The medical community was unprepared for the large number of patients who became physically dependent on painkillers during the opioid epidemic that has killed thousands of Long Island residents, a Stanford University addiction specialist testified Thursday in Central Islip.
Anna Lembke, a professor of psychiatry at Stanford and a physician who treats patients struggling with addiction and dependence, said many health care providers never learned how to properly wean longtime users off opioids because the opioid crisis that began in the 1990s was unprecedented.
"This is a brand-new problem that we have never encountered before," Lembke said during testimony in the landmark lawsuit filed by Nassau, Suffolk and New York Attorney General Letitia James against opioid manufacturers and distributors.
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.
Attorneys for 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's testimony came as James and officials in 14 other states said they had reached a $4.5 billion agreement with OxyContin maker Purdue Pharma, the company many public health experts say played a primary role in the opioid epidemic by marketing their products as safe. James said New York would receive about $200 million of the settlement.
Purdue is not a defendant in the lawsuit filed by James, Nassau and Suffolk.
Before the epidemic, Lembke said, physicians would gradually reduce opioid use over two weeks. That did not work for patients who had been using large dosages of opioids for long periods of time, she testified under direct examination from Jayne Conroy, an attorney for Suffolk County. Those patients often suffered from muscle aches, insomnia, severe depression and other painful withdrawal symptoms.
"There was a lack of understanding in how to do that because this was an unprecedented problem," Lembke said.
Tapering off opioid use for patients who had taken high dosages for long periods of time could take months or even years, Lembke said. In some cases, physical dependence is irreversible, she said.
Earlier in the day, attorneys for the drug manufacturers and distributors cross-examined University of Florida professor emeritus David Courtwright, a drug-use and policy expert who testified Wednesday. He had testified that a "narcotic conservatism" that grew out of the abuse of opioids during the late 1800s had eroded by the 1990s, fueling the opioid epidemic.
Courtwright acknowledged under cross-examination that the government set quotas for the production of opioids and that black market heroin had played a role in earlier drug epidemics.