On Monday, an Oklahoma judge sided with the state's attorney general, Mike Hunter, and fined opioid maker Johnson & Johnson a whopping $572 million. Then on Tuesday, NBC News reported that lawyers for Purdue Pharma and its owners, the Sackler family, had offered to settle more than 2,000 lawsuits against the company for $10 billion to $12 billion. These are big numbers, but how can you put a price on the misery bottled, packaged and sold by the pharmaceutical companies helping to fuel America’s opioid epidemic?
These are big numbers, but how can you put a price on the misery bottled, packaged and sold by the pharmaceutical companies fueling America’s opioid epidemic?
One morning not long ago, I sat in on a meeting of church and civic leaders in Mount Airy, North Carolina. For those of you who didn’t grow up eating supper on a TV tray in front of “The Andy Griffith Show,” that’s the town that inspired the fictional town of Mayberry. But for a community that banks on its image of wholesomeness — tourists can take a ride down Andy Griffith Highway in Deputy Barney Fife’s police cruiser — Mount Airy faces issues now that Sheriff Andy Taylor never imagined. So many people are incarcerated on addiction-related charges that there’s no longer room for the likes of Mayberry’s fictional town drunk Otis. Surry County has among the highest opioid-overdose rates in the state.
With fully two-thirds of the public-health provider’s slots for medication-assisted treatment, or MAT, going unfilled, the goal of that morning meeting was to figure out how to get addicted people who live in the rural county’s hinterlands transported to treatment clinics, as many of the addicted don’t have cars or gas money. Before the assembled church leaders could offer up their volunteer drivers and vans, the president of a local civic group cut in with, “When they relapse,” she said, “we should just let them die and take their organs!”
Transportation, it turns out, was the simple problem — the much bigger issue was stigma.
I thought of that response yesterday when reading Oklahoma Judge Thad Balkman’s decision. Though Johnson & Johnson prefer you remember it as the company that makes your baby powder and Band-Aids, Balkman ruled that they were guilty of helping to create the kind of public nuisance now being experienced in Mayberry and across America: crowded jails, overwhelmed foster care systems and the kind of human suffering faced when paramedics find a couple three-days-dead from a heroin overdose with their baby beside them, left to die of dehydration and starvation.
J&J still denies any wrongdoing and says it plans to appeal, but the “judge very very firmly said, ‘You are guilty. You killed thousands of Oklahomans,’” said Dr. Jason Beaman, an Oklahoma State University professor and addiction treatment doctor who testified at the trial. “The judge acknowledged all the many bodies on autopsy tables that have Johnson & Johnson products in them,” he told me. Not just the Duragesic fentanyl patch made by a J&J subsidiary but also the active pharmaceutical ingredients extracted from the company’s Tasmanian poppy fields — the narcotic wallop contained in OxyContin and so many other painkillers that have contributed to the worst drug epidemic in American history.
I met Beaman in Tulsa recently, on a book tour stop for my book about the crisis, “Dopesick: Dealers, Doctors and the Drug Company That Addicted America.” At that stop, as on scores of stops across America, I heard parents weeping quietly in the back row about their children, some dead of overdoses and others still out on the streets, one fentanyl-packed shot away from death. In Floyd, Virginia, a mother in my book signing line asked me to write, “This will be the year,” as a plea to her own son. In suburban Philadelphia last week, another mother asked me to inscribe her copy to her daughter with the words, “You can do it.”
But most can’t do it, not alone, not without the help of buprenorphine and methadone, lifesaving medicines to which only one in five opioid-addicted Americans has access. Which is why the abatement plan approved in Oklahoma called for $232 million of J&J’s fine to pay for addiction treatment services, including MAT, in a state that annually loses the equivalent of a large high-school graduating class to overdose deaths. Another $31 million was set aside for supplementary services such as housing, employment, juvenile justice costs, and, yes, transportation to treatment. Before addiction specialists can start the work of implementing the solutions funded by this settlement, appeals will no doubt be filed as defendants continue to claim they weren’t to blame, instead placing the financial onus on federal and state programs that are already bearing the brunt of the downstream costs of the crisis — on taxpayers.
But perhaps most importantly, decisions like this week's place the blame squarely on the profit-seeking companies that flooded America’s medicine cabinets by telling lies about the addictive nature of their drugs, as the Justice Department has reported. These companies cynically pushed pills that would — sooner rather than later — lead to addicted folks crowding our nation’s jails and begging for rides to treatment.
It’s worth remembering that ignorant North Carolina civic leader’s words: let them die and take their organs.
As Big Pharma’s lies are exposed, Americans must replace ignorance and stigma with education and empathy and encourage their elected officials to meet the addicted where they are — offering them clean-syringe exchange services and social supports and connecting them to evidence-based treatment like MAT. We must understand that most of those with opioid use disorder became addicted through no fault of their own but rather at the manipulative hands of powerful strangers — in the board rooms where men and women charted poppy field production and paid money to influence doctors with misleading messages (and coupons) in American communities from Tulsa to Mayberry.