The effort to hold drug companies, pharmacies and drug distributors accountable for their role in the opioid crisis has led to a whirlwind of legal activity in the United States that can be difficult to track.
Three trials are currently underway, in Florida, West Virginia and Washington State. New legal deals are struck virtually every week to provide governments with money to fight the crisis and, in some cases, funds for drugs to reverse overdoses or aid in treatment.
In total, more than 3,000 lawsuits have been filed by state and local governments, Native American tribes, unions, hospitals and other entities in state and federal courts regarding the toll of opioids. Most allege the industry has created a public nuisance in a crisis that has been linked to the deaths of 500,000 Americans over the past two decades.
Collectively, the companies have already faced settlements, judgments, and civil and criminal penalties totaling more than $47 billion. The main entities targeted are the companies that manufactured and sold the pills; the companies that distributed them; and the pharmacies that dispensed them.
Here is an overview of the disputes and settlements involving the various companies:
Purdue is the maker of OxyContin, an extended-release version of oxycodone that contains higher doses in pills. The drug, released in 1996, has become a widely marketed blockbuster – and is closely associated with the first wave of the epidemic.
Like other opioids, it has been promoted not only for post-surgery and cancer pain, but also for chronic pain – an area where doctors were previously reluctant to prescribe such potent drugs.
Facing thousands of lawsuits, the company filed for bankruptcy protection in 2019 to help reach a settlement.
An agreement is now in place, but it is not final.
It calls on members of the Sackler family who own the company to give up their stakes, allowing it to become a new entity – known as Knoa Pharma – whose profits will fund the fight against the opioid crisis. Additionally, family members have to pay between $5.5 billion and $6 billion over time, with some of the money going to the victims.
Earlier this year, three family members attended an online hearing in which parents described the loss of children to addiction that began with OxyContin, and people recovering from an addiction described their journey.
As part of the exchange, members of the Sackler family would receive protection from opioid lawsuits.
For the settlement to be finalized, a higher court must overturn a judge’s decision that rejected an earlier version of the agreement. A hearing on the matter is scheduled for April 29 before the United States Court of Appeals for the 2nd Circuit.
In the meantime, activists and some US senators are calling on the Justice Department to consider lawsuits against family members.
Other Drug Manufacturers
In a major court victory for drugmakers last year, a California judge ruled against some local governments in their case against pharmaceutical companies Johnson & Johnson, Endo International and Teva Pharmaceutical Industries.
Some of those drugmakers — Johnson & Johnson, Allergan and Teva — are currently on trial in West Virginia.
But the companies have largely settled lawsuits.
Mallinckrodt, which was a leading producer of generic oxycodone, also used bankruptcy court to reach a settlement, agreeing to a $1.6 billion nationwide settlement in 2020.
Johnson & Johnson has agreed to a $5 billion nationwide settlement. It was announced alongside a separate settlement involving the three largest drug wholesalers. The company’s Janssen subsidiary stopped selling its fentanyl patches and painkillers in the United States in 2020. J&J was also the first drugmaker to be held responsible for the opioid crisis in a lawsuit, although the Oklahoma Supreme Court later overturned the decision.
Endo made the opioid Opana, which was eventually taken off the market. The company has entered into individual agreements with states. Deals since last year with Florida, New York, Texas, West Virginia and select Tennessee district attorneys totaled more than $200 million.
Late last year, a New York jury found Teva partly responsible for the state’s opioid crisis through its marketing of the fentanyl drugs Actiq and Fentora. Most of the other companies that the state and two counties sued settled before or during a trial last year. A separate trial must be held to determine damages.
Since the New York lawsuit, Teva has reached settlements with Texas, Florida and Rhode Island totaling more than $250 million. It will also provide drugs to reverse overdoses and treat addictions.
Allergan, now a subsidiary of AbbVie, has settled lawsuits involving the extended-release morphine pill Kadian. He made a major deal with New York last year. Since then, it has been part of the Multi-Company Colonies in Florida and Rhode Island.
Executives of drugmaker Insys were found guilty in 2019 of bribing doctors across the United States to prescribe their Subsys fentanyl sublingual spray. The company’s founder, John Kapoor, was sentenced to 5½ years in federal prison.
The company also paid $225 million to resolve federal investigations into allegations that it paid bribes and used other illegal marketing tactics.
The big three national companies — AmerisourceBergen, Cardinal Health and McKesson — finalized their settlement, worth a total of $21 billion over 18 years, in February.
The deal, combined with Johnson & Johnson, is expected to be the biggest deal between pharmaceutical companies and governments.
Total amounts include separate settlements covering all federally recognized Native American tribes.
As settlement money begins to flow to state and local governments, officials are trying to figure out how to prioritize it. The funds come at a precarious time: the number of overdose deaths in the United States from all drugs topped 100,000 in a 12-month period for the first time last year. The majority of these deaths are due to opioids – and in particular the illicit synthetic versions, including fentanyl.
Unlike the tobacco regulations of the 1990s, there are safeguards designed to direct most opioid settlement funds toward solving the crisis. Public health experts have ideas on how to proceed, but the decisions rest with government officials.
Distribution companies also went on trial last year in West Virginia. A judge has yet to rule.
Final arguments in Washington State’s lawsuit against the distributors are expected this week.
Pharmacy chains have been sued less often than companies that manufacture or distribute opioids. In a groundbreaking case, a federal jury in Ohio last year found that CVS, Walgreens and Walmart recklessly distributed massive amounts of painkillers in Lake and Trumbull counties.
Late last month, CVS moved to Florida. That left Walgreens to go to trial on Monday.
Global consultancy McKinsey & Company also struck deals last year with states, Washington, DC and US territories to advise companies on how to sell more prescription opioids amid the overdose crisis. . These settlements totaled more than $600 million.
A group of US senators are pushing for a federal investigation, saying there were conflicts when the company consulted on issues related to opioids for both the companies and the US Food and Drug Administration.