After a year of drug document subpoenas, interviews, and fact finding, the City of Chicago filed a lawsuit Monday against five pharmaceutical companies alleging that they deceptively marketed opioid painkillers like Percocet and OxyContin for chronic pain management, even though the companies knew the drugs were ineffective at treating chronic pain and carried a high risk of addiction.
The deceptive marketing practices have caused health problems in Chicago, the city alleged in a release, stating that opioid misuse resulted in 1,080 emergency room visits in Chicago in 2009. The city seeks to end deceptive marketing practices and seeks punitive damages. The city claims that the City's Health Insurance plan "has reimbursed claims for approximately $9.5 million on these drugs since 2008."
Chicago's lawsuit has implications far beyond the city limits. If the allegations are true, they get at one root cause of the growing rates of addiction and death from opioid painkillers and heroin in the United States. Drug overdose deaths, the majority of which are caused by prescription painkillers, have more tripled since 1990, according to the CDC, and in 2010, prescription opioid painkillers caused 16,651 overdose deaths in the U.S.
In the 122-page complaint filed in Cook County Circuit Court on Monday, the City of Chicago argues that the shift in medical use of opioid painkillers was the direct result of deliberately misleading marketing from pharmaceutical companies. (Earlier this month, two counties in California filed a similar suit.) According to the complaint, "in 2010, 254 million prescriptions for opioids were filled in the U.S." (By comparison, in 2009, there were 44 million prescriptions filled for the anti-depressant, Xanax.) It also reports that "20 percent of doctors visits resulted in the prescription of an opioid." According to the press release, this accounted for a quadrupling of sales for these drugs from 1999 to 2010.
The complaint argues that the five companies named in the suit—Purdue Pharma L.P., Cephalon, Inc., Janssen Pharmaceuticals, Inc., Endo Health Solutions Inc. and Actavis plc—led to a huge market ($8 billion in revenues in 2010) for these drugs by telling doctors (incorrectly) that they were effective for chronic pain management, which now accounts for roughly 87% of the opioid prescriptions given out in this country.
"They knew—and had known for years—that opioids were too addictive and too debilitating for long-term use for chronic non-cancer pain," the complaint reads. "In order to expand the market for opioids and realize blockbuster profits, Defendants needed to create a sea-change in medical and public perception that would permit the use of opioids for long periods of time to treat more common aches and pains, like lower back pain, arthritis, and headaches."
Purdue Pharma declined to comment. Teva, which owns Cephalon, Janssen, Endo, and Actavis could not be immediately reached for comment.
How did we get here? The recreational use of opioid painkillers began with a sea-change in the way doctors prescribed prescription painkillers, experts say. According to the CDC, there has been a tenfold increase in medical use of opioid painkillers for the treatment of pain since 1990.
This began, says Dr Jason Jerry, a psychiatrist and addiction expert at the Cleveland Clinic, with a cultural shift in the 1990's in the medical community's attitude toward pain and pain medication. Prior to that point, he says, most doctors wouldn't have considered using prescription painkillers for problems like low back pain. "They were for end-stage cancer pain or patients who had recently undergone surgery," he says, adding, "the marketing practices in the pharmaceutical industry shifted the culture of medicine to the point that there was a fifth vital sign in medicine: pain."
The rise in use of prescription painkillers has also led to a resurgence in heroin use. A recent analysis from JAMA Psychiatry showed that prescription drug abuse has become a gateway for heroin use. In the 1960s, 80% of heroin users (who were mostly young city dwellers) initiated heroin first, but in recent years, as users have become older and more suburban; 75% of heroin users started using heroin after getting into opioid painkillers first.
Chicago's lawsuit, if it succeeds, may mark a turning point in the epidemic of opioid abuse.