Originally in Asheville Citizen-Times

May 16, 2018

The maker of the widely used opioid OxyContin used false or misleading information to persuade doctors to prescribe the painkiller, state Attorney General Josh Stein said here Wednesday after his department filed suit against Purdue Pharma.

Purdue "engaged in a host of deceptive marketing practices," Stein said in an interview at the Citizen Times. "They were more focused on how much money they could make selling their products than the potential and real risks (OxyContin) posed to people."

North Carolina was one of six states that filed similar lawsuits Tuesday against Purdue, a privately held company based in Connecticut, that allege the company engaged in deceptive trade practices.

Purdue denies the allegations. 

OxyContin is perhaps the best known among a group of drugs that have been abused so often that opioid-related deaths now outnumber fatalities in automobile crashes in North Carolina. Physicians say opioids are much more addictive than drug makers initially led them to believe.

Stein says he wants Purdue to change the way it sells its products and "help to clean up the mess that it helped to create" by providing money the state could use to mitigate damage that opioids have caused.

"People are dying, people are struggling with addiction. Families are experiencing incredible pain. ... Courts are clogged. The emergency departments are filled. Social services are strained," he said.

That creates costs borne today by taxpayers that should be covered at least in part by companies whose practices sparked the opioid crisis, he said.

The state's lawsuit lists several ways it says Purdue deceived physicians to get them to prescribe OxyContin. It says the company, sometimes acting through groups it sponsored:

--Came up with and publicized a concept it called "pseudo-addiction ... the idea that it is the pain itself, not the addiction, that causes people to engage in desperate drug-seeking behavior" like getting prescriptions from more than one doctor or forging prescriptions.

Purdue used the concept to suggest people behaving badly might actually need to take more opioids. The idea "has no valid scientific basis," the lawsuit says.

--Claimed that common pain relievers like aspirin, acetaminophen and ibuprofen "are actually riskier than opioids for chronic pain" -- another claim the state's complaint says is not backed up up science.

--"Spread the false information that there actually are no maximum dosage limits for OxyContin."

--Downplayed the risks of addiction to opioids.

Purdue signed settlements in 2007 with the federal government and some states, including North Carolina, in which it agreed to change its marketing practices. The settlements included $634.5 million payments to the federal government and $19.5 million divided among North Carolina and 25 other states and the District of Columbia.

That would usually be enough to get a company to play by the rules going forward, Stein said.

Instead, "What has become clear to us is that Purdue did not respect the terms of the document it signed and needs to be held accountable for all of its acts since 2007," he said.

The state Department of Justice, which Stein heads, and similar agencies at other states have been cooperatively investigating Purdue and the lawsuit is based in part on documents obtained during that process.

Both sides said there had been discussions of a new legal settlement before lawsuits were filed Tuesday. Stein said those talks will continue.

“We are disappointed that after months of good faith negotiations working toward a meaningful resolution to help the state of North Carolina address the opioid crisis, the attorney general has unilaterally decided to pursue a costly and protracted litigation process," Purdue said in a statement.

"We vigorously deny these allegations and look forward to the opportunity to present our defense,” the company said.

North Carolina is one of 40 states working cooperatively to investigate the behavior of drug companies and pharmaceutical companies in selling opioids. The state sued a smaller drug company in late 2017.

Stein said pharmaceutical companies like Purdue "influenced an entire generation of doctors' thinking about pain."

"Doctors were told that opioids were the most effective way of dealing with pain and that they didn't pose much risk of addiction. We realize now that neither of those things were true," he said.

The other states that filed lawsuits Tuesday are Florida, Nevada, North Dakota, Tennessee and Texas.