Vermont is the latest state to sue Connecticut-based Purdue Pharma L.P. over its opioid drug, OxyContin, joining many others in the fight against the large manufacturer for sparking a nationwide epidemic. The state is accusing the company of using deceptive marketing practices to advertise its painkillers as an appropriate treatment for chronic pain.
Vermont Attorney General T.J. Donovan said the pharmaceutical company’s opioid marketing was the “genesis” of a health crisis. “Vermont has suffered too long,” he said. “Too many lives have been ruined.”
The 100-page complaint accuses the manufacturer of engaging in unfair, false, and misleading conduct by minimizing the serious risks of addiction; overstating the effectiveness of screening tools to prevent addiction; and failing to disclose or denying that the dangers of opioids increase with an increased dose. The lawsuit seeks civil penalties, fees and costs and damages and calls for Purdue to change its practices. It does not specify a monetary amount sought.
Purdue has denied the allegations but has publicly stated it shares the concerns of those who have initiated litigation against it. The manufacturer responded, “While our opioid medicines account for less than two percent of total prescriptions, we will continue to work collaboratively with the state toward bringing meaningful solutions to address this public health challenge.”
A number of other states have filed similar lawsuits against the manufacturer alleging deceptive marketing tactics and claiming unfair and deceptive trade practices. Patients receiving substance abuse treatment whose addictions started with prescription painkillers have said they were not warned they might become addicted to their medication.
The complaint indicates, “Purdue’s sales representatives regularly omitted from their visits to Vermont prescribers any discussion of the addiction risks that are plainly associated with long-term use of opioids.” Donovan added, “Just ask any Vermonter. Ask the thousands of Vermonters whose lives have been ruined by addiction. Ask the hundreds of Vermonters who have lost a loved one to an overdose. Ask any child who’s living in a home with an addicted parent or any grandparent who’s now parenting that child.”
In 2011, John Brooklyn, a Vermont-based family physician and addiction specialist began working with his colleagues on an idea to provide a more comprehensive response to the opioid crisis. The program they came up with is modeled after the rest of the health care system. “The parallel universe would be cardiology or infectious disease, where if you get sick and your primary care doc can’t take care of you, you’d get referred to a cardiologist,” Brooklyn explained. “The nexus of this was really to try to integrate substance use treatment in primary care.” That way, he added, “if [a doctor] had a patient that they didn’t really know what to do with, they could refer them to someone like myself who’s board-certified in addiction medicine.”
The approach was called “the hub and spoke model.” Under Vermont’s approach to opioid addiction, the hub is the place where someone gets the intensive treatment. The spoke is where they get follow-up care. So, a patient will continue to get their medication, as well as access to therapy and other resources. However, after intensive treatment, they’ll have to come in on a less frequent basis. The system is designed to provide a referral point for providers who have complicated patients struggling with addiction.
After this concept had been rolled out, in 2014, former Gov. Peter Shumlin, a Democrat, made the fight against the abuse of heroin and prescription opioids the center of his State of the State address. Two years later, in 2016, he said the Food and Drug Administration’s approval of OxyContin in 1996 “lit the match that ignited America’s opiate and heroin addiction crisis.” Now, the state feels it’s time to hold Purdue accountable.
The opioid crisis has collectively led to more than 64,000 drug overdose deaths nationwide in 2016 alone. Opioid overdoses, it is estimated, could kill as many as 650,000 or more people than live in Vermont today across the country over the course of the next decade. And, according to Donovan’s office, 455 Vermonters have died from opioid-related overdoses over the past five years.