Medical Ethics

Tennessee Lawmakers Take on Opioid Marketing

By November 22, 2018 No Comments

The battle against opioid addiction has taken a new turn, and perhaps it is long past due that the fight is going local, instead of being played out on a national stage. In Knoxville, Tennessee, lawmakers are going on an attack against three drug makers, TennesseePurdue Pharma, Mallinckrodt and Endo Pharmaceuticals.

The lawmakers are charging that the companies named above are culpable of poor marketing practices that minimized the addictive properties of the drugs. Tennessee has a controversial drug law called the Tennessee Drug Dealer Liability Act (or popularly known as the “Crack Tax”), and under that act they will be treating the pharmaceutical companies as though they were drug pushers.

The prosecutors are accusing the companies of lying to patients about the addictive nature of opiates, and marketing techniques that positioned them as breakthrough drugs for the treatment of pain. They are calling the marketing practices deceptive and fraudulent.

Tennessee – An Unusual Approach

In treating the problem as a legal argument under the laws the state enacted, they have “rolled out” an innocent victim and his mother. A baby boy, known as “Baby Doe,” was born in March 2015. He was born addicted to opiates. His mother was addicted to painkillers and as she bought her drugs in Sullivan County, Tennessee, it is in their jurisdiction to bring forth the charges.

The following quote appeared in the lawsuit:

“It is now beyond reasonable question that the manufacturer defendants’ fraud caused Mary Doe and thousands of others in Tennessee to become addicted to opioids — an addiction that, thanks to their fraudulent conduct, was all but certain to occur.” The lawsuit also states that the State of Tennessee logs more opiate prescriptions per capita than any state in the nation except West Virginia.

As it is shaping up, there are many other lawsuits shaping up in at least six other states as well as The Cherokee Nation. In Tennessee, they want to categorize the pharmaceutical manufacturers as drug dealers and make them pay for all of the damage they have done. The prosecutors understand that unlike the street drug dealers who were originally the target of the Tennessee Drug Dealer Liability Act, the pharmaceutical companies have lots of money. In fact, billions of dollars in annual sales from the opiates alone.

The Problem of Responsibility

One of the key issues here, is who will ultimately assume responsibility? As the prosecution goes up the ladder it will be harder to prove. Is it the patient, the physician or the pharmaceutical companies? Did the patients understand just how addictive the artificial opiates were? Did the pharmaceutical companies lie to the doctors about the research? What about the drug representatives and the pharmacies?

Pain is an awful sensation following surgery or for chronic and excruciating conditions but the problem with painkillers is that patients who become addicted often continue on long after the body has healed.

There has not only been a long history of doctors over-prescribing painkillers, but apparently pharmaceutical companies have been accused of knowing that pain killing medications work for less time than indicated on the bottle. This means that an opioid supposedly claimed to be good for “12 hours,” may only work for 8. When the pain kicks back in (or the “buzz” wears off), patients often over medicate or potentially “overdose.”

If the pharmaceutical companies understand this, are they not culpable? In 2015, more than 20,000 Americans died of opioid deaths, much higher than heroin addiction. Deaths in 2015 were 72% higher than 2014, and the numbers are climbing. Again, this is from prescription medication, not from illegal street drugs.

The Ethical Case

The legislation and lawsuits against the pharmaceutical companies have been growing. Panels to discuss “the problem” have been convened. However, this appears to be an ethical, as well as a biological, drug dependency issue rather than a legal case. Street drugs are one thing, and nothing we can say ethically will change that. It is a case for law enforcement.

However, with the growing number of patients addicted to opioids, some of that illegal street stuff has been converted “in-house.” Legally or illegally obtained, the opioid epidemic is not about to go away unless gatekeepers along the way are also held ethically accountable.

The epidemic deserves ethical training. The issue is that no one in positions of authority are demanding such training. It is understandable. To institute training is also to admit training is needed. It is not a question of Tennessee lawmakers prosecuting, but of Tennessee lawmakers calling for ethical training for any healthcare provider who comes into contact with opioids. Until that is done, the problem will continue.


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