NORMAN, Okla. (Legal Newsline) – An opioids researcher on Tuesday compared doctors over-prescribing opioids to the breaking of a figurative dam that flooded Oklahoma - and the country - during testimony in an important trial taking place in the state.
“They (Johnson & Johnson) reframed the reasons for caution (prescribing drugs),” said Dr. Andrew Kolodny, co-director of Opioid Policy Research for the Brandeis University Heller School for Social Policy and Management in Massachusetts. “People were suffering (pain) and it was said, 'Don’t worry about dependence.' It was seen as a way to improve the quality of life.”
The trial in the Cleveland County District Court is being streamed live courtesy of Courtroom View Network.
The suit launched by Oklahoma Attorney General Mike Hunter alleges that J&J and Janssen carried out a fraudulent advertising campaign to over-supply opiates in Oklahoma for profits leading to an epidemic Hunter called the worst in the state's history. J&J's opioid brands are Duragesic, which dispenses opioids by the use of a timed-release patch, and a pill called Nucynta.
Thousands of cases are still pending around the country and the Oklahoma case is being followed nationwide. It's also the first opioid trial under the "public nuisance" legal theory, attempting to hold pharmaceutical companies, distributors and pharmacies liable for the nation's addiction crisis. Critics of the nuisance claim say the state’s case is in reality a products liability case.
Two other co-defendant pharmaceutical companies, Purdue Pharma of Connecticut and Teva Pharmaceutical based in Israel, earlier settled with Oklahoma, $270 million from Purdue and $85 million from Teva. That left J&J (and Janssen) as sole defendants in the case.
In the Purdue Pharma settlement, private attorneys took in $60 million, while about $200 million went to a research project at Oklahoma State University, which is Hunter's alma mater.
Purdue officials pleaded guilty in 2007 of misleading the public about the risk of addiction from their opioid pain killer OxyContin and agreed to pay $600 million, at the time one of the largest pharmaceutical settlements in U.S. history.
Attorneys for Johnson & Johnson did not have time to question Kolodny on Tuesday.
Brad Beckworth the state-hired attorney with the Dallas-based Nix Patterson law firm asked Kolodny how many times Janssen officials had tried to help him abate the opioid crisis.
“Never,” Kolodny answered.
“Have they (Janssen) vilified you?”
“Yes,” Kolodny said.
Kolodny said Oklahoma is at the top of the list of states hardest hit by the opioid epidemic. He said up until 1995, the figurative dam holding back the waters of drug abuse still held, protecting the public. However, he said the epidemic took off when doctors began prescribing powerful opioids for common (non-cancer) pain.
“Was it (epidemic) caused by an over-supply of drugs?” Beckworth asked.
“That’s correct,” Kolodny said.
“Why did we end up with an over-supply?”
Kolodny indicated the medical community became more aggressive in using such drugs to treat pain.
“It wasn’t just the (drug) sales reps,” he said. “It was professional societies, hospitals and medical boards. There was a big difference from the stingy doctors of the past.”
“Was the message pervasive?” Beckworth asked.
“That is an understatement,” Kolodny said.
Kolodny said after 1996 the country became flooded with opioids. No such epidemic happened in Europe.
“Are Europeans tougher than Americans?” Beckworth asked.
“I don’t think so,” Kolodny said.
“Well something happened,” Beckworth said. “Are Europeans healthier?”
Kolodny disagreed, adding there was zero evidence that Americans have done better treating chronic pain than doctors in Europe.
Tasmanian Alkaloids, a poppy-processing subsidiary of Johnson & Johnson from 1982 to 2016, 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 was used to create a substance called “thebaine,” used in the production of OxyContin and other opioids.
Kolodny said he had visited the Tasmanian poppy fields and that Johnson & Johnson supplied the poppy substance for Teva Pharmaceuticals, Purdue and other drug companies.
Kolodny explained that customarily, poppies were processed for their sap and turned into raw opium, then refined. He said Johnson & Johnson instead would mow a field to get poppy straw, then refine it, producing a genetically altered strain for the production of thebaine used in Oxycodone (used to make the OxyContin brand).
This was labeled the “Norman Mutation.”
Company literature said it was intended to “meet anticipated (drug) demand” in 1994 through development of a high-thebaine poppy.
Beckworth asked Kolodny if the current epidemic would be easy to fix.
“No,” Kolodny said. “We will be struggling with this for decades. We’re still dealing with the heroin addiction epidemic in New York in the 1970’s, that’s 50 years out and the community is still feeling the effects.”
Kolodny said the U.S. with five percent of the world's population consumes 88 percent of the world's Oxycodone supply.
He added that the drug company was trying to sell more opioid drugs by targeting the public and doctors.
"They're doing this when its clear we have an opioid drug problem," Kolodny said.
A J&J document outlining strategic objectives in a sales campaign recommended "keep the patient on Duragesic longer."
"This is awful," Kolodny told Beckworth.