With Johnson & Johnson ruling in Oklahoma, opioid reckoning finally starts taking shape


AUGUST 29, 2019 AT 9:47 AM

I testified at the Oklahoma opioid trial and welcome the verdict. Now we need to treat everyone in need, educate America and end this health crisis.

From the witness stand in Norman, Oklahoma, I raised my right hand and told the truth, the whole truth and nothing but the truth: For years, opioid makers like Johnson & Johnson and their proxies downplayed opioid risks, exaggerated benefits and flooded the country with their products. Even with evidence that their actions were fueling the worst drug addiction epidemic in U.S. history, they continued to promote aggressive prescribing.

This week, the judge in Oklahoma agreed, ruling that Johnson & Johnson participated in a deceptive, multifaceted campaign that changed the culture of opioid prescribing and led to a public health crisis. The court ordered the company to pay $572 million to help the state fight the epidemic and repair the damage.

After years of the opioid crisis, a reckoning is finally taking shape. States, cities and counties have sued opioid makers and distributors, and many more cases like Oklahoma’s are playing out across the country.

My 2006 moment of truth on opioids

My role in speaking out against opioid makers didn’t begin in the courtroom. It started more than 15 years ago. Fresh out of my residency, while working for New York City’s health department on an effort to reduce drug overdose deaths, I began treating patients suffering from opioid addiction. I had expected my patients to come from the city’s poorest neighborhoods, which had been hit hard with drugs in the 1970s and 1980s. But people streamed in from all boroughs. They were of all backgrounds, all ages, and in most cases, their addiction began with prescription opioids.

The real moment of truth hit me in 2006, still long before the opioid crisis was receiving national attention. A researcher from the Centers for Disease Control and Prevention published a remarkable finding. He demonstrated that the sharp increase in opioid overdose deaths paralleled a similar increase in opioid prescribing. The explanation for the soaring increase in deaths was clear. As the medical community began prescribing opioids more aggressively, millions of Americans became addicted and thousands started dying from overdoses.

The spike in prescribing was not driven by new evidence that long-term opioid use was safer or more effective than previously believed. Rather, it was a brilliant marketing campaign, disguised as education, that led to the change in practice. Doctors might have been less gullible if we had only been hearing these messages from drug company sales reps. But these messages were coming from every direction — professional societies, eminent pain specialists, hospitals and even state medical boards.

Correct the record on opioid risks

Now, with litigation aimed at holding opioid manufacturers, distributors and retailers accountable, how will the next chapter in this crisis unfold?

If we want to reduce overdose deaths and improve outcomes in people who are addicted, the influx of money from trials and settlements should be used to make treatment free and easier to access than prescription opioids, illicit fentanyl and heroin. The need for more and better treatment is vast. It is tangible, especially in communities hardest hit by the epidemic, and it is measurable. For these reasons, the pressing need for treatment often overshadows the second piece of the solution: prevention.

To be successful, we must contain the epidemic by educating everyone — from doctors to parents and from teens to seniors — about the risks of opioid use. This kind of national public awareness campaign would empower people with the truth.

Horrifically irresponsible: Even as opioid deaths grew, drugmakers and distributors made and sold pills ‘like Doritos’ https://www.usatoday.com/story/opinion/2019/08/12/opioid-epidemic-prescription-pills-made-sold-like-doritos-editorials-debates/1992787001/

The truth is, when patients take opioids every day for as little as five days, physiological dependence begins to set in, making it difficult to discontinue use. If prescribers had a better understanding of opioid risks and benefits, they would prescribe more cautiously. Opioid makers invested millions of dollars in a campaign that deceived the medical community about opioids. Yet, little has been done to correct the record.

Tobacco campaign is precedent

The truth is, the effects produced by oxycodone and hydrocodone are indistinguishable from heroin. If more parents knew that, they could intervene if their teenager gets an opioid prescription. Teens would understand that borrowing a few pills from a friend to get through a sports injury is risky and could lead to addiction. Adults would recognize that when prescribed an opioid, they should take the smallest dose for the shortest period of time.

The truth is, drug companies used unconscionable sales tactics, like offering a free initial supply of OxyContin and fentanyl patches to get people hooked. If more doctors and the broader public knew how deceitful opioid makers were, attitudes toward those companies and their products would change. The unfair stigma that puts blame on patients would shift.

My dad helped me see the light: Doctors can stop the opioid crisis at its source if they quit overprescribing. http://www.usatoday.com/story/opinion/2017/08/04/doctors-stop-opioid-crisis-quit-overprescribing-marty-makary-column/504860001/

We have a precedent for such a campaign working. After big tobacco companies paid millions to settle lawsuits, part of that money went to fund a national public education campaign called “truth.” In the past 20 years, the campaign has prevented millions of youth from becoming smokers. A similar education campaign needs to happen with prescription opioids, too.

With more than 2 million opioid-addicted Americans in need of treatment, it can be easy to lose sight of our need to prevent new cases of opioid addiction. By dedicating funds to a prevention campaign for the public and prescribers, we can contain the problem. That must happen to bring this devastating epidemic to an end.

Dr. Andrew Kolodny is co-director the Opioid Policy Research Collaborative at Brandeis University and executive director of Physicians for Responsible Opioid Prescribing. Follow him on Twitter: @andrewkolodny



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