Since 2014, state and local governments have filed thousands of lawsuits against pharmaceutical companies they blame for causing the "opioid crisis" by exaggerating the benefits and minimizing the risks of prescription pain medication. The theory underlying these cases is pretty straightforward: Drug manufacturers lied, and people died.
Two recent rulings show how misleading this widely accepted narrative is. Both decisions recognized that undertreatment of pain is a real problem and that bona fide patients rarely become addicted to prescription opioids, let alone die as a result.
Three California counties, joined by the city of Oakland, started the flood of litigation against opioid manufacturers with a 2014 lawsuit arguing that they created a "public nuisance" by encouraging increased use of their products through a false or misleading marketing campaign. In a scathing November 1 ruling, Orange County Superior Court Judge Peter J. Wilson concluded that the plaintiffs had failed to prove any of their allegations.
A week later, the Oklahoma Supreme Court rejected similar claims against Johnson & Johnson, one of the defendants in the California case. The court said Cleveland County Judge Thad Balkman, who in a landmark 2019 ruling held the company liable for his state's opioid-related problems, "erred in extending the public nuisance statute to the manufacturing, marketing, and selling of prescription opioids."
Both rulings emphasized that opioids have legitimate medical uses and concluded that drug companies could not be held responsible for abuse of their products. While "improper use of prescription opioids led to many of these [opioid-related] deaths," the Oklahoma Supreme Court observed, "few deaths occurred when individuals used pharmaceutical opioids as prescribed."
The justices noted that "opioids are currently a vital treatment option" for chronic pain, "a persistent and costly health condition" that "affects millions of Americans." They added that the federal Food and Drug Administration "has endorsed properly managed medical use of opioids (taken as prescribed) as safe, effective pain management, and rarely addictive."
Wilson rejected the plaintiffs' contention that roughly 25 percent of patients who are prescribed opioids for pain become addicted, saying "the more reliable data" suggest the rate is less than 5 percent. He also rejected claims that the defendants had misled doctors by saying opioid treatment "improves function" and by suggesting that patients desperate for pain relief might be mistaken for "drug-seeking" addicts.
Wilson noted that the plaintiffs "made no effort to distinguish between medically appropriate and medically inappropriate prescriptions." Since both California and the federal government have determined that the benefits of medically appropriate opioid use outweigh its risks, he said, a rise in prescriptions by itself cannot constitute a public nuisance.