On August 26, 2019, Oklahoma District Court Judge Thad Blakman held healthcare giant Johnson & Johnson responsible for its role in the opioid epidemic in Oklahoma by delivering a $572 million verdict in favor the state. The judge cited the aggressive marketing strategies employed by Johnson & Johnson to increase opioid sales that involved minimizing the risks of addiction and dependence, a sales strategy also known as the “addiction ditch.”
What Happened in Oklahoma?
In the first opioid epidemic case to reach trial, Oklahoma Attorney General Mike Hunter claimed that opioid overdoses killed more than 4,600 people in the state from 2007 through 2017 with thousands more currently battling opioid addiction. The state estimates that it will cost $17.5 billion over 30 years to handle the crisis through opioid use disorder screenings, prevention and treatment, recovery services, medical education, and pain management programs.
What Did Johnson & Johnson Do?
The judge found that Johnson & Johnson engaged in deceptive marketing campaigns aimed at convincing Oklahoma doctors and the public that opioids are safe and effective for long-term use and treatment of chronic pain.
In addition, Johnson & Johnson sales representatives persuaded doctors that patients’ pain symptoms were under-treated and that patients were being harmed as a result. A technique known as “pseudoaddiction” was used to convince doctors that if patients were requesting higher doses they were not necessarily addicted to the opioid, but rather they needed the higher dose to treat their pain.
In trial, the co-director for the Opioid Policy Research Collaborative at Brandeis University, Dr. Andrew Kolodny, testified that Johnson & Johnson and their proxies downplayed the risks of opioid
use, exaggerated the benefits, and saturated the market with opioids. For instance, Johnson & Johnson minimized the fact that when patients take opioids every day for as few as five days,
physiological dependence begins to set in and it becomes extremely difficult to discontinue opioid use. As a result, there are now more than 2 million opioid-addicted Americans who need treatment.
What are Prescription Opioids and Why are they Dangerous?
Prescription opioids are used for moderate to severe pain relief. To achieve relief, opioid receptors attach to brain cells and release signals to block pain receptors and boost feelings of pleasure. Opioids are intended to be used for a limited time to treat pain that does not respond to standard painkillers such as Aspirin, Ibuprofen, and Paracetamol.
However, opioids are extremely addictive and can be dangerous if abused. The feelings of pleasure resulting from opioids can be addictive. As a result, the patient develops a psychological dependence on opioids in order to achieve feelings of pleasure. Additionally, if opioids are consumed at too high of doses, breathing and heartbeat are slowed which may lead to death.
A study on opioids conducted by the Center for Disease Control and Prevention revealed the severity of the drug's addictiveness. In a sample of opioid naïve, cancer-free adults who received opioid prescriptions, the likelihood of chronic opioid use increased with each additional day of treatment starting with day 3 and the most drastic increase in chronic opioid use occurred after the 5th and 31st day of treatment.
What is the Opioid Epidemic?
The Center for Disease Control and Prevention reported that almost 400,000 overdose deaths in the United States between 1999 and 2017 were tied to opioids.
Startling research from the Center for Disease Control and Prevention in 2006 revealed a stark increase in opioid overdose deaths paralleling a similar increase in opioid prescriptions. Before the opioid epidemic, unintentional drug poisoning mortality rates increased on average 5.3% per year. However, at the beginning of the opioid epidemic (1990-2002), unintentional drug poisoning mortality rates increased by 18.1% per year.
Between 1999 and 2002, the number of opioid-related poisonings listed on death certificates increased by 91.2%. By 2002, opioid-related poisoning was involved in 5,528 more deaths than other addictive drugs such as heroin or cocaine.
What is Happening with Other Opioid Manufacturing Companies?
When Oklahoma initially sued to combat the opioid epidemic plaguing the state, Purdue Pharma and Teva Pharmaceuticals were named as defendants in addition to Johnson & Johnson. However, Purdue Pharma and Israel’s Teva Pharmaceuticals settled with the state prior to trial. Purdue Pharma, the maker of the blockbuster drug OxyContin, agreed to pay $270 million. Teva Pharmaceuticals, one of the world’s leading providers of generic drugs, agreed to pay $85 million.
Since Purdue Pharma did not go to trial, their marketing strategies for OxyContin were not revealed in court; however, the American Public Health Association published an analysis of their manipulative marketing tactics.
Purdue Pharma introduced the opioid OxyContin to the market in 1996 through aggressive marketing and promotion. The high availability of OxyContin correlated with increased abuse, diversion, and addiction. As a result, by 2004 OxyContin became a leading drug of abuse in the United States.
Aggressive and deceptive marketing strategies included creating individual profiles of physicians based on their prescribing patterns and creating a national database to identify the highest and lowest prescribers of particular drugs in a single zip code, county, state, or the country as a whole. After the profiles were compiled, Purdue Pharma targeted physicians who were already the highest prescribers for opioids in the country due to their large numbers of chronic pain patients.
Purdue Pharma also introduced a lucrative bonus system that incentivized representatives to increase OxyContin sales in their region. The representatives also created a patient coupon program for OxyContin which provided patients with a free, limited-time prescription for 7 to 30 days.
These manipulative marketing tactics disguised the risk of addiction associated with opioids for the treatment of chronic pain. As a result, sales representatives were told to relay the message that the risk of addiction was “less than one percent.” However, the studies providing these claims proved to be defunct and resulted in Purdue Frederick Company Inc. (an affiliate of Purdue Pharma) pleading guilty to criminal misbranding charges in 2007.
Dangerous Drugs and Deceptive Marketing
The $572 million verdict in Oklahoma against Johnson & Johnson is only the beginning of justice in the opioid epidemic plaguing the country. Companies who fueled the opioid epidemic by predatory marketing techniques increased the presence and availability of dangerous and addictive products. However, cities, states, and municipalities across the United States are fighting to hold those companies responsible for the devastation and predation.