The state of South Carolina is suing Purdue Pharma over its alleged contributions to the opioid epidemic.

South Carolina Attorney General Alan Wilson announced the lawsuit at a press conference on Tuesday. It accuses the Connecticut-based company of deceptive marketing practices and downplaying the addictive qualities of OxyContin.

In particular, the suit addresses Purdue Pharma’s failure to comply with the state’s Unfair Trade Practices Act. In 2007, Purdue Pharma signed an agreement with South Carolina and other states, which required the company to correct its marketing practices.

However, according to Wilson, Purdue Pharma continued to encourage doctors to prescribe OxyContin for unapproved uses. Representatives also assured doctors that the users would become only “pseudoaddicted.” Supposedly, they could reverse their symptoms by taking even more drugs.

In reality, OxyContin is a Schedule II controlled substance, which means it is highly addictive.

“Opioid addiction is a public health menace to South Carolina,” Wilson said at the press conference. “We cannot let history record that we stood by while this epidemic rages.” Recovering addicts and family members of overdose victims stood around him.

“While we vigorously deny the allegations,” a Purdue Pharma spokesperson said in a statement, “we share South Carolina officials’ concerns about the opioid crisis and we are committed to working collaboratively to find solutions.”

Over 565 South Carolinians died of opioid overdoses in 2015. Last year, the state had the ninth-highest opioid prescribing rate in the country.

Comparatively, the U.S. as a whole had over 33,000 people die from opioid use in 2015. Experts predict that number will rise.

This is not the first legal action against Purdue Pharma. In January, the city of Everett, Washington. sued the company for negligence and inaction over the city’s OxyContin crisis. Six months later, the state of Ohio sued Purdue Pharma and four other companies over their marketing of OxyContin and other drugs.

Most recently, New Hampshire filed its own lawsuit on August 1. Like South Carolina, the state accuses Purdue Pharma of overstating the benefits of opioids and recommending it for unapproved uses.

In a similar action, the Cherokee Nation sued six pharmaceutical companies in April, accusing them of unjustly profiting from over-prescription of opioids.

Last week, President Trump declared the opioid epidemic a national emergency. Since then, he has not specified any plans or resources to combat the crisis.

Delaney Cruickshank

Delaney Cruickshank is a Staff Writer at Law Street Media and a Maryland native. She has a Bachelor’s Degree in History with minors in Creative Writing and British Studies from the College of Charleston. Contact Delaney at DCruickshank@LawStreetMedia.com.

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The Cherokee Nation has filed a lawsuit in the Cherokee Nation District Court against six distribution and pharmacy companies, claiming that they have unjustly profited through over-prescribing and selling opioids.

The companies included in the lawsuit include three pharmaceutical companies: McKesson Corporation, Cardinal Health, and Amerisource Bergen. It also includes three pharmacies: CVS, Walgreens, and Walmart. The lawsuit claims that it was the companies’ responsibility to monitor opioid prescriptions and orders in Cherokee Nation, identify the red flags present, and report those issues to the federal government. Essentially, the companies should have noticed warning signs like individual patients trying to fill prescriptions from multiple doctors, or driving long distances to fill prescriptions for no apparent reason.

The lawsuit details the horrific effects that prescription opioids have had on the community, noting that American Indians are more likely to die from drug overdoses than other ethnic groups. Annual deaths from opioid overdose have doubled in Cherokee nation between 2003-2014, and now outnumber deaths from car accidents. It also points out that young people have been hit particularly hard. It reads:

A 2014 study funded by the National Institute on Drug Abuse found a much higher prevalence of drug and alcohol use in the American Indian 8th and 10th graders compared with national averages. American Indian students’ annual heroin and OxyCotin use was about two to three times higher than the national averages in those years.

The lawsuit also details the issues with women who are addicted to opioids and become pregnant, as well as the harm to the community as a whole when drug addiction and crime rise. The Cherokee Nation is seeking restitution for health care costs for those who have been affected by opioid addiction.

Cherokee Nation isn’t the first area to file a lawsuit against companies for the metoiric rise in opioid issues around the U.S.–earlier this year, Everett, Washington became the first city to sue a painkiller manufacturer. A tiny town in West Virginia, called Kermit, sued McKesson, AmerisourceBergen, Cardinal health, Miami-Luken, AD Smith Corporation and a former Kermit pharmacy, Sav-Rite Pharmacy. Those are just a couple examples–there have been others, and until the opioid crisis in the U.S. is under control, there are sure to be more.

In the Cherokee Nation lawsuit, the companies named in the suit have either elected not to comment or have pointed out that they have stringent policies in place to deal with opioid abuse, or that addiction is the real issue.

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

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States where medical marijuana is legal have seen drops in opioid hospitalizations and overdoses, according to a new study published in the April issue of the Drug and Alcohol Dependence journal. And despite the loosening of marijuana laws across the country, states that have legalized medical marijuana have not seen an uptick in marijuana hospitalizations. Opioids have ravaged communities across the nation, and some researchers see marijuana as a viable alternative for treating certain ailments.

In states with medical marijuana laws in place, hospitalizations for opioid dependence and abuse dropped by an average of 23 percent, according to the study. In addition, treatment for overdoses decreased by an average of 13 percent. Yuyan Shi, the study’s author, told Reuters that legalizing medical marijuana “may have reduced hospitalization related to opioid pain relievers.” But Shi cautioned that the results are “still preliminary.”

Marijuana’s potential as a replacement for opioids stands in stark contrast to comments Attorney General Jeff Sessions made a few weeks ago. “I am astonished to hear people suggest that we can solve our heroin crisis by legalizing marijuana,” he said, “so people can trade one life-wrecking dependency for another.” Pro-marijuana activists and many others are concerned that Sessions, who once said “good people don’t smoke marijuana,” will crack down on marijuana use, even in states where it is legal.

Comparing the two substances is precarious. Heroin is highly addictive–and is upending communities all over the country–while there has never been a reported marijuana overdose, according to the Drug Enforcement Administration. But the DEA does classify both heroin and marijuana as Schedule I substances.

Despite Sessions’ fear mongering and the federal illegality of marijuana, doctors sometimes prescribe or recommend medical marijuana to patients as a substitute for treating side effects from certain diseases, in lieu of Vicodin or Oxycontin, two powerful opioids. Prescription pain medications or other opioids like heroin kill 91 Americans each day.

Roughly 60 percent of Americans live in an area–one of 28 states or D.C.–where medical marijuana is legal, and researchers are increasingly examining the drug’s medical utility. A report in January from the National Academies of Sciences, Engineering, and Medicine found that marijuana does in fact have therapeutic properties. Still, the Drug and Alcohol Dependence study came to a restrained conclusion: “future investigation is needed to explore the causal pathways of these findings.”

Alec Siegel

Alec Siegel is a staff writer at Law Street Media. When he’s not working at Law Street he’s either cooking a mediocre tofu dish or enjoying a run in the woods. His passions include: gooey chocolate chips, black coffee, mountains, the Animal Kingdom in general, and John Lennon. Baklava is his achilles heel. Contact Alec at ASiegel@LawStreetMedia.com.

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Addiction has become a gigantic problem in the United States. According a recent report by the Surgeon General, one in seven Americans will suffer from sort of addiction disorder over their lifetimes, and only 10 percent will receive any sort of treatment for their addiction. Surgeon General Vivek Murthy released the “Surgeon General’s Report on Alcohol, Drugs, and Health” for the first time ever yesterday. The report outlines the issues with substance abuse in the United States, and provides guidelines for how to remedy them. But will President-elect Donald Trump actually follow them?

The numbers are shocking: 74 Americans die from prescription painkillers and heroin overdoses every single day; drug abuse is now the leading cause of accidental death. That’s one American dying from an overdose every 19 minutes. And according to USA Today:

Nearly 21 million Americans struggle with substance addictions, according to the report. That’s more than the number of people who have all cancers combined.

And while those numbers are shocking, they shouldn’t necessarily be surprising. Coverage, particularly of the heroin crisis, has gotten more intense than ever. Photos and videos of individuals overdosing have become almost the norm on social media and in the news, in an attempt to shed real light on the epidemic.

Murthy’s suggestions include treating addiction–particularly opioid addiction–as a public health issue, by veering away from the abstinence-only solutions that became popular during the War on Drugs. Murthy points out that addiction is a “disease of the brain, not a character flaw,” and advocates for implementing preventative measures early, like addressing children still in school. The Surgeon General also pointed out the need to invest in life-saving measures like suboxone, which can counter overdoses.

President-elect Trump talked a lot about substance abuse–particularly opioid addiction–on the campaign trail. He obviously talked a lot about stopping the drug trade from South America, which wasn’t on Murthy’s list of recommendations. But he also spoke about drug courts, treatment, and prevention, which could be steps in the right direction, if he is able to pay for them.

The substance abuse addiction crisis is a real problem in the United States. We’ll have to see if Donald Trump is able to follow through on his promise to fix it.

Anneliese Mahoney

Anneliese Mahoney is Managing Editor at Law Street and a Connecticut transplant to Washington D.C. She has a Bachelor’s degree in International Affairs from the George Washington University, and a passion for law, politics, and social issues. Contact Anneliese at amahoney@LawStreetMedia.com.

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Mel Brooks Tried Pulling Down President Obama’s Pants

Why? Because he’s Mel Brooks. Best known for his films “Spaceballs” and “Blazing Saddles,” the 90-year-old director was at the White House last night accepting the National Medal of the Arts from President Obama. Which is pretty awesome!

Anyway, Mel Brooks, like many 90-year-olds, doesn’t give a shit about social conduct. So he decided to pull a gag, by pretending to pull down Obama’s pants.

Rant Crush

RantCrush collects the top trending topics in the law and policy world each day just for you.

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One of the tendencies people have when combating a problem is the tendency to over-correct. Rather than taking a moderate approach in the first place, they move from one extreme to another. Our drug and alcohol policy sometimes appears to be following that same tendency. Like the boom and bust of capitalism, we put cocaine in our soda and then switched to putting those who use the drug in jail. In the current climate, we have gone from drug companies and doctors promoting opioid painkillers as a life-saving innovation to defeat pain, to restricting the drugs we can use to combat addiction out of fear that it might contribute to the problem even more.

It is of course not an either/or proposition, yet we currently don’t place restrictions on opioid painkillers in the way that we restrict drugs used to treat those who are addicted to opioids. The fear is that if people have unlimited access to drugs like Suboxone they will abuse them rather than use them in recovery. Suboxone is a drug that can mimic some of the effects that opioids have on the brain in order to diminish cravings for and withdrawal from actual opioids. Addicts might also sell drugs like Suboxone to others. We’ve seen this happen with prescriptions for other drugs–in fact, it continues to be a major contributor to the opioid epidemic–so it is not surprising that this fear exists.

Some people will undoubtedly abuse access to Suboxone and drugs like it, the same way that some people abuse cough syrup, which is now restricted in many places. But do the potential abuses of Suboxone and other opioid addiction treatment drugs justify how we restrict them? Or are they such a necessary tool in combatting drug addiction that we should look for alternate means to prevent their abuse so more people can utilize them?

The Devil In the Details

To better understand restrictions on drugs like Suboxone we first need to understand exactly what these drugs do and how they can be dangerous.

When you take an opioid painkiller the drug activates the opioid receptors in the brain, which both blocks pain and creates the high associated with opioids. The more you take the less it becomes about reducing pain and the more it involves achieving that high. Eventually, the brain becomes accustomed to the opioid’s presence and you need more to get high, or even just to maintain normalcy and avoid withdrawal. Because of the way the body processes opioids, once you are chemically addicted to the drug you’ll never get rid of that reaction to it; your brain is permanently wired that way. Many people can and do quit using opioids and avoid addictive behaviors, but the inability to reset your brain chemistry to where it was originally is one of the things that makes opioid addiction particularly difficult to overcome.

Drugs that activate these opiate receptors in the brain are referred to as agonists. A full agonist opioid is a drug like heroin. An antagonist is a drug that attaches to the opiate receptors in the brain but does so without activating them, therefore blocking the opioid from attaching to those receptors. Antagonists, such as Naloxone, are typically used to reverse opioid overdoses and can have no opioid effect at all.

Why People are Uncomfortable With Suboxone

The trouble with Suboxone, in terms of getting skeptics’ approval to use it for addiction treatment, is that while it acts as an antagonist (it blocks opioids) it also acts as a partial agonist. Meaning that it works the same way an opioid does but to a lesser degree. So Suboxone will have some opioid effect–such as suppressing withdrawal symptoms and cravings for an addict–without providing a high.

It is the unique nature of drugs like Suboxone, which are both antagonists and partial agonists, that makes them so effective for the treatment of opioid addiction. They are able to deal with the symptoms of withdrawal and cravings that make addiction recovery so difficult as well as prevent addicts who relapse from getting the chemical rewards for their slip, which keeps that behavior from reinforcing the addiction. But it has led some to argue that giving Suboxone treatment to addicts is simply replacing one addiction with another. This same rationale is what limits maintenance treatment in drug courts, which you can read more about here. It’s an understanding of addiction that focuses on willpower and personal responsibility–which are important elements in combating addiction–but doesn’t give full credit to the best practices determined by the science of how certain drugs affect the body.

This video introduces some of the reasons–from the perspective of an addict and from medical professionals–why treatments with drugs like Suboxone are so effective.

Why Suboxone?

In fact, using partial agonists like Suboxone in treatment isn’t just one effective treatment option, it is the most effective treatment option. Opioid addicts who use the more common rehabilitation model of a 12-step Narcotics Anonymous style program without using opioid replacement medications are twice as likely to have a fatal overdose compared with addicts who use these medications. There have also been numerous studies that show that using these medications leads to other improvements in quality of life and reduces HIV transmission.

This is not to say that psychological treatments and communal supports such as Narcotics Anonymous are not a key component to addiction recovery. But they are often not enough to help most opioid addicts. Most opioid addicts would benefit from access to medications as well. This is like treating a cardiac condition by reducing stress through yoga and getting a pet. Both of those things are treatments that can help in your recovery but are part of a more complex treatment plan that includes other lifestyle changes and medication. A drug addiction recovery plan that dismisses medication as a potential tool is, according to many medical professionals, as unethical as a treatment plan for heart disease that ignores medication.

Regulations and Restrictions

Because of the fear that addicts will personally abuse or sell Suboxone and other partial agonists, federal regulations restrict the amounts that doctors can prescribe. In their first year practicing, doctors can treat 30 patients, and in subsequent years, they can treat 100 patients. This may seem like a lot, but in communities with thousands of addicts needing treatment and few doctors, these restrictions can prevent many people from getting these medications. Senators Ed Markey and Rand Paul introduced a bipartisan bill last year, known as The Recovery Enhancement for Addiction Treatment Act, which would allow nurse practitioners and assistants to administer these drugs, raise the first year cap from 30 patients to 100, and create a pathway for certain doctors to eliminate the patient cap altogether after their first year.

Recently the TREAT Act passed through the HELP Committee (Health, Education, Labor and Pensions). In the video below, Senator Rand Paul gives a brief explanation of why he is promoting this policy change:

Restrictions on Suboxone reduce its supply, and therefore, curtail its potential for abuse. But since there is no similar restriction on the amount of painkillers that doctors can prescribe–which is a huge contributing factor to the massive increase in opioid addiction and the sale of opioids–it makes little sense to restrict Suboxone. The use of Suboxone and other partial agonists won’t actually produce a high for an addict so there is less incentive for an addict to try to obtain Suboxone illegally when he or she could try to get full agonists and get high.

There are some drugs that can be used to replace opioids that produce similar euphoric effects, in a lesser quantity, but not all of them do. At best, the use of Suboxone will prevent withdrawal symptoms and block a full opioid from taking effect, which is exactly why they are helpful to addicts trying to quit their addiction. So while they could be misused and sold, their misuse isn’t damaging in the same way that misusing a prescription for Vicodin would be.

A better strategy for curtailing drug abuse would be to regulate the amount of full agonists that can be prescribed; if we are going to regulate anything. But this regulation would run into some of the same concerns that the current regulations for Suboxone do. Rather than encouraging or requiring proper training for those who are allowed to prescribe these drugs, regulations place a one-size-fits-all rule in every community. There may be some doctors in areas that have more patients in real need of opiates, just as there are communities where the demand for Suboxone has far outstripped doctors’ ability to provide treatment. Like the current regulation of Suboxone, regulations for painkillers would also reduce the supply of the drugs–but placing restrictions that are too harsh on painkillers reduces everyone’s ability to get them–even those who legitimately need them.

Conclusion 

Regulations on drugs like Suboxone are an understandable reaction to a situation that has many lawmakers panicked. If the supply of drugs is causing a problem, then cracking down on the supply of drugs seems like the solution. The idea that the answer to bad drugs may be MORE drugs seems counterintuitive. And it is a tough sell in a culture that has been trained to treat addiction more like a psychological or spiritual dilemma than a medical one.

But drug addiction is a complex problem with psychological and medical components. Ignoring either of those elements makes combating addiction much more difficult and places more barriers in front of those in recovery. Changes in policy that allow patients to get individualized treatment for their illness, versus hoping you win the Suboxone lottery, will ultimately lead to better outcomes. Doctors do need appropriate training to deal with the specific issues involving opioid addiction. The medical profession has much to answer for when it comes to the promotion and prescription of unnecessary painkillers. But throwing the baby out with the bathwater and restricting their ability to prescribe effective treatment just because they had a hand in causing the disease is not effective.

Resources

The Washington Post: Getting Pain Killers Is Easy. Getting Help For Pain Killer Addiction Is Hard

The Huffington Post: Senate Bill Would Dramatically Alter Treatment For Heroin Addiction

Senator Edward Markey: TREAT Act One-Pager

The Daily Beast: Why Drug Rehab Is Outdated, Expensive and Deadly

Serenity Recovery: Kentucky Just Passed A New Law To Help Addicts

WJHL: New Tennessee Law Puts Restrictions on Suboxone, Subutex Prescribing

NAABT: What’s This Agonist/Antagonist Stuff?

PEWCharitableTrusts: States, CDC Seek Limits On Painkiller Prescribing

Mary Kate Leahy

Mary Kate Leahy (@marykate_leahy) has a J.D. from William and Mary and a Bachelor’s in Political Science from Manhattanville College. She is also a proud graduate of Woodlands Academy of the Sacred Heart. She enjoys spending her time with her kuvasz, Finn, and tackling a never-ending list of projects. Contact Mary Kate at staff@LawStreetMedia.com

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In a rare show of bipartisanship, the Senate managed to pass a bill that would create new block grants for states and government agencies to fund prevention, education, and treatment for opioid addiction. These efforts come as drug overdose deaths reached the highest level in history in 2014, surpassing traffic and gun-related deaths. Opioid overdoses, which involve drugs like prescription painkillers and heroin, make up the majority of drug overdoses and were involved in 28,647 deaths in 2014 based on data from the CDC.

The increase in drug deaths has been driven by a rise in painkiller and heroin overdoses, which were the cause of six in 10 overdose deaths in 2014. Opioid-related deaths have been steadily increasing for over a decade, going up 200 percent since 2000. Heroin overdoses alone tripled between 2010 and 2014.

In light of the epidemic, Congress may now be taking important steps to prevent these deaths. The Comprehensive Addition Recovery Act (CARA) passed the Senate on Thursday with a 94-1 vote. The bill aims to help fund education, treatment, and prevention programs to combat overdose deaths. Senators Sheldon Whitehouse and Rob Portman have done much of the work to push the bill through the Senate and make drug addiction a national priority.

A central goal of CARA is to increase the availability of Naloxone, a life-saving medication that can counter the effects of an overdose. Expanding law enforcement and first responders’ access to Naloxone can have significant effects on efforts to combat overdoses. Based on the CDC’s analysis of Naloxone training programs, between 1996 and 2010 about 53,000 people were trained to use the drug, resulting in over 10,000 overdose reversals.

The bill also prioritizes aid to states with laws that reduce liability for people administering Naloxone, which may encourage states to adopt similar laws in order to encourage responders to use the drug without fear of a lawsuit in the event of complications.

Provisions in CARA also seek to reduce misuse and overprescription of painkillers, which is a large contributor to drug overdoses. The bill would create a task force to issue new standards for painkiller prescription as well as implement safeguards to ensure proper disposal of unused medications to prevent children from accessing them.

One of the most important aspects of the bill is its focus on treatment. Not only would it help increase funding for evidence-based treatment programs, it would also reinforce the idea that drug addiction should be viewed as a disease that should be treated rather than punished. By funding treatment alternatives to incarceration, the bill could help shift drug policy toward efforts that reduce dependency rather than merely penalizing it.

While CARA has broad-based bipartisan support, it still has some challenges. It initially faced difficulty in the Senate after New Hampshire Senator Jeanne Shaheen attempted to add a Democratic-backed amendment calling for $600 million in additional emergency funding. The Republican leadership in the Senate holds that sufficient funding already exists for the legislation. The bill will also need to pass the House, where an identical piece of legislation is currently in committee. Relative to most bills, CARA has a decent chance of passing as it has been well received by both parties and the White House, but election year politics could end up derailing these efforts.

Kevin Rizzo

Kevin Rizzo is the Crime in America Editor at Law Street Media. An Ohio Native, the George Washington University graduate is a founding member of the company. Contact Kevin at krizzo@LawStreetMedia.com.

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