The health-care conglomerate’s conduct has emerged as an early test of whether the pharmaceutical industry will be forced to pay billions of dollars to more than 1,600 cities, counties, states, Native American tribes and others across the United States that have sued to recover the costs of coping with the crisis.
Those defendants include manufacturers, distributors, chain drugstores and others. Many of the lawsuits are consolidated in an enormous federal case in Ohio that is scheduled to begin in October.
But Judge Thad Balkman, who is hearing the case here in Oklahoma without a jury, insisted on Tuesday’s court date, making the civil trial in the Cleveland County courthouse the first to get underway. The legal arguments unveiled before a packed gallery of lawyers, experts, media and the public are expected to be echoed at future trials.
Two earlier defendants in the case — pharmaceutical manufacturers Purdue Pharma and Teva Pharmaceuticals — settled separately with the state for $270 million and $85 million, respectively. Earlier this month, a North Dakota judge threw out another case against Purdue.
About 400,000 people died of opioid overdoses between 1999 and 2017, about half of them from prescription drugs. More than 2 million Americans suffer from an opioid use disorder.
Lawyers for the state honed in on that toll as the case began Tuesday morning. State Attorney General Mike Hunter told Balkman that 4,653 Oklahomans died of overdoses between 2007 and 2017, in what he termed “the worst man-made public health crisis in the history of our country and this state.”
He accused Johnson & Johnson, its subsidiary, Janssen Pharmaceuticals, and other drug companies of mounting “a cynical, deceitful, multimillion-dollar brainwashing campaign to establish opioid analgesics as the magic drug” for pain beginning in the 1990s, when health-care providers came under mounting pressure to treat pain more aggressively.
One of the more dramatic moments came when attorney Bradley Beckworth showed what he said were notes written by a Janssen sales representative named Melinda Dickson after a 2004 visit with an unnamed Tulsa physician. The doctor was concerned about the company’s Duragesic fentanyl patch being diverted to illegal use on the street.
“Emphasized when someone does divert, it’s usually not repeated,” Dickson wrote. “Either fatal or they do not get affect they are looking for.”
Beckworth said the note, and others like it, showed that Janssen managers were aware of the damage pharmaceutical opioids were causing but “chose to exploit it” instead of speaking up.
Beckworth also said Johnson & Johnson and Janssen repeatedly downplayed the risk of opioid addiction and overdose. Through subsidiaries Tasmanian Alkaloids and Noramco, the company set out to dramatically increase the amount of the ingredient thebaine needed to manufacture Purdue Pharma’s OxyContin and other drugs, he said.
And the company worked hard to develop a poppy plant with increased concentrations of the substance, Beckworth alleged, rewarding the employee responsible for producing the better poppy with a medal.
“If you oversupply, people will die,” Beckworth repeated throughout his portion of the arguments, which lasted more than an hour.
The state is seeking as much as $17.5 billion during the next few decades to “abate” the drug crisis through treatment programs, syringe exchanges and other services for substance abusers. The notion that the money will pay to mitigate future harms is a key and contested point in the trial.
Johnson & Johnson attorney Larry Ottaway took on most of the accusations directly. He played a video the company distributed that warns teens about the dangers of abusing prescription drugs and highlighted labels on Duragesic and the pill Nucynta that warn of the risk of “addiction, abuse and misuse” that can lead to “overdose and death.”
Ottaway ran through a litany of federal and state agencies that regulate opioids, from the U.S. Food and Drug Administration to the state’s own Drug Utilization Review Board. He noted that many factors influence a doctor’s decision about whether to prescribe opioids. Those include education, clinical experience, medical literature, other physicians, continuing education classes and company salespeople.
He said the state cannot trace a single case of addiction or overdose death specifically to a Janssen medication.
The company, Ottaway asserted, tries to address patients’ pain while balancing the need for its medications against the risk of abuse, as the FDA and the Centers for Disease Control and Prevention recommend.
“Serious, chronic pain is a soul-stealing, life-robbing thief,” he said. “It leads to depression. It leads to suicide.”