On Monday August 26 in America, Johnson and Johnson (they were only one of thirteen named plaintiffs in the case) were fined $572 million dollars for “public nuisance“, and hit with an abatement (cease and desist) order after an 8 week court hearing – In the case of Oklahoma State vs Pharmaceutical companies. This was for their pivotal role in Oklahoma’s ongoing prescription opioid epidemic. I had seen some news reports, and thought I’d go and read the judges 42-page ruling. It’s sectioned into 68 points. I encourage everyone to have a look at it.
It’s important to note that the 12 other plaintiffs in the case had already settled out of court and made large payments of various sizes to the state of Oklahoma.
This is just my opinion based on some of the findings. Everything in quotations is directly from the legal documents of the hearing.
It’s important to hear point 3 in the report in full.
“All parties agreed that Oklahoma is suffering a crisis related to opioid abuse. That from 1994 to 2006 prescription opioid sales increased fourfold, and that from 2011-15, over 2100 Oklahomans died of an unintentional prescription opioid overdose. It is undisputed that in 2015 over 326 million opioid pills were dispensed to Oklahoma residents, enough for every adult in the state to have 110 pills each. Oklahoma dispenses the most prescription fentanyl per capita. In 2017 4.2 % of babies born covered by Soonercare [health insurance company] were born with Neonatal Abstinence Syndrome (also called NAS), a group of conditions caused when a baby withdraws from certain drugs its exposed to in the womb before birth.”
This one paragraph speaks volumes. How did we get here?
It’s stated that “This [present] stage of the opioid crisis was started by and still primarily involves prescription opioids.”, and that “Through the mid-90s there was no opioid epidemic.”
I realised at this point my own lack of knowledge regarding the difference between opiates and opioids. I thought it was a language thing, but it turns out opiates are opium poppy based. Opioids are synthetic or semi synthetic.
“In the 90s Johnson and Johnson through its subsidiary ‘Tasmanian Alkaloids’, based in Tasmania, cultivated raw materials such as morphine and thebaine that were then imported to another subsidiary, Noramco in the US. These were then refined and made into APIs (Active Pharmaceutical Ingredient). In 1994 Johnson and Johnson and Tasmanian Alkaloids “…anticipated demand for oxycodone.”. They started a project to develop a high thebaine variety of poppy, which they named the “Norman poppy” to meet the demand. Internally they described it as “a transformational technology that enabled the growth of oxycodone.” “Noramco then sold majority of its controlled substances via long term agreements to all 7 of the top US generic companies with opioid APIs including oxycodone, hydrocodone and naloxone” and “…grew to be the number one supplier of narcotic APIs in the US. The world’s largest market.”
In 1997 Johnson and Johnson started a concerted effort to get their drugs out there. Oxycontin, made by Purdue (another named defendant), was originally prescribed for chronic pain caused by cancer, but was now being successfully marketed for non-cancer patients. They relaunched their fentanyl-based products for that same target demographic.
How did they do this?
They started a campaign to “educate” doctors through various ways. Systematically keeping a relationship with them throughout their careers. They paid for articles to be put in medical journals, they held payed dinners and conferences and symposiums with paid speakers. Third party advocate groups were involved. “Doctors would speak to other doctors at these events”.
They “emotionally sold“ the idea that acute pain was under treated in the medical profession. That if not addressed by prescribing opioids in the short term, acute pain could turn into long term “chronic pain” and that not prescribing was harming patients in the long run. They also told physicians that patients that were turning up for more pills before the last prescription ran out, was not a sign of addiction or abuse, but was because the patients were being under prescribed…….
Johnson and Johnson used these various speaking events to change the “prescribing behaviours of Oklahoman physicians”. They also sent their sales reps repeatedly to Oklahoma clinics and healthcare practices. 1000s of phone calls. Brought food and refreshments. “Strategies developed for the sales force included utilizing a coupon program as a marketing tool for Duragesic in which the sales representative delivered to a physician a sample voucher for a box of 25mcg or 50mcg patches redeemed at pharmacy for free 15-day trial of Duragesic.”
I had to read this a few times to work out if this meant that the Doctors would give this free to a patient. Like a dealer tempting a user with banging stronger smack in a ‘first 15 days for free’ type deal, (no dealer is this generous!) or did the Doctors charge the patient and pocket the money for the stronger gear and the patient comes back for more anyway? This is an interesting consideration.
The sales reps were also trained in how to steer away from the “addiction ditch“, and to accentuate the efficiency of prescription opioids. Stating that prescription opioids are safer and had a 2.6% less risk of abuse. But the sales reps “were not trained in red flags that could indicate a ‘pill mill’ including pain clinics where patients were lined up out the door” or (and yes, I’m reading this correctly) “passed out in the waiting room “.
No, they were trained to target other different pain specialists and primary care physicians with high opioid prescription rates instead.
As well as wining and dinning and indoctrinating and putting pressure on healthcare professionals they set up committees populated with paid shills, and Doctors, all with ties to the defendants. In which speakers, organisations which had received huge funds from Johnson and Johnson such as the American Academy of Pain Medicine , the American Pain Society, the American Geriatrics Society and the Pain Care Forum, to name just a few, advocated for the use of opioids in “chronic pain management.”
They also employed strategies to influence a “wide range” of government agencies with their messages. They set up a group known as (NPEC) National Pain Educational Council to provide Continuing Medical Education (CME) related to pain and opioids.
How Drs and physicians who weren’t invested financially and cared about the wellbeing of their patients could stand against the tide of this overwhelming assault, is beyond me. Though saying this, we are talking about a country where private healthcare means you can near enough get anything you can pay for. How many good hearted well-meaning clinicians tried withstanding this barrage? Their concerned voices drowned out, and careers jeopardised?
All this concerted effort feels to me a multipronged attack or a slow grooming of every institution involved in the care of the health service clients of Oklahoma, whom I have a massive amount of sympathy and for. What chance did they have? All these people and institutions of authority, power and education. Those you trust to help you are in fact steering you into a trap. Not making your situation better but much worse. Johnson and Johnson, and government agencies such as the FDA [Food and Drug Administration] knew this long ago.
“In 1998 the FDA found that 3 pamphlets they used to promote Duragesic contained false and misleading information”. “Deceptively minimising the risks and safety issues.”
In 2001 Johnson and Johnsons own scientific advisory board suggested they should stop disseminating the information, of the low abuse potential of Duragesic, fentanyl patches. probably from a legal point of view because “aggressively marketing Oxycontin on this same issue is what got Purdue ‘in trouble’ “…… and that minimising the risk was dangerous, because of the “lethal nature of Duragesic “. That’s their own people saying this.
In 2004 the FDA concluded that the Duragesic file card presented false and misleading safety and effectiveness claims for the drug. And they were told basically to remove the misleading information from their promotional material.
There is much more in the documents. But I don’t have the time or space. This blog’s long enough as it is.
We are in 2019. How could this go on for so long? Because we are looking at the respectable face of corporate drug dealers. No different than other kingpins like El Chapo or Frank Lucas. Except maybe race, class and good lawyers and establishment connections. Their – oh so civilised respectable prescription drugs, designed Breaking Bad style to be 100s of times more powerful than street gear. Yet they seem more callous and calculated and insidious. Their tentacles embedded deeper. The negative effect on communities profounder.
This is just one report on their effect on one state. Extrapolate that by 5o states [opioids were involved in the deaths of over 400.000 Americans between 1999 and 2017 according to the US Centres For Disease Control and Prevention]. Extrapolate that again by the all the other countries Johnson and Johnson, its subsidiaries and the 12 other companies listed as plaintiffs in this action operated in.
Yes Johnson and Johnson provide nappies and shampoo for babies… but also the Duragesic (they helpfully provide the dosage recommendations for 2 year old and under on their website) and the tramadol and codeine and fentanyl and oxycodone that those same babies became exposed to in the wombs of Johnson and Johnsons opioid clients…. But then to their credit Johnson and Johnson does make naloxone to help the withdrawals and ween you off.
Because they are a business. People are not seen as patients. But customers. A source of revenue. It doesn’t make sense that they wouldn’t want people to not take their drugs. They’d want more people to take more. An exponential growth of profits. The bottom line. Like all corporations, if there is no oversight they will run amok. It’s just what conglomerates do.
Despite all this, the judge fined the company just over half a billion dollars (to be used for the financing and treatment of Oklahoma’s opioid victims. For one year only), rather than what the State sought, which was a 17 billion dollar fine. A touch for Johnson and Johnson really because the result of this verdict meant that the company’s stocks went up by over 5.2% in 24 hours. Nice.
They are still appealing the verdict.
Good work fellas!
An Interesting article by Mr Anon…….