KayLynn Roberts-McMurray

The Ely Times

Editor’s note: Part two of a four part series

Part two of a four part series

Since 1997, almost 400,000 people have died from overdose involving an opioid, including prescription and illicit opioids like heroin and fentanyl.  On average, 130 Americans die everyday from an opioid overdose, according to the CDC.  White Pine County’s opioid deaths have climbed to a total of 26 since 2006. The epidemic of opioid addiction has swept through the United States over the past two decades, and is currently erupting across the country, leaving a nation wondering how could this happen and who is responsible. 

Everyone wants someone to blame.  It’s the fault of doctors.  It’s the patient’s own fault. It was pharmacists. It was the medical boards; the politicians; the failure of governmental agencies that oversee the medical industry; or pharmaceutical company CEOs that managed the manufacturing and distribution of these highly addictive pain pills. Perhaps we can blame the sales reps that pushed the opioids into hospitals, clinics, and into the hands of the public in mind boggling amounts while lying about their safety.

Whomever is ultimately to blame in your estimation, the country, our state, and our county is collectively awakening from an opioid induced stupor, opening our eyes to realizing the deadly impact of unfettered drug dealing on a massive scale. Those responsible for contributing to the crisis are all now on notice.

Recently, 40 states, including Nevada, have taken active aim at pharmaceutical companies with lawsuits, in attempts to hold these drug-making corporations responsible for behaving like drug dealers bent on corporate wealth-care over our nation’s healthcare. 

This past Monday, Oklahoma judge, Thad Balkman, deemed Johnson & Johnson subsidiary, Janssen Pharmaceuticals, culpable for their actions of liberally dispensing opioid medication into that state. Oklahoma argued in court that Johnson & Johnson contracted poppy growers in Tasmania, supplied 60 percent of the opiate ingredients that drug companies used for opioids like oxycodone, and aggressively marketed those pain meds to doctors and patients as safe and effective and non-addictive. 

Ordering the parent company to pay $572 million in damages, Judge Balkman said, “As a matter of law, I find the defendant’s actions caused harm,” Balkman further wrote in his decision that Johnson & Johnson had promulgated “false, misleading, and dangerous marketing campaigns” that had “caused exponentially increasing rates of addiction, overdose deaths” and babies born exposed to opioids.”

The lead attorney for the state of Oklahoma, Brad Beckworth, left court proclaiming, “We’ve shown that Johnson & Johnson was at the root cause of this opioid crisis.  It made billions of dollars from it over a 20-year period.”  

All in all, Oklahoma was awarded $927 million, a cumulative amount from the Johnson & Johnson judgment and previous settlements this year with two other drug manufacturers that produce opioids, Purdue Pharma and Teva Pharmaceuticals which agreed to pay $270 million and $85 million, respectively.  This judgement is good news to 2,000 cities, counties and other jurisdictions with opioid cases pending in federal court. Johnson & Johnson is appealing the decision. 

As of Wednesday, August 28 NPR and other organizations reported Johnson & Johnson, the Sackler Family owned, Purdue Pharma, Endo International, and Allergan have been reportedly working with multiple Attorneys General, seeking to quickly and quietly resolve every one of those 2000 lawsuits levied against it in global settlements.

Joining the cavalcade of court cases, on June 17th, Nevada’s Attorney General Aaron D. Ford announced the State of Nevada had filed a complaint against over 40 opioid manufacturer defendants including Teva Pharmaceuticals, Actavis Pharma, Purdue Pharma, members of the Sackler family which controlled Purdue Pharma, SpecGX LLC, Mallinckrodt LLC, as well as top executives of Insys Therapeutics, and various entities created by manufacturers and their executives to hide assets and evade liability.  Distributor defendants include McKesson Corporation, Cardinal Health LLCs, AmerisourceBergen Drug Corporation, Walgreen Co., Walmart Inc. and CVS Pharmacy.

“The defendants created an unprecedented public health crisis for their own profit and the deaths of thousands of Nevadans are on their hands,” said AG Ford. “Their conspiracy to dupe doctors into prescribing more and more deadly and addictive pills has left countless Nevada families and the state suffering in the wake of their greed. Their blatant disregard for human life shocks the conscience. My office will not rest until they pay for the devastation they have caused to our state.”

 Through the close examination of these cases, from the ground up, from patients to medical providers, to the suppliers of the pain medications, all have had a hand in the opioid epidemic.  Since the DEA was forced to release their data tracking opioid pain medication sales, the United States has been digging into the information and examining what happened and what is being done to correct the damage done. 

Going straight to the sources of the medical-provider side of the opioid crisis in White Pine County, for this article, The Ely Times has sifted through hundreds of pages of information and spoken with pharmacists, doctors, shariffs, hospital CEOs and a Congressman in attempts to put the pieces of the opiate addiction puzzle together.   

Dr. George Norman Christensen, in the business of providing medical services to the people of White Pine County for 51 years, and a recent recipient of the Distinguished Nevadan Award, sat, speaking quietly and thoughtfully about how pain medicine has changed patient care over his tenure. 

When asked about the over 5 million opioid pills that flooded into White Pine between 2006 and 2012, that has ultimately led to a heroin problem in our county,  he said, “You can’t single out any one individual. It’s the nature of the medication. Tylenol can be habit forming if you use it incorrectly.  Addiction is a disorder that leads to the disease that kills you.”  He continued, “As your department of narcotics investigation will tell you, for the price of oxycodone you can get a whole bunch of heroin.  The patient has to want to take care of pain, we have medications that will take care of pain without the buzz.  If they are only going for that fine feeling, that leads to addiction.”  

A prominent physician that has seen and done almost everything in medicine, going above and beyond for his patients, Dr. Chris has sat on the Board of Medical Examiners and observed dramatic changes to medical technology in his tenure, and advancements in pain medicine. Dr Chirs stated, “There are people who have true pain, but there are no objective measures, everyone’s perceptions are different. It’s subjective. Then the government puts into place 10 smiley to not smiley faces, well you can’t measure true pain that way.  The patient tells you they have pain, and well, you’ve gotta do something about that doctor.  You get an eye for the ones who are abusing, but scripts are written.  People come in with their stories and you gotta treat them. We have an Opioid Risk Tool to help guide physicians, it really isn’t a physician problem. But, I think this problem evolved and everybody is a little to blame.”  

Putting things in perspective, William Bee Ririe Hospital CEO, Matt Walker, spoke with The Ely Times about how medical providers here are handling the opioid epidemic at the county level; “I think all of us were a little bit naive as to what was happening, and part of the issue is patients, the more you are on them [opioids] you become accustomed to them. Some of these patients have been on them for 15- 20 years, slowly getting on a higher and higher dose. As providers, we used to always be taught patients shouldn’t be in pain.”  This type of treatment methodology exasperated health care providers and catapulted prescriptions for opioid pain meds into the millions.  

Since the Controlled Substance Abuse Act went into effect January 1, 2018, aimed at regulating narcotic pain pills and curbing the opioid epidemic.  Known as AB474, the state measure altered patient care as it relates to the prescribing of controlled substances. under this new law, prior to being prescribed a narcotic, your physician is required to: (1) run a report on your prescriptions through a state-wide prescription database, (2) obtain your written informed consent to receive prescribed controlled substances for pain; and (3) evaluate you for possible risk of addiction or dependence on controlled substances.  In addition, your initial prescriptions and refills may be limited in days and dosage and for treatment lasting 30 days or more, you will be required to enter into a prescription medication agreement. Your provider may also require you to submit to screenings and other diagnostic tests.

Expanding the breadth of the opioid crisis, and asking about a medical industry consensus pertaining to tracking the beginning of the opioid crisis, the same name keeps being repeated: Purdue Pharma. Walker acknowledges, “People can point their finger in a lot of ways, but Purdue Pharma came up with the pain scale and they’re the ones that lobbied the American Hospital Association and Joint Commission and got it pushed through as a mandatory thing. The Pain scale didn’t exist prior to that.  It gives the patients an unrealistic expectation, and on the providers side, nurses and doctors are taught patients shouldn’t be in pain, so we increase the dose and it creates this cycle, and it just continues.”  

Explaining how pain became synonymous with mandatory treatments,Walker went on to explain, “Ultimately though, I think multiple people are responsible. The government is responsible; they sent out Hospital Consumer Assessment of Healthcare Providers and Systems or HCAHP scores that say if you are in pain, your hospital is doing a poor job; The Joint Commission came in and said ‘Every patient must have a pain scale or we won’t accredit you and Centers for Medicare & Medicaid Service won’t pay you. The pharmaceutical companies lied and said these weren’t addictive. But, the truth is though, going through pharmacy school, everyone knew they were addictive, so I don’t really buy anyone saying they didn’t know opioids were addictive.”

As startling as it is to hear, Walker laid bare the reality of the egregious nature of the systemic issues plaguing the healthcare system, “This is what we were told we had to do. The government was telling us; the Joint Commission was telling us, the AHA… it was across the board, so we had to comply.”  This accounting of the epidemic illustrates a perfect storm of conditions that led us to where we are now, 400,000 deaths later and heroin use on the rise. 

Nevada is taking the prescription and illicit opioid epidemic seriously on the state level and attempting to curb the flow of pills that have inundated every county.  At least one of Nevada’s federal representatives is also promising to hold overprescribing opioid distributors responsible.  

Congressman Steven Horsford spoke last Friday with The Ely Times and responded to being questioned as to if he will move Congress to hold companies that manufactured and distributed 76 billion opioid pills in seven years accountable, “ Yes. I know this is being handled at two levels. The State AG is in litigation with pharmaceutical companies. And due to the impact that opioids have had on local communities, local services, hospitals and uncompensated care, there now is an omnibus lawsuit that is happening across the country, similar to the Big Tobacco Industry in the 90’s, where information was brought forth to show that they knew all along that their product was addictive and yet weren’t being forthright with that information.  

I believe ultimately we will end in some settlement where they will be held accountable. But, Congress, yes is doing oversight and investigation hearings about what CEOs may have known, companies may have known about certain products they put out on the market.  And what they have done what they have done with price gouging. If someone broke the law or misled the public they absolutely need to pay.” 

Prescription opioid pain medications have ravaged the country, our state, and our county, and over the last twenty years have opened a door to illicit and dangerous narcotics like crystal meth and heroin.  White Pine County Sheriff, Scott Henroid presented harsh realities this past week when he spoke with us about this issue, saying, “This epidemic has been in place for a long time. It’s nothing new to us.  The legislation moved to get more stringent with the distribution on the medical side, I think that’s a great thing. Has it eliminated it? No. But what we’ve seen is, because it’s tougher to get the opiates, they are turning to other drugs like heroin.  Heroin is on the rise.”

Next week, The Ely Times will detail the law enforcement elements White Pine County and State officials are undertaking in order to eradicate prescription and illegal opiate drugs from our streets, our neighborhoods and our communities. 

If you are addicted to opioid prescription medication or struggling with heroin addiction, please know you are not alone. Help is a phone call away.  Call Carson-Tahoe Behavioral Health at 775-445-8000. Or call the Mallory Center: 775-445-8889. Locally, you can call the Sheriff’s Office at 775-289-8808.