for certain treatments. In fact in March 2019, a judge found United Behavioral Health liable for denying benefits, saying the insurer was more concerned with profits than the well-being of its clients.

Opioid Painkiller Risks & Drug Injuries

Even though prescription opioid overdose deaths often involve benzodiazepines, some doctors fail to monitor all the different drugs their patient is taking.

Many patients take painkillers in conjunction with benzodiazepines, which are central nervous system depressants used to sedate, induce sleep, prevent seizures, and relieve anxiety. Addictive and potentially dangerous benzodiazepines include:

•    Alprazolam (Xanax)
•    Diazepam (Valium)
•    Lorazepam (Ativan)

It is important to avoid taking benzodiazepines while taking prescription opioids whenever possible. Doctors who prescribe both opioids and benzodiazepines for the same patient may be found negligent should Cincinnati opioid painkiller injury or death occur.

Pain Clinic Overdose Deaths

Many doctors at pain management clinics fail to take basic precautions like taking occasional urine samples from patients to check for other counteracting drugs. They also fail to follow reasonable addiction protocols and monitor patients for signs of addiction. A study last year found that over 90 percent of overdose survivors were still able to get another prescription for opioids.

Other doctors have been sued for not providing safe and hygienic healthcare. The family of one victim in South Carolina recently sued a pain management clinic after a man developed a fatal infection from pain injections. The investigation discovered the clinic wasn’t following basic hygiene recommendations, like wearing sterile gloves.

Ohio victims of painkiller injuries and deaths are filing claims against unscrupulous doctors and pain clinics for their unethical and illegal behavior. Doctors have a responsibility to place their patients’ well-being ahead of drug sales, and if they fail to do so, they may have committed a negligent and criminal act.

Health care providers, including doctors at pain management clinics around the country, are being held accountable when patients overdose on opioid painkillers they prescribed.

Doctors have faced numerous civil lawsuits from individuals and families, and even faced murder charges for overprescribing dangerous and addictive painkillers such as fentanyl, hydrocodone, oxycodone and morphine.

Some doctors face charges of illegally distributing drugs connected to overdose deaths, and the very nature of the pain clinics they run, though legal, are extremely dangerous.

Doctors have been named in lawsuits for prescribing “excessive amounts” of potent, highly-addictive drugs. The Centers for Disease Control and Prevention estimates that the annual economic burden of prescription opioid abuse in the United States is over $78 billion.

The number of doctors penalized by the U.S. Drug Enforcement Administration has grown more than five-fold in recent years, mostly due to opioid overdose deaths.

One of the largest reasons for doctors to over-prescribe is for profit, and huge pharmaceutical kickbacks from drug companies. Doctors who value profit over their patients’ lives must be held liable to protect future victims of painkiller abuse.

Attorney Generals Sue Manufacturers

It’s not just doctors who have been facing legal action for the opioid epidemic. A number of states have filed suit against pharmaceutical companies for their roles in the opioid epidemic, including the state of Ohio. Ohio consistently ranks near the top of drug overdose rates. In 2016, 2.3 million people in Ohio, or about a fifth of the state’s population, were prescribed opioids.

A recent complaint filed by the Ohio Attorney General alleges that drugmakers downplay the risks and tout the benefits of opioids, helping to fuel Cincinnati opioid painkiller injury, and the prescription painkiller crisis responsible for the deaths of more than 3,000 people in Ohio in 2016.

The Ohio lawsuit lawsuit claims drugmakers violated multiple state laws, including the Ohio Corrupt Practices Act, and committed Medicaid fraud. Primary care doctors were being told that true addiction is extremely rare, but the reality is much different. OxyContin, for example, included a fraudulent marketing campaign that claimed the drug was not as addictive as other alternative drugs.

Opioid Painkiller Overdose

Several drugmakers are under fire for their important role in the addiction epidemic in America. Companies such as Purdue Pharma, Abbott Laboratories, Johnson & Johnson, Teva Pharmaceuticals, Endo Health Solutions and Allergan have all been named in lawsuits alleging they know the terrible risks of the drugs they make and still encourage doctors and patients to use them in many uncertain circumstances.

In 2014, pharmaceutical companies spent $168 million through sales reps peddling prescription opioids to influence doctors. Also, some large pharmacy chains such as Walmart, CVS and Walgreens have been named in lawsuits, and are being investigated in their role in opioid addiction deaths and opioid painkiller injury.

The current litigation seeks to hold the drug industry accountable for producing, marketing and distributing opioid painkillers without proper warnings, and compensate families and communities for the costs incurred as a result of opioid  painkiller injury, opioid-related deaths and addictions.

Opioid Prescriptions and Physician Payment

There are obvious conflicts of interest with the pharmaceutical industry. Studies by researchers at Yale University and Harvard Medical School have found that the more money physicians are paid by pharmaceutical companies, the more likely they are to prescribe certain drugs.

Concerns about payments to doctors by opioid manufacturers were identified in another study by researchers at Boston University. Pharmaceutical companies pay doctors to do medical research, then also pay doctors for promotions, consulting and speaking engagements.

The conflict goes beyond merely painkillers. Researchers have examined government databases and found that when doctors receive payments from manufacturers of certain cancer drugs, they are more likely to prescribe those drugs to their patients.

Paying doctors for speaking and consulting is legal, but ethically dangerous. Pain experts are allowed to share experience and information about medications, but with the painkiller epidemic, it is very controversial.

Illegal Opioid Sales & Regulation

The Food and Drug Administration cracked down on Web sites like “AnonShop,” “Remedy Mart,” “TramadolHub” and “One Stop Pharma” that are illegally selling opioid medications online to residents, including tramadol and oxycodone, extremely potent painkillers.

The FDA warned about 53 websites to stop selling the products or face a regulatory action, such as having the products seized. The FDA Commissioner described the internet as “virtually awash in illegal narcotics,” and implied that additional actions would be coming.

The FDA has been inundated with bad news regarding the epidemic of opioid abuse and overdose deaths in the United States. In response to the opioid crisis across the country, the federal safety agency has developed a plan to reduce the impact of opioid abuse in the U.S. The FDA has said it is committed to enhancing safety labeling, requiring new data, and seeking to improve pain treatment. The FDA Opioid Action Plan will include:

• Expanded use of advisory committees—the FDA will convene an expert advisory committee before approving any New Drug Application for an opioid that does not have abuse-deterrent properties.
• Develop warnings and safety information for immediate-release opioid labeling. The FDA is developing additional warnings and safety information.
• Strengthen post-market requirements—the FDA is strengthening the requirements for drug companies to generate post-market data on the long-term impact of using opioids.
• Update Risk Evaluation and Mitigation Strategy (REMS) Program—The aim is to increase the number of prescribers who receive training on pain management and Prescription Errors in order to decrease inappropriate opioid prescribing.
• Expand access to abuse-deterrent formulations (ADFs) to discourage abuse. The pharmaceutical industry has shown significant interest in developing ADFs and the technology is progressing rapidly.
• Support better treatment. The FDA is reviewing options, including over-the-counter availability, to make naloxone more accessible to treat opioid overdose.

Opioid Painkiller Injury Lawsuits

Every decision a physician makes regarding prescription drugs should be in the best interest of the patient, and not the financial interest of the doctor. In light of the opioid epidemic, drug companies have begun curtailing the practice of paying doctors for promotional activities such as speaking engagements.

But many doctors who prescribe a lot of opioids are still paid large amounts of money by pharmaceutical companies. Several patients have filed lawsuits against these high prescribers and drug makers.

Cincinnati opioid painkiller injury lawsuits claim drug makers have violated multiple laws and committed Medicaid fraud. Drug makers are being sued for fraudulent marketing campaigns that downplay the addictive nature of opioid drugs. Other have been taken to court for falsifying medical records, misleading insurance companies and providing kickbacks to doctors. Drug Companies Targeted in Opioid Abuse Lawsuits include: 

• Insys Therapeutics Inc.
• Purdue Pharma
• Abbott Laboratories
• Johnson & Johnson
• Teva Pharmaceuticals USA
• Endo Health Solutions
• Allergan
• Purdue Frederick Company
• Cephalon Inc.
• Endo Pharmaceuticals Inc.
• Janssen Pharmaceuticals