After more than 2,600 lawsuits nationwide involving their role in the opioid epidemic sweeping through the country, Purdue Pharma — the manufacturer of prescription painkiller OxyContin — filed for bankruptcy Sept. 16.

In 2017, opioids were responsible for 47,600 of the 70,237 U.S. drug overdose deaths — with more than 28,000 of these opioid-related deaths being attributed to synthetic opioids, such as fentanyl. From 1999 to 2017, more than 400,000 Americans have died from opioid overdoses.

The declaration of bankruptcy followed a tentative $10 to $12 billion settlement with 27 states and thousands of cities and counties throughout the nation — with nearly 20 other states rejecting the terms of the settlement.

Dr. Richard Blondell, physician and vice chair for addiction medicine at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo, said the company’s heavy marketing downplaying the addictive nature of OxyContin helped start the epidemic. 

“They promoted this drug heavily,” Blondell said. “I can remember representatives coming around with little bags, pens and clocks. They had a clock that just had 12 on there to remind us to prescribe it every 12 hours. The older physicians said, ‘Boy don’t listen to them. They don’t know what they’re talking about, these are addictive drugs,’ — and it turns out those old, family doctors were right.”

Dr. Steven Aks, immersive physician and head of toxicology at Cook County Health, said it’s important to distinguish that there are two “faces” to the current opioid epidemic: pharmaceutical pills and street drugs.

 “There’s no single factor that you can point out and say, ‘This caused the opioid epidemic,’” Aks said. “It’s not just the pharmaceutical companies. It’s not just the regulatory bodies and it’s not just when people use drugs on the street, but all of these things coming together is what kept it moving.”

Ed Silverman, senior writer and Pharmalot columnist at health news website STAT, has covered the pharmaceutical industry for over two decades. He said the lawsuits have been a “helpful tool” in uncovering the extent to which Purdue has contributed to the opioid crisis through their marketing.

“The lawsuits help us understand their thinking, their tactics, their strategy,” Silverman said. “I think that’s important more generally because it’s sort of a window into how these sorts of decisions are made more broadly when it comes to marketing medicines. And when it comes to scrutinizing the decisions that need to be made balancing profits versus patients.” 

After talks to reach a settlement with other companies failed on Friday, litigation into the epidemic is set to continue today in Ohio, with the Summit and Cuyahoga county lawsuits taking center stage. Purdue Pharma won’t be included in this particular litigation, but countless other pharmaceutical companies are included in nationwide suits. 

Robert Drain, U.S. bankruptcy judge, placed a hold on any further lawsuits against the company until Nov. 6.

Wendy Epstein, professor of law at DePaul University and faculty director of The Mary and Michael Jaharis Health Law Institute, said the move to place a hold on further suits is “typical” in Chapter 11 bankruptcy cases.

“The next step is that the litigation could be continued in front of a bankruptcy court or the litigants could instead attempt to negotiate a resolution,” Epstein said. “The reason for this is it allows a bankruptcy court to manage a company’s creditors, which a plaintiff becomes if it wins in litigation and is awarded damages. There is a fixed amount of money to be distributed and the bankruptcy court manages that process.”

“This settlement framework avoids wasting hundreds of millions of dollars and years on protracted litigation and instead will provide billions of dollars and critical resources to communities across the country trying to cope with the opioid crisis,” Purdue Chairman Steve Miller said in a statement.  

Blondell said the declaration is a “capitalistic tactic” that has been used by other companies in the past — especially since the Sacklers themselves did not file for bankruptcy.

“That’s generally what companies do when they make a big mess in the face of lawsuits — they just declare bankruptcy and walk away,” Blondell said. “Meanwhile, the Sacklers are sitting on their billions and billions of dollars. It’s just some of the flaws of the capitalistic system that we live in.”

Illinois Attorney General Kwame Raoul filed a lawsuit in April against the company that alleged Purdue representatives “dispatched sales representatives to Illinois hundreds of thousands of times” between 2008 and 2017 and “funded third-party publications under the guise of educational materials to promote opioids and downplay their risks.” In August, Rauol expanded the lawsuit to include members of the Sackler family.

“The Sackler family knowingly misled the public and continued pushing Purdue’s addictive opioids without care or consideration of the death and destruction their product caused, and I stand with a majority of state attorneys general to say that the current proposal is not sufficient,” Raoul said in a Sept. 11 press release.

Aks, the physician with Cook County Health, said illicit opioids are also a big problem.

“Most of the country has been affected by the pharmaceutical pills, but Cook County has been ravished by street drugs,” he said. “Like 80 to 85 percent of the deaths in Cook County are from street drugs, including illicit fentanyl, and it’s more like 15 to 20 percent are from the pills directly.”

Purdue Pharma isn’t the only corporation under fire for its role in the epidemic. Health care products company Johnson & Johnson, which manufactures painkillers and other drugs under its Janssen subsidiary, reached a $20.4 million settlement in two Ohio counties and was fined $572 million in an Oklahoma-based case — currently under review following the proceeding judge’s $107 million miscalculation in the award.

“They [Purdue Pharma] started it, but there’s a lot of blame to go around,” Blondell said. “If being blamed is a pharmaceutical company problem, they did it and they have to pay. They started it, but they had a lot of willing accomplices.”

While the outcome of further litigation is uncertain, Blondell said any money from these settlements needs to go to measures to begin the recovery process in the wake of the crisis.

“We need evidence-based treatment programs, which are generally unfunded, to clean up some of the mess we made — to deal with some of the people who were prescribed,” Blondell said. “But the other thing we need is prevention. Every epidemic we’ve ever faced in the history of humans has been through prevention.”