As the first state trial of the opioid epidemic begins in Oklahoma on Tuesday, families that have lost loved ones to opioid overdoses see a chance to hold drug companies accountable after years of waiting for recompense.
Gail Box will be following the trial closely, but she won’t be at the courthouse in Norman, the city where she last spent time with her son Austin in May 2011, when he graduated from the University of Oklahoma. Five days later, he was unconscious in a hospital after an overdose, with five different prescription painkillers and an anti-anxiety drug in his bloodstream. He died the same day. He was 22 years old.
“I just cannot go there,” she said of the town where her son played middle linebacker for the Sooners. “It is too painful for me to go there.”
Box is convinced that a stiff financial penalty against drug companies will provide accountability for her son’s death, as well as providing the treatment and other services substance users need.
“It’s not going to mend my broken heart,” she said. “It’s not going to stop me from mourning my son. But hopefully it will stop the mourning of other people’s sons and daughters.”
Much has changed since Oklahoma Attorney General Mike Hunter sued three drug companies and their subsidiaries 23 months ago, alleging they are responsible for the opioid scourge.
The central character in the opioid epidemic, Purdue Pharma, has settled with the state for $270 million and will not be on trial in Judge Thad Balkman’s courtroom. On Sunday, a second defendant, Teva Pharmaceuticals, settled out of court for $85 million. The state has dropped all but one accusation against the remaining company — Johnson & Johnson — and is pinning its strategy on a novel use of Oklahoma law.
During two years of pretrial battles, the number of people who have lost loved ones to opioid overdoses or seen lives ruined by addiction has steadily grown larger. In Oklahoma and elsewhere, they are among those most interested in the outcome.
“It’s a club nobody wanted to join,” said Bill Guy, 69, an Oklahoma teachers union organizer whose 34-year-old son, Chris, died of a heroin overdose in 2016. He wants companies held accountable for deaths like his son’s, and he wants to prevent future death and addiction. “It’s not about retribution for me.”
When compared to other states, Oklahoma’s drug overdose rate of 20.1 per 100,000 residents is near the middle of the pack, far below West Virginia’s rate of 57.8, but much worse than Nebraska’s 8.1, according to 2017 data from the Centers for Disease Control and Prevention.
Overdose deaths from prescription opioids have plunged in Oklahoma since they peaked at 478 in 2012, according to state data. In 2017, 277 deaths in the state were attributed to the prescribed painkillers.
The state’s total number of overdose deaths continues to climb gradually, however, led in recent years by alcohol, methamphetamine and illegal opioids such as fentanyl and heroin. In 2017, 743 people died of overdoses.
Like more than 1,600 other states, cities, counties, Native American tribes and other groups that have filed lawsuits, Oklahoma contends that pharmaceutical companies sparked the crisis of the past two decades, ignoring the growing toll and, in some cases, deceptively promoting the drugs.
Oklahoma is seeking a penalty in the billions of dollars to “abate” the crisis, alleging it will take as much as $17.5 billion across the next 20 to 30 years to compensate for the damage. Its single charge is that the drug companies created a “public nuisance,” a violation historically alleged when one party’s activities negatively affect others — a neighborhood crack house or a factory that pollutes a waterway, as examples.
The companies have asserted that they responsibly marketed legitimate narcotics approved by the Food and Drug Administration to quell pain and cannot be linked to deaths from illegal abuse of the drugs.
In a statement released Friday, John Sparks, Oklahoma counsel for Johnson & Johnson and its subsidiary, Janssen Pharmaceuticals, said “Janssen is confident it acted responsibly in the marketing and promotion of its products. Its FDA-approved medicines helped people in pain, and Janssen successfully worked with regulators to prevent diversion and abuse of its opioid medications.”
With Balkman refusing to delay the Tuesday court date, Oklahoma’s case is the first of more than 40 state lawsuits to come to trial and is being closely watched elsewhere.
Purdue Pharma, the company widely blamed for sparking the epidemic with the 1996 introduction and promotion of its painkiller OxyContin, will not be seated among the defendants. The company settled with the state in March, agreeing to pay $270 million, much of which will fund a treatment and research institute at Oklahoma State University.
Mark McBride, an Oklahoma state representative from Moore, said many communities directly affected by the opioid crisis turned their attention away from the case in recent months when they learned most of the Purdue settlement would go to a school, rather than to localities. McBride and other legislators objected to the move, arguing they should have been allowed to decide how to spend the funds. He bemoaned the fact that cities and towns that have borne the brunt of crisis received just $12.5 million from Purdue.
“I don’t think people really understand that there is something like this going on,” McBride said of the trial. The funds from the Teva settlement will go to the state, and details on how to spend it are still being worked out.
Becky O’Dell, executive director of Parents Helping Parents, a 1,200-member support group for Oklahoma parents of children with substance-abuse disorders, said the members of her organization are keenly interested in holding drug companies responsible for the damage in Oklahoma.
“What I hear is they should be held accountable,” she said. “I think they just want the epidemic addressed. They just want the problem addressed.”
Austin Box was a star high school athlete in Enid, Okla., where he suffered the first of a string of football injuries, his mother said. He, his family and his doctors carefully managed pain control with over-the-counter drugs and physical therapy, using no opioids until he ruptured a disc in his spine before his senior year at Oklahoma in 2010, she said. He received morphine in the hospital and a prescription for one opioid painkiller, with no refills, when he was discharged.
Gail Box believes that’s all it took for her son to become addicted. He began acquiring opioids from friends, she said, to manage his pain and the mental toll of the injuries. Her husband, Craig Box, declined to be interviewed because he could be called as a witness in the trial.
After graduating on May 14, 2011, and returning home from a road trip with his father, Austin Box was found unconscious May 19 at a friend’s home in El Reno. Medics and doctors could not save his life.
Gail and Craig Box have created a foundation in Austin’s name, and Gail speaks at gatherings across the state about four times a month. She also served on the board of the state’s Department of Mental Health and Substance Abuse Services, where she met Hunter.
“I will continue to beat myself up for not realizing how dangerous opioids were, and are,” she said. “I want to send a message to the drug companies. They are responsible, they are directly responsible, for deaths as a result of not being totally honest [about] the addictive nature of prescription opioids.”