In an effort to help stop a "public health nightmare," the City of Philadelphia on Wednesday sued several regional pharmaceutical companies, claiming that their marketing methods have been so misleading, they have fueled the city's opioid crisis.
Numerous state and county governments have filed such suits recently, but Philadelphia has the highest overdose rate per capita of any big U.S. city, officials noted.
The 160-page suit, filed in Philadelphia Common Pleas Court, both attacks marketing practices and seeks to recover the costs of treatment and other expenses incurred by the city connected with the epidemic.
"We need them to stop claiming these drugs are necessary for long-term chronic illness," City Solicitor Sozi Pedro Tulante said of the pharmaceutical makers. "They clearly are not."
Among the named companies: Allergan, Cephalon, Teva Pharmaceuticals, Endo Health Solutions and Endo Pharmaceuticals, Janssen Pharmaceuticals, Johnson & Johnson, Purdue Pharmaceuticals LP, Purdue Pharmaceuticals Inc., and Purdue Frederick Co. Inc.
Endo Pharmaceuticals; Janssen, whose parent is J&J; and Purdue denied the allegations in the lawsuit. Allergan and Teva, which is also the parent of Cephalon, did not immediately respond to request for comment.
"We are deeply troubled by the prescription and illicit opioid abuse crisis, and are dedicated to being part of the solution," Purdue said in a statement. "As a company grounded in science, we must balance patient access to FDA-approved medicines, while working collaboratively to solve this public health challenge."
Once all cases have been analyzed, drug-overdose deaths in 2017 are expected to total more than 1,200, city officials said. The deaths are from all kinds of drugs, but most of the rise has been fueled by opioids.
"At the peak of the AIDS epidemic in 1994, there were 935 deaths in the city," said Health Commissioner Thomas Farley.
In 2016, the most recent year for which national data are available, there were 63,600 drug-overdose deaths in the U.S., according to the Centers for Disease Control and Prevention.
While many people overdose on illegally obtained opioids such as heroin and fentanyl, health authorities say that often, addictions begin when a physician or dentist prescribes powerful painkillers in too large a quantity, or for longer than truly needed. In the past, opioid medications were reserved for the worst pain, such as what cancer patients may experience. Over time, the drugs have come to be used for everything from back pain to toothache to migraines.
A city survey last year estimated that a third of Philadelphia's population used a prescription opioid like Percocet or OxyContin in the previous 12 months, and more than 81 percent of them received the prescriptions from their health-care providers.
"This epidemic can be traced back to the defendants' false and deceptive marketing to doctors and the public that these drugs are safe and effective for the daily treatment of long-term chronic pain," Tulante said.
The lawsuit, Tulante said, was not intended to demonize the health-care or pharmaceutical industries. The city wanted to "follow the facts and see if there was any violations of law," and believes it found those violations in the industry's marketing practices, he said. Several law firms in the city are helping with the litigation, on a contingency basis, because it's too complex a suit for the city to handle on its own, he said.
Tulante said the lawsuit was "replete" with examples, including how the defendants sometimes used "front groups" and "commissioned, edited, and arranged for the placement of misleading favorable articles in academic journals."
He mentioned a 1980 letter to the editor in the New England Journal of Medicine that Purdue repeatedly cited as an article that reported the results of a peer-reviewed study. One author complained that his letter had been "distorted and misused," according to the lawsuit.
The lawsuit states that while Americans are 4.6 percent of the world's population, they consume 80 percent of the "global opioid supply." From 1999 to 2010, the sale of prescription opioids in the U.S. nearly quadrupled. In 2010, there were enough opioids prescribed – 254 million prescriptions – to medicate every American adult round the clock for a month.
Tulante said that along with the rise of opioid use came "historically high" numbers of babies born exposed to the drugs, increased cases of hepatitis C infections, and emergency-room visits.
The financial loss to the city is "in the millions," Tulante said. There are the obvious costs incurred by police and first responders called to overdose scenes, as well as the city's role as an employer dealing with addicted workers, he said.
"This issue did not happen overnight nor will it be resolved overnight," said David T. Jones, commissioner of the Department of Behavioral Health and Intellectual disAbility Services. He said the city was taking steps such as providing treatment to those in prisons and helping them remain in treatment once they are released.
Scott Weisenberger, vice president of clinical services for the treatment provider Recovery Centers of America, said he was heartened to see that Philadelphia had filed the lawsuit. Ninety-five percent of the center's patients are from the five-county Philadelphia area, he said.
"There is no single answer to the opioid epidemic and heroin crisis," he said. Anything that draws attention to the issue and helps the public make better choices is useful, he said.
In addition to the lawsuits, 41 state attorneys general, including Pennsylvania and New Jersey officials, have also launched a coordinated investigation into whether eight manufacturers and distributors of opioids engaged in unlawful practices in the marketing and sale of the drugs.
In September, Delaware County became the first in the state to sue to try to recover tens of millions of dollars it has spent on treatment and other services for residents. The manufacturers named in Delaware County's suit include locally based Teva, Janssen, Endo, and the Stamford, Conn.-based Purdue Pharma. In October, New Jersey filed suit against Insys Therapeutics Inc., manufacturer of the fentanyl-based painkiller Subsys.
Families are also filing suits.
Last fall, the family of 39-year-old Joey Caltagirone, of Philadelphia, sued Cephalon and Teva alleging the drugmakers' marketing tactics were responsible for his addiction after a doctor prescribed 5,918 fentanyl lollipops from August 2005 to December 2011 for migraines, a condition the drug was not approved to treat. Caltagirone died three years later from an overdose of methadone.
More than 200 lawsuits against drug companies have been consolidated in a Cleveland federal court as part of what's known as multidistrict litigation. The suits, brought by municipalities in California, Illinois, Kentucky, Ohio, and West Virginia, were consolidated to cut down on redundant filings that could further delay a lengthy process.
Philadelphia will not be part of that consolidation because it filed its suit in state court, not federal, Tulante said, due to a "false claims ordinance" that is specific to the city.
"This is a Philadelphia problem," said Tulante. "This should be filed in Philadelphia."