Indiana counties, cities sue opioid distributors and manufacturers

A slew of cities and counties in Indiana have joined the growing ranks of municipalities and states that have sued the major drug distributors for allegedly overlooking suspicious opioid prescriptions and fueling the abuse epidemic.

Harrison County, Terre Haute, Fort Wayne, Muncie and the town of Atlanta filed lawsuits Friday and Monday accusing the "big three" wholesale drug distributors—AmerisourceBergen, Cardinal Health and McKesson Corp.—of fulfilling massive opioid orders and not warning authorities of the likely diversion of the addictive pain pills. The counties, cities and communities claim they've been left to pick up the pieces of the onslaught of the epidemic while the distributors profit.

"Despite the clear evidence before their eyes—that the number of opioids being sent into communities like the plaintiff's community could not be explained or justified by any conceivable medical need, but could only be explained by a flourishing and rapidly expanding black market for opioids—these wholesale distributors continued to push their substances into the community, willingly and knowingly becoming participants in the black market they were fueling," the Harrison County lawsuit reads.

Indiana, which has the ninth-highest opioid prescription rate of 109.1 per 100 persons, saw its opioid overdose deaths increase 52% from 2015 to 2016—with overdose deaths more than doubling doubled in the last three years, according to the lawsuit. Harrison County's rate of opioid prescriptions in 2016 was 91.7 per 100 persons while the number of nonfatal emergency department visits related to opioid overdoses nearly doubled from 2012 to 2015.

Cardinal Health contested the "misguided" lawsuits because it does not manufacture, promote or prescribe prescription medications to the public and actively combats the opioid diversion.

AmerisourceBergen echoed that narrative, saying that it mitigates the diversion of opioids without interfering with doctors' clinical decisions by halting tens of thousands of suspicious orders, refusing service to customers deemed as diversion risks and providing daily reports to the Drug Enforcement Administration.

Vigo County and the cities of Greenwood, Noblesville and Kokomo filed related lawsuits Monday that also target opioid manufacturers including Purdue Pharmaceuticals, claiming that they misled physicians and patients through allegedly deceptive marketing practices. The manufacturers allegedly inflated opioids' benefits while downplaying their addictive nature, according to the lawsuits.

"The manufacturers aggressively pushed highly addictive, dangerous opioids, falsely representing to doctors that patients would only rarely succumb to drug addiction," the Vigo County lawsuit reads. "These pharmaceutical companies aggressively advertised to and persuaded doctors to prescribe highly addictive, dangerous opioids, turned patients into drug addicts for their own corporate profit."

In similar cases, Purdue has vigorously denied such allegations but said it is committed to working collaboratively to find solutions.

The defendants are trying to shield themselves from liability via the "learned intermediary" defense by saying the physicians are the ones prescribing the medications, legal experts said. It can work in some cases, but not when the manufacturer presents false data and studies and recommendations to the middlemen, they said.

Indiana is one of many states that has gone after opioid distributors and manufacturers with the intent to end the alleged negligence, recover the cost of responding to the crisis and start an "abatement fund" to pay for programs addressing the epidemic.