Anyone in involved in healthcare and insurance, particularly workers’ compensation, is aware of the opioid medication epidemic leading to over 16,000 deaths per year, according to the CDC. Countless cases of dependence, misuse, diversion and medical complications have resulted from the growth of prescription opioid use and dose. The latest dogma is that this epidemic has led to a renewed heroin epidemic as more people are medically introduced to opioids via prescription medications. Given this deterioration to national health, we must ask who is accountable for the prescription opioid epidemic? According to two counties in the State of California, a significant responsibility lies with certain drug companies who have aggressively marketed prescription opioid medications.

Clearly there is plenty of culpability to go around. Many prescribing physicians, usually not adequately trained in addiction, have liberally prescribed opioid medications like they prescribe anti-inflammatories and without the requisite fear of and respect for one of the most addictive substances known to man. Perhaps, since these medications were cleared by the FDA, they believe they must be safe. Injured workers have assumed that if the ER gives them a bottle of 60 pills for a minor injury, they must be safe. Meanwhile, some drug abusers have found an ample source of prescription medications for abuse. But if you “follow the money,” as some would say, you’ll find that certain pharmaceutical companies have played a key role in letting, perhaps forcing, the opioid genie out of the bottle.

In what is expected to be a long and complicated legal case, the Orange County District Attorney and Office of the County Counsel for the County of Santa Clara have filed a lawsuit against major pharmaceutical companies for allegedly violating state law. In the May 22, 2014, press release announcing the lawsuit, Orange County District Attorney Tony Rackauckas stated, “We have charged these pharmaceutical companies for knowingly harming public health by waging a massive campaign to sell huge quantities of these dangerous drugs for profit.”

Some experts predict that some of the pharmaceutical companies will base part of their defense on the position that it is the FDA who regulates medications and therefore it is not the role of the state to determine effectiveness. But the lawsuit places direct responsibility with the named drug companies for alleged actions as:

1. “misrepresentations regarding the benefits of opioids for chronic pain”
2. “misrepresentations regarding the adverse outcomes and risks of opioids”
3. “Misrepresentations regarding superiority”
4. “Defendants, Directly and Through Their Agents and Front Organizations, Made and Caused Their Misrepresentations to Be Made and Broadly Disseminated”
5. “Defendants Often Acted Together in Promoting Opioids, Opposing Regulation, and Facilitating Supportive Standards to Approve Opioids”

At the recent National RX Drug Abuse Summit meeting in Atlanta on April 22-24, 2014, there was ample criticism of the FDA for not stemming the growth of the prescription opioid problem and allowing a new opioid product on the market without a real need. One speaker asserted that the drug companies are creating “life-long customers” by promoting opioids for pain, and then marketing other opioid medications to treat addiction/dependence.

The California lawsuit promises to be a fascinating public revelation of the factors contributing to the prescription opioid epidemic. But will it help reverse the opioid predicament similar to how the tobacco lawsuit affected that industry? It is likely that the problem requires a multi-level approach that includes continued efforts toward legislation, regulation, education (doctors and patients) and litigation. Medical organizations can play a key role. As medical professionals, we can be instrumental in improving the situation by first acknowledging that prescribing chronic opioids for chronic pain may be as risky as throwing gasoline on a brush fire. But we can only be successful overall if parallel efforts can decrease the consumer demand for opioids.

About the Author

Steven M. Moskowitz, MD, is the Senior Medical Director and supervisor of Paradigm Outcome’s complex pain program. Dr. Moskowitz is a specialist in physical medicine and rehabilitation with clinical expertise in complex musculoskeletal and neurologic rehabilitation including spinal cord injury, multiple sclerosis and chronic pain.

For more information on managing pain, and appropriately prescribing pain medication within the context of a rehabilitation plan, follow Paradigm Outcomes on LinkedIn, Twitter, and Facebook. You can also visit our website.