Implications of Opioid Lawsuits on Opioid Availability, Opioid Access for Patients, Health Care Providers

Pharmacy Times interviewed Jeffrey B. Simon, JD, co-chair of the National Opioid Litigation Conference and a lead negotiator for the many local districts participating in the historic settlement in a multi-district opioid lawsuit in Texas.

Alana Hippensteele: So, could you tell me a bit more about what the National Opioid Litigation Conference is and what is its involvement in suits of this kind?

Jeffrey B. Simon: In its initial conception, when we first did it in 2018, the concept was let's not focus on the litigation, let's focus on the epidemic. So, although lawyers who represented political subdivisions or defended drug companies in the opioid supply chain were invited to attend and make presentations and contribute to panels, and they did so, there was an understanding that what we really wanted to talk about was the nature and dimensions of this public health crisis, and let's hear mostly from public health professionals and people who are in health administration and talk about, again, why we have this problem and what might be done about it.

Over time, it became ever clearer that the money that is necessary to do real harm reduction to really attack the problem is going to come because of the work done in the civil justice system. So, it would have been unnatural not to bring current trends in the litigation to the fore of the conference as well.

So, we have done that over the course of several years, and now it's, I think, a very healthy mix of public health professionals talking about where we are in the epidemic and where we are in problem solving, as well as what are the cutting-edge issues in the litigation and are they focused on public health issues or have they diverged in some way and changed the players who are central to both dynamics—the public health crisis and litigation itself?

Alana Hippensteele: Right. What are the implications of these lawsuits for opioid availability and access for patients and health care providers?

Jeffrey B. Simon: No informed person would ever suggest that opioids should be banned and that there is no legitimate therapeutic use for opioids—there is now, there are those uses, which we use to narrowly tailor them for managing acute pain for short periods of time in a medically monitored setting.

The essence of the opioid epidemic is that when, for a variety of reasons, prescribing habits change and doctors began prescribing opioids more commonly, even ubiquitously for many different types of complaints of pain to many different types of patients for whom opioids would not historically have been prescribed—and done so in high volume 30/60/90 day periods of time as opposed to 3 days at a time and in very high doses—because people naturally develop tolerance to these opioids as they take them over time and need higher and higher doses to achieve the same pain relief. But unfortunately, as they do physical dependence, and all too often, addiction can set in.

So it is that kind of prescribing, which is for non-cancer, chronic pain in high doses for perpetual use, that we should not be prescribing opioids. And that certainly has been reduced because of the litigation and regulatory scrutiny about how much harm that kind of prescribing does. Now, what we see sometimes that, as I say, no informed person should want is for doctors who are treating patients with prescription opioids to simply cut them off. That's a very dangerous proposition because when a person is physically dependent on opioids, that means they will develop withdrawal symptoms from abrupt cessation of their opioid usage because their body now requires the external supply of opioids, and if you just cut them off, the body goes into heaving withdrawal.

People must be carefully medically tapered off opioids if they have been taking them for long term. So, the goal is to have people who have been taking opioids for chronic pain for significant periods of time to be medically tapered off them safely and effectively. Cutting them off will do as much harm as putting them on long-term opioids did in the first instance.