Ken Terry

Several large pharmacy chains have sued 500 unnamed doctors in northeast Ohio as part of the sprawling litigation that has arisen from the opioid epidemic, The Washington Post recently reported.

The federal lawsuit alleges that opioid prescribers bear some of the responsibility for the overuse of these powerful drugs, which have killed more than 400,000 Americans during the past 20 years.

Among the plaintiffs in the case are CVS, Walgreens, Walmart, Rite Aid, Discount Drug Mart, Giant Eagle, and HBC Service Company, Robert Pitts, an official with the US District Court for the Northern District of Ohio, told Medscape Medical News.

The suit refers to the defendants, he said, as “John Does 1-500.” According to the Post, the pharmacies’ attorneys said they would name the physicians only if their identities were revealed in the course of the legal proceedings.

Following widespread lawsuits against manufacturers and distributors of opioid drugs, two Ohio counties, Cuyahoga and Summit, in 2018 sued the major drugstore chains, alleging they had failed to halt the diversion of prescription narcotics to the black market.

US District Judge Dan Aaron Polster, who is hearing that case, later allowed the plaintiffs to amend the suit to include the pharmacists who allegedly didn’t exercise due diligence before dispensing the drugs. According to the Post, that’s what led to this complaint against the physicians who prescribed the opioids.

In the suit filed January 6 in the Cleveland federal court, the Post said, the pharmacy chains argued that the doctors and other prescribers should have to pay some of the penalty if the drugstore companies are found liable at trial. Polster has scheduled the trial for October.

Polster is in charge of the nearly 2500 opioid-related lawsuits filed against the pharmaceutical industry in federal courts across the country. Among the complainants are cities and counties, Indian tribes, hospitals, union benefit funds, and the relatives of infants born with neonatal abstinence syndrome, the New York Times reported.

More than 300 suits have also been filed in state courts across the country. State attorneys general have filed 89 suits against drug companies. About half of the attorneys general have proposed a $48 billion settlement in those cases, but the other states have not approved it.

The Post noted, “Drug manufacturers and distributors agreed or were ordered to pay hundreds of millions of dollars in settlements and one court verdict reached in state and federal courts last year. But the big pharmacy chains have not been held liable so far.”

Physicians’ Responsibility
In regard to the pharmacy chains’ suit against the Ohio doctors, organized medicine has remained conspicuously silent. American Medical Association spokesman Robert J. Mills told Medscape Medical News that the association would have no comment on the litigation. The Academy of Medicine of Cleveland and Northern Ohio and the Ohio State Medical Association did not respond to requests for comment.

Most doctors across the country who have prescribed opioids did so to treat pain, “and they thought they were doing the right thing,” Sylvia Martins, MD, PhD, associate professor of epidemiology and director of the substance use epidemiology unit at Columbia University’s Mailman School of Public Health, New York City, told Medscape Medical News. “But there were some people who were overprescribing. Also, in some cases, the dosages could have been lower or other options could have been tried first.”

Martins traces the role of physicians in the opioid epidemic back to the early 1990s when the huge increase in opioid prescribing began. “There was this idea that pain should be the fifth vital sign, and there was a push from Big Pharma for doctors to prescribe opioids for pain,” she said.

“Some doctors would be a little lax, a little less rigorous in prescribing and were using opioids as the first option instead of trying nonmedical options or other medications or first evaluating what would be the patient’s risk of addiction. There has to be a balance. There are people with chronic noncancer pain who need to be on opioids, maybe for a long time. But doctors, encouraged by Big Pharma, were also prescribing larger doses. So it’s complicated, but overprescribing does have a role in this crisis,” Martins said.

Some research, she added, shows that physicians who were “aggressively targeted by drug company marketing” prescribed more opioids than those who weren’t targeted.

Medical schools also bear some responsibility, she said. For many years, medical schools didn’t offer much training on “prescribing for pain, on what would be the best opioid dosage, how to start, how to identify patients at risk. That’s changing now, but it also needs to be put into context.”

Could pharmacists have done more to mitigate the crisis? “Pharmacists could help combat the epidemic, but it’s complicated,” Martins said. “Because then the pharmacist has to say, ‘We’re going to deny you this prescription.’ The pharmacist can help identify people who are doctor shopping and inform the state prescription drug monitoring program. But it’s hard to overrule a doctor’s prescription.”

On the other hand, she observed, pharmacists can identify overprescribing and can flag it to physicians. “And if a person is having problems with opioids, they can link them with treatment.”