Several opioid manufacturers have now been sued by two California counties and the City of Chicago. The manufacturers have been accused of overselling the drugs’ benefits while understating their risks. We know today that opioids are not as effective for chronic pain as touted by drug companies in the 1990′s, and that the risk of addiction is extremely high. The higher risk and lower effectiveness wasn’t accepted science until very recently. The lawsuits ask: What did the drug manufacturers know about the drugs, and when did they know it – and, were local governments and the patients within those cities and counties lulled into thinking the painkillers were more effective and less risky than Pharma said?
Two things intrigue me about these lawsuits: First, what will happen during “discovery,” the process of the parties’ demanding production of documents, taking depositions, and seeing what evidence exists? What evidence is out there, or when it comes to a pharmaceutical company’s headquarters, what evidence is in there?
Second, what are the implications for healthcare providers who have prescribed these drugs to chronic pain patients? Will the drug companies be shown to have conducted the most careful, thorough and scientifically rigorous studies possible in coming to the novel conclusion that opioids were (after decades of belief to the contrary) generally nonaddictive when taken long-term? Is that why the FDA approved drugs like Oxycontin for long-term use? Is that why the Federation of State Medical Boards worked with the drug companies to teach the medical profession that it was now OK to prescribe strong opioids for chronic pain? Is that why in the face of a crisis of addiction, overdose and death, healthcare providers are being denounced as drug dealers in white coats, and aggressively targeted for criminal prosecution? Or might the discovery process in the lawsuits yield different evidence of what Pharma knew and when?
The basic question I think these suits will answer, as it relates to doctors, is: Is today’s opioid madness the result of bad doctoring, or were doctors and other providers misled, or insufficiently advised about risk by drug companies who stood to make billions? The outcome of the lawsuits, and the evidence produced as the suits move forward, will be critical to proper assignment of blame for today’s public health crisis. I don’t want to jump to conclusions, but I have a feeling that the FDA, the Federation of State Medical Boards, and others who accepted Pharma’s arguments and gave doctors the green light to start prescribing opioids for long-term use and chronic pain, will end up with so much egg on their faces, they’ll worry about contracting salmonella.