A syringe used to inject OxyContin found on the ground in Everett, Washington, whose mayor is suing Purdue Pharmaceutical Elaine Thompson/AP Photo

Pharmaceutical companies misled the public into a cycle of addiction, cities say. Now, they’re being taken to court.

It started with a few states, whose rural areas experienced the ravage of the opioid epidemic, and sought to hold pharmaceutical companies accountable with lawsuits. Now, the movement is spreading: New states are filing suits over the opioid crisis at a rapid clip. But so are cities and counties, aiming to halt potentially dangerous opioid distribution practices, and recoup the enormous past (and future) costs. That expense includes caring for, treating, and sometimes burying the addicted; supporting their children; and paying paramedics, police, and city officials.

Chicago was the first city to take legal action in 2014, but almost ten others have decided to file lawsuits in the past year—with Seattle, Indianapolis, and Cincinnati all filing in the past three months. Miami might soon join them.

Drug companies marketed and sold too many prescription drugs to too many patients, they argue, without offering adequate and accurate information about their risks. As a result, thousands of users have become dependent, often turning to harder versions of those originally prescribed opioids.

The cities developing the lawsuits listed below are bolstering the state effort in holding Big Pharma accountable, much in the way that 46 state and local attorneys worked together to take on Big Tobacco in 1998. Then, their efforts were successful: tobacco companies ended up paying out more than $200 billion in settlements for peddling addictive, harmful drugs. The opioid industry could be next.

In most cases, the pharmaceutical companies in question have continued to vehemently deny wrongdoing, and reaffirmed their commitment to combatting the epidemic and promoting responsible use.

Thus far, at least one state action has been successful. One of the first lawsuits brought by West Virginia against Cardinal Health and Amerisourcebergen ended in settlements of $20 million and $16 million, respectively.

Here are some of the new, city-spearheaded lawsuits:

Seattle, Washington: “Knowingly conducted an uncontrolled experiment”

Since 2000, 10,000 people have died from opioid overdoses in Washington state; in King County, where Seattle is located, two-thirds of the 332 drug-use deaths in the last year were opioid-related. Each year, the numbers rise, according to University of Washington researchers.

In September, the state of Washington and the city of Seattle both announced they would separately sue pharmaceutical companies for their role in that acceleration.

Seattle’s case, led by city attorney Pete Holmes, targets Purdue Pharma and Teva Pharmaceuticals. It’s not just that the companies aggressively peddled opioids to doctors, attorneys argue: it’s that they downplayed—and in some cases failed to disclose entirely—the dangerous and addictive nature of the drugs in question. At the same time, they overstated the drugs’ benefits.

They even introduced the new medical concept of “pseudo-addiction,” recommending that doctors respond to warning signs of opioid addiction by prescribing more opioids. If a patient asks for higher dosages of drugs, hoards drugs, or wants early refills of drugs, they’re not addicted—they really just need more drugs to quell their pain, Purdue claimed. Cities are calling the theory bogus—it’s based primarily on one cancer study—but Purdue has insisted it’s legally and medically valid: the FDA itself approved OxyContin labeling that “embodies the concept” of pseudo addiction, Purdue says.

“Purdue Pharma has knowingly conducted an uncontrolled experiment on the people of Washington state,” said Washington Attorney General Bob Ferguson at a news conference. Teva and Purdue are denying these allegations, saying they are dedicated to balancing the dual priorities of providing crucial drugs and preventing drug abuse.  

It was actually a much smaller locale that brought the first of Washington’s lawsuits. The city of Everett, located north of Seattle with a population of 108,000, alleged in January that Purdue knew their pills were being trafficked illegally within the city, but did not intervene or alert law enforcement. In September, a Seattle judge ruled that the city of Everett could proceed with the lawsuit, rejecting the pharmaceutical company’s March argument that the city’s case had no merit. Still, Purdue told CBS News that Everett’s narrative of their involvement in the Everett crisis is “flawed” and “inaccurate.”

Indianapolis, Indiana: “They sought relief from pain and were administered addiction”

Last year, 1,498 people died of an overdose across the state of Indiana, and 345 of them were within Indianapolis’ Marion County. In Indianapolis alone, overdose medication (the expensive and hard-to-administer drug, Narcan) has been deployed by paramedics 1,670 times so far in 2017.

This fall, the city hired a private firm tasked with arguing that Big Pharma conspired to increase sales by misrepresenting how addictive their drugs really were. The city also alleges that, when “unquestionably suspicious” opioid orders were requested, drug companies failed to report them. “They all sought relief from pain and were instead administered addiction,” said Mayor Hogsett in a news conference.

Indianapolis hasn’t identified all the defendants yet, but the mayor and an attorney named Purdue Pharma, Endo, Teva and three distributors (Cardinal Health, McKesson Corporation and Amerisource Bergen) as likely targets—those who sold the bulk of the OxyContin and oxycodone to Indianapolis residents.

Purdue “vigorously den[ies] these allegations”; Teva and Endo wrote of their commitment to making drugs accessible but keeping drug use safe and appropriate; and the representative for all three city distributors said that while they, too, want to be part of the solution, they “aren’t willing to be scapegoats.” It’s a bigger problem than just distribution, they insist.

Cincinnati; Dayton; and Lorain, Ohio: “a year-and-a-half supply” for 802,000 residents

In 2014, Ohio had the highest rate of overdose deaths in the nation—and in subsequent years, the number of deaths has risen. Along with taking lives, the crisis has sucked valuable public resources from cities in the state. So this summer, Cincinnati announced it would join its sister city Dayton, as well as their shared home state, in bringing suits against pharmaceutical companies.

Both Cincinnati and Dayton are suing Big Three” distributors AmerisourceBergen, Cardinal Health and McKesson Corporation; and Dayton is also suing five manufacturers (Purdue Pharma, Endo Health Solutions, Teva Pharmaceutical Industries, Johnson & Johnson and its subsidiary Janssen Pharmaceuticals, and Allergan) and four physicians. “They profited by breaking the law and we want our money back," Cincinnati mayor John Cranley told WCPO. “We are in a state of emergency. We need action now,” Dayton mayor Nan Whaley said at a news conference.

Both cities’ suits start with the common argument that drug distributors and manufacturers misled the public for profit. Both also hinge on the high volume of opioid shipments these companies approved—“enough for a year-and-a-half supply of opioids for Hamilton County's 802,000 residents,” officials estimate—which Cincinnati argues was in violation of the 1970 Controlled Substances Act. But Dayton’s suit extends the scope of responsibility to include individual doctors who acted as consultants to drug manufacturers, promoting and deceptively marketing opioids to patients.

The Big Three distributors issued statements similar to those published in response to other cities’ suits: Cardinal Health writes that they “care deeply about the devastation opioid abuse has caused American families and communities” and they all want to find a solution—but, writes McKennan, because they “do not manufacture, promote or prescribe prescription medications to members of the public,” they “believe these copycat lawsuits filed against us are misguided.” AmerisourceBergen insists they do inform the DEA of suspicious orders, and comprehensively track and report the details of pharmacy orders. The manufacturers and physicians did not issue statements of their own.

Another smaller Ohio city, Lorain, also filed a suit against more than 11 companies in late June.

Princeton, West Virginia: “It’s a war”

The small city of Princeton, located in southern West Virginia, voted this month to sue Amerisourcebergen Drug Corporation, Cardinal Health Inc, and other as-of-yet unnamed pharmacies within the city limits. The lawsuit has not been filed, and there has been no response from the companies the city did name.

“It’s more than serious,” said Mayor Dewey Russell during the city council meeting, before the affirmative vote on whether to proceed with a legal case. “It’s an epidemic, it’s a war.”

The state of West Virginia already settled one case against 14 drug distributors in 2016, from which they received around $40 million. Their success inspired Princeton and other West Virginian cities to follow suit.

Chicago, Illinois: “Stop this deceptive and unlawful marketing”

Chicago led the city-level charge in 2014, when they sued Purdue Pharma L.P., Cephalon, Inc., Janssen Pharmaceuticals, Inc., Endo Health Solutions Inc. and Actavis, for the same sort of misleading, manipulating, and overselling other cities have condemned them for.

“The purpose of the lawsuit is simple,” said Chicago Corporation Counsel Stephen Patton in 2014. “To stop this deceptive and unlawful marketing and hold these companies responsible for the harm their deception has caused.”

The case is still in the discovery phase in the U.S. District Court for the Northern District of Illinois.

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