Josh Stein, North Carolina’s attorney general, announced on Tuesday that he and 40 other attorneys general had expanded their investigation into manufacturers and distributors of prescription opioids in an attempt to hold the pharmaceutical industry responsible for its part in the nationwide overdose crisis.
At a news conference broadcast live on Facebook, Stein, a member of the executive committee leading the probe, announced that the state officials have sought records of the marketing and sales practices of five manufacturers and three distributors of powerful prescription painkillers.
The investigation builds on one started earlier this year into Purdue Pharma, a company that several states have sued and accused of using deceptive marketing practices related to OxyContin. Their allegations come nearly a decade after three Purdue Pharma executives pleaded guilty and paid a $634 million fine for an OxyContin branding strategy that overstated the benefits of opioids for treating chronic pain.
As part of the expanded investigation, the attorneys general have added Endo, Janssen, Teva/Cephalon, Allergan and their related entities to the list of opioid manufacturers from which they want more information.
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The investigation also focuses on AmerisourceBergen, Cardinal Health, and McKesson for information about their opioid distribution practices.
“As millions of Americans were becoming addicted to prescription painkillers and communities were struggling to respond to this crisis, drug companies were reaping enormous profits,” said Stein, a Democrat and former state senator elected attorney general last year. “If these companies broke the law in any way, if they created the misery that the people in North Carolina are suffering, I will hold them accountable.”
The pharmaceutical industry faces dozens of lawsuits brought by states, cities and counties as opioid addiction and overdose deaths spike.
Nationwide and in North Carolina, opioids – prescription and illicit – are the main driver of drug overdose deaths, which now top car accidents as the No. 1 cause of accidental death. In North Carolina, it is estimated that nearly four people die each day from accidental drug overdoses.
Opioids are compounds that bind to the brain’s opioid receptors, blocking pain and slowing breathing. The drugs trigger the release of dopamine, and new users typically feel a calm, happy high while under the influence. Regular users develop a tolerance to the drugs, requiring more and more to achieve the same effect.
The widening epidemic can be traced to the 1990s, when doctors began to treat pain more aggressively.
Prescriptions for hydrocodone or oxycodone, which are also known by brand names Vicodin and OxyContin, have skyrocketed over the years, from 76 million in 1991 to nearly 259 million in 2012, former U.S. Surgeon General Vivek Murthy has said. As of 2013, hydrocodone, the generic version of Vicodin, was prescribed to more Medicare patients than any other drug, according to a ProPublica project.
At the news conference on Tuesday, Stein described his experience traveling the state and hearing from people who have suffered addiction and loss from the crisis.
Steve Shelton, in an emotional few minutes at the podium, shared his story of losing his youngest son Caleb, a former Guilford County high school and college baseball player.
“Addiction is a disease that knows no boundaries. It transcends age, race, gender,” Shelton said, adding that his son’s addiction was rooted in surgeries he had after athletic injuries and a motorcycle accident. “Caleb was caught up in a substance abuse disorder he neither wanted nor could control.”
Ashley Fabrizio, a former Nash County high school cheerleader who was given her first painkillers after an injury, talked about how easy it was to get refills of prescription painkillers from doctors who barely questioned her.
It all started when she came down wrong on her ankle after being thrown in the air. Her ankle popped and she was in severe pain, she said. While in the ambulance, Fabrizio said, the responders “ juiced” her up. She was given Vicodin. Four days later, she went back to see an orthopedic surgeon, complained of more pain and was prescribed Percocet. She returned to the doctor later with more pain complaints and was prescribed 50 more Vicodin, she said, with a refill option for 50 more.
“Now I was 16 and 100 pounds,” Fabrizio said – and at the time, “being in school and walking around, I was high as a kite.”
Fabrizio was able to break her habit and go on to college, but got into painkillers again several years later when her brother introduced her to a street dealer who was selling Oxycontin.
“It was like an old familiar friend,” Fabrizio said as she chronicled the push and pull between using the opioids and clearing her system of them.
Mandy Cohen, secretary of the state Department of Health and Human Services, said for Fabrizio and others, access to insurance and continued treatment and health care was important in the fight against opioids. Cohen and Stein were critical of state lawmakers who have blocked a Medicaid expansion that would have brought millions in federal spending to North Carolina, some of which would have been available to addicts in need of health care.
“This epidemic is affecting too many people,” Stein said as he outlined a multi-pronged effort to go after traffickers, dealers and the pharmaceutical industry.
The attorneys general plan to investigate whether the drug manufacturers overstated scientific backing for their opioid products, their sales strategies “and whether they misled doctors,” Stein said. He also plans to investigate whether distributors noticed a suspicious shift in distribution of the drugs that they failed to report, which would violate law.
Cardinal Health issued a statement on the investigation, saying the company looks forward to working with the attorneys general during the investigation.
“As a pharmaceutical distributor, we operate as part of a multi-faceted and highly regulated healthcare system,” the company statement said. “We do not manufacture, promote or prescribe prescription medications to members of the public – and believe everyone in that chain, including us, must do their part to address the current crisis.”