It’s not yet clear how a national lawsuit against pharmaceutical manufacturers and distributors will affect Clatsop County, but locals involved with the issue say the fight to curb opioid addiction will extend well beyond the courtroom.
Clatsop County joined a handful of Oregon counties in a lawsuit that, for now, is being heard by a federal judge in Ohio and involves scores of other communities across the country.
The suit claims a number of drug manufacturers and distributors — through misleading information about addiction potential and inadequate record keeping — should bear much of the responsibility for spikes in opioid addiction the past two decades.
“What I hope would come from this would be a major airing of the whole, miserable event,” said Dr. Thomas Duncan, the county’s public health officer. “A lot of people cashed in on the gullibility of patients.”
More than 27 percent of Clatsop County residents were prescribed opioids in 2015, according to the Oregon Health Authority. Curry County’s rate, by comparison, was 35 percent — the 74th largest figure of any county in the country.
Heroin and mixed prescription drugs led to 12 overdose deaths from 2014 to 2016, according to Clatsop County Medical Examiner JoAnn Giuliani.
“Most of what we would be alleging would be characterized as bad acts by the distributor,” said Michael Rose of D’Amore Law Group, which is representing the Oregon counties in the suit. “Generally, in discussions, the counties aren’t concerned with making a lot of money. There’s a concern about the harm they see every day.”
Distributors say they do not manufacture or prescribe the drugs, and the U.S. Drug Enforcement Administration is responsible for limiting production.
“Given our role, the idea that distributors are responsible for the number of opioid prescriptions written defies common sense and lacks understanding of how the pharmaceutical supply chain actually works and is regulated. Those bringing lawsuits would be better served addressing the root causes, rather than trying to redirect blame through litigation,” John Parker, senior vice president of the Healthcare Distribution Alliance, said in a statement.
D’Amore Law Group has agreed to pay all of the legal costs on behalf of the counties in return for a 25 percent fee on any financial damages awarded. Clatsop County Counsel Heather Reynolds told county commissioners last month — prior to their vote to enter the litigation — that she does not see a “legal negative.”
Plaintiffs are seeking monetary damages as well as some restrictions on how companies may sell the drugs. The amount of damages available to cities and counties will be revealed in upcoming pretrial hearings as evidence and data are shared. Damages could be based on local costs for law enforcement, drug programs and increased jail populations, for example.
“It’s going to be very specific to each county,” Rose said.
After the litigation’s discovery phase, it could take a number of turns. Due to its complexity and the large volume of parties involved, the federal judge may choose certain “bellwether cases.” These cases — likely not the Oregon counties — would return to their local jurisdictions and be resolved there, offering clarity for settlement discussions in Ohio, Rose said.
If no settlement is reached in the main case, many jurisdictions — including the Oregon counties — may return to resolve their specific complaints in federal courts within their home states.
“This is really just sort of an early organizational approach,” Rose said. “If there is a national resolution, it’s about making sure our counties have a seat at the table.”
Duncan, who has been practicing medicine since the mid-1970s, said prescription levels have ebbed and flowed throughout his career.
Beginning in the 1960s, state medical officials would suspend or revoke licenses for doctors who prescribed relatively small amounts of opioids. A few decades later, the state Legislature — concerned that those with chronic pain were not being properly treated — banned medical officials from sanctioning doctors who prescribed adequate opioid amounts.
“In the early ’90s, we were beginning to get a handle on it. But we’ve seemed to have swung from post to post, from underprescribed to overprescribed,” Duncan said.
Elevated prescription levels followed during the past two decades, and doctors have absorbed criticism for their part in the opioid crisis. While some of the “boots on the ground” doctors have earned the blame, not enough is directed at top medical officials, Duncan said.
“We were being pushed into prescribing huge amounts of narcotics through trainings that were funded by the drug companies,” he said. “It’s a mare’s nest.”
Duncan likened the opioid issue to problems surrounding tobacco, in that both involve potentially valuable, but highly addictive, substances used for profit. States and cigarette makers reached a multibillion-dollar settlement of tobacco-related claims in 1998 that curtailed marketing.
“When you think about the tobacco lawsuit, and this is really the same thing, it could be a useful exercise,” Duncan said.
He cautioned though, against a repeat of the “moral panic” he witnessed in the early days of his career. He hopes any legal decision would recognize that chronic pain is difficult to treat and opioids have a role to play — in the right doses.
“People need to understand there is such a thing as chronic pain,” Duncan said. “People have pain that cannot be resolved by sitting around and doing drum circles.”
Hitting the manufacturers who profit from drug sales is a “good first step,” said Debbie Morrow, a member of the Columbia Pacific Coordinated Care Organization Board of Directors.
More important, though, will be partnerships between public, private and nonprofit interests on outreach such as needle exchange programs and mental health treatment. That would require a comprehensive plan involving many community groups, Morrow said.
“Stemming the tide of this is not going to be the result of any policy change,” she said. “There has to be a prescribed way of dealing with this. We’re trying to connect the dots and collect the infrastructure that is needed for treatment.”
The complex litigation currently concentrated in Ohio may, depending on damages awarded and precedent set, connect some of those dots.
“The lawsuit, wherever it’s going, will demonstrate this issue’s complexity,” Duncan said.