Commonwealth of Virginia
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ATTORNEY GENERAL HERRING SUES PURDUE PHARMA FOR LIES THAT HELPED CREATE AND PROLONG OPIOID CRISIS
~ Lawsuit filed in Tazewell County Circuit Court alleges that Purdue engaged in an illegal, decades-long campaign to lie and deceive Virginians about the risks of its opioid drugs ~
RICHMOND (June 27, 2018)—Attorney General Mark R. Herring today filed a lawsuit accusing Purdue Pharma of profiting from an opioid crisis that it helped create and prolong through a decades-long campaign of lies and misrepresentations in violation of the Virginia Consumer Protection Act. Since 2007, 8,000 Virginians have died from an opioid overdose, including 5,000 from a prescription opioid overdose. During the same period, Purdue made false claims about the purported safety, efficacy, and benefits of its opioids, including OxyContin, pumped tens of millions of pills and patches into the Commonwealth of Virginia, and reported billions in profits.
Attorney General Herring's lawsuit was filed this morning in the Circuit Court of Tazewell County, where the rate of fatal prescription drug overdoses is more than four times the state average. The suit, which also alleges Purdue created an unlawful public nuisance, asks for injunctive relief to put an end to Purdue's lies and deception about its opioids and for monetary compensation and damages as determined to be appropriate by the court.
"For decades, Purdue Pharma has amassed a fortune and built an empire on suffering and lies about the dangers of its drugs and its central role in creating and profiting from the deadliest drug epidemic in American history,” said Attorney General Herring. "The opioid crisis that is touching so many Virginia families is the direct and foreseeable result of Purdue's complex, large-scale, and years-long campaign of deception. For too long Purdue has ignored its moral and legal responsibilities, while working overtime to boost the sale of its opioids by increasing the number of doctors who prescribe, increasing how much they prescribe, increasing the number of people asking for and taking opioids, and increasing the amount they take. I have filed suit to stop the lies, to stop the perverse incentives that have pumped millions of pills into Virginia, and to stop the heartbreak and loss of life.”
Attorney General Herring's suit alleges that Virginia's opioid crisis "is the direct and foreseeable result of a decades-long, complex, large-scale campaign of misrepresentations and deception.” At the heart of Purdue's unlawful scheme were lies that its opioids were safe, carried a low risk of addiction, and were more effective than other pain relievers. Purdue knew that all of these claims were false, yet it engaged in an elaborate scheme to push the lies through aggressive sales tactics, marketing, and seemingly independent patient advocacy organizations.
PURDUE'S LIES AND MISREPRESENTATIONS
The suit alleges that Purdue built its opioid empire on lies about the effectiveness and purported safety of its drugs:
Purdue lied about the risks of prescription opioid addiction. Purdue systematically misrepresented the potential for addiction, minimized the discussion of the risk of addiction or omitted it altogether, mischaracterized the symptoms of addiction, and misrepresented the extent to which addiction risk could be minimized or controlled.
Purdue promoted a fabricated condition called "pseudoaddiction” to leverage signs of addiction and abuse into more sales. Purdue claimed signs of addiction, like doctor shopping or requests for higher doses or early refills meant that patients had "pseudoaddiction,” meaning that the patient just needed a higher dose of opioids, not addiction treatment. This false concept was marketed to healthcare providers, patients, and the public and led to increased sales.
Purdue lied about the risks of increased doses of opioids. Because it was invested in the concept of "pseudoaddiction,” Purdue needed to make larger doses of opioids seem safe and necessary. Purdue-backed publications claiming that some patients "need” a larger dose, and that certain opioids have a "no ceiling dose,” effectively telling Virginians that there was no limit on the amount of certain opioids they should seek or could take. One of Purdue's websites even encouraged patients to be "persistent” in finding doctors who would give them the amount of drugs they wanted.
Purdue lied about the ease of preventing or mitigating addiction. Through its own materials and sponsored organizations and publications, Purdue sought to reassure doctors that addiction was rare and could be easily identified and prevented with just a few simple questions.
Purdue lied about the relative benefits of its opioids.
Alleged superiority of prescription opioids. Purdue went to great lengths to claim that opioids were more effective than over the counter pain relievers. Despite no evidence to support its claims, Purdue simultaneously exaggerated the benefits of opioids and downplayed the effectiveness of nonsteroidal anti-inflammatory drugs (NSAIDs), while also exaggerating the risks of NSAIDs and downplaying the risks of opioids. One Purdue sponsored publication falsely claimed that NSAIDs caused "10,000 to 20,000” deaths annually, while also claiming that there was no upper limit of opioids that could be consumed.
Abuse-deterrent formulations. Purdue labeled and marketed a reformulated OxyContin as "abuse deterrent,” when in reality, there is no evidence to suggest that abuse-deterrent formulas have any effectiveness as a risk-mitigation strategy for deterring or preventing abuse or addiction. This marketing as "abuse deterrent” convinced 46% of physicians in a 2014 survey to say the product was less addictive when it was just as dangerous.
Purdue mispresented the effectiveness of its drugs.
For treating chronic pain. Purdue marketed its products for long-term use, and specifically for the treatment of "chronic pain,” despite a lack of evidence that long-term opioid use was an effective treatment and Purdue's knowledge that it lacked scientific support for its claim.
Benefits over NSAIDs. Purdue haled opioids as the "gold standard” for pain relief, claiming that "the pain relieving properties of opioids are unsurpassed,” despite having no scientific evidence that its opioids were any more effective than over-the-counter non-opioid pain relievers.
In improving function and quality of life. Through its sponsored third parties, Purdue pushed the false claims that opioids could increase long-term functionality and improve quality of life.
PURDUE'S SALES AND MARKETING TACTICS
Purdue employed a team of dozens of salespeople in Virginia who used false claims about safety and effectiveness to market its opioids directly to health care providers who, relying on these false claims, prescribed opioids in situations they would not have otherwise done so, or in larger doses than they otherwise would have.
Purdue created and supported third party groups, individuals, resources and publications that it paid to validate its false and unsupported claims. Purdue donated millions of dollars to trade organizations and specialty advocacy organizations in addition to paying "key opinion leaders” such as doctors who could credibly promote its false messages about the safety and efficacy of opioids. This includes Dr. J. David Haddox who created the concept of "pseudoaddiction” and went on to become a vice president of Purdue. Purdue also sponsored publications that pushed its misrepresentations including the American Pain Foundation's "Treatment Options: A Guide for People Living with Pain,” "A Policy Maker's Guide to Understanding Pain and Its Management,” "Getting the Help you Need,” and "Exit Wounds,” a pamphlet targeted specifically at veterans.
Purdue's sales teams pushed its false claims directly to Virginia healthcare providers, even those known to be irresponsible prescribers. Purdue employed a team of dozens of salespeople who made hundreds of thousands of contacts with Virginia prescribers. Evidence shows that Purdue salespeople called on doctors they knew to be irresponsible prescribers, even those whose licenses had been suspended for improper prescribing, and, in one case contacting a doctor while his license was suspended.
Purdue's compensation structure incentivized its salespeople to push opioids as hard as possible, even to irresponsible prescribers. Purdue's Incentive Bonus Program, effective January 1, 2013, made clear that sales representatives would not receive a bonus based on sales from providers who the sales representatives reported and were placed in a "cease calling” status, but could potentially receive a bonus for those in "cease calling” if the sales representative did not initially report the provider.
THE IMPACT OF PURDUE'S UNLAWFUL CAMPAIGN OF LIES
Millions of Purdue's opioid pills and patches have been used to fill prescriptions in Virginia over the last decade. The human and fiscal impact has been significant and severe.
From 2007 to 2017, 7,890 Virginians died of an opioid overdose, including 4,929 from prescription drugs. In 2017 alone, 504 deaths were attributable to prescription opioids, the highest number ever recorded in Virginia.
In 2017, accidental overdoses accounted for 8,578 emergency room visits and Virginia spent approximately $28 million on hospital visits because of opioid use.
In 2016, 4,076 doses of naloxone were administered to Virginians in the midst of an overdose.
In 2013, Virginia's Medicaid program spent $26 million filling opioid prescriptions, and since 2007 has spent approximately $88 million on medication assisted treatments for opioid addiction and overdose medications like naloxone.
More than one third of the 31,000 Virginians who sought substance abuse treatment at a Community Service Board were seeking opioid abuse treatment.
The heroin and prescription opioid epidemic has been a top priority for Attorney General Herring. He and his team continue to attack the problem with a multifaceted approach that includes enforcement, education, prevention, and legislation to encourage reporting of overdoses in progress, expand the availability of naloxone, and expand access to the Prescription Monitoring Program. He has supported federal efforts to improve the availability of treatment and recovery resources and made prescription drug disposal kits available across the Commonwealth. Attorney General Herring recently outlined his recommended next steps for combating the crisis, focusing on law enforcement initiatives, support from the medical community, and recovery, treatment, prevention and education. He and his team also continue to participate in a multistate investigation into the practices of additional drug manufacturers and distributors to determine what role they may have played in creating or prolonging the crisis and what accountability they should face.
Attorney General Herring and his team have handled 117 cases against heroin and fentanyl dealers and traffickers involving more than 667 pounds of heroin (302 kilograms) worth more than $37 million on the street. These cases against dealers and traffickers have involved 39 overdose victim fatalities as well as 47 overdose victims who survived.
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