Tucson Medical Center became one of the first hospitals in Arizona to file a lawsuit against some of the largest pharmaceutical companies and distributors in the United States, claiming they negligently and fraudulently created the opioid crisis that is “devastating communities” in the state and across the country.
The hospital is seeking compensatory and punitive damages in a civil jury trial against 25 opioid manufacturing/marketing companies, including Johnson & Johnson, Purdue Pharma, Abbott Laboratories, Janssen Pharmaceuticals, Allergan, Teva Pharmaceuticals, Watson Laboratories and Insys Therapeutics.
Six distributors of opioids are also listed as defendants, including Cardinal Health, McKesson Corp. and AmerisourceBergen Drug Corp.
Insys Therapeutics of Chandler is also the target of a civil investigation by the Arizona Attorney General’s Office and a criminal probe in Massachusetts over how the firm marketed its fentanyl product.
“The massive quantities of opioids that flooded into Arizona as a result of defendants’ wrongful conduct — 431 million doses in 2016, or enough for every Arizonan to have a two-and-a-half-week supply — has devastated communities across the State, especially the southern Arizona community served by Tucson Medical Center,” the hospital said in its lawsuit, filed Wednesday in Pima County Superior Court.
TMC charged that opioid manufacturers intentionally downplayed addiction risks, suggested that “pseudo addiction” should be treated with more opioids, promoted long-term opioid use, claimed that dependence could be easily managed and more. The hospital claims that distributors failed to monitor, detect, investigate, deny inappropriate refills and report suspicious orders of prescription opioids as required by law.
TMC alleges in its 270-page lawsuit that the companies violated Arizona racketeering and corruption (RICO) statutes, violated the Arizona Consumer Fraud Act and engaged in wide-ranging negligence, fraud, fraudulent concealment and unjust enrichment. The pharmaceutical industry raked in about $11 billion in revenue from opioid sales in 2010 alone, Wall Street analysts have said.
The hospital said the companies created a deceptive marketing scheme solely designed to increase the sales and use of opioid drugs, which are now the most common treatment for chronic pain.
The resulting opioid crisis has stretched TMC’s resources, and it continues to incur “substantial unreimbursed costs” for its treatment of patients with opioid-related conditions, the lawsuit stated. The hospital said it is attempting to seek reimbursement of those costs from the companies named in the lawsuit.
The hospital said that from April 2016 to September 2017, about 22,000 patients were seen by TMC for opioid-related conditions, including addiction, overdoses and associated illnesses. Of those, about 10,000 were admitted to the hospital.
TMC filed the lawsuit because “Arizona is disproportionately affected by the opioid crisis,” said Tim Hartin, TMC chief legal officer. “Pima County is disproportionately affected in Arizona. And based on conversations with other hospitals, we are catching the worst of the epidemic here in Tucson.”
TMC officials said the hospital has taken several steps to help address the problems created by the opioid crisis.
“We participated in the development of — and have fully implemented — the prescribing guidelines set forth in the governor’s Arizona Opioid Epidemic Act, which enacted a detailed and overarching approach to opioid usage,” said Rhonda Bodfield, TMC director of communications and government relations.
The hospital also saw an increased need in 2016 for specialized care for newborns exposed to opioids taken by their mother. So TMC created the Neonatal Abstinence Syndrome Annex within its newborn intensive care unit to help soothe and care for those babies. It has also created programs to help new parents deal with substance abuse.
TMC has also created surgical procedures that reduce the need for opioids during recovery and worked to develop guidelines for treating chronic pain in emergency situations.
Opioid overdoses in Arizona increased 74 percent from 2013 to 2017 and shows no signs of slowing.
Pima County in particular has felt the brunt of the crisis, with an 18 percent increase in overdose deaths from 2010 to 2016, with 67 percent of the deaths in 2016 caused by an opiate compound, TMC said.
“This issue deserves the right to be heard by a Tucson jury and judge,” Hartin said.
“The misuse and abuse of prescription opioids is a complex public health challenge that requires a collaborative and systemic response that engages all stakeholders. Given our role, the idea that distributors are responsible for the number of opioid prescriptions written defies common sense and lacks understanding of how the pharmaceutical supply chain actually works and is regulated," said John Parker, senior vice president for the Healthcare Distribution Alliance, the national trade association representing distributors, including AmerisourceBergen, Cardinal Health and McKesson.
"Those bringing lawsuits would be better served addressing the root causes, rather than trying to redirect blame through litigation," he said.
The Star reached out to Purdue, Janssen Pharmaceuticals and Abbott Laboratories for comment Wednesday afternoon.
Janssen responded with a statement: “Our actions in the marketing and promotion of these medicines were appropriate and responsible. The labels for our prescription opioid pain medicines provide information about their risks and benefits, and the allegations made against our company are baseless and unsubstantiated. In fact, our medications have some of the lowest rates of abuse among this class of medications.”
Purdue and Abbott officials were not immediately available for comment, but Purdue has published an open letter stating the company is aware and concerned about the epidemic.
“Earlier this year we decided that our sales representatives will no longer promote opioids to prescribers,” the letter read.
TMC officials said any monetary compensation garnered from the lawsuit will be a drop in the bucket for the industry.
“Money is part of it, but the lawsuit is about … establishing a framework within Southern Arizona so that we can get out from underneath this epidemic,” said attorney Samuel Mitchell, who is serving as outside counsel for TMC. “This means expanding the number of treatment centers, pressuring the industry to tell the truth, re-educating doctors to only use opiates when appropriate.”
Dr. Len Ditmanson, an opioid addiction specialist at TMC, said the standard of care shifted about 20 years ago toward using opioids to manage pain because the newest, evidence-based science demonstrated it was safe. What wasn’t understood at the time, he said, was that the science claiming that opioids were safe was being paid for by pharmaceutical companies.
“Doctors are taught to do no harm,” Ditmanson said. “But we have harmed and hurt so many people by miscalculation about the use of opioids.”
The law firms of Mitchell & Speights, Motley Rice and Barrett Law Group are representing TMC in the lawsuit as outside counsel.