NORMAN, Okla. (Legal Newsline) – Fighting back tears, a father who lost his son to an opioid overdose recounted the nightmare during testimony in a trial alleging that Johnson & Johnson flooded the state with addictive drugs for profit.
“I can’t explain what happens when a child dies,” Craig Box, a business lawyer in Enid, Oklahoma, said of the heartbreak of his son's death.
Box was followed on the stand by a drug historian who said the current opioid epidemic is the second one in the country’s history, a lesson not learned but repeated.
Courtwright and Portenoy
The trial in the Cleveland County District Court is being streamed live courtesy of Courtroom View Network.
The state of Oklahoma, led by Attorney General Mike Hunter, is suing New Jersey-based corporate giant Johnson & Johnson and its subsidiary, Janssen Pharmaceuticals, claiming their advertising and promotion of pain-killing opioid drugs led to an overdose epidemic in the state.
The potential precedent-setting trial is the first such hearing to hold pharmaceuticals to blame for the opioid crisis that state officials say is the worst in the history of Oklahoma. The case is being watched nationwide and could be followed by those pursuing and defending litigation in other states.
Two former co-defendants in the case earlier settled with Oklahoma: Purdue Pharma of Connecticut for $270 million and Israel-based Teva Pharmaceutical for $85 million.
The pain-killing opioids in question include a medication called Duragesic that features a timed-release patch and a pill called Nucynta.
Box’s son, Austin, a football star with the University of Oklahoma, died in May 2011 after an opioid overdose. He had been taking medications for pain as a result of a sports-related back injury.
“What we learned was that he had opioids in his system,” Box said.
“Did you make a determination of what brand?” asked plaintiff attorney Michael Burrage.
“No,” Box said.
Box said because of the visibility his son had achieved in football, he heard from the parents of other young people who had died under similar circumstances. It led him and his wife to form the Austin Box 12 Foundation.
“We try to warn other parents about how addictive these drugs are,” Box said. “People don’t understand what they can do and how quickly they can do it.”
Dr. David Courtwright, a drug industry historian formerly with the University of North Florida and the author of a book on opioid addiction called “Dark Paradise,” said this is the second drug epidemic.
“This happened before?” asked plaintiff attorney Trey Duck with the law firm of Nix Patterson in Austin, Texas.
“Yes,” Courtwright answered.
Courtwright explained that from the 1870s to the 1890s, the use of opioids as medicines for pain and other conditions grew rapidly.
“Most typically, it was white women who were the majority (users), people who went to doctors, not Civil War veterans,” he said.
Heroin was also used at the time as a prescription drug partly as a cough suppressant.
As time went by, doctors became more aware of the dangers of opioid drugs and scaled back prescribing them putting an end to the first opioid crisis. Courtwright called it a type of “narcotic conservatism” that acted as a barrier to abuse.
“Physicians had become wary of using them (opioids) by the 1890s,” Courtwright said.
Use of aspirin as a pain reliever was developed in 1899.
“By the 1920s, the use of opioids was considered an out-of-date practice?” Duck asked.
“Yes,” Courtwright said.
Courtwright added that users of such dangerous drugs in the early days were usually older, more seriously ill people who died and were not replaced by younger users.
Under cross-examination, Larry Ottaway, attorney for Johnson & Johnson, asked Courtwright if doctors who prescribe opioid drugs should know about the potential for addiction.
“Yes,” Courtwright said.
“You’re not a physician?” Ottaway asked.
“No,” Courtwright said.
“You haven’t talked to a single doctor or patient?”
“I haven’t interviewed anyone,” Courtwright responded.
Ottaway asked if the government agencies like the Drug Enforcement Administration (DEA) regulated and set quotas on the manufacture of drugs.
“Yes,” Courtwright agreed.
Courtwright added that given the information that was available as far back as 1980, the current epidemic should have been foreseeable.
Another witness, Dr. Russell Portenoy, executive director of the MJHS Hospice and Palliative Care Institute of New York, appeared in a filmed deposition taken last January.
Janssen Pharmaceuticals provided funding through donations for research to MJHS and other medical organizations.
Portenoy was asked if drug companies used positive statements about opioids to portray them as safe and effective.
“Yes,” Portenoy said.
He was asked if he was aware that sales reps intending to sell opioid drugs to doctors referred to the doctors as “targets.”
Portenoy responded he had not heard the term targets used.
Testimony also centered on Tasmanian Alkaloids, a poppy processing subsidiary of Johnson & Johnson from 1982 to 2016, that produced about 40 percent of the world’s legal opiate crop. The firm, based in Tasmania, developed a new strain of poppy officials called Norman, the crop used to create a substance called thebaine that was used in the production of OxyContin and other opioids.
State attorneys general are seeking to make a case that Johnson & Johnson sought to influence-peddle to health organizations like the MJHS through donations and to sell more opioids to doctors. Links with growers like Tasmanian Alkaloids and an over-supply of powerful pain-killing drugs, they contend, caused the opioid epidemic.
Portenoy was told drug companies had accepted zero responsibility and was asked if they should have.
“I believe...pharmaceutical companies should accept partial responsibility for what occurred, educating the public about the need to be cautious,” he said.
Defendant attorneys however gained agreement from Portenoy that the risks and benefits of a prescribed medicine should be the responsibility of a patient’s doctor.