One big question is whether these painkillers were ever appropriate for people with chronic conditions like unexplained back pain — rather than pain linked to cancer, or a recent injury or surgery.
In 2016, when the CDC issued a new guideline for primary care doctors, it stated that there was “insufficient evidence” to back the usefulness of opioids long-term for chronic pain.
The American Academy of Pain Medicine responded that opioids are “an important option” for those with chronic pain.
But the state attorney general coalition is urging insurers to make non-opioid pain management for “chronic, non-cancer pain” a priority.
The lawsuits at hand will also examine whether the industry fairly reported the danger of addiction. From 8 to 12 percent of chronic pain patients prescribed opioids develop a problem. Some go on to become dependent on illegal drugs. About 80 percent of heroin users first took a prescription drug. Some drug users also crush up prescription pills to make them more potent.
Faced with huge costs, political leaders have turned to law firms involved in the tobacco lawsuits of the 1990s, when governments successfully cited the cost of treating diseases linked to smoking.
“The costs of this opioid crisis are more severe for governmental entities than those posed by tobacco,” said Steve Berman, who helped negotiate the $246 billion tobacco settlement in 1998. “States and cities are getting slammed with opioid-dependence costs that are a much more immediate threat than long-term illnesses tied to tobacco.”
If you add up costs for treatment and policing as well as lost economic output, the opioid abuse bill comes to tens of billions of dollars every year.
Political leaders can use a variety of strategies, using fraud and consumer protection laws as a basis for fines. Manufacturers can say that they didn’t have a duty to look beyond winning approval from the Food and Drug Administration, which included addiction warnings. If probes show that the industry hid or ignored evidence against opioids, its best strategy may be to settle rather than argue innocence. Today’s tragedy, in fact, may not have been predictable. If so, the question remains: who pays the bill?
March 31, 2020
Christopher Nystuen, MD, MBA