Witness: Opioid makers told doctors addiction risk was minimal 

The pharmaceutical makers sued by Nassau, Suffolk and New York State Attorney General Letitia James falsely told doctors the addiction risk of opioids was minimal, fueling a drug epidemic that killed thousands of Long Islanders, a Stanford University professor testified Monday in Central Islip.

Dr. Anna Lembke, a professor of psychiatry at Stanford and a physician who treats patients struggling with opioid abuse, said Teva Pharmaceuticals, Endo Pharmaceuticals and Allegan Finance used misleading sales brochures, marketing videos, medical journal articles and other promotional materials to convince health care providers, regulators and policymakers that their opioid pain medications was safe — with disastrous results.

"The promotional messages targeting doctors and other health care institutions led to increased prescribing of opioids, which led to a greater supply of opioids in the community," Lembke testified under direct examination by Jayne Conroy, an attorney for Suffolk County. "That led to more people becoming addicted to opioids, more people overdosing on opioids and more people dying from opioids."

The false statements by the manufacturer defendants also fueled the black market drug trade, Lembke said. "Those individuals, many of them, progressed to heroin and illicit fentanyl," Lembke said of patients who became addicted to prescribed opioids.

The lawsuit filed in New York State Supreme Court alleges drug manufacturers and distributors created a public nuisance by misleading physicians and patients with marketing that minimized the dangers and addiction risks of opioids. State and county officials say they hope to hold the companies accountable for the death and misery caused by the opioid epidemic, and to recoup hundreds of millions of dollars for treatment, recovery and prevention.

"They were maximizing profits at the expense of public health and safety," Lembke said.

Attorneys for the drugmakers and distributors have said their clients are not responsible for the epidemic, arguing they followed all regulations and are being made scapegoats for the actions of health regulators who encouraged opioid use, doctors who overprescribed the painkillers and other forces beyond their control.

Lembke said her research showed that 8% to 12% of patients prescribed opioids by doctors will get addicted. The World Health Organization, she said, defines that risk as "common" or "very common."

Teva, Endo, Allegan and other manufacturers, however, contended throughout the late 1990s and 2000s that the risk of addiction was rare in patients suffering with chronic pain. Doctors who were wary of addiction, Lembke testified, were accused of opioid phobia. Patients who exhibited signs of addiction by seeking out greater dosages of the drugs were said to be suffering from "pseudoaddiction" because their pain was inappropriately managed. The cure for pseudoaddiction was more opioids, she said.

"It made it that much harder for a clinician, a doctor to diagnose addiction in a patient who was developing that problem while being prescribed opioids for the treatment of pain because it taught doctors that when you see a patient that looks like they are getting addicted, they are not really addicted," Lembke testified.

The drug manufacturers paid millions of dollars to influential physicians, medical organizations and regulatory bodies to tear down circumspection about opioids and addiction, Lembke said, which gave opioids a legitimacy that was hard to combat.

One physician considered a key opinion leader in pain management was later hired as a consultant by New York State, which Lembke said showed that the pharmaceutical companies’ push to promote opioids was extremely successful. Endo attorney Jim Heirschlein, during cross-examination, asked Lembke if she was biased because she works with patients struggling with addiction — not with patients who have benefited from opioid use. He then played a clip from a 2016 NPR interview in which Lembke admitted she was biased.

Lembke said she entered the addiction field with an open mind and her opinions are based on years of research and experience.

Cross-examination of Lembke is expected to continue on Tuesday.

There are seven drug manufacturers and distributors, as well as their subsidiaries, named as defendants in the trial before New York State Supreme Court Justice Jerry Garguilo. It is being held at Touro College’s Jacob D. Fuchsberg Law Center, rather than the nearby Cohalan Complex, to accommodate the large number of lawyers and staff involved in the case.