Joining a chorus of Hoosier cities and counties, Indiana Attorney General Curtis Hill has filed a lawsuit against Purdue Pharma alleging its misrepresentation of the risks and benefits of opioids played a role in the state's opioid crisis.
"Purdue Pharma bears significant responsibility for the opioid crisis here in Indiana because it promoted widespread over-prescribing through a deceptive and misleading marketing campaign," Hill said Wednesday.
Since 2012, Purdue Pharma has accounted for 54 percent of opioid prescriptions for Hoosiers in in state Medicaid programs and over 50 percent of state employee health or workers' compensation plans, Hill said.
Federal lawsuits have been filed against numerous opioid manufacturers by the cities of Indianapolis, Kokomo, Alexandria, Zionsville, Jeffersonville and Elwood, among more than 30 cities and counties. Most claim the manufacturers violated federal racketeering laws.
Hill's lawsuit, however, was to be filed in Marion County, allowing his office to claim Purdue Pharma violated Indiana's Deceptive Consumer Sales Act; Prescription Drug Discount and Benefit Cards statute; False Claims Act; and Medicaid False Claims Act.
From 2012 to 2016, there were 58 Indiana counties with opioid prescribing rates greater than 100 prescriptions per 100 residents. As of 2016, the number had dropped to 84 opioid prescriptions per 100 Hoosiers.
Purdue Pharma, which includes three companies based in Stamford, Conn., is not connected to Purdue University.
Purdue Pharma's sales tactics were called into question by Hill.
Purdue's sales representatives allegedly mentioned that their early-release opioids, such as OxyContin, Butrans or Hysingla, provided a slow-onset, stable dose, which misled physicians into believing the opioids were safer, according to the lawsuit.
The lawsuit claims that one Indiana prescriber recalled a Purdue Pharma employee told her, within the last two years, that extended release opioids were less addictive because they provided a more stable relief without an immediate "rush."
Last year, Purdue Pharma L.P. announced it would join the Prescription Drug Safety Network to bring prevention education created by Washington, D.C.-based EverFi to 200 high schools across the country.
In a 2017 statement, Craig Landau, M.D., chief executive officer of Purdue Pharma L.P. said, “This educational initiative complements our ongoing programs which include supporting legislation to limit opioid prescribing, distributing the CDC Guideline for Prescribing Opioids for Chronic Pain, advancing law enforcement access to naloxone, and furthering the development of opioids with abuse-deterrent properties.”
On Oct. 29, Hill announced that his office would provide EverFi with $20,000 annually for three years to expand the computer-based program into 10 Indiana counties.
Three health associations in the state, including the Indiana State Medical Association, recently issued guidelines for prescribing opioids for chronic pain. In part, the guidelines suggest physicians should consider non-pharmacologic therapies to treat acute pain. Doctors are also to instruct patients on the proper use of medication and expectations for duration of treatment, among other guidelines.
In Hill's 98-page lawsuit, no exact financial penalty is sought. However, there is a request for an award, as allowed by state law, for triple the damages concerning payments made on behalf of the state for opioid prescriptions covered by Indiana Health Coverage Programs, state employee health plans and state workers' compensation programs.
More than $200 million has been spent through state-funded health programs for opioid prescriptions and related treatment, Hill said.
"Many of these opioid prescriptions were not medically necessary or appropriate and would not have been written but for the efforts of Purdue Pharma," said Hill.