Legislators and public health experts speculate Onondaga County’s lawsuit against several pharmaceutical companies could earn the county reparations for preventative spending on the opioid crisis.

The Onondaga County Legislature filed a lawsuit last week in federal court against more than 20 pharmaceutical companies for irresponsible marketing practices of opioid drugs to health care providers, alleging that the practices contributed to the nationwide epidemic of opioid addiction. Chief among the grievances is that the companies misled health care providers on the addictive nature of opioid drugs, leading them to believe they were safe to prescribe to patients hoping to manage acute pain in the long term.

David Knapp, a floor leader of the Legislature, said the cost of combating the addiction crisis in Onondaga County is steep both financially and socially.

“It’s literally millions (of dollars), and could even be in the hundred million range,” he said of the annual cost to the county.

Knapp said the legislators were “amazed” at the potential cost, calling the situation “a perfect storm.” He added that the social cost manifests in young people who are initially prescribed opioid drugs to manage pain. Some eventually become addicted to the drugs and start using heroin to avoid withdrawal once their prescriptions run out, he said.

“Profits are one thing, but you’ve got to look at the big picture on some of this stuff before you go out and market it to everybody,” Knapp said. “You can’t just look at the effectiveness of a drug but also what the social implications are.”

Onondaga County also has the highest rate of neonatal abstinence syndrome in the state, said Dessa Bergen-Cico, an associate professor of public health and addiction studies in Syracuse University’s David B. Falk College of Sport and Human Dynamics.

“If you look at county and national data, the overdose and death rates keep escalating year after year,” she said. “This past year, the numbers of deaths from opioid overdoses exceeded those attributed to gunfire and auto accidents.”

She added that this case has several parallels with the Tobacco Master Settlement Agreement of 1998. That’s promising because the opioid crisis has yet to reach its peak, she said. After the MSA was implemented, she said, lump sums of money were awarded to the counties and states named as plaintiffs, and health departments could apply for a given amount of money according to population and need.

Winning reparations from pharmaceutical companies could help mitigate the costs of providing treatment and emergency services, Bergen-Cico said. That money, she said, could be allocated to the opioid task force that meets bimonthly and has started to meet on the SU campus to accommodate an influx of members. For Onondaga County, Knapp said these services could include 911 operation and corrections office services, among others.

The roots of the opioid crisis can be traced back to the 1990s, when pharmaceutical companies started to push pain as the fifth vital sign, Bergen-Cico said. Pain’s new status as a fifth vital sign meant it was assessed with the same attention as blood pressure, pulse, temperature and respiration.

Lisa Olson-Gugerty, an associate teaching professor of public health at Falk and a family nurse practitioner in emergency medicine, said the marketing push by pharmaceutical companies was a response to growing demand by patients that health care providers use narcotics to help manage acute pain.

New York state passed a law in 2016 that prevents providers from prescribing more than a week’s supply of opioids to patients, said Olson-Gugerty, who’s prescribed opioids only three times in the past year, she said.

The best-case scenario, Knapp said, would be pharmaceutical companies paying reparations to the county to offset its share of Medicare and Medicaid in acknowledgment of their contributions to the opioid crisis.

“The county picks up half of the state share of Medicaid, and that alone is $100 million,” Knapp said. “And not all of that is for opioid abuse, but a good share of it is.”

Knapp added that while the suit could take several years, the cost to taxpayers will be minimal, since the lawyers will be paid on a contingency basis, meaning they’ll be paid from potential winnings from the judgement.

Olson-Gugerty said if the suit is successful, health care providers should advocate for the removal of pain as the fifth vital sign, which would address a cultural norm that harms health care providers and patients alike.

“We’re responding to the public’s request to address, specifically and directly, the vital sign that was named incorrectly as pain.” she said. “A vital sign is measurable. Pain is not. Pain is subjective.”

Published on January 30, 2018 at 9:47 pm

Contact Charlie: cesawyer@syr.edu