MONTICELLO, NY — The current heroin overdose crisis that is gripping the country in many cases started with people abusing legal prescription opioids; and states, counties  and other municipalities are taking the manufacturers of those opioids to court, and although none has so far gone far enough to result in a court ruling, those who sue are increasingly obtaining out-of-court settlements.

The trend started with Orange and Santa Clara counties in California, which filed lawsuits three years ago. Teve Pharmaceuticals, one of the targets of the suit, has said it will settle for $1.6 million. According to the Orange County Register (tinyurl.com/ybr2fsjp), a number of opioid manufacturers nationwide “have paid more than $300 million to avoid civil trials.”

Now Sullivan County is following the lead of four other counties in New York State in formally filing a lawsuit against several pharmaceutical manufacturers. The lawsuit accuses the drug companies of having “manufactured, promoted, and marketed opioids for the management of pain by misleading consumers and medical providers through misrepresentations or omissions regarding the appropriate uses, risks and safety of opioids.”

The lawsuit claims that the drug companies knew that opioids were too addictive and debilitating for long-term use, and also knew that with long-term use, higher doses are needed to achieve pain relief, seriously increasing the risk of addiction. The lawsuit also says that studies regarding the safety of opioids were deliberately limited to short-term studies.

The lawsuit also accuses the manufacturers of convincing the medical community that opioids were safe “through a coordinated, sophisticated, and highly deceptive marketing campaign that began in the late 1990s, became more aggressive in or about 2006, and continues to the present.”

The lawsuit says the increase in opioid use has been dramatic. “Since 1999, the amount of prescription opioids sold in the U.S. nearly quadrupled. In 2010, 254 million prescriptions for opioids were filled in the U.S.—enough to medicate every adult in America around the clock for a month. In that year, 20% of all doctors’ visits resulted in the prescription of an opioid (nearly double the rate in 2000). While Americans represent only 4.6% of the world’s population, they consume 80% of the opioids supplied around the world and 99% of the global hydrocodone supply. By 2014, nearly two million Americans either abused or were dependent on opioids.”

This has led to enormous profits for drug companies, but also an enormous spike in the number of opioid overdoses, which have quadrupled since 1999. According to the lawsuit, nearly half a million people in the U.S. suffered overdose deaths from 2002 through 2014.

All of this has happened, the suit charges, with no substantial medical benefit. The lawsuit says, “Since 1999, there has been no overall change in the amount of pain that Americans report.”

The impact on Sullivan County has been especially serious. The lawsuit says, “In Sullivan County in 2014, there were 234 opioid-related emergency department admissions, the highest rate per 100,000 residents of all counties in New York (and a 134% increase since 2010). Law enforcement in Sullivan County have administered Naloxone, a medication used to block the effects of opioids, especially in overdose, a reported 25 times through December 31, 2015, one of the highest administration rates of all counties in the State of New York. Even with preventative efforts in force, in 2015 alone there were 11 deaths reported in Sullivan County from overdoses involving opioid pain relievers.”

Then there is the issue of withdrawal. Again from the lawsuit, “Discontinuing opioids after more than just a few weeks of therapy will cause most patients to experience withdrawal symptoms. These withdrawal symptoms include: severe anxiety, nausea, vomiting, headaches, agitation, insomnia, tremors, hallucinations, delirium, pain, and other serious symptoms, which may persist for months after a complete withdrawal from opioids, depending on how long the opioids were used.”

All of this, the lawsuit argues, has led to significant costs for the county including “health care costs, criminal justice and victimization costs, social costs, and lost productivity costs.”

Legislator Alan Sorensen was the lawmaker who most aggressively pursued the lawsuit and convinced his colleagues to move in that direction. He said, “While we can’t bring back those who have lost their lives as a result of drug abuse, we can hold these companies accountable for their predatory practices in promoting addictive substances to consumers.” [See editorial on page 6.]