Last week, the pharmaceuticals giant Johnson & Johnson was ordered to pay just over $570m (€518m) in compensation by a court in the south western US state of Oklahoma. Irony of ironies, the company’s share price rose following the news, the markets having anticipated that the award would be even higher.
Johnson & Johnson (J&J) looks set to appeal the verdict, but this is just one skirmish in what is shaping up to be a lengthy and potentially bloody war of attrition as individuals, shareholders, and states take up the cudgels against the purveyors of treatments which have turned out, in many cases, to have had lethal side effects.
The US federal National Institute on Drug Abuse has estimated that the total cost in financial terms of prescription opioid disorders and overdoses reached almost $80bn in 2012. But the personal costs from poorly controlled mass pain-killing prescriptions have been incalculable.
According to one estimate, there have been more than 700,000 deaths through overdoses involving opioid substances, with millions more affected. Critics argue that manufacturers, distributors, and certain pharmacies and doctors have colluded in the flooding of communities across the country with highly addictive pain control pills.
Much of rural America, along with the country’s rust belt, has been particularly hard hit. Death rates among Afro-American drug users — previously stable after decades of heroin use — have soared following the rapid spread in the use of the painkillers.
Penn State University looked at the various ways in which state budgets have been affected by the opioid crisis. They estimate that the cost to Medicaid programmes between 1999 and 2013 reached at least $72bn and that an additional $40bn in financial burdens have been accumulated since then.
A further $12bn is believed to have been lost to the wider economy between 2000 and 2016 as a result of the decline caused in drug users’ employability and career prospects. Then there are the childcare and child welfare implications. County jails are filled to overflow and courts across the US have been forced to process a much higher number of cases.
While many manufacturers have no doubt behaved properly, several others could be caught up in the legal net and of course, Oklahoma is just one of many states considering, or have embarked on, legal action.
One company that has already been caught up in the crisis is Endo International, which employs 3,000 people, and has its global head offices in Ireland. It is facing law suits in a number of US states based on allegations over the marketing of its drug, Opana ER. Bloomberg has reported that Endo is seeking to reach a deal with the various litigants that would cap its legal exposure.
Negotiations involve state and local governments seeking a global settlement of opioid claims against drugmakers including J&J, Endo International, and drug distributors McKesson and Cardinal Health.
Much attention has been paid to the travails of Purdue Pharma — a company owned by the Sackler family, a branch of which has been involved over the years in philanthropy in the arts, having funded extensions to institutions such as the Louvre.
The Sackler family and their embattled drugmaker, Purdue Pharma LP, are backing a proposal to resolve all opioid lawsuits against themselves and the company for more than $11bn in what would be the largest settlement to date in the sprawling litigation. In return, the Sacklers and Purdue — maker of OxyContin pain medicine — would see more than 2,000 suits against them reportedly wiped out.
Purdue has come under fire for having helped to spark the crisis back in 1991 on foot of an “aggressive marketing effort” behind its high profile drug, OxyContin.
To date, the US, and in particular, its economically and socially stressed regions, has been regarded as the epicentre of the opioid crisis. However, there are indications of overspill into Europe and more widely into those parts of the world where regulation of the market remains fairly primitive.
The UK medical journal, The Lancet, recently posed the question: “Are we facing an opioid crisis in Europe?” According to the journal, there is a lack of data on the scale of the epidemic in Europe.
It is estimated that 83 Dutch people died from prescription overdoses in 2017. The US mortality rate was around 10 times higher. According to The Lancet, the lower mortality rate in Holland may be down to better healthcare. In Ireland, we certainly cannot afford to be complacent given the widespread nature of illegal drug use across society, problems in accessing healthcare and an ageing population.
According to researcher Emma McDonnell of the University of Limerick, as reported in the Irish Medical Journal, the prevalence of codeine use in Ireland is at an elevated level. “Codeine addiction is an epidemic verging on eruption,” she said.
Speaking at the annual conference of the Irish Council of General Practitioners last year, Professor Denis Cusack reported on the “remarkable increases in the prescription of certain addictive medications for medical cardholders”.
Ireland hosts a wide range of pharma companies, employing thousands of people, and its health service is also a major consumer of drugs. The Government may be reluctant to join the ranks of the litigants, aware of the potential exposure of Irish pharma investments. And in the end, it may be left to victims to take up the cause by themselves, and shareholders in once rock solid, defensive pharma companies also find themselves exposed.