It's long been said that trends start in California. With one eye on the balance sheet and one on the legal history books, five of the world's largest drug manufacturers are probably hoping that's not true. However, shortly after Orange and Santa Clara counties filed lawsuits against those companies for waging a "campaign of deception" in the marketing of their painkillers, the City of Chicago has also joined the fight, with many other state and local governments paying close attention and exploring their options. Any hope that the Golden State isn't blazing another new trail, it appears, may be misplaced.
While the legal basis of the California lawsuits might sound slightly mundane -- that the drug companies broke the law regarding false advertising, unfair business practices and creating a public nuisance -- the damage alleged is anything but: These companies have created a nationwide "population of addicts." Chicago's lawsuit rests on a similar legal theory, namely that the pharmaceutical companies in question used deliberately misleading marketing techniques to cause an explosion in prescriptions for, and sales of, some of the most addictive chemical compounds man has ever engineered: opioid painkillers.
Announcing the lawsuit, Chicago Mayor Rahm Emanuel laid the blame for the nation's opioid epidemic squarely at the feet of "big pharma." Deceiving the public in order to expand their customer base and increase their bottom line, Emanuel said, has been an ongoing practice of opioid manufacturers for years, and it's time to say "enough is enough." As a clinician whose work offers a daily glimpse into the nightmare world of how these powerful narcotics are ravaging America, and as an attorney, I couldn't agree with him or these lawsuits more. Yes, if this is, as Businessweek calls it, Rahm Emanuel's War on Drugs, sign me up.
But rather than comparing these legitimate attempts at holding drug makers accountable for their misdeeds to the portrait of inefficacy known as the "war on drugs," a more analogous relationship can be found with the "big tobacco" litigation of the nineties. As the New York Times and others have noted, there are important parallels between the current lawsuits and the ones two decades ago, which resulted in a $246 billion settlement. Chief among them in my mind? That government entities sued to address a public health problem and force changes in an industry with a knack for multitasking: minting money while stuffing body bags.
So how, exactly, have the makers of these pain medications duped the public and unleashed this grim, widespread and underreported health crisis? According to the lawsuits, they aggressively and dishonestly marketed opioids as rarely addictive (which is astoundingly, shockingly untrue) while simultaneously promoting the drugs as safe and effective for a wide range of conditions for which they are not, including chronic pain. Downplaying the risk while overselling the benefits? Again with the multitasking.
To fully understand the scope of the problem these lawsuits seek to address is to grapple with disbelief. The death toll from prescription drug overdoses -- driven primarily by opioid painkillers -- has increased every year for 11 years straight, with painkiller overdoses sending more than 16,000 Americans to their grave in 2010 alone. And that's just the number of outright deaths, which doesn't even scratch the surface compared to the numbers of people who find their bodies addicted, their brains hijacked and their lives ruined by these drugs. Every day, more than 5,000 people start using prescription opioids for nonmedical purposes, 1 in 20 people in the U.S. (age 12 or older) reported using prescription painkillers for nonmedical reasons in the past year, and enough prescription painkillers are prescribed annually to medicate every American adult around the clock for a month. As if these numbers -- some of which are probably on the low end due to the nature of self reporting -- weren't bad enough, there's another sinister row to the domino trail of death tipped into motion by big pharma's greed: the recent surge in heroin addiction.
What do prescription painkillers have to do with heroin addiction? A lot. An awful lot. Both derived from the poppy plant, the contents of FDA-blessed opioid pills and cartel-smuggled heroin bags act on the human body in a very similar, very potent way. The powerful high produced by the drugs is similar, the tolerance and cravings that quickly develop are similar, the lethality is similar, and more and more these days the user profile is similar. In fact, people who were previously using or abusing prescription opioids make up the largest percentage of new initiates into heroin use. Why? Largely because of one thing prescription painkillers and heroin don't have in common -- their price tag.
Both the California and Chicago lawsuits open with the same, telling line: "A pharmaceutical manufacturer should never place its desire for profits above the health and well-being of its customers." And it's that word -- profit -- that highlights the relevant difference between opioid painkillers and heroin for the addict who is trying to procure them. One is expensive, one is cheap. You unwittingly get hooked on the expensive stuff and, assuming you're not as wealthy as big pharma, you eventually find yourself desperately resorting to the cheap stuff. If this sounds like some sort of fantastical leap -- from doctor-prescribed medication to dealer-slung dope -- it is not. It is common, it is utterly heartbreaking, and it is all too real.
But will lawsuits aimed at holding pharmaceutical companies responsible for the damage they've done make any of it less real? Will it bring any of the victims back, restore any of the lives and livelihoods lost, or repair any of the families ripped apart? Will it mend any of the broken hearts or heal any of the tormented minds? No. It won't do any of that. But what it might do is stem the tide, and slow the bleeding. It might force the manufacturers of these drugs -- drugs which are entirely appropriate and useful in certain situations -- to stop marketing them as something they're not, and to stop denying how dangerous they really are. Ironically, what these lawsuits might accomplish is to curtail future infliction of the very thing these drugs are advertised to relieve -- pain.
The tobacco litigation of the '90s eventually came to be known in our everyday language simply as the "big tobacco lawsuit" and the "big tobacco settlement." This shorthand referred primarily to the fact that it was the biggest tobacco manufacturers who were the named defendants, but it also made sense for other reasons. The scope of the problem they created was big, and so was the dollar figure eventually placed on their culpability. As the California and Chicago lawsuits, as well as any progeny they may inspire move forward, maybe we'll start to refer to them simply as "Big Pain," and for all the same reasons.
*The opinions expressed are solely those of Patrick R. Krill.