Oklahoma Judge Issues Massive Verdict Against Johnson & Johnson In Opioid Trial

An Oklahoma state court Judge has handed down what many are hailing as a landmark ruling related to the opioid crisis, but there's reason to be skeptical about his conclusions.

A state court judge in Oklahoma handed down a ruling on Monday in favor of the state in its lawsuit against pharmaceutical giant Johnson & Johnson, ordering the company to pay more than half a billion dollars in damages for its role in marketing Oxycodone through physicians, thus contributing to the nation’s opioid crisis:

NORMAN, Okla. — A judge Monday found Johnson & Johnson responsible for fueling Oklahoma’s opioid crisis, ordering the health-care company to pay $572 million to remedy the devastation wrought by the epidemic on the state and its residents.

Cleveland County District Judge Thad Balkman’s landmark decision is the first to hold a drugmaker culpable for the fallout of years of liberal opioid dispensing that began in the late 1990s, sparking a nationwide epidemic of overdose deaths and addiction. More than 400,000 people have died of overdoses from painkillers, heroin and illegal fentanyl since 1999.

“The opioid crisis has ravaged the state of Oklahoma and must be abated immediately,” Balkman said, reading part of his decision aloud from the bench Monday afternoon.

“As a matter of law, I find that defendants’ actions caused harm, and those harms are the kinds recognized by [state law] because those actions annoyed, injured or endangered the comfort, repose, health or safety of Oklahomans,” he wrote in the decision.

With more than 40 states lined up to pursue similar claims against the pharmaceutical industry, the ruling in the first state case to go to trial could influence both sides’ strategies in the months and years to come. Plaintiffs’ attorneys around the country cheered the decision, saying they hoped it would be a model for an enormous federal lawsuit brought by nearly 2,000 cities, counties, Native American tribes and others scheduled to begin in Cleveland, Ohio, in October.

Balkman did not give the state everything it sought — state attorneys had asked for $17.5 billion over 30 years for treatment, emergency care, law enforcement, social services and other addiction-related needs. But the judge concluded it would cost $572 million to address the crisis in the first year based on the state’s plan. He said the state did not provide “sufficient evidence” of the time and money needed to respond after that.

At a news conference following the decision, Oklahoma Attorney General Mike Hunter described it as a “great triumph” two years in the making.

But just moments after the judge ruled, Johnson & Johnson, which has denied wrongdoing, said it would appeal. Company attorney Sabrina Strong said at a news conference, “We are disappointed and disagree with the judge’s decision. We believe it is flawed.

“We have sympathy for those who suffer from opioid use disorder,” Strong added. “But Johnson & Johnson did not cause the opioid abuse crisis here in Oklahoma or anywhere in this country.”

Elizabeth Chamblee Burch, a professor at the University of Georgia School of Law who followed the case, said in an email that other states will almost certainly adopt some of Oklahoma’s strategy — for instance, arguing for Johnson & Johnson’s culpability because it had two subsidiaries that produced, refined and supplied the ingredients for opioids to many other companies.

But with state laws differing, it is unclear whether other plaintiffs would be successful at proving the company harmed their residents, she said.
Alexandra Lahav, a professor at the University of Connecticut School of Law, said it’s too early to predict the impact of Balkman’s decision on future cases.

“I think it’s important that people remember that this is just Oklahoma law, and it’s a lower court judge,” she said. “It hasn’t been vetted on appeal yet.”

Still, she said, the ruling may provide momentum to the idea that there is merit to these claims and encourage other states to pursue similar strategies.

As an outside observer, Lahav said, she is not convinced that Johnson & Johnson’s role as supplier of raw materials to other drug companies sufficiently connects it to the opioid crisis. But Balkman clearly accepted that, she said.

“I’m unconvinced that should be laid at Johnson & Johnson’s door,” she said.

Hunter (R) brought suit in 2017 against Johnson & Johnson and two other major drug companies, accusing them of creating “a public nuisance” by showering the state with opioids while downplaying the drugs’ addictive potential and persuading physicians to prescribe them even for minor aches and pains. Before the late 1990s, physicians reserved the powerful drugs primarily for cancer and post-surgical pain, as well as end-of-life care.

More than 6,000 Oklahomans have died of painkiller overdoses since 2000, the state charged in court papers, as the number of opioid prescriptions dispensed by pharmacies reached 479 every hour in 2017.

Johnson & Johnson’s products — a prescription opioid pill and a fentanyl skin patch sold by its subsidiary, Janssen Pharmaceuticals — were a small part of the painkillers consumed in Oklahoma. But Hunter painted the company as an industry “kingpin” because two other companies it owned had grown, processed and supplied 60 percent of the ingredients in painkillers sold by most drug companies.

“At the root of this crisis was Johnson & Johnson, a company that literally created the poppy that became the source of the opioid crisis,” the state charged.

The state also said the health-care giant actively took part in the industry’s effort to change doctors’ reluctance to prescribe opioids by mounting an aggressive misinformation campaign that targeted the least knowledgeable physicians.

The company’s “marketing scheme was driven by a desire to make billions for their pain franchise,” Hunter wrote. “To do this, they developed and carried out a plan to directly influence and convince doctors to prescribe more and more opioids, despite the fact that defendants knew increasing the supply of opioids would lead to abuse, addiction, misuse, death and crime.”

I didn’t follow this case closely and quite honestly haven’t dived deeply into the complex issues surrounding the opioid crisis in the United States beyond what’s been covered in the news. It seems to me, though, that this verdict is excessive and that the ruling itself ends up assigning far more liability to Johnson & Johnson and its subsidiaries than the evidence supported either in the case that was laid out before him or in what we know about the opioid crisis in general and the factors that have helped create what some people call the “Hillbilly Heroin” phenomenon that has led to overdose deaths, suicides, and other issues related to drug addiction.

As German Lopez at Vox has noted, the opioid epidemic essentially has taken the form of three phases:

The opioid epidemic can be understood in three waves. In the first wave, starting in the late 1990s and early 2000s, doctors prescribed a lot of opioid painkillers. That caused the drugs to proliferate to widespread misuse and addiction — among not just patients but also friends and family of patients, teens who took the drugs from their parents’ medicine cabinets, and people who bought excess pills from the black market.

A second wave of drug overdoses took off in the 2000s when heroin flooded the illicit market, as drug dealers and traffickers took advantage of a new population of people who used opioids but had either lost access to painkillers or simply sought a better, cheaper high. And in recent years, the US has seen a third wave, as illicit fentanyls offer an even more potent, cheaper — and deadlier — alternative to heroin.

It’s the first wave that really kicked off the opioid crisis — and where opioid makers and distributors come in.

Manufacturers of the drugs misleadingly marketed opioid painkillers as safe and effective, with multiple studies tying the marketing and proliferation of opioids to misuse, addiction, and overdoses. Opioid makers like Johnson & Johnson, PurdueEndoTeva, and Insys are all accused of playing a role here.

As a group of public health experts explained in the Annual Review of Public Health, the companies exaggerated the benefits and safety of their products, supported advocacy groups and “education” campaigns that encouraged widespread use of opioids, and lobbied lawmakers to loosen access to the drugs.

The result: As opioid sales grew, so did addiction and overdoses.

Obviously, the drug manufacturers and the medical profession played a role in all of this in the drugs were often marketed as being safe, effective, non-addictive medications that could relieve chronic pain or pain associated with surgery or medical treatment. It seems fairly clear, though, that a good part of the responsibility for the first wave of the addiction crisis that Lopez wrote about lies with doctors who handed out prescriptions for opioids like they were, well, candy and many people took them believing that they were ingesting a safe and non-addictive product.

For many people, course, that’s exactly what Oxycodone and other manufactured opioids were, and for many people, they were an essential part of dealing with the pain associated with surgery or injury. When I had my wisdom teeth pulled, for example, I was given a prescription for one of these opioid drugs in case I needed it. The same thing happened many years ago when an at-home accident resulted in a trip to the emergency room and more stitches than I care to admit to at this point. In neither case did I bother to have the prescription filled nor did I use the pills I was given because, well, I didn’t need them. That’s not always true of people who were in the situation(s) I was in, and the fact that this new class of drugs existed that allowed them to function without being in pain seems to me like it was a positive thing, not a negative one.

Opioid drugs have also meant the difference between a bearable and unbearable life with chronic back pain and other issues that made simple tasks impossible. To argue now that the drugs themselves are responsible for the entire addiction crisis, rather than the people who used the drugs for illicit purposes or engaged in illegal schemes to obtain them on the black market is to argue, falsely, that opioid are essentially no different from tobacco products which, even when used properly, ultimately lead to cancer, emphysema, and other diseases.

The final problem with the ruling and verdict in this case is the fact that the evidence developed at trial appears to show that Johnson & Johnson and its subsidiaries played only a small role in the market and distribution of these drugs in Oklahoma specifically. Additionally, it’s worth noting again the manufacturers and distributors of these drugs are not the ones who put them in the hands of patients and users. The responsibility for that lies with the medical profession and the individual doctors who wrote prescriptions for these drugs whenever their patients complained of pain. The fact that they in general, and J&J in particular, are being targeted is largely due to the fact that its the drug companies that have deep pockets.

Johnson & Johnson has already announced their intention to appeal the ruling, which will make its way through the Oklahoma appellate court system and, if there are any Federal issues involved, could ultimately end up before the U.S. Supreme Court. At issue in the appeal will likely be the extent to which the evidence justified holding J&J responsible for all of the demonstrable damage that Oklahoma claimed in the case and the size of the damage award which, although it was far below the $17 billion that the state was requesting, still seems to me to be rather excessive. In the meantime, with this ruling in the books, look for other states to pursue similar lines of argument both against these defendants and against other drug manufacturers involved in the sale and marketing of opioids. Whether any of that will help the people suffering from addiction is another question entirely.

Here’s the Court’s ruling:

Oklahoma Et Al v. Johnson &… by Doug Mataconis on Scribd

FILED UNDER: Health, Law and the Courts, , ,
Doug Mataconis
About Doug Mataconis
Doug holds a B.A. in Political Science from Rutgers University and J.D. from George Mason University School of Law. He joined the staff of OTB in May 2010. Before joining OTB, he wrote at Below The BeltwayThe Liberty Papers, and United Liberty Follow Doug on Twitter | Facebook

Comments

  1. Just Another Ex-Republican says:

    This one is really hard for me. My dad has struggled for decades with chronic back pain from an injury sustained in the 60’s. He’s had multiple surgeries that never really solved the pain, gone through years and years of physical therapy, and it just kept getting worse as he got older (now in his late 70’s). Opioids finally helped-but they have become almost impossible to obtain, especially for an elderly man whose primary care and pain specialist retired within a couple months of each other. Over a 10 year history of the prescription (showing no signs of abuse and a steady use rate), but no one will approve it again without going through physical therapy and recommending additional surgeries first. It’s maddening, and another example of how an understandable desire to prevent abuse has unintentionally caused problems for legit users.

    I have no doubt the epidemic is real, and a good portion of the blame should go to greedy drug companies and doctors who saw $ instead of patients. But how do we handle that without putting people like my father through, literally, over a year of almost daily agonizing pain between one subscription ending after his original pain specialist retired, and another specialist (and sub-specialists for test after test, and every one of them with a huge backlog) working through their due diligence to get him a new prescription?

    Impossible to discuss with him too. I don’t dare mention an epidemic to him any more, because as far as he’s concerned approximately 40,000 people a year dying of overdoses is a rounding error in mortality stats, not an epidemic that justifies him going through hell. And while I disagree with my MAGA father on just about everything else, I’m not sure he’s wrong here.

    And the more million/billion dollar lawsuits that go through, the harder and harder it will get for people with a legitimate need.

  2. KM says:

    @Just Another Ex-Republican:

    a good portion of the blame should go to greedy drug companies and doctors who saw $ instead of patients.

    Warning: unpopular opinion. I’m definitely getting downvoted for this.

    While drug companies due indeed see you as only walking ATMs, I have to question this common conceit: what is it that makes people think that they’d be any different then a capitalist company producing a product. Of *COURSE* they want your money – do you think they do this for fun? Of course they’ll lie and fib and fudge wherever they can – that’s what any corporation can and will do if they have half a chance. Why we treat the medical field as somehow sacred is beyond me. For god’s sake, they decided pain was a disease in it’s own right instead of a warning symptom to another issue. That would be like treating the blinking lights on your dashboard as a separate ongoing problem to be managed instead of telling you things like your engine’s about to crap out on you.

    My contention is most of the blame lies on a populace that’s glad to pop pills for anything and everything without question. When the doctor gives you a prescription, ask questions. Don’t just fill it and stuff it in your mouth. Ask what it is, why they are giving it to you and if there are alternatives. Doctors are not perfect and they are not the boss of you. Far too many people happily accept as gospel everything they hear because it’s the path of least resistance. Chronic back pain? Well, we can do physio or surgery or life-style changes….. nah, take the happy pill and the pain floats away. It’s easy to ingest something – it’s hard to revamp your life to deal with a chronic illness. I know someone in their 40’s who’s got a box full of meds they take daily “for their bad knees” because they don’t want to do the walking regimen and have let their legs muscles damn near atrophy. They *can* walk but they don’t want to because it hurts. It will stop hurting if they walk regularly to build up the muscle but that initial pain and effort isn’t worth it. Why bother when a pill makes it stop? So what if it became 2 pills, 3 pills, a whole handful? It’s easier!

    Other countries don’t really have this problem because they weren’t bombarded with ads that promised instant gratification. Americans were promised “what back pain?” and ran with it. We internalized the notion we should *never* be in pain and that it’s better to be dependent on a substance then suffer. We can blame Big Pharma all we want but in the end, they’re out there to sell a product and you need a willing market for it. The lies worked because it’s what we wanted to hear and gave us the quick shortcut instead of real healing. Until that mindset changes, we’ll just see a new crisis in a few years.

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  3. Mister Bluster says:

    So does this mean that the recovering drug addict Rush Limbaugh will have to take up residence in tha Sooner State to gain any benefit from this decision?

    Before his addiction became known, Limbaugh had condemned illegal drug use on his television program, stating that “Drug use, some might say, is destroying this country… And so if people are violating the law by doing drugs, they ought to be accused and they ought to be convicted and they ought to be sent up.”
    WikiP

  4. Slugger says:

    The pharmaceutical industry is very heavily regulated. Many of these regulations create exclusive licenses to make, distribute, and market. They give monopoly power over things that can be literally life-saving and enhancing to the manufacturers. Obviously, power can be misused as long as people not angels run things. The opiate makers broke their end of the deal by false and misleading marketing to doctors and patients. I don’t know the relevant state laws, in fact I think that lawmakers are often heavily influenced by the regulated to the expense of the public interest, but I am not boo-hooing this result.

  5. grumpy realist says:

    How much of the opioid plague is due to the pharmaceutical manufacturers, how much is due to the pharmacies all too willing to disperse ridiculous amounts (far more than would be needed for the local population), and how much due to the doctors over-prescribing?

    How much addiction is due to people starting off by taking opioids for pain control and then getting hooked, versus people who start taking the pills because they’re bored, can’t find a good job, and the only thing to do is video games/naughty movies/pills?

    (P.S. I was provided with a few pills after my breast operation but I quickly segued over to using ice bags instead due to the side effects. Talk about being doped up!)

  6. Just Another Ex-Republican says:

    @KM: I don’t actually disagree with that much KM. I’m happy to add oversight and cultural issues to the list of problems.

    It’s boggling to me how our medical system is simultaneously over-regulated in some ways, and wildly under-regulated in others. I do think the decision a few decades back to allow drugmakers to advertise directly to end-consumers did no favors to anyone except the manufacturers and has caused much of the cultural issues you and others mention, while also incentivizing some common big business marketing techniques to promote sales that never should have been allowed.

    I certainly don’t have any glib answers to the problems. It’s a mess. Even stopping big pharma from direct advertising probably isn’t possible-the fightback about big government stopping you the consumer from making your own decisions would be impossible to defeat (even though the idea that your average consumer has a bleeping clue about how to diagnose and treat their medical issues is ludicrous).

  7. gVOR08 says:

    They gave me bottle of Oxycodone after I broke my arm. I took a couple as directed. Haven’t felt like that since the sixties. (Yes, I’m that old.) For about twenty minutes Rush Limbaugh started to make sense. By then we were aware of the addiction risk and the industrial strength Tylenol or whatever they were seemed adequate to more or less let me sleep, so I passed on any further Ocycodone.

    Additionally, it’s worth noting again the manufacturers and distributors of these drugs are not the ones who put them in the hands of patients and users. The responsibility for that lies with the medical profession and the individual doctors who wrote prescriptions for these drugs whenever their patients complained of pain.

    But,

    Manufacturers of the drugs misleadingly marketed opioid painkillers as safe and effective, with multiple studies tying the marketing and proliferation of opioids to misuse, addiction, and overdoses. Opioid makers like Johnson & Johnson, Purdue, Endo, Teva, and Insys are all accused of playing a role here.

    As a group of public health experts explained in the Annual Review of Public Health, the companies exaggerated the benefits and safety of their products, supported advocacy groups and “education” campaigns that encouraged widespread use of opioids, and lobbied lawmakers to loosen access to the drugs.

    The result: As opioid sales grew, so did addiction and overdoses.

    OK, the doctors prescribed, but I don’t see how J&J doesn’t bear some responsibility if they lied to the doctors.

  8. steve says:

    I lived through this while in practice and have followed it pretty closely, though I am more familiar with the case against Purdue. What you need to remember is that drug companies developed these narcotics then advertised them as having a very low addiction risk, while providing studies that “proved” their claims. Simultaneously it was also the drug companies behind the effort to make pain the 5th vital sign. At the time, I thought it was too good to be true. We have always wanted narcotics that dont cause addiction (or respiratory depression) so I can understand people believing the data drug companies provided, but it just seemed like it was too good to be true. Since I just do OR and ICU stuff I dont deal with oral meds much, so maybe if I were a PCP I would have fallen for it also, I dont know.

    That said, I think the evidence is pretty good that the drug companies mislead providers, and it is also clear that they knew drugs were being sold in abnormally high amounts, more than could be accounted for by normal consumption, in some areas of the country. Pharmacies in tiny towns selling enough pain pills to supply a largish city.

    Steve

  9. gVOR08 says:

    @Just Another Ex-Republican:

    It’s boggling to me how our medical system is simultaneously over-regulated in some ways, and wildly under-regulated in others.

    I’m afraid I laugh whenever I see a reference to the our “health care system”. We don’t have a system. We have a collection of individual organizations with an overlaying patchwork of regulation. No one organized it, it just grew.

  10. Moosebreath says:

    @gVOR08:

    “They gave me bottle of Oxycodone after I broke my arm. I took a couple as directed. Haven’t felt like that since the sixties.”

    Not quite being as old as you, but my experience is similar. In the early ’90’s, I stepped on a nail which went through my sneaker and created a puncture wound on the ball of my foot. The hospital gave me Percocet and told me to take a half, one if really needed. I took a half that night, and my last thought for the evening was, “I am not sure if I could get out of this bed if it were on fire.”

    A few months later, one of my wisdom teeth which had long since come in took a turn into my cheek. I saw the oral surgeon for a consultation, and he said, “This is nothing. Do you want me to take it out right now?” So he shot me with novocaine and removed it. He gave me a Percocet prescription if I needed it, and I decided not to have it filled.

  11. An Interested Party says:

    Obviously, the drug manufacturers and the medical profession played a role in all of this in the drugs were often marketed as being safe, effective, non-addictive medications that could relieve chronic pain or pain associated with surgery or medical treatment. It seems fairly clear, though, that a good part of the responsibility for the first wave of the addiction crisis that Lopez wrote about lies with doctors who handed out prescriptions for opioids like they were, well, candy and many people took them believing that they were ingesting a safe and non-addictive product.

    Somebody explain why it would be so horrible to get rid of or substantially reduce private insurers and no longer treat health care as a for-profit business enterprise…

  12. Just Another Ex-Republican says:

    @gVOR08: Yeah, it’s almost like it’s an incoherent, disorganized, illogical mess or something.

  13. Carol says:

    I’ve never understood the addictive attraction to these drugs. They alleviate pain, but don’t give you a buzz. If you have chronic pain then the source of the pain needs to be addressed and that isn’t the responsibility of the drug companies. If the result of all this hoopla is that these drugs are off the market for people who actually need them, it will be a tragedy.

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  14. Just nutha ignint cracker says:

    @Moosebreath: @gVOR08: My situation is completely different. The opioids don’t seem to offer me any pain relief at all and I’ve never had the sensation of being “high” from taking anything. My guess is that because I took Theophyline-based medications for asthma for roughly 25 years, the sensations associated with drug euphoria may be pretty blunted. When I first started taking Quadranal (iirc) when I was about 6 or 7 I remember it making me dizzy the first few times I took it, but I was young and adapted quickly.

    Fortunately, I’ve always had a fairly high pain threshold, so I don’t even have much history using aspirin except for fever reduction a few times. Mostly I remember being told to drink ice water when I had a fever.

  15. Just nuther ignint cracker says:

    @An Interested Party: Because capitalism, that’s why! Also because the money looks really good in one’s wallet.

  16. gVOR08 says:

    Just hearing that there is a combined suit against Purdue in Ohio. Described as the largest civil suit in history. Purdue apparently just offered a 10-12 billion dollar settlement, threatening that otherwise they’ll declare bankruptcy, leaving much less.

  17. Bob@Youngstown says:

    @gVOR08: I’ll be the first to admit that I’m not a bankruptcy expert… but doesn’t Purdue’s offer of a 10-12 billion settlement suggest that Purdue has assets in excess of 10-12 billion? (OTOH, are they expecting their insurer to pony up 10-12 billion).

    If Purdue has 10-12 billion in net worth, why would a bankruptcy (dissolving and liquidating) result in a value “much less than the 10-12”

  18. Richard Gardner says:

    Interesting stuff on the conservative Mormon (LDS) judge (from just before the decision) https://www.cnn.com/2019/08/26/health/oklahoma-opioid-judge-thad-balkman-profile/index.html – bottom line is he is respected from both sides of the aisle.

  19. Jen says:

    The sooner we can figure out why some people become hopelessly addicted and others have no problem stopping, the better. I know two people who were prescribed opioids and became addicted, both died by suicide after becoming unable to tolerate life because of the addiction.

    Here in NH, one of the most distressing aspects of the over-prescribing of opioids is the number of high school athletes who became addicted. Tons of data and research about teen brains and addiction out there, and yet doctors handed these prescriptions out, based on manufacturer assurances they were safe.

    Do I wish the people who need them could get them with no problem? Yes, of course. But manufacturers do share in the blame for misleading doctors (who really should have known better, I’m with Steve on this–I just don’t get how anyone could look at a medication based on opioids and not think “how can that *not* be addictive?”), and the only thing that seems to get through to corporations are large jury verdicts.

  20. grumpy realist says:

    Most of the instances we’ve mentioned here have been for non-chronic, temporary pain (broken arm, recovering from surgery, etc.) I can see how the simple relief from acute, chronic pain could set up a dependency by itself. (And how do we know whether that’s an addiction to the opioid and how much relief from the pain.)

  21. KM says:

    @Bob@Youngstown:
    Depending on how it’s structured, they may be counting on future sales to offset it. Yeah, you won X billion dollars but when is the first payment due, let alone the last? If it’s something like 20-30 years it’s a definite dent in the bottom line but not insurmountable for a company like Purdue.

    Also, we need to look into where that money is going. What’s the money being used for and how much of it is going to end right back up in their coffers? After all, if it’s going to something like counseling or treatment, how many individuals affiliated with these companies would be in prime position to recoup some of that cash?

  22. KM says:

    @grumpy realist:

    And how do we know whether that’s an addiction to the opioid and how much relief from the pain.

    We don’t, just like we don’t know if it’s truly “pain” or “discomfort” (for lack of a better term)… and yes, there’s a difference between the two. Discomfort is a lingering headache you can’t shake but coffee or a aspirin can alleviate. You can still function but it sucks – an opioid is overkill here, taken more as habit rather then need. Pain is a migraine that means you can’t stand a speck of light or it drives an ice pick through your skull and you vomit for 2 hours. An opioid here may be the only method of relief.

    One of the things that was noted when the pain scale went into use was that most people tended to over-inflate the number unless given some sort of boundary limit. “How’s the headache? OMG, it’s a 8!” vs “On a scale of 1-10 where 1 is relatively pain-free and 10 is the worst pain you can imagine, how’s the headache? Oh, like a 2 or something, can I have an Advil please?” Context is everything and if your context is zero pain, any pain is way too much.

    I’m not denying people are in pain – I’m saying their sense of pain has been wildly distorted by the new cultural assumption that the natural state of being is utterly painless. To quote the Princess Bride, “Life is pain, highness. Anyone who says differently is selling something.”
    Normal aches and pains aren’t even a 1 on the scale but for some reason, we’ve forgotten it’s entirely normal to be a bit achy from life as we get older or prolonged physical activity over a lifetime. People understand relief from acute pain but it’s the lingering “I don’t feel well” that’s really what fuels addiction. There’s always something that can count as being “not well” so your brain rationalizes the continued use well after true pain has faded into lingering discomfort.

  23. Bob@Youngstown says:

    @Jen:

    the only thing that seems to get through to corporations are large jury verdicts.

    I’m not so sure of that anymore. What might be even more effective is a CEO or a corporate board in a jail cell.

  24. Bob@Youngstown says:

    IMO, there is no single “party” to blame here. As it relates to prescription opioids, manufacturers, distributors, pharmacies, physicians and consumers all share some responsibility for the overall problem. Who I don’t think should be held responsible are folks like Ex-Republican’s Dad, neither should they be victimized.

    Oh, if I had a magic wand, (or a reliable diagnostic test) that prescribers would be able to discriminate between those in actual, unrelenting, physical pain versus those who are temporarily discomforted. Even better if that magic wand were able to discriminate between those patients who will become addicted (physiological craving versus psychological craving), responsible physicians could counsel patients on the outcome of opioid usage.

    In the meanwhile (waiting to develop that wand or diagnostic) responsible physicians and patients have to be vigilant to symptoms of physiologic craving in absence of actual pain.

    What we don’t need, and what should be punished, are manufacturers that insist, despite evidence to the contrary, that opioids are completely safe for use. What we don’t need are members of the supply chain that cast a blind eye to over-serving, in disregard of a responsibility to alert authorities that communities (particularly rural, where the mobility of consumers is more-or-less stable) are being supplied at rates that are inexplicable.

  25. gVOR08 says:

    @Bob@Youngstown: But we don’t do that. Yes, Sacklers should go to jail, but that doesn’t seem to be on the table.

    Read an article years ago to the effect that other countries offer universal health care and regulate things like drugs more effectively. IIRC an example was that we regulate the heck out of drug tests but have no national database of drug results after they’re on the market. The only quality control we impose is the clumsy one of our absurd tort system.

  26. Raoul says:

    I don’t think the way to make public policy is having each state sue one at a time- can we have a settlement like we did with tobacco?

  27. Bob@Youngstown says:

    @Raoul: I think that is what is happening in the Cleveland case.

  28. Kathy says:

    This relates to something I’ve been pondering lately. For the past three decades, companies, especially big ones, have set up the goal of making money and maximizing share value.

    This has always been the case, yes, but in the past companies took pride in making a product or providing a service that people found valuable enough to pay for, as well as being a good place to work at. So the goal was to make money by making a good product. Merely making money wasn’t enough.

    Now it is. And the result is that everything else, including having a good product or service, is secondary to the larger goals.

    Opioids are a good example. they’re not a valuable product for most people, although they are for some. Compare them to chemotherapy, antibiotics, anti-viral drugs, or even aspirin. If you don’t have cancer, an infection, or a headache, these drugs have no value for you. That is, you won’t spend money on them if you don’t need them.

    The value of opioids is limited, too. But several drug companies, intent on making money, managed to sell them to people who didn’t need them, and ordinarily wouldn’t have paid for them.

    I agree the notion of “taking something” helps in this regard. But that’s not limited to America. Every time I have a cold, I get asked “What are you taking for it?” My replay is always: “Nothing.” This is followed by recommendations for antibiotics, vitamin C pills, or even Tamiflu. so this story could well be repeated elsewhere.

  29. Just nutha ignint cracker says:

    @Kathy: I always took newspaper capsules. They were specially treated newsprint dust in capsule form. You’d take 2 the first night of your cold, get lots of bedrest, drink lots of fluids, and in 3 or 4 days, your cold would be gone. They were amazing! 😛

  30. Tyrell says:

    @grumpy realist: Yes, there is something wrong with the system. Some people play the revolving doctor game. They visit several different doctors and get prescriptions from each of them. Evidently there is no database or system that can stop that sort of thing.

  31. Kathy says:

    @Just nutha ignint cracker:

    I’ve manged to avoid catching cold two years running now. My method consists of two simple things: 1) using alcohol gel on my hands often, especially after touching another person, and 2) drinking some milk almost every day (not much, about 1.25-1.5 cups between the morning oatmeal and putting a little milk in my coffee); the notion is getting enough vitamin D helps far more than getting an overdose of vitamin C (I do get plenty of vitamin C anyway).

    I’m not sure how much the vitamin D helps. I’m sure killing germs off my hands does help (I also avoid touching my eyes, ears, nose, and mouth).

  32. Gustopher says:

    @Kathy: The Vitamin D theory is intriguing. Perhaps my “I have a cold” drink should be a White Russian rather than a Screwdriver.

    Alcohol definitely helps a cold. Or at least helps me deal with the horrors of life that is a cold.

  33. An Interested Party says:

    What might be even more effective is a CEO or a corporate board in a jail cell.

    If only…it’s funny how corporations seem to get all the benefits of personhood but none of the liabilities…

  34. Just nutha ignint cracker says:

    @Tyrell:

    Evidently there is no database or system that can stop that sort of thing.

    Yes indeed. The computerized data base was a feature of Obamacare that conservatives objected to. Free market to the rescue again!

  35. Matt says:

    @grumpy realist: Over a decade ago I worked at a job that hired a lot of high school aged kids. I remember vividly being told more than once by different kids that popping Vicodin was fine because it was legal so it had to be safe…..

    @Just nutha ignint cracker: Well if that kind of database existed you know damned well Tyrell would be complaining about it’s nebulous existence and stuff…