Opioids – Health Care



In lawsuits around the U.S. that blame major pharmacy chains, such as Walgreens and CVS, for the country’s opioid crisis, the healthcare giants appear to be following a similar legal strategy: Blame the doctors instead.

In Florida earlier this month, Walgreens and CVS filed a third-party complaint that says that 500 anonymous physicians—Dr. John and Jane Doe—are responsible for fueling that state’s opioid epidemic, not the pharmacists who filled the opioid prescriptions.

It comes after a group of major pharmacy chains that included CVS and Walgreens, filed legal action in an Ohio court in January to shift the responsibility to physicians in a major federal opioid trial that claims the large companies are culpable for prescribing the drugs that have fueled the opioid crisis.

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In those filings, the pharmacy chains, which also included Walmart, Rite Aid, HBC and Discount Drug Mart, said it was actually hundreds of Ohio physicians and other healthcare practitioners who write the prescriptions that bear the blame for providing opioids to patients—not the pharmacists who filled those prescriptions.

Florida’s Attorney General Ashley Moody was having none of that legal argument. “This stunt is simply a tone-deaf distraction by two of the wrongdoers in the national opioid crisis that is claiming 15 lives in Florida every single day,” Moody said in a statement.

She filed a motion to strike or sever the third-party complaint (PDF) filed by CVS Pharmacy Inc. and the Walgreen Company, pharmacy retailers who were named as co-defendants in a suit brought by the Attorney General’s office against Purdue Pharma, the maker of OxyContin, and other manufacturers, distributors and chain pharmacies. 

In her motion to throw out the third-party complaint in Florida, Moody said CVS and Walgreens have records that include the names of the doctors who wrote the opioid prescriptions, “Yet, CVS and Walgreens have not named a single prescriber and, instead, have filed this pleading against 500 John and Jane Doe defendants,” she wrote. “Our complaint alleges that these national pharmacies are responsible for knowingly flooding Florida with billions of dangerous and addictive pills all while the opioid crisis continued to spiral out of control.”

Like several other states seeking to recoup millions of dollars spent battling the costly opioid epidemic, Florida filed a lawsuit in 2018 that named the two retail pharmacy giants as defendants.

The defendants should have known they were fueling an opioid epidemic, the lawsuit said. A Walgreen’s drug distribution center sent 2.2 million opioid tablets to a single pharmacy in tiny Hudson, Florida, in 2011 a roughly six-month supply for each of its 12,000 residents, the lawsuit said. CVS distributed more than 700 million opioid doses in Florida between 2006 and 2014, it said.

In response, Walgreens and CVS filed a third-party complaint in January saying they are not liable for the opioid crisis and asking the court to focus on the physicians who prescribe the drugs.

“Pharmacists do not write prescriptions and do not decide for doctors which medications are appropriate to treat their patients,” the complaint says. “While pharmacists are highly trained and licensed professionals, they did not attend medical school and are not trained as physicians. They do not examine or diagnose patients. They do not write prescriptions.”

Proactive outreach, including knocking on the doors of individuals who recently overdosed on opioids, can be an effective way to engage more people who have opioid use disorder with long-term care, according to researchers at The University of Texas Health Science Center at Houston (UTHealth).

In a pilot study, the UTHealth research team measured results of a clinical research program, HEROES, that they created to curb opioid use disorder (OUD) in Houston. Findings were recently published in the Journal of Substance Abuse Treatment. HEROES is one of only a handful of programs in the country engaged in large-scale, door-to-door outreach and tracking results.

According to data from the Harris County Institute of Forensic Sciences, there were 325 opioid-related deaths from January through November of 2019 in Houston, up from 295 in all of 2018. The risk of overdose deaths is rising due to the increased availability of fentanyl and synthetic opioids. Federal data shows nearly 90% of people who have substance use disorder in the U.S. are not currently in treatment.

People with OUD don't always voluntarily seek treatment like you would with any other disease. Even if they recognize they need help, there are few places for them to turn, especially if they don't have insurance. We want to remove all those barriers and bring help directly to them at a time when they are more likely to accept it."

James Langabeer, PhD, EdD, MBA, professor at UTHealth who leads the HEROES program

Theories suggest that people have greater readiness for behavioral change during critical periods or life events, and surviving an overdose could represent such an event, said Langabeer, who was the lead author on the study.

Langabeer and his team at HEROES designed an intervention strategy to identify survivors of overdose through secured data from Memorial Hermann-Texas Medical Center and the Houston Fire Department Emergency Medical Services. Using a motivational interview guide, a trained recovery support coach and a paramedic knock on their doors. If the survivors are home and willing to talk, the team uses motivational interviewing techniques to encourage them to enroll in the HEROES program at no cost to them.

"This type of engagement is important because it helps to emphasize compassion and collaboration with each patient. We use it to have the person feel autonomy in their own decisions and not to be led or forced to a conclusion, but to reach a choice on their own and to feel accountable for it. We find that if they are engaged, they are more likely to follow through in the long run," Langabeer said.

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The peer recovery coaches are people who are in long-term recovery from opioid use disorder themselves.

"We've been through the fire and came out with buckets of water to fight this disease," said Jessica Yeager, a coach with HEROES. "Now people can look at me and say 'You're just like me – you can help me!' If someone had knocked on my door when I was at my worst, my life would be different today."

Between April and December 2018, the team visited 103 people, and 33% chose to engage in the treatment program. After 30 days, 88% of those participants were still active in the program, and 56% were still active after 90 days.

"Having one third of people we reached out to agree to a major step in their recovery while we are in their doorway is a huge accomplishment and much better than we expected, since other studies have shown far lower results," Langabeer said. "Recognizing that major life decisions require time, we are extremely satisfied with the results. Also, we've seen people choose to come into treatment weeks or even months later, so the information we provide during outreach can also help shape future choices."

Treatment through the HEROES program includes access to opioid overdose reversal medication, a recovery coach available 24/7, behavioral counseling with an addiction therapist, weekly support group meetings, and help connecting to county resources.

Another study Langabeer's team just published, which appeared in Substance Abuse Treatment, Prevention, and Policy, found evidence that engaging individuals through nontraditional routes such as community outreach, the criminal justice system, and emergency departments can be effective in engaging more people in medication-assisted treatment.

"We have to find more proactive ways to identify and locate these individuals in order to offer choices and paths for recovery that fit their unique situation," said Langabeer, who was the senior author of the study.

The HEROES program currently has more than 500 participants.


University of Texas Health Science Center at Houston