State AGs band together for stepped-up probe into opioid drug marketing

Attorneys general from 41 states are joining together to investigate the opioid industry.

After years of going it alone in investigating opioid drugmakers, attorneys general across the U.S. are joining forces to drill into painkiller marketing practices.

AGs in 41 states issued subpoenas to Endo, Johnson & Johnson's Janssen unit, Teva Pharmaceutical and Allergan, and issued a request for further information to Purdue Pharma, as part of a bipartisan probe into the industry's role in the opioid addiction crisis.

Dozens of states, counties and local governments have independently sued opioid drugmakers, alleging they used fraudulent marketing to sell the powerful painkillers, thus fueling a nationwide epidemic. The newly pooled approach steps up those efforts as officials sift evidence to determine whether companies are culpable in the crisis.  

"As we have shown in other contexts, broad coalitions of attorneys general can effectively impact national problems through litigation or settlements, often more effectively than they can when acting alone," Connecticut attorney general George Jepsen said in a Tuesday statement. Michigan AG Bill Schuette said the investigation focuses on the "marketing, distribution and sale of opioids."

As Kansas attorney general Derek Schmidt noted, the announcement is unusual because AGs typically wouldn't confirm or deny an active investigation. The officials aren't just looking at the drug industry, either. They also sent info requests to top drug distributors McKesson, AmerisourceBergen and Cardinal Health, and are reaching out to health insurers to see how they might be able to help.

In a letter to America's Health Insurance Plans (AHIP), which represents insurance companies, the attorneys general urged that industry to tweak its policies to "prioritize non-opioid pain management options over opioid prescriptions for the treatment of chronic, non-cancer pain." 

In response to the subpoena, an Allergan spokesperson said the company is "working cooperatively with state attorneys general in the multistate investigation on their requests for information regarding opioid marketing practices." He added that Allergan hasn't promoted its branded opioid Kadian since 2012 and hasn't promoted Norco since 2003. Together, those two meds accounted for .08% of U.S. opioid prescriptions last year, according to the company. 

A spokesperson for Johnson & Johnson's Janssen said the drugmaker received and will "address the request from the coalition of state attorneys general, and will continue to work with stakeholders to support solutions." 

"Janssen has acted responsibly and in the best interests of patients and physicians with regard to these medicines, which are FDA-approved and carry FDA-mandated warnings about possible risks on every product label," he continued. The company also said it gives doctors "complete and accurate" information on prescribing its opioids.

A Teva spokesperson the company is "committed to the appropriate promotion and use of opioids."

"We have programs in place that educate prescribers, pharmacists, and patients on the responsible and safe use of these products," she added. "We are committed to working with the healthcare community, regulators and public officials to collaboratively find solutions."

Endo declined to comment. Representatives for Purdue didn't immediately respond to a request for comment. 

As industry watchers know, the investigation comes after numerous states and local governments independently sued opioid drugmakers for their alleged role in the deadly epidemic. Ohio in a lawsuit said the companies borrowed a page from the "Big Tobacco playbook" to convince “key opinion leaders” and professional societies of the benefits of opioids while downplaying risks. As each new suit is filed, the industry's legal expenses and potential liability grows. 

The FDA has also gotten involved in the situation, pushing Endo to remove one of its opioids and promising a review of the risks and benefits of similar drugs on the market.  

Opioid overdoses kill 91 people in the U.S. each day, according to the CDC.