Opioid abuse has reached epidemic proportions in the United States. According to the Department of Health & Human Services, 12.5 million people misused prescription opioids and 33,091 Americans died from opioid overdose in 2015 alone. These medications provide important pain relief for many. However, over the years, drug companies inflated the effectiveness of delayed-release medications like OxyContin and downplayed their addictive properties, creating conditions ripe for abuse.
Beasley Allen is representing multiple local governments in Alabama against both manufacturers and distributors of opioids for increased costs faced by local governments related to the opioid epidemic. Providing city and county resources to battle the opioid crisis causes local governments to sustain economic damages and ongoing significant financial burdens.
These opioid lawsuits allege the crisis was created by the pharmaceutical industry, which instead of investigating suspicious orders of prescription opiates, turned a blind eye in favor of making a profit. They intentionally misled doctors and the public about the risks of these dangerous drugs, and municipal governments are left struggling to cope with the consequences.
These opioid manufacturers, drug distributors and pharmacies are finally being held accountable for creating and fueling the nation’s opioid epidemic. In August 2019, Johnson & Johnson and its subsidiary Janssen Pharmaceuticals were found responsible for escalating the opioid epidemic in the state of Oklahoma and were ordered to pay the state $572 million. Both Purdue Pharma, makers of OxyContin, and Teva Pharmaceuticals settled before the trial began for $270 million and $85 million, respectively.
Purdue Pharma, one of the primary targets of lawsuits in filed by states, local governments and Native American tribes, is currently negotiating a $10-$12-billion global settlement. The settlement would involve the billionaire Sackler family giving up ownership of Purdue Pharma and turning it over to a public trust, donating opioid antidotes and addiction treatments currently under development, paying $3 billion out of their own pockets, and contributing an additional $1.5 billion from the sale of Mundipharma, another family-owned drug company.
What are Opioids
Opioids are a class of painkillers that include the illegal drug heroin, as well as legally prescribed drugs such as:
- oxycodone (OxyContin),
- hydrocodone (Vicodin),
These drugs interact with opioid receptors on nerve cells in the body and brain to elevate pain. These medications are often prescribed following surgery or injury, or for health conditions like cancer.
Opioids are generally safe when taken short-term and as prescribed by a doctor. But because they produce a sense of euphoria, they are often misused. Regular use, even as prescribed by a doctor, can lead to dependence. Some users can experience withdrawal symptoms when trying to get off the drugs.
In recent years, there has been a dramatic increase in the acceptance and use of these powerful painkillers for the treatment of chronic, non-cancer pain, such as back pain or osteoarthritis, despite serious risks and the lack of evidence regarding their long-term effectiveness.
Opioid side effects include sensitivity to pain, nausea and vomiting, sleepiness and dizziness, confusion, depression, low levels of testosterone, constipation, sweating, as well as an increased risk of opioid addiction, opioid abuse, opioid overdose and death.
The First Opioid
- Morphine has been used as a painkiller for more than 200 years and is considered the “gold standard” among opioid therapy, serving as the gauge by which other opioids are measured. The medication is derived from the poppy straw of the opium plant, and remains one of the most widely used opioid painkillers in the world. It is used to treat acute and chronic pain, and in palliative or end-of-life settings to minimize shortness of breath. Like all other opioids, morphine is addictive and is associated with life-threatening adverse effects like opioid overdose. It is sold under the brand names MS Contin, Avinza, Kadian, and Oramorph.
Opioids Less Potent Than Morphine
- Codeine is also derived from opium, but is about seven to 14 times less potent than morphine. It is used to treat mild to moderate pain and diarrhea, and is sometimes combined with acetaminophen or aspirin. Codeine is also used in cough syrups or cold and cough medicines, which are available over-the-counter in some states. However, the Food and Drug Administration (FDA) is considering regulatory action for these products. These syrups have been mixed with sodas and other ingredients, given nicknames like Dirty Sprite or Purple Drank, and used recreationally. In January 2018, the FDA warned that codeine should not be given children younger than 12 or 18 (depending on the circumstances) because the risk of slowed or difficult breathing, misuse, addiction, overuse, and death outweighed any benefits of the drug.
- Meperidine is a synthetic opioid used for post-surgical pain relief. It is about seven to 10 times less potent than morphine, but it contains an ingredient that produces a toxic byproduct in the body that can cause tremors and seizures, particularly in patients with kidney problems. Meperidine is generally not recommended for acute or chronic pain because of its short half-life. Brand names include Demerol and Meperitab.
- Tramadol is used to manage moderate to moderately severe pain. It is about a tenth as potent as morphine, and is considered less addictive than other types opioids. The FDA has also warned against using tramadol in children younger than 12 or 18 (depending on the circumstances) because the risk of serious adverse events outweighs the benefits. The drug is available under the brand names Ultram, Ultram ER, and Conzip.
- Tapentadol is a newer opioid to treat moderate to severe acute or chronic pain, and specifically pain associated with diabetic neuropathy. It comes in both immediate-release and extended-release versions. The drug is about two to three times less potent than morphine and, like Tramadol, is considered less addictive than similar narcotics. Brand names include Nucynta, Nucynta ER, and Palexia.
Opioids As Potent As Morphine
- Hydrocodone is one of the most popular opioids on the market. It is equivalent in strength to morphine and is used to relieve moderate to severe pain. Hydrocodone is often sold in combination with other medications like acetaminophen. Extended-release versions of hydrocodone are available but should not be used to treat pain that can be controlled by as-needed medication. Brand names include Vicodin, Lorcet, Zamicet, Hycet, and Norco.
Opioids More Potent Than Morphine
- Oxycodone is about 50 percent more potent than morphine and was initially reserved only for patients suffering from cancer pain or in hospice care. Oxycodone is now prescribed to treat pain severe enough to require daily, around-the-clock, long-term treatment, and is sometimes prescribed to treat back pain or pain after surgery. In 1995, OxyContin manufacturer Purdue Pharma released its extended-release formulation of oxycodone, which fell into the hands of abusers who crushed the drug to snort or inject for an even greater high. This was a major factor in fueling the nation’s current opioid epidemic. The brand name opioid Percocet combines oxycodone with acetaminophen.
- Methadone is an opioid that is used to manage cancer pain, and is often prescribed through clinics to help people trying to overcome heroin addiction or addiction to other opioid medications. It is three times stronger than morphine, but lessens the painful symptoms of opioid abuse and can reduce cravings. It also doesn’t deliver the same euphoria as other opioids. Brand names include Methadose and Dolophine.
- Hydromorphone is five to 10 times stronger than morphine but works over a shorter duration. It is a common second-line treatment for patients for which morphine is no longer effective. In 2005, a hydromorphone by the name of Palladone was withdrawn from the market after several patients died after combining it with alcohol. Other brand names include Dilaudid.
Heroin was once used to treat morphine addiction. It is now an illegal drug. Heroin is about two to five times more potent than morphine. It is also a derivate of the poppy plant and is either snorted, smoked or injected, giving users a high that lasts several hours. Heroin was widely misused in the 1960s and 1970s, and has made a resurgence in recent years as prescription painkillers have become harder to obtain.
- Oxymorphone carries three times the strength of morphine. It is sold under the brand name Opana. In 2017, Opana manufacturer Endo Pharmaceuticals agreed to remove from the market its extended-release version, Opana ER, at the request of the FDA, because of its high abuse potential. Abusers were crushing and injecting the extended-release medication despite its so-called tamper-resistant coating, upping its strength to 10 times that of morphine. Illicit intravenous use of Opana ER was linked to a 2011 outbreak of hepatitis C in New York, a 2015 outbreak of HIV in Indiana, and a serious blood disorder called thrombotic microangiopathy.
- Buprenorphine is another opioid used to treat opioid addiction. It is 25 to 100 times more potent than morphine and has the ability to suppress opioid withdrawal symptoms and cravings. Unlike methadone, buprenorphine can be prescribed and dispensed at a doctor’s office. It is sold under the brand names Subutex and Buprenex.
- Fentanyl packs a punch 100 times greater than morphine, and comes in a variety of forms from lozenges and lollipops to sprays and skin patches. It is only intended for the management of serious pain such as breakthrough pain in cancer patients currently on around-the-clock opioids. However, some drug makers have encouraged doctors to prescribe the medication to patients with lesser maladies, like chronic back pain or migraines, which has bolstered the opioid crisis. Fentanyl overdose claims hundreds of lives each year, including pop star Prince. The drug has also made its way to the streets, often sold illegally mixed with heroin, cocaine or other dangerous chemicals. Brand names include Sublimaze, Duragesic, Actiq, and Subsys.
- Carfentanil is a lethal, synthetic opioid similar to fentanyl but 100 times more potent, making it 10,000 stronger than morphine. It is not intended for humans. In fact, its only legitimate use is to tranquilize elephants and other large animals. But in recent years, it has become a deadly street drug. Carfentanil, fentanyl and another synthetic opioid called U-47700 have been combined in recent years to create a dangerous new street drug called “Gray Death,” which can be absorbed through the skin and kill instantly.
- Dextromethorphan (DXM)
- Dextromethorphan is a cough suppressant found in many OTC cold medicines and cough syrups, and is often combined with antihistamines and decongestants. It is an opioid without the effects on pain reduction or addiction and does not act on the opioid receptors. But when taken in large doses, DXM causes a depressant effect and sometimes a hallucinogenic effect similar to PCP, which can lead to addiction. Misused, the medicine is sometimes combined with soda for flavor and called “robo-tripping” or “skittling.” Adverse effects from abusing DXM include loss of consciousness, heart arrhythmias, and death. DXM is sold under the brand names Robitussin, Alka Seltzer Plus, Delsym, Mucinex DM, Vicks NyQuil and DayQuil.
- Loperamide is a readily available anti-diarrheal treatment. It is also an opioid designed not to enter the brain. But, when taken in large amounts and combined with other substances, the drug can cause euphoria. As a result, loperamide is sometimes misused for a high, as well as to lessen opioid cravings and opioid withdrawal symptoms. The FDA has repeatedly cautioned the public about severe adverse effects of misusing loperamide, including heart rhythm problems and death. Brand names include Imodium A-D.
- Kratom is a botanical substance often marketed as an herbal supplement in the form of capsules, extracts, powders or teas to treat pain, diarrhea, and opioid addiction. The herb also gives users opioid-like euphoria that can last several hours. Kratom is often combined with other drugs that affect the brain including illicit drugs, prescription opioids, benzodiazepines, and OTC medicines like loperamide. In February 2018, the FDA issued a statement that the compounds of kratom are so similar to those of opioids that the herb would now be classified as an opioid. The agency also warned that kratom has been linked to serious side effects and deaths. Several states have banned the substance, but it is still readily available online.
The Opioid Epidemic
The opioid crisis has reach epidemic proportions in the U.S. with the number of opioid prescriptions nearly quadrupling in recent years. In 2015, 92 million U.S. adults – or about 38 percent of the population – were legitimately prescribed these painkillers, according to the National Survey on Drug Use and Health. About 11.5 million people misused these powerful painkillers, and another 1.9 million reported full-fledged opioid addiction. There is no demographic that has not been affected by these dangerous drugs. This crisis destroys lives regardless of age, race, wealth or location.
The rate of opioid overdose deaths has increased in step with the growing number of prescriptions, leading to one of the worst drug crises in American history. Opioid overdoses killed more than 33,000 people in 2015 alone. That’s more than guns, car crashes, and HIV/AIDS ever killed in one year in the U.S., according to the Centers for Disease Control and Prevention. Opioids are also are being blamed on a drop of life expectancy in the U.S. for the second year in a row – the first time there has been a two-year drop in U.S. life expectancy since the early 1960s.
The economic toll of prescription opioid misuse in the U.S. is just as dire, according to the CDC, totaling about $78.5 billion a year, including the costs of health care, lost productivity, addiction treatment, and criminal justice involvement.
In 2017, President Trump declared the opioid crisis a national public health emergency, which allows the quick hiring of personnel, expanded access to telemedicine services, and flexibility in use of grant money to tackle the epidemic. The declaration falls short of a national emergency under the Stafford Act, which would have allowed the use of money from the federal Disaster Relief Fund to fight the crisis.
Opioid Epidemic: Who is to Blame?
The opioid epidemic has grown substantially in the past decade, fueled by drug companies that flooded the health care system with these highly addictive drugs with marketing that misled the public about their safety and effectiveness. They pushed doctors to adopt more liberal prescribing practice without disclosing how dangerous the drugs are. Some opioid manufacturers paid kickbacks to doctors and promoted off-label uses for these powerful painkillers in order to increase profits. As a result, America became the world’s leader in opioid prescriptions.
It didn’t take long for illicit drug traffickers to escalate the opioid crisis, bringing into the country heroin and illegally produced opioids, including a particularly deadly form of synthetic fentanyl.
Opioids and Infants
The opioid epidemic has also taken its toll on the most vulnerable among us. According to the National Institute on Drug Abuse, every 25 minutes, a baby is born addicted to opioids – a condition called Neonatal Abstinence Syndrome (NAS). Babies with NAS suffer painful symptoms of opioid withdrawal in the hours and days after they are born and are more likely to suffer long-term complications like developmental delays and hearing or vision impairment, compared to babies born to mothers who did not use opioids.