Professor recounts history of opioid epidemics in trial against makers, distributors

Physicians ignored century-old lessons learned during America’s post-Civil War opioid crisis by overprescribing powerful opioid drugs in the 1990s and 2000s, a medical historian testified Wednesday in Central Islip.

University of North Florida professor emeritus David Courtwright, an expert in the history of drug use and drug policy, was the first of what could be hundreds of witnesses called in the landmark lawsuit filed by Nassau, Suffolk and New York Attorney General Letitia James against opioid manufacturers and distributors.

Courtwright said the "narcotic conservatism" that prevented widespread addiction from prescription opioids from the turn of the 20th century until the 1980s had crumbled by the '90s, fueling the opioid epidemic that has killed thousands of Long Island residents in recent years.

"We have been here before. This country was burned badly by the opioid epidemic of the late 1800s. We learned lessons from that," Courtwright said under direct examination by Hunter Shkolnik, an attorney for Nassau County.

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.

Thursday, Courtwright is expected to be cross-examined by attorneys for drug makers and distributors, who say they were not responsible for the epidemic. They argue that 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.

While opioids had been used -- and abused -- throughout much of American history, Courtwright said America’s first "medical opioid epidemic " was sparked by doctors who aggressively prescribed powerful pain medications in the 1870s and 1880s to treat everyday aches and ailments, including premenstrual cramps. The importation of opioids tripled during those years -- and 70% of those who became addicted were women.

Patent medicines -- concoctions made from secret formulas and sold over the counter to address specific ailments -- also often contained opioids, Courtwright said. The use of morphine spiked, he said, as the use of hypodermic needles became more common.

Doctors and public health experts realized patients were becoming addicted to the drugs they had been prescribed, Courtwright said. Medical journals, textbooks and other periodicals soon contained warnings about the dangers of opioid drugs and addiction. By the 1890s, Courtwright said, opioid addiction caused by inappropriate prescriptions began to decline.

Lawmakers also took notice, passing legislation intended to prevent drug abuse and addiction. Those laws included the U.S. Pure Food and Drug Act, which required manufacturers to list ingredients on labels, and the Harrison Narcotics Act of 1914, which regulated and taxed the importation of opioid products. The Controlled Substances Act of 1970, meanwhile, codified on a national scale how opioids are manufactured, distributed and prescribed.

Opioids also got a bad name in American culture, thanks to novels such as "The Wizard of Oz" by Frank Baum and "The Man with the Golden Arm" by Nelson Algren, Courtwright said. Opioids continued to be abused throughout the 20th century, Courtwright said, but the source of those drugs was smugglers and underground traffickers.

The "narcotics conservatism" created by medical community warnings, legislation and popular culture was like a dam that prevented widespread abuse of prescription opioids. But it began to crumble by the 1980s, Courtwright said.

"The dam starts to fall apart in the late 1980s and 1990s," he testified.

The result, Courtwright added, is the second medical opioid epidemic that has devastated Long Island families and killed a half million Americans.

"I never thought I would see anything like this in my lifetime," Courtwright said.

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.