News of the $527 million judgement levied against Johnson and Johnson this past August for its role in proliferating the country’s opioid crisis marked a turning point in the epidemic which has been escalating in scope and notoriety for years.
In the months following the ruling, opioid-related litigation has spiked, evoking a sense of dejva vu in Americans old enough to remember the takedown of the tobacco industry in the late 1990’s.
Totaling $206 billion, while the Tobacco Master Settlement Agreement was costlier than the $48 billion global deal currently being discussed, there are more similarities between the two landmark cases than differences. Most notably, each was fueled by deceitful marketing backed by enormous budgets. They also had an acute understanding of their audiences and capitalized on their knowledge for profit.
This month’s announcement that the state of California sued popular e-cigarette manufacturer Juul Labs Inc. for targeting youth with advertisements has created a heightened sense of awareness and urgency around understanding how we got here in order to avoid continuing to allow these types of preventable health emergencies from happening.
Malevolent Intent
Long before Philip Morris and its cohorts were taken to task, a New York-based family of physicians-turned-advertisers was developing the guide for malicious medical marketing.
Realizing early on that persuading physicians rather than consumers alone was the key to peddling prescription drugs, Arthur Sackler, one of the family’s three brothers, found prosperity in the 1950’s and 60’s selling antibiotics and tranquilizers using a mix of creative coaxing and flat out lies in his promotion of the drugs. An entrepreneur at heart, the success of an advertising agency he acquired led him, along with his brothers, to purchase Purdue Frederick, now known as Purdue Pharma. Purdue is infamous for its development of OxyContin, a powerful pain pill and one of a short list of narcotics blamed for mass opioid abuse. As the Sackler family’s wealth ballooned into the billions, its top profit-yielding product contributed to the deaths of thousands of Americans.
While it seemed Purdue’s greed knew no bounds, it’s ability to continue using falsities to profit from other’s pain did. In September of this year, the company reached a pending multi-billion dollar deal to resolve thousands of lawsuits against it related to a laundry list of its unscrupulous promotional tactics. It subsequently filed for bankruptcy.
Almost congruently, another one of the country’s pharma behemoths experienced its rise and fall.
During the press conference announcing California’s lawsuit against Juul, the state’s Attorney General said the manufacturer, “adopted the tobacco industry’s infamous playbook, employing advertisements that had no regard for public health and searching out vulnerable targets.”
Groundhog Day
The Johnson and Johnson case, the verdict of which was last week reduced by $107 million due to a calculation error on the ruling judge’s part, was centered on claims by the state of Oklahoma that the manufacturer and its partners led “a cynical, deceitful, multimillion-dollar brainwashing campaign.” According to one of the plaintiff’s attorneys, Brad Beckwith, the effort was based on “false claims that its opioids were safe and effective for long term treatment of chronic pain despite a lack of clinical studies and history of narcotics creating addiction.” Overprescription led to addiction attributed to more than 4,000 deaths in the Sooner State in less than a decade.
To push its product, Johnson & Johnson and other opioid producers relied on relationships with physicians. Study results published in the Journal of the American Medical Association (JAMA) Open Network earlier this year linked opioid deaths with interactions between physicians, pharmaceutical companies and their representatives. The research revealed payments received by physicians, often in the form of speaking and consulting fees, travel, and meals, totaled $39 million in a little more than two years at the height of the opioid crisis. Further, opioid overdose deaths jumped by nearly 20 percent for “every three additional payments made to physicians per 100,000 people in a county.”
Johnson & Johnson created the demand, provided the supply and lined its pockets in the process. In 2018 alone, Janssen Pharmaceuticals, its drug-making division, made more than $23 billion.
While the tactics it employed varied, the tobacco industry also leaned heavily on marketing to generate demand, sparing no expense in manifesting the public’s desire for, and consumption of, cigarettes. According to Growing up Tobacco Free: Preventing Nicotine Addiction in Children and Youths, it spent $4.6 billion in 1991 on promoting them, having upped its spend nearly four-fold from 1980 to counteract declining rates of tobacco use. Knowing most individuals smoked their first cigarette by age 18, promotion focused on the middle and high school set and reached its intended audience using branded merchandise, sponsorships, outdoor advertising, and cartoon characters.
Despite its colossal spend, equivalent to an almost unimaginable $12.6 million dollars per day one year, mounting skepticism around the industry’s marketing practices combined with heightened awareness of tobacco’s negative health effects and a mounting death toll came to a head with the Tobacco Master Settlement Agreement. The largest class action settlement at the time, the deal was reached between three of the country’s largest tobacco producers and Attorney Generals representing 46 states with a portion of the settlement earmarked for covering medical costs.
If the terms sound familiar, it’s because the global opioid deal currently on the table seems modeled after the Agreement. It proposes five of the biggest opioid manufacturers pay a nearly 50/50 split of cash and services and drugs to treat opioid addiction.
Glass Half Full
If the tobacco industry’s demise is a bellwether for the future of our country’s relationship with opioids, we can look forward to positive change.
In the 20-plus years since the Master Tobacco Settlement was reached:
Lessons Learned
During the press conference announcing California’s lawsuit against Juul, the state’s Attorney General said the manufacturer, “adopted the tobacco industry’s infamous playbook, employing advertisements that had no regard for public health and searching out vulnerable targets.”
While it may feel like history is repeating itself, the suit was filed after a reported 33 total nationwide vaping-related deaths vs. the tens of thousands of lives lost to smoking and opioid abuse.
Only time will tell if this is an early indicator that the rise of consumerism in healthcare is contributing to our collective ability to nip preventable health crises in the bud. In the meantime, OrderInsite will continue empowering pharmacists on the front lines of the opioid epidemic with tools to help them make more informed decisions regarding opioid inventory, purchasing, diversion and orders.
The pandemic shone light on the burdens pharmacists’ face, but if we zoom out, we can understand how COVID was just a milestone on a more than 30-year timeline of industry evolution characterized by historic M&A.
With mounting challenges stacked on top of pharmacists who are already under water, how do we bring the profession back from the precipice? Technology to manage, monitor and master prescription drug inventory.
In looking at parallels between COVID-19 and opioid abuse, two of the country’s most prominent public health emergencies in the last decade, there is a stark and alarming difference in the role data has played in how each crisis has unfolded and been addressed.
