North Carolina Attorney General Josh Stein has filed another lawsuit against a pharmaceutical giant, this time going after Purdue Pharma, the Connecticut-based company that developed the prescription painkiller OxyContin.
"The opioid epidemic is a heartless killer," Stein said at a news conference announcing the lawsuit. "More than 13,000 people have died of an opioid overdose in North Carolina since 1999. The crisis has ruined and taken lives, destroyed families and posed a steep financial burden on our communities with health care, criminal justice and social services bearing the brunt. And sadly this crisis will worsen before it improves."
The 47-page complaint against Purdue was filed in Wake County Superior Court on Tuesday in conjunction with five other states accusing the drug company of fueling a national opioid epidemic through deceptive marketing of the prescription painkillers.
State attorneys general in Nevada, Texas, Florida, North Dakota and Tennessee also turned to their state courts to litigate their complaints that Purdue Pharma violated state consumer protection laws to deceptively market its prescription painkillers to generate billions of dollars in sales.
The lawsuits are part of an intensifying effort by state attorneys general to engage pharmaceutical companies in the nationwide battles to reverse the path of destruction that opioid addiction has left in its wake. The effort is also offering opportunities for victims and survivors — such as grieving family members, hopeful survivors and treatment providers — to share stories that show the human impact of the flood of opioids, prescribed and illicit, in a state struggling to combat a crisis.
"Fundamentally this crisis is about over-prescription," Stein said.
"The number of opioid pain pills prescribed dramatically increased over the last 20 years," he said. "At the same time, the number of people dying of overdoses increased dramatically."
In 1999, 109 people in North Carolina died from accidental opioid overdoses, according to the lawsuit filed against Purdue in Wake County Superior Court. By 2016, that number increased to 1,384 — more than tenfold.
More than 13,000 North Carolinians have died from opioid-related overdoses since 1999, according to the lawsuit, and more than 19,000 North Carolinians have received opioid-related substance abuse treatment.
"During 2017, alone," the lawsuit states, "emergency medical technicians administered naloxone — medication that can reverse the effects of an opioid overdose — to more than 15,000 people across North Carolina."
The North Carolina lawsuit accuses Purdue of using branded and unbranded marketing materials provided to patients and prescribers to:
▪ Target such vulnerable populations as the elderly and veterans.
▪ Downplay concerns about opioid addiction while suggesting instead that people engaged in "desperate, drug-seeking behavior" should receive more opioids, not fewer. "Some of Purdue's own doctors eventually acknowledged that 'pseudo addiction' was 'an excuse to give patients more medication,' and 'led us down a path that caused harm'," Stein told reporters gathered for a news conference on Tuesday.
▪ Portray aspirin and ibuprofen as riskier than opioids for chronic pain without supporting such claims with valid science. "Purdue's marketing efforts told prescribers that these nonaddictive drugs were actually riskier than opioids for chronic pain," Stein said.
▪ Claim there were no maximum dosage limits for OxyContin, that the only real limit was when when a patient's life became threatened by slowed breathing.
"Through these and many other deceptive statements, repeated thousands of times in numerous forms over many years, Purdue and others in the pharmaceutical industry achieved what marketers often dream of, but rarely pull off: a comprehensive transformation in the attitudes, habits and practices of the consuming public," the lawsuit contends. "Ultimately, Purdue's false statements played a major role in moving North Carolina out of a world in which opioid use was sharply limited, due largely to well-documented concerns about addiction and patient safety, and into a world where opioid prescriptions, addictions, and overdoses — and all of the pain and loss that flows directly from them — have become omnipresent."
Purdue, which ended the promotion of opioids in February after other lawsuits, denied the allegations.
"We are disappointed that after months of good faith negotiations working toward a meaningful resolution to help the state of North Carolina address the opioid crisis, the attorney general has unilaterally decided to pursue a costly and protracted litigation process," Robert Josephson, a company spokesman, said in an email.
Since North Carolina elected Stein in 2016, he has made combating the opioid crisis a priority of his administration.
Late last year, Stein sued Insys Therapeutics, an Arizona-based pharmaceutical company that he accused of illegally pushing a fentanyl-based cancer pain medication at headache clinics in North Carolina to fatten company coffers.
A mother's grief
During his first year in office, he toured the state, listening to families affected by the crisis, law enforcement officers, health care providers and people involved with substance abuse treatment and those well-versed in holes in the systems.
On Monday, Stein held a roundtable discussion in Raleigh with parents and others who lost children or family members to opioid overdoses.
Debbie Dalton came to the capital city from Cornelius, her emotions still raw from the loss of her only child on Dec. 4, 2016.
Hunter Dalton had just graduated from UNC-Charlotte in 2016 and moved to Raleigh to start a new chapter of a life filled with promise.
He worked at Citrix, “had a heart of gold,” his mom said, “and had a gift of making every person he met feel like they were the most important person in the world.”
“He was living the dream,” Dalton said.
That dream became a nightmare for his parents, a scene too familiar to too many North Carolina families, the roundtable participants said.
Dalton was at home, settled in for the evening, writing out Christmas cards. She was signing her name and her husband's to the cards and stopped to think about whether to automatically add Hunter's, too, as she had done throughout his childhood.
"I was wondering, should I still sign his name," Dalton recalled.
Then the phone rang. Her son's name popped up on the screen.
But It was her son's roommate, not the voice she was expecting.
"He said Hunter overdosed," Dalton recalled, her voice trembling at the memory.
Dalton had been in Raleigh, partying with friends. Then he was in a hospital bed, hooked up to a respirator and other machines keeping him alive for seven more days.
"What happened with Hunter was he thought he was using recreational drugs and fentanyl was involved," Dalton said.
Still grappling with her new reality, Dalton has used her grief to fuel her commitment to educate others about the perils of recreational drug use. She carries two photographs of her son to illustrate how quickly a life can change. The first photo is of her 6-foot-3 outdoorsman in rock-climbing gear, perched high above the ground, his gloved hands gripping a rope and a broad smile stretched across his face. The other is a photograph of the face she encountered inside the hospital room, where she held her son's hand during the last days of his life.
"What we're trying to do is we're trying to educate and to warn and to let people know there are no safe drugs," Dalton said. "Fentanyl's a game-changer. You know he didn't see this coming, our community didn't see this coming, and we want to make sure people are aware of this."
The Daltons do not know the origin of the fentanyl that ended their son's life.
Though Stein has pursued legal action against companies that marketed pharmaceutical fentanyl-based products such as Insys, he said chasing the illicit fentanyl providers has proven tougher.
"The illicit fentanyl is very tough because they're just using the postal service to send the stuff into the country so we need Congress to give the postal service the technology to stop the stuff from flowing in here, but at the end of the day, the way we're going to solve the drug crisis is to reduce the demand because where there's demand somebody's going to supply that," Stein said.
As the state's top prosecutor, Stein noted ongoing efforts among law enforcement agencies to go after drug traffickers in criminal court.
"We will keep doing this as much as we possibly can," Stein said. "But we've got to help people who are addicted get healthy so that they don't want to buy these drugs,"
At his news conference on Tuesday, Stein welcomed two people among those trying to help the addicted get healthy.
From pills to heroin
Justin Garrity is a volunteer coordinator at Healing Transitions, a Wake County organization that provides long-term residential services to people with stories similar to his.
Garrity started smoking marijuana when he was an awkward 12-year-old, who wanted to impress an older boy who lived near his parents' home in Apex. As he juggled school and a social life that included more and more drug use, Garrity escalated his drug use to cocaine and pills that often circulate among teens from unused, expired or unwanted medications in family medicine cabinets.
When the OxyContin and other prescription pills became too difficult to get, Garrity, a high school athlete, turned to heroin to feed his addiction.
"By the age of 25, I was living out of my car in a Walmart parking lot with a university degree," Garrity said. "I never thought in a million years I would be addicted to heroin. I never thought I would be homeless."
Garrity got treatment during that time and stayed clean for several months before he reconnected with an old girlfriend and got arrested at a Motel 6.
He spent a night in jail and then got back to Healing Transitions where he invested the next 14 months in his recovery.
Now his passion is running and trying to help people avoid the pitfalls that he didn't.
Gina Musa, a peer support specialist at Healing Transitions, also knows the constant push and pull of addiction.
Like Garrity, her journey to heroin started with pills.
"I started off by taking prescription medication from my parents' medicine cabinet," Musa said. "They had no idea what was going on. And my friends — we did the same thing."
As her life went on, Musa turned to physicians to help her with back pain she got from swimming.
"I went to a doctor who prescribed me 120 OxyContins every month," Musa said. "And that was normal for me. I thought that's what I had to have in order to live."
Eventually, Musa said, the Drug Enforcement Administration shut that doctor down but her addiction did not subside with the absence of her prescriber.
Eventually she shifted from what she described as "socially acceptable pills" to heroin.
"They are two people," Stein said, thanking Musa and Garrity for sharing their stories of recovery. "There are tens of thousands of people in North Carolina who are struggling and not enough of them have achieved recovery yet and sadly there are about 13,000 who didn't make it and the holes in their families' hearts can never be healed. That's why we're here today."