Opioid lawsuit: We’ve seen this before, and it didn’t go well.

When you live in Tobacco Road region of North Carolina, the local news tends to focus on 3 things; Duke basketball, UNC basketball, and Duke vs.UNC basketball. So it was a little surprising to see in the front page of my local paper that my own county is joining a lawsuit against three of the nation’s largest opioid distributors.

Perhaps I shouldn’t have been surprised, given the scope of the opioid epidemic. Opioid related deaths have topped 40,000 in recent years. The drug overdose death rate in in my home state of North Carolina jumped by nearly 24.7% from 2015 to 2016 and area hospitals including my own ICU can certainly attest to this.

Multiple state and county governments are joining lawsuits against opioid manufacturers and distributors to recoup costs which they allege were due to the crisis the companies helped create. And in a bit of sweet, sweet irony, even JCAHO (aka Joint Commission) a not-for profit entity responsible for antagonizing accrediting health care organizations is getting sued. I can tell you that no doctor will shed a tear over that one.

If all of this hullabaloo is giving you a sense of deja vu, I can’t blame you. We’ve done this before. 2018 marks the 20 year anniversary of the historic settlement between states and tobacco companies. Now that it’s clear that history is trying to repeat itself, it’s worthwhile to see what happened the last time we did this; are there lessons that we take away from the last 20 years?

While opioids have caused widespread harm, tobacco use dwarfs it. Tobacco abuse kills TEN TIMES as many people, an estimated 480,000 Americans every year, according to the CDC. To that end, several states attorneys general sued tobacco companies for costs incurred by smoking to their respective medicaid budgets in the  1990’s. The historic tobacco settlement was a huge victory. $206 billion was to be paid to the states over a span 25 years.  This money, the government said, was to be used to cover costs for tobacco related illness borne by state Medicaid programs and to pay for tobacco cessation programs.

However there was no mechanism in these agreements to ensure that the money was to be used for these purposes, only a pledge by politicians that they would do so. 20 years after the Master Settlement Agreement and we find that little of the money is being spent as intended. The American Lung Association reports that only 2% of the settlement money is being spent on smoking cessation programs. Amazingly, some states have used the money for tobacco production. But of these states, none is as egregious as my own home state of North Carolina. Here’s what an ALA post said:

“North Carolina used 75 percent of its settlement funds for tobacco production. Some of those North Carolina funds went to private tobacco producers, covering tobacco-curing equipment, a tobacco auction hall, video production for a tobacco museum and plumbing for a tobacco processing plant.”

Here in Orange county, a lawyer from a firm specializing in nursing home lawsuits, McHugh Fuller, gave a presentation to the Orange County Board of Commissioners to join 200 other governments nationwide in a suit against opioid  producers and distributors.  Despite having a relatively lower rate of opioid overdoses than other counties, the Board voted to join the suit. And why wouldn’t they?  It’s free money with little to no risk! Presentations like this are likely happening in city halls all over the country. Lawyers and government officials are seeing the potential for big pay-offs and increased revenues. Heck, they’re even bringing back  the same lawyers from the tobacco lawsuit.

Perhaps more important than who is in these meetings though, is who’s not in them. Health care providers, patients, their families, first responders. These lawsuits are entirely punitive, with no discussion on how the potential awards are to be used to help victims and their families. 

Meanwhile the tobacco settlement money continues to be wasted, even as tobacco continues to  kill more people than opiods by far. There remains little discussion about how to use this money better, or even whether it could be used to help victims of the opioid epidemic.

Clearly both healthcare and patient advocates need to take up a greater leadership role as these lawsuits go forward. There needs to be strong mandates so that the money from these settlements goes to the people it’s supposed to help and not wasted on building some  museum commemorating the history of vicodin.  As long we leave things up to lawyers and politicians we can expect no improvement in the lives of the people these suits are supposed to help.

Deep Ramachandran, M.D. is a Pulmonary, Critical Care, Sleep Medicine physician, and CHEST Journal Social Media Editor. He blogs at Caduceusblog and the CHEST Thought Leaders Blog. He is on twitter @Caduceusblogger.

Devastation in Puerto Rico leads to hospital shortages in U.S.

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Hospitals run short of critical medications after loss of production in Puerto Rico facilities. 

“Doc, you mind switching that to an oral preparation?”, our clinical pharmacist inquired during multi-disciplinary rounds as intravenous infusion devices beeped annoyingly in the background.  Taking care of ICU patients can be extraordinarily complicated, so doing it as part of a team helps make sure that all bases are covered. ICU’s like ours have a BEEP BEEP BEEP. Excuse me, for a moment,  Staci, can you get that thing to stop, please? BEEP, BEEP, BEE– Thanks, Staci!. As I was saying, like many hospitals, ours uses a multidisciplinary model which makes rounds on all patients in the ICU.  An ICU nurse, clinical pharmacist, dietitian,  social worker, pastoral care, respiratory therapist, each provides important insight and perspective that guides patient care in the right direction.

As a pulmonary, critical care doc, I’m lucky to have a great team, so my ears perked up when I heard the suggestion. This was now the third patient he had made a suggestion to switch a medication to the oral route from the intravenous route. “What gives, Scott?” Over the past few years, we’ve been experiencing alot of spot medication shortages either because of inadequate supply, or because of precipitous price increases;  we can usually change to an alternative. But today was different. Today we were switching a number of different medications, all of which were intravenous to oral formulations of the same or similar medicines.

“It’s not the medicines,” he replied, “It’s the bags they’re in”. Continue reading “Devastation in Puerto Rico leads to hospital shortages in U.S.”

Doctors’ Prescription to Reduce Gun Violence

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Like a lot of people, I get pretty numbed to gun violence on television. I stopped watching the local news because all they seem to show is news about shootings. The general public’s perception about gun violence is that it’s always somebody else, that the person  who was shot had somehow been involved in crime. The numbness we feel to gun violence often ends for most of us when things hit close to home, when you or someone you know is affected. Continue reading “Doctors’ Prescription to Reduce Gun Violence”

Stem Cells and COPD: What You Need to Know.

I enjoy fielding questions from patients. Yes, I sense you’re rolling your eyes, but really, anything that I can answer that helps keep them out of the hospital is, I feel, time well spent. Recently though,  I’ve been fielding a number of questions that have me concerned. These questions often have a leading tenor about them like, “are you using stem cells for COPD yet?” The questions imply that stem cells are the de rigeur treatment for COPD. Now I may not be at the leading edge of any fashion, but being unfashionable in my treatment regimens? Never!

I can’t blame anyone for wanting to seek out treatments for COPD. It is after all, a leading cause of death and illness in the U.S. And it’s widely regarded that the changes caused by COPD/emphysema in the lungs are permanent. While there are now several different treatment options for emphysema/COPD, very few can prolong life. So if I had a family member with emphysema, I might naturally seek out treatments for COPD that go beyond the usual treatments, and with all the hype surrounding stem cells, why not take a look?

What people find when they google “stem cells and COPD” is in a word, distressing. It’s a fantasy world full of promises of health, healing, and better breathing. Equally distressing are the things that people who visit these sites aren’t recognizing: the greed, lies, lack of ethics, illusions, and misleading claims. Continue reading “Stem Cells and COPD: What You Need to Know.”