Should We Blame Pharmacies or the Government for Opioid-Related Deaths?
A federal jury in Cleveland yesterday concluded that three major pharmacy chains had contributed to a “public nuisance” in two Ohio counties caused by an oversupply of prescription opioids. The verdict, which represents the first time that retailers have been held legally liable for the “opioid crisis,” followed two recent rulings in which a California judge and the Oklahoma Supreme Court rejected similar claims against drug manufacturers.
These cases, along with thousands of other lawsuits by state and local governments that blame legal drug suppliers for opioid-related addiction and deaths, ask courts to focus on one link in a long causal chain. That chain includes decisions by state and federal regulators as well as actions by manufacturers, distributors, doctors, pharmacists, patients, black-market dealers who sell diverted pills, and nonmedical users who consume them.
In the Ohio case, Lake and Trumbull counties argued that the defendants—CVS, Walgreens, and Walmart—had ignored “red flags” indicating that some of the prescriptions they filled were medically inappropriate. The defendants argued that they had done nothing but fill seemingly legitimate prescriptions for legally approved medication written by licensed and regulated doctors. They emphasized the crucial roles that government agencies such as the Food and Drug Administration (FDA) and the Drug Enforcement Administration played in overseeing the distribution of prescription opioids, making them complicit in the supposed public nuisance described by the plaintiffs.
The government is likewise responsible for the harm caused by its ham-handed efforts to reduce opioid prescriptions, as illustrated by a recent case involving a Kentucky man, Brent Slone, who killed himself after his pain medication was suddenly slashed. His wife, CaSonya Richardson-Slone, sued Commonwealth Pain and Spine, which operated the clinic she blamed for denying her husband proper pain treatment. Last August, a Louisville jury awarded her and the couple’s daughter $7 million in damages. As STAT reporter Andrew Joseph’s thorough and illuminating account of the case shows, the situation that drove Slone to suicide is a predictable result of the government’s demonstrably counterproductive attempt to reduce opioid-related deaths by limiting access to pain medication.
In a 2011 car crash, Joseph reports, Slone suffered “a broken pelvis, a compressed spinal cord, and other injuries that caused chronic pain and put him in a wheelchair.” He was already taking opioids for pain relief in 2014, when he sought treatment at Commonwealth Pain and Spine. His daily dosage at the time was about 240 morphine milligram equivalents (MME), but it would eventually rise to a peak of 540 MME after a series of surgeries.
As Joseph notes, Slone’s treatment “coincided with campaigns to rectify opioid prescribing.” Responding to rising opioid-related deaths, regulators and legislators sought to discourage pain pill prescriptions across the board. In the effort to drive down consumption of opioid analgesics, chronic pain patients like Slone, who account for a disproportionate share of the total, were an obvious target.
Between 2010 and 2017, the number of opioid prescriptions per 100 Americans fell by 28 percent. During the same period, the rate of high-dose opioid prescriptions—defined as 90 MME or more per day—fell by 56 percent. In 2016, the Centers for Disease Control and Prevention (CDC) further encouraged the latter trend by publishing guidelines that were widely interpreted (misinterpreted, according to the CDC) as recommending that doct
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