Ohio is the latest US state to take legal action against manufacturers of prescription opioid painkillers. Attempts to strangle the legal supply of these drugs at home could reduce the demand for similar, illicit drugs like heroin and possibly impact the supply chain in Mexico.
In a suit filed on May 31 in Ross County, Ohio's Attorney General Mike DeWine accused five drug companies of misleading the public about the risks of using prescription opioids and their addictive nature.
The drug producers also denied the dangers of high opioid dosages and falsely touted the benefits of long-term opioid use in their marketing materials and dissemination campaigns, according to DeWine.
Purdue Pharma LP, Johnson & Johnson's Janssen Pharmaceuticals Inc unit, a unit of Endo International Plc, Teva Pharmaceutical Industries Ltd's Cephalon unit and Allergan Plc were the five companies targeted in the lawsuit.
The over-prescription opioid painkillers such as Purdue's OxyContin, Cephalon's Actiq, and legal versions of fentanyl -- as well as the lack of adequate government regulation around their distribution -- is widely blamed for creating the opioid epidemic currently ravaging communities in the United States.
Many addicts in towns and cities across the United States have migrated from those prescription painkillers mostly Mexican-sourced heroin, creating a boom for organized crime in that country and prompting opium poppy cultivation and drug-related violence south of the border to spike.
According to DeWine, 2.3 million Ohio residents were prescribed opioids in 2016, nearly a fifth of the state's population. Ohio has been one of the states hardest hit by the crisis, which killed more than 33,000 people through overdoses in 2015 across the country. West Virginia and New Hampshire also showed some of the highest overdose rates that year, according to the Centers for Disease Control and Prevention.
The number of deaths attributed to controlled prescription drugs (CPDs) continues to outpace those for cocaine and heroin combined, according to the latest National Drug Threat Assessment Summary from the Drug Enforcement Administration (DEA); that has been the case since 2002.
DeWine's complaint accuses the companies of violating Ohio's Consumer Sales Practices Act, committing Medicaid fraud, and having created a public nuisance by disseminating false and misleading statements. The lawsuit seeks to stop the companies from being able to represent their opioid products in the way they currently do, as well as civil penalties to pay for some of the costs of the addiction and overdose crisis.
Janssen spokesman Jessica Castles Smith said in a statement emailed to Reuters that the allegations "are both legally and factually unfounded."
None of the other companies have denied the allegations so far.
The Ohio lawsuit comes after similar actions against legal opioid manufacturers by two counties in California, the city of Chicago, four counties in New York, and the states of Mississippi and New Hampshire over their marketing, sales and distribution practices. There have also been some successful federal legal actions in this space.
Prosecutors are now also targeting the distribution networks around prescription opioids, which is a relatively new strategy. A number of counties in West Virginia have filed lawsuits in recent months against drug wholesalers McKesson Corp, Cardinal Health and AmerisourceBergen for failing to report suspicious orders of opioids in the state.
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The latest lawsuit from the state of Ohio, as well as recent moves to go after other parts of the drug distribution chain, are further official efforts that are essential to combat growing opioid addiction and overdose crisis in the United States. Focusing on the legal supply side, and honing in on wholesalers as well as producers, shows that all parts of the supply chain could be held responsible, and this could have an impact as far away as Mexico.
Andrew Kolodny, co-director of the Opioid Policy Research Collaborative at the Heller School for Social Policy and Management welcomed the lawsuit and others like it, in part because of the payments they can prompt from offending companies.
"The municipalities and states that are filing these suits are now dealing with a very expensive problem," he told InSight Crime, referring to the cost of treating addictions and related infections, as well increased spending on the social consequences such as the rise of children entering the foster care system as their parents become addicts.
In theory, reducing the number of people addicted to these pain pills will reduce firstly the rate of overdoses -- legal pills are the major cause of opioid deaths -- and secondly the demand for the illegal substances they switch to when their legal supply runs out, namely heroin and fentanyl.
"We have to start seeing the instance of opioid addiction going down and the only way we can prevent people from getting opioid addicted is with much more cautious prescribing and a very significant reduction in prescription opioid consumption in the US, which would help reduce demand," said Kolodny, who also emphasized the importance of the availability of addiction treatment.
More regulation of prescription pain killers is needed, but it is not the only answer. A focus on the supply side, which could result in restricting the availability of some of these powerful painkillers, risks victimizing people who legitimately need those medications to relieve their suffering. A focus just on the pain pills is prone to ignore other social and economic factors that also drive people to using opioids.
Kolodny and other experts criticised the administration of former President Barack Obama for being slow to react to the opioid epidemic. It was only in 2016 that Congress and President Obama added $1 billion to drug treatment through the 21st Century Cures Act.
There has been some pessimism over the implications of some of President Donald Trump's recent budget proposals for this issue. Trump -- who promised to end the US opioid addiction crisis and spend more on drug treatment during his presidential campaign –- has both given and taken away reasons to hope that more will be done to reverse the problem.
His suggested budget cuts to Medicaid have raised fears that addiction treatment for legal opioid and heroin addicts could be reduced, which would be a huge impediment to reducing addiction. But suggested cuts in overall spending on the Department of Justice (DOJ) of $1.1 billion from 2017 levels were softened by an additional $198.5 million to "reduce violent crime, combat the prescription drug and opioid epidemic, and target Transnational Criminal Organizations."
Reducing addiction in the US and subsequently demand for illegal heroin and fentanyl would impact organized crime in Mexico, Colombia, Guatemala and other Latin American nations, where the drug is produced and transported. Some recent bilateral efforts could also signal a renewed push on this part of the drug trafficking business.
William Brownfield, the US Assistant Secretary for International Narcotics and Law Enforcement Affairs (INL), said that the United States is in talks with Mexico about helping fund the latter country's poppy eradication efforts. And a recent conference backed by funding from the Mérida Initiative aimed to better equip Mexican law enforcement for detecting and seizing fentanyl -- part of further, but as yet undisclosed, efforts to combat the deadly synthetic opioid.
In May 2017, the US Treasury Department also added a little-known Mexican heroin trafficking group to its "Kingpin" list, perhaps symbolizing a stronger focus on criminal groups dedicated to trafficking opioids.
Despite these recent developments, Trump wants to cut overall US spending on anti-narcotic operations in Mexico.
In March 2016, the DEA said that Mexican organized crime was challenging the dominance of Colombian groups in the US heroin market. A year later, Brownfield said that as much as 94 percent of the heroin entering the United States is trafficked from Mexico. Illegal fentanyl is also becoming an increasingly important part of the portfolio of Mexico's crime syndicates with seizures in Mexico rising.
An uptick in the production and trafficking of heroin by Mexican poppy farmers and organized crime syndicates in response to booming US demand has been a major contributor in making an already bad situation in Mexico even worse. But rather than addicts dying, Mexicans are being killed in drug-related violence.
To be sure, homicides across Mexico are growing, and violence related to the heroin trade is being felt most acutely in the state of Guerrero, Mexico's heroin heartland. The country's most violent entity, thanks to the heroin boom, the state has descended into criminal chaos that the local government admits it cannot control. Self-defense groups now operate in over half of the state's municipalities due to an absence of an effective state presence. Some of them are reportedly financed by or allied with organized crime.
The uptick in demand for opium poppy in Guerrero coincided with the fragmentation of the dominant criminal player, a trend being seen across the region. The killing of Arturo Beltrán Leyva in 2009 weakened the Beltrán Leyva Organization (BLO), which broke into pieces that are now feuding for control of the heroin highway that runs through the state, as well as other lucrative criminal markets.
Increased poppy eradication in Guerrero, even if it is funded by the United States, promises to do little to bring down both cultivation and violence unless the root drivers behind the drug trade are addressed. Poverty and the lack of alternative sources of income give farmers in the Guerrero hills few other options through which to feed their families.
The recent actions by the US government both at the state and federal level, and at home and abroad, show that the opioid crisis is firmly in its crosshairs. But companies like Purdue Pharma are now looking beyond the US as prescriptions for their products falling and legal action against them grows, reports the Los Angeles Times. A network of companies owned by Purdue's parent is moving into Latin America, Asia, the Middle East and Africa. The question for these regions will be whether governments of those nations will learn from the mistakes made in the United States to avoid their own opioid epidemics.