Being an addict has been costly for Chris Bott. He lost his job, alienated his family and got kicked out of his parents’ house after a prescription OxyContin habit turned into a full-blown heroin addiction.
He’s been arrested, charged with felonies, and locked up in jail for days. He has overdosed multiple times and nearly died. At 38, he’s close to celebrating a year of being sober, his first since his early 20s. But the addiction lurks, ready to pull him back under. “It’s always something I deal with, this defect in my brain,” he says. “Despite all this rational knowledge that this is what’s going to kill me if I go back to it, I still have this strong urge to do it one more time.”
Dane County has also paid a toll for Chris’s struggles — and for thousands of other residents struggling with addiction. It houses addicts in jail and pays most court-related costs, including salaries of prosecutors and court personnel. It also pays for programs to help addicts avoid criminal convictions, and then pays for programs to help them recover.
Now county officials are looking to recoup some of that money from those they believe caused this epidemic: the pharmaceutical companies that made and marketed the drugs.
In Wisconsin, 65 out of 72 counties have filed lawsuits against the makers of prescription painkillers. Dane County Executive Joe Parisi said in December the county would join the plaintiffs, and this week, announced the hiring of a consortium of five law firms — the same one that Milwaukee County hired — to represent the county. Officials did not say when they expect to file.
“The opioid epidemic has strained our resources and cost local communities millions of dollars as we try to get people the treatment and recovery that they so desperately need,” Parisi said at a news conference. “In Dane County alone, we have added staff in the DA’s deferred prosecution unit, where we spend $230,000 per year trying to keep up with the crush of opioid cases. We have partnered with local health care providers to get more people into treatment. We have seen workload increases in our medical examiner’s officer, sheriff’s department, county protective services, foster care, courts, Dane County Emergency Management, and other county-funded departments and divisions and services we provide.”
There are more than 600 similar lawsuits across the country, according to attorney Krista Baisch of Crueger Dickinson, a Milwaukee-area law firm representing most of the Wisconsin counties, but not Dane County or Milwaukee County.
“It’s our belief that the counties are bearing the brunt of the costs,” Baisch says.
In order for Dane County to make its case in court, it will have to demonstrate the many ways the epidemic has taken a toll. That’s not a simple matter.
In Dane County, no one has a precise figure for how much the opioid epidemic has cost. How do you ask families who lose someone to put a price on their pain? And how do local governments calculate all of the ways they respond to the havoc that addiction brings to their community?
John Peck
Used syringes, like this one along Stoughton Road in Madison, have become a common sight in many communities.
Anecdotes of the damage are easy to find. “Just wanted to give people a heads up, we found a fresh hypodermic needle on our front lawn today while we were doing yard work,” reads a recent posting from an east side resident on NextDoor, a neighborhood discussion app. “Keep an eye out, it wasn’t there yesterday. We don’t have kids but there are a lot on our street.”
Last year, the federal government declared opioid addiction a public health emergency. Drug overdoses are now the leading cause of accidental death in the United States.
It’s the deaths that make opioids different, says Madison Police Officer Dan Swanson. “We’re trying to stop the body count that we’re climbing toward. There’s no other drug right now in our community that’s responsible for this many people dying.”
In 2000 there were 13 opioid deaths in Dane County; in 2015, there were 57. In 2016, the most recent year for which we have records, 85 people died in Dane County from an opioid overdose.
“That’s 85 moms and dads and brothers and sisters and aunts and uncles and daughters,” says Sarah Johnson of Public Health Madison & Dane County. But, she adds, “That’s just the tip of the iceberg. That’s just what we see. It expands so much deeper than that, in terms of first responders, the increased kids in our foster care system, and human services providing treatment to those folks. It goes a lot deeper that just the deaths we see.”
Swanson says that police and emergency personnel are spending more time responding to crimes and emergencies that are related to addiction, increasing costs for agencies. Nearly every day, Madison police officers respond to overdose-related calls where a person’s heart has stopped and they’re not breathing.
“We had 259 overdoses that our office responded to in 2017 alone,” Swanson says. That’s in addition to the several hundred more across Dane County last year. Dane County Emergency Medical Services saw a 30 percent spike in suspected overdoses last year.
An emergency room stay for an opioid overdose on average costs $48,000, according to an estimate put together by WEA Trust, a local insurance company for public employees. If the patient is uninsured, that emergency room cost is likely spread out among all patients.
In addition to supporting local medical services, the county also prosecutes drug possession and crimes that people commit while high or trying to get high. That’s often theft, but can also be prostitution or assault. If a person ends up in the Dane County jail, it costs the county about $120 a day to house and feed them, according to Elise Schaffer, a spokesperson for the sheriff’s office. The county also runs diversion programs and a drug court aimed at getting people with addictions medical treatment rather than prison sentences.
“You have the jail costs, the district attorney or assistant district attorney costs, the court reporter’s cost, the judge’s costs,” Swanson says. “I imagine it’s not cheap.”
“Since we’re losing more than 50,000 of our citizens every year, about 150 Americans are going to die today, just today, while we’re meeting.” —U.S. District Judge Dan Polster
The expenses for treatment add to the tally. Dane County spends $7.5 million a year in alcohol and drug prevention and treatment programs. County officials report that 30 percent of residents receiving county-funded treatment sought help with problems related to opiate use. For opioid-related addictions, the county offers a needle exchange program, referrals to counseling and detox centers, and a recovery coach program.
“On one side we are just trying to keep people alive. So that’s providing access to naloxone or Narcan, the drug overdose reversal medication,” says Johnson. “It’s also about providing syringe services to keep them free of diseases, until they’re ready for treatment.”
Bott is one of the lucky ones. He received eight days of detox at about $500 a night, followed by 30 days of inpatient treatment at Tellurian, which cost several thousand dollars. He’s not quite sure who paid for his treatment — BadgerCare might have picked up some of the costs. But he says without the help of the county, he never would have been able to get help.
“I don’t know any addicts coming up off the street who have money to put themselves into treatment,” he says. “Most people have alienated themselves from their families and friends. They’re alone.”
After years of trying to absorb these costs alone with limited resources, governments across the country want help from the drug companies who make and sell opioid painkillers.
The lawsuits allege that the drug companies are making a harmful product, that they lied to doctors about their products’ addictive qualities and that they’ve engaged in an industry-wide conspiracy to fraudulently market them as safe.
Baisch, one of the lawyers working on the lawsuits, says that drug companies evaded Food and Drug Administration regulations by claiming that the class of drugs they were selling (opioids) was generally not addictive; they had already been sued for such claims about particular drugs, like OxyContin.
The FDA approves new drugs, but not all claims made by drug companies. And FDA does not develop or test products before approving them. Instead, as its website says, “FDA experts review the results of laboratory, animal, and human clinical testing done by manufacturers.”
Companies have done well with opioids. Purdue Pharma made $35 billion from OxyContin, according to an Oct. 30 article in The New Yorker.
According to Parisi’s office, more than 300,000 prescriptions for opioids were dispensed to Dane County residents annually since 2013 and, on average, 21 million opioid pills are dispensed to residents annually. “That equates to over 39 opioid pills being prescribed to each of Dane County’s approximately 531,000 residents every 12 months.”
Source: Wisconsin Dept. of Healt
Parisi blames the drug companies directly, saying “It’s time that drug companies that are profiting from these drugs be held accountable for the damage that they are causing to families across our county.”
Pharmaceutical companies deny they have acted irresponsibly in manufacturing the drugs. “Patients’ needs and safety have guided our steps,” Purdue wrote in a statement. “It’s what led us to research and develop medications to help patients.” The company says it is developing non-opioid pain medicines and opioids that are more difficult to abuse.
Richard Greenlee, corporation counsel for Rock County, says suing was a no-brainer. “We’re hoping to recoup the costs that taxpayers are having to endure for the treatment of these opioid addictions which have really corrosive and devastating effects on sometimes the poorest members of our communities,” he says. “The county has spent a lot in the last 10 years providing addiction therapy and other opioid treatments for members of the public. So we’d like to hold the pharmaceutical manufacturers accountable for their behavior in pushing those opioids onto members of the public.”
Wisconsin is also home to the first Native American tribe in the U.S. to file a federal lawsuit against the opioid drug companies and distributors. The St. Croix Chippewa Indian tribe in northwestern Wisconsin runs its own health clinic, addiction treatment center, and child welfare system. Jeff Cormell, a lawyer for the tribe, says the opioid epidemic has been a huge drain on resources.
For tribal members who get addicted to painkillers, Cormell says, “The tribe paid for those prescriptions to be filled. The tribe paid for the doctor’s time. The tribe paid for that person to go to the drug treatment facility. From beginning to end, the tribe is paying the cost for all of it. The tribe will continue to do it because it cares for its people and will always take care of its people, but this lawsuit has become necessary because the drug companies knew.”
The tribe is seeking to hold the whole supply chain accountable for the drug epidemic: the drug makers, the distributors and the pharmacies.
“They knew what they were doing,” Cormell alleges. “The profitability on this drug was so high that it became a financial decision and not a medical decision. They put profit above public safety.”
There is a precedent for a lawsuit of this scale. In the mid-’90s, more than 40 states filed lawsuits against tobacco companies, seeking compensation for the severe health problems — and subsequent costs — caused by smoking.
The suits were settled in 1998, when tobacco companies agreed to pay $246 billion over 25 years, most of it distributed to state governments. Wisconsin has so far received about $2.5 billion from the settlement.
Cormell believes the opioid lawsuits will be historic in their size and scope. “This is going to be up there with the BP oil spill and the tobacco litigation.”
The lawsuits that have been filed in federal court so far have been consolidated and assigned to U.S. District Judge Dan Polster in Cleveland. This process is used by federal courts to relieve backlog and expedite cases. Plaintiffs are grouped together and their cases are negotiated by a small team of lawyers and one judge.
This judge has said he would like to see the parties settle by the end of the year, rather than have the cases proceed to trial, which could take years.
“I did a little math,” he said in court in January. “Since we’re losing more than 50,000 of our citizens every year, about 150 Americans are going to die today, just today, while we’re meeting.”
The challenge for the plaintiffs will be to prove the drug companies were deceptive in marketing the drugs.
“There was no evidence behind the claims that were put forward that these medications are completely safe.” —Dr. Aleksandra Zgierska
Dr. Aleksandra Zgierska, an assistant professor at the UW-Madison School of Medicine and Public Health and expert in addiction medicine, believes that pharmaceutical companies misled doctors who prescribed the drugs.
“The underlying messaging that clinicians and patients had been receiving was that opioids do not cause addiction in patients who are using it for pain,” she says. “And that opioids don’t have a ceiling dose, or upper limit, of dosing.”
But she adds, “There was no evidence behind the claims that were put forward that these medications were completely safe.”
She says it’s not fully understood how to predict the effect of opioids on a particular patient or precisely who will become addicted to them. Some patients find taking opioids increases their pain over time; others find they don’t work. Doctors sometimes respond by increasing the dosage, which can inadvertently make the problem worse.
“Now we know that these medications can cause — and do often cause — addiction in a subset of patients who were prescribed them for pain,” she says. “And we also know that they can promote pain.” The higher the dose, the higher the risk of increased pain and overdose, she adds.
Dr. Randall Brown, director of the Center for Addictive Disorders at UW Hospital, says doctors felt pressure to help patients who were suffering.
“It went so far as to a number of professional organizations pushing a campaign around pain being the fifth vital sign.” He says that the medical establishment began to see pain as “something that needs to be measured with the frequency — and addressed as urgently — as heart rate, blood pressure and temperature.”
The problem was there weren’t yet publicly available, large randomized scientific trials documenting addiction or highlighting problems. “We didn’t really have literature to tell us otherwise, that prescribing opioids and continuing to increase the dose until patients were reporting adequate pain relief and improved function is problematic,” Brown says. “This all moved forward over a landscape of horribly imperfect science.”
Zgierska stresses that there is a group of patients with chronic pain — and some with acute pain — for whom opioids are medically appropriate. “It’s not that we shouldn’t be using opioids at all. It’s about being aware of the risks, and judicious use when needed.”
The medical establishment would do well to learn about other effective and underused approaches to managing pain, including exercise and physical therapy. For years, UW researchers, in collaboration with the Dalai Lama, have been studying meditation as a way for patients to control pain. New studies have also revealed that opioid use is lower in states that have medical marijuana. And studies have started to pile up showing ibuprofen and acetaminophen — which are non-addictive and much cheaper — to be as or even more effective pain relievers than opioids.
Doctors need to help open a dialogue with patients about the risks of addiction, says Zgierska. “If patients feel that it’s okay to discuss with their clinicians and families and say ‘Hey, I have a problem. I need help,’ and not be looked down upon, this will help us address the existing crisis.”
Every week, more counties file lawsuits against the drug companies, which get added to the docket in Cleveland. The next hearing with Judge Polster in Cleveland is May 10.
There are signs that drug companies are responding to the pressure from the lawsuits. In March, Purdue Pharma, maker of OxyContin, said in a statement, “We have restructured and significantly reduced our commercial operation and our sales representatives will no longer promote opioids to prescribers.”
The company also said it is “deeply troubled by the abuse and misuse of our medication” and “will continue to take meaningful action to reduce opioid abuse,” citing their reformulated drug that was released in 2010 to be harder to crush and snort. Purdue’s chief medical officer calls the opioid epidemic “among the greatest challenges our nation faces.”
According to The New Yorker, Purdue has been sued thousands of times over OxyContin since its release in 1996, and often settles out of court. The company has also paid hundreds of millions of dollars in criminal fines.
While there’s hope that Dane County may one day be reimbursed for some of its costs dealing with the epidemic, those who became addicted may never be entirely free of the life-long struggle to stay sober.
“That’s been a hard pill to swallow,” says Bott. “This might be with me the rest of my life.”
