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Attorney General Peter F. Kilmartin announced Monday that the Office of Attorney General has filed a civil lawsuit against prescription opioid manufacturers and distributors over their alleged campaign of unfairly, deceptively, and fraudulently marketing and promoting opioids in Rhode Island. The suit follows an investigation into the extent of the proliferation of prescription opioids in the state of Rhode Island, including the societal and financial consequences.

“We can no longer let opioid manufacturers and distributors create chaos in our state. Today, I’m proud to say my office is continuing the fight on behalf of all of our residents,” said Kilmartin. “The opioid epidemic is a major public health crisis in Rhode Island and we must use every tool at our disposal to fight back. This suit reflects what we found through our investigation and seeks to hold those we believe to be responsible accountable for their actions, as well as seeking long-term remedies to help our citizens.”

“The opioid and addiction crisis is the most urgent health care crisis of our time. Rhode Island has taken steps to address the crisis with an emphasis on treatment, recovery and prevention,” said Governor Gina M. Raimondo. “This crisis has touched every single Rhode Island community, and I’ve met too many parents who have lost children to an overdose after getting addicted to prescribed painkillers. I applaud Attorney General Kilmartin for taking on opioid manufacturers and distributors.”

The complaint was filed in Rhode Island Superior Court and names opioid manufacturers: Purdue Pharma L.P., Purdue Pharma Inc., The Purdue Frederick Company, Inc., and Insys Therapeutics, Inc.; and distributors: McKesson Corporation d/b/a McKesson Drug Company, Cardinal Health, Inc., and the AmerisourceBergen Drug Company as defendants.

As the suit states, when Purdue developed OxyContin in the mid-1990s, the company knew that to expand its market and profits, it needed to change the perception of opioids to permit and encourage the use of opioids more liberally. This required persuading prescribers and patients that opioids were appropriate for prolonged use for more widespread, less severe pain conditions such as back pain, migraines, and arthritis.

Purdue helped cultivate a narrative that pain was under-treated and pain treatment should be a higher priority for health care providers. This paved the way for increased prescribing of opioids for chronic pain. The State alleges that, as part of the company’s strategy, Purdue misrepresented the risk of addiction for pain patients as modest, manageable, and outweighed by the benefits of opioid use.

Specifically in Rhode Island, Purdue aggressively marketed its opioids, making thousands of visits to doctors, knowing that its in-person marketing, or “detailing,” was effective. Purdue’s deceptive marketing caused prescribing not only of their opioids, but of opioids as a class, to skyrocket. Opioids are now among the most prescribed classes of drugs. In 2015 on an average day, more than 620,000 opioid prescriptions were dispensed in the U.S. While previously a small minority of opioid sales, today between 80 percent and 90 percent of opioids (measured by weight) used are for chronic pain.

The complaint further alleges that Defendant Insys paid prescribers to give sham lectures to promote its highly potent fentanyl-based opioid Subsys, as part of a kickback program to encourage high volume fentanyl prescribers.

Additionally, distributors contributed to the opioid crisis. According to the Complaint, distributors persistently disregarded their obligations to identify suspicious orders and customers, facilitating and failing to stop the diversion of opioids within and to Rhode Island.

Opioid Impact in Rhode Island

  • l Prescriptions within Rhode Island exceeded the national average from 2006 through 2012, reaching a high in 2012 of 83.2 opioid prescriptions per 100 people. Over this time period, Rhode Island’s Medicaid program (the Medical Assistance Program) spent more than $6 million to pay for prescriptions of Purdue-branded opioids, along with additional funds for Purdue’s generic opioids and for the costs of providing and using opioids long-term to treat chronic pain. From May 23, 2014 to March 4, 2016, the State’s Medical Assistance Program spent more than $175,000 to pay for prescriptions of Insys opioids. The Medical Assistance Program also spent more than $15 million over the last four years for medication assisted treatment—a number that will continue to grow.
  • Within Rhode Island, the age-adjusted overdose rate in 2015 of 28.2 per 100,000 people ranks fifth in the nation.
  • From 2014 to 2015, Rhode Island experienced a 24% one-year change in overdose deaths, the third highest change in America.
  • The rate of deaths from synthetic opioids like fentanyl ranked third in the nation in 2015.
  • From 2011 to 2016, Rhode Island saw a 303% increase in overdose fatalities.
  • In Rhode Island, annual accidental drug overdoses increased from 111 in 2011 to 336 in 2016. Since 2016, more than 60% of drug overdose deaths in Rhode Island have involved fentanyl.
  • Since 2017, Rhode Island has spent more than $2 million per year to provide medication assisted opioid addiction treatment for incarcerated addicts.
  • In Rhode Island, the incidence of neonatal abstinence syndrome increased from 2.8 cases per 1,000 in 2002 to 7.3 cases per 1,000 in 2012.

The State alleges in the Complaint that the defendants created a public nuisance, committed violations of the State False Claims Act, engaged in fraud and fraudulent misrepresentation, were negligent/negligent per se/grossly negligent and engaged in negligently misrepresentation, and were unjustly enriched.

To read the full complaint, go to www.riag.ri.gov/documents/StateVPurdue.pdf.

This announcement is separate from the previously announced multi-state investigation by attorneys general into various opiate manufacturers and distributors. That investigation is ongoing.

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