Santa Barbara County is joining the ranks of cities, counties and states filing lawsuits against prescription opioid manufacturers and distributors in an attempt to recover the costs of dealing with those who are addicted to the drugs.
The lawsuits contend the national prescription opioid crisis was caused by the drug companies’ marketing practices and efforts to get doctors to prescribe the drugs in large volumes.
In a closed session Dec. 11, the Board of Supervisors voted 4-1 to initiate litigation to recover damages resulting from addictions “caused by the deceptive marketing and sale of prescription opioids.”
The board later voted 4-1 to hire the Law Firm of Keller Rohrback LLP on a contingency basis to prepare and handle the lawsuit to be filed as part of the National Prescription Opiate Litigation.
More than 100 individual lawsuits were consolidated in December 2017 by the U.S. Panel on Multidistrict Litigation, and thousands of governmental entities, individuals and organizations have since joined the legal action.
Nationally, opioids have killed 350,000 people, and Santa Barbara County has not been immune to the addiction’s effects, experiencing rates of opioid prescriptions, deaths and emergency room visits that exceed the state average, according to a report prepared by County Counsel Michael Ghizzoni.
The county’s 63 accidental opioid-related deaths tallied by the Behavioral Wellness Department in 2015 was six times the number reported in 2008, according to Ghizzoni’s report.
That rising trend appears to have reversed since Behavioral Wellness launched its Overdose Prevention Program that provides naloxone for first responders to administer to potential overdose victims.
After the program started in September 2015, opioid-related deaths fell to 43 the following year, then to 34 in 2017 and 21 in the first six months of 2018. Four of last year’s deaths involved fentanyl, which is often produced illegally.
Ghizzoni said the decline is considered a direct result of the 1,500 naloxone kits Behavioral Wellness has distributed.
From the inception of the program until December 2018, county health and wellness staff have reversed 404 overdoses, and sheriff’s deputies have reversed about a dozen.
Without the kits, it’s possible the death rate would have skyrocketed, based on the number of overdoses that were reversed.
Some health officials believe the number of opioid addicts in the county is continuing to grow, based on national trends.
Opioid sales in the United States quadrupled between 1999 and 2010, Ghizzoni said in his report, and in 2016 the number of overdose deaths from prescription opioids and illegal opioids, including heroin and fentanyl, was five times higher than in 1999.
Naloxone is an antidote to opioid overdose, but it doesn’t treat the addiction, which is why by the end of this year, Behavioral Wellness plans to create a buprenorphine clinic.
Buprenorphine reduces addicts’ craving for opioids, reduces the symptoms of withdrawal and is far less likely to cause addiction because of a “plateau effect,” where increasing doses do not supply an increasing high.
But distributing naloxone and administering buprenorphine costs money, and Behavioral Wellness isn’t the only county department that’s taken a financial hit from the fight against prescription opioids.
Although no dollar figure has been put forward by the county, treating opioid-addicted individuals and responding to overdoses and deaths have also increased the costs for the Sheriff’s Office, Public Health Department, District Attorney’s Office and Public Defender’s Office.
To sue or not to sue
Ghizzoni said the risk is low in hiring Keller Rohrback to handle the lawsuit because the firm will only get paid if the county is awarded damages, receiving 17 percent of the net recovery.
In addition, the contract covers both the trial and any appeal. The county will not have to pay any attorney fees or other expenses from public funds, only from any damages awarded, and the county counsel will retain complete control over the case.
While there is no initial cost in filing the suit, it will require about 200 hours of staff time from several departments, Ghizzoni said.
Not all the supervisors and members of the public believe suing the opioid manufacturers and distributors is the best course of action.
Fourth District Supervisor Peter Adam voted “no” in both the decision to initiate litigation and to hire a law firm to represent the county.
“We’ve known for 100 years (opioids are) addictive, and if a doctor doesn’t know it’s addictive … that's an irresponsible doctor,” Adam said. “My initial feeling on these kinds of things is I don’t like them very well.
“I understand people’s frustration to want to do something,” he added, but he said there are better ways to attack the problem.
Andy Caldwell, of the Coalition of Labor, Agriculture and Business, whose request to speak pulled the decision to hire the law firm from the administrative budget, said the lawsuit wouldn’t have any effect on the addiction crisis.
“It takes $1 billion to $2 billion and 10 to 15 years to get a drug to market,” Caldwell said. “And we have drugs that work. They’re controlled by the Food and Drug Administration. Nonetheless, we have a bona fide, genuine opioid crisis in America.”
But he said suing the drug companies would be at the bottom of any list of solutions he would consider, if it was even on the list.
“The point is you’re not doing anything by suing except driving up costs,” Caldwell said. “Look for a solution that actually produces change — and not the type of change where you’re reaching into someone’s pocket.”
First District Supervisor Das Williams responded that the catalyst for the lawsuits is the abundance of legal opioids on the market.
He said everything the drug manufacturers did was to make it difficult to regulate opioids, to make doctors think there was no danger and to encourage them to prescribe large amounts.
“If you think we’re immune, ask our first responders what they’re responding to,” Williams said. “This part of the drug epidemic is something we can do something about.”
Defendants in other lawsuits filed so far include Purdue Pharma, Cephalon, Teva Pharmaceutical, Johnson & Johnson, Janssen Pharmaceuticals, Ortho-McNeil-Janssen Pharmaceuticals, Noramco Inc., Endo Health Solutions, Mallinckrodt, Allergan, Actavis, Watson Pharmaceuticals, Insys Therapeutics, AmerisourceBergen Drug Corporation, Cardinal Health and affiliated companies.
The lawsuits have various contentions but generally allege prescription opioid manufacturers overstated the drugs’ benefits, downplayed the risks and aggressively marketed the drugs to doctors — both directly and through other physicians.
They also allege the distributors failed to monitor, detect, investigate, refuse and report suspicious orders of prescription opiates.
Lawsuits say the coordinated actions raise questions about the manufacturers’ and distributors’ knowledge of and conduct regarding the diversion of prescription opiates to the black market.