Fentanyl is a potent opioid analgesic and has been the center of the opioid and overdose epidemic. As an illicit agent, fentanyl is often in the form of a powder, which is then either insufflated (the fancy medical term for snorting) or dissolved in water and injected intravenously. It is fifty to one-hundred times more potent than heroin, the drug it replaced as the illicit opioid of choice. It can cause significant euphoria and analgesia, which is why it is so widely used. It can also cause respiratory depression or complete respiratory arrest, the reason it can be so deadly. It is readily absorbed when insufflated or injected and the actions are almost immediate. These are the facts.
By Jennifer Oliva and Nicolas P. Terry
The much publicized settlement between Purdue Pharma, its Sackler family owners, and the Oklahoma attorney general that we have discussed here, here, and here, posed an overarching question: Post-Oklahoma, would the opioid litigation center of gravity swing back from the states to the federal opioid multidistrict litigation in Cleveland (discussed in detail here)?
A month later, the Cleveland case remains muted, particularly so for the reporters trying to cover what is happening in Judge Polster’s courtroom where, once again, sunshine seems discouraged. In contrast, outside the Northern District of Ohio, the action has been fast and furious and that’s before the promised Oklahoma trial against the non-Purdue defendants.
Speaking of settlements, West Virginia, the state with the highest drug overdose rate in the United States, settled its claims against “Big Three” drug distributor McKesson Corporation for $37 million on May 2. West Virginia had accused McKesson (America’s largest drug distributor and seventh on the 2019 Forbes Fortune 500 list with an annual revenue north of $208 billion), of negligently flooding the state with prescription opioids.
West Virginia’s complaint against McKesson was damning, alleging, among other things, that the drug distributor sent approximately 1.4 million prescription opioids or 118 opioid painkillers per resident to modestly-sized Grant County, West Virginia alone over a five-year period. Read More
By Faith Khalik
During the case’s first hearing in January 2018, Judge Dan Aaron Polster told lawyers that he expected to see a settlement that would reduce the adverse public health impact of the opioid crisis, instead of just “moving money around.” The amicus brief submitted by PHLW et al. proposes just that: a settlement that includes a framework for addressing the opioid crisis and has a meaningful positive impact on public health.
Specifically, the brief proposes the creation of a nonprofit foundation to monitor the settlement’s implementation, participate in development and implementation of evidence-based programmatic initiatives, and administer funding for local treatment and prevention resources.
In my last post about recent developments in American aggregate opioid litigation, I teased about a future segment documenting a fantastic conversation with Professor Elizabeth Chamblee Burch. This post delivers that promise. Professor Burch is Fuller E. Callaway Chair of Law at the University of Georgia School of Law and an expert in complex litigation, mass torts, multidistrict litigation, and civil procedure.
Readers can access her impressive scholarly contributions on these topics here.
As Professor Burch elucidates in her research, the United States civil justice system has witnessed the waning of class certification cases and, concomitantly, the rise of multidistrict litigation (MDL) to resolve high-stakes, aggregate civil disputes.
This trend includes the massive national multidistrict litigation currently pending in the United States District Court for the Northern District of Ohio (Opioid MDL). Unlike class certification litigation, which is governed by Federal Rule of Civil Procedure 23, the MDL process is subject to the 1968 Multidistrict Litigation Act. Read More
Jennifer Oliva’s insightful commentary on Oklahoma’s settlement with Purdue Pharma and the Sackler family detailed the settlement terms and posed important questions about the sufficiency of the agreed damages. I’d like to push a little further on a couple of fronts.
First, what does the journey from Cleveland, Ohio to Norman, Oklahoma tell us about the opioid litigation and the multi-district (MDL) process, some aspects of which I have addressed elsewhere. Second, while dollar figures (expressed in profits, harms, and even philanthropy) have dominated the headlines, should we be paying more attention to non-monetary remedies?
The Beazley Institute for Health Law and Policy at Loyola University Chicago School of Law and Annals of Health Law & Life Sciences invite original submissions for presentations at our Thirteenth Annual Health Law Symposium: Addressing the Health Care Needs of Justice-Involved Populations. The Symposium will take place at Loyola University Chicago School of Law on Friday, November 15, 2019 beginning at 9:00am.
The Symposium will explore legal barriers that justice-involved populations face in accessing health care, and address how those barriers can be alleviated. “Justice-involved populations” generally refers to individuals who are incarcerated in prisons, jails, immigrant detention centers, juvenile detention centers, on probation, or individuals who are otherwise involved with the U.S. justice system. Read More
Media reports suffered no shortage of hot takes concerning opioid “arch-villain” Purdue Pharma’s agreement to pay $270 million to settle its OxyContin lawsuit in Oklahoma. The highlights of that settlement include Purdue’s payment of $102.5 million to fund a new Center for Addiction Studies and Treatment at Oklahoma State University, $60 million for attorney’s fees and litigation expenses, $20 million worth of drugs to treat opioid use disorder, and $12.5 million to cover the opioid-related costs incurred by Oklahoma’s local governments. Members of the Sackler family, who were not named as defendants in the litigation, also agreed to contribute an additional $75 million to Oklahoma over a five-year period.
A noteworthy concentration of the media coverage dedicated to Purdue’s Oklahoma settlement has involved speculation regarding its potential impact on the numerous outstanding opioid cases in other states as well as the myriad federal cases aggregated in the opioid multidistrict litigation (Opioid MDL) before the United States District Court for the Northern District of Ohio. The New York Times, for example, was quick to claim that the Oklahoma resolution “could jolt other settlement talks with [Purdue], including those in a consolidated collection of 1600 cases overseen” in the Opioid MDL. The Wall Street Journal similarly reported that “Purdue Pharma LP has forged the first deal to resolve more than 1,600 lawsuits blaming the OxyContin maker for fueling the opioid crisis, a move that could lay the groundwork for the resolution of the rest of the litigation.”
From 1999 to 2017, almost 218,000 people died in the United States from overdoses related to prescription opioids. Overdose deaths involving prescription opioids were five times higher in 2017 than in 1999, according to the CDC.
Previous research has indicated that patients who receive higher doses of prescription opioids have an increased risk of overdose and mortality. In response, several states have established Morphine Equivalent Daily Dose (MEDD) thresholds that convert opioid prescriptions to their equivalent dose in morphine and divides the total prescription by the number of days the prescription is intended to last, allowing for comparison among different opioid formulations and strengths. MEDD policies set thresholds for prescribers, which may only be exceeded in limited circumstances, such as when being prescribed to certain patient groups or as short-courses.
Sara Heins, PhD, an associate policy researcher at RAND Corporation, used policy surveillance to track MEDD policies through June 1, 2017 (data are available on LawAtlas.org). She published an article in Pain Medicine on March 13 that describes U.S. MEDD policies.
We asked Dr. Heins a few questions about her work and this recent publication. Read More
The opioid epidemic has hit people from all walks of life. In my duties as an acute care nurse practitioner in a busy suburban emergency department I have taken care of a lot of people who face opioid addiction, ranging from young men to elderly woman.
It is an epidemic that doesn’t discriminate. There are some people who have been hit particularly hard.
In my practice, these tend to be people with housing insecurity, job instability and who are marginalized for an array of reasons. We know that people with substance use disorder often have chronic pain or medical issues. Co-morbid trauma-related mental health issues are also very common. Efforts to reduce access to opioids has been a major component of policy and practice. This has included prescribing limits and prescription monitoring programs, with the intent that limiting access will reduce the likelihood of either initial use or ongoing substance misuse. Read More
As a nurse practitioner in a busy suburban emergency department, pain is my job. Pain is one of the most common reasons people come to an emergency department (ED). It could be abdominal pain, chest pain, back pain or even emotional pain, including depression or suicidal ideations. Pain is a driver for people seeking medical care. We have made pain into a vital sign, and we ask, “How would you rate your pain on a scale of 1 to 10?” a mandatory question for any patient who steps through our door.
This whole concept evolved circa 1987 when the Institute of Medicine urged healthcare providers to use a quantified measure for pain. It gained even more traction in 1990 when then president of the American Pain Society, Dr. Mitchell Max, called for improved means to assess and treat pain. The term “oligoanalgesia” gained popularity in the published literature, meaning that we weren’t giving enough pain medication to patients in the ED, in clinics or in any other healthcare setting. Healthcare providers responded. We asked about and we thought, more effectively treated pain to address this issue.