Weekly Mass Torts Bulletin 2023-July-10

The Mayor of Hawaii County announced that the county will get $489,000 in opioid settlement monies this year and slightly more than $100,000 per year following that until 2038.

In accordance with a $26 billion federal settlement with many drug producers and distributors, the state will get $81.4 million over the course of 18 years.

A methodology that took into consideration the state's population and the effects of the opioid crisis was used to determine Hawaii's share. The Big Island will strive to guarantee that it obtains an additional share of the settlement monies the state receives, according to the mayor, who noted that the first sum granted to Hawaii County won't go very far. It has already requested an additional $2 million, he claimed.

The mayor said that if there was more money available, the first thing to do would be to start the island's first detox center. The government and the Big Island Substance Abuse Council are thinking about renovating a space in Hilo across from the courthouse for that usage. Given recent depressing numbers, there is a definite need for a detox center on the Big Island.

Federal statistics show that fentanyl overdoses account for the majority of drug overdose deaths on the Big Island, which occur once every 11 days. One person in Hawaii overdosed on drugs every 27 hours in 2022, totaling 320 fatalities. According to the Hawaii High Intensity Drug Trafficking Area, that is an increase from 305 in 2021 and 266 in 2020.

In Hawaii, the problem is considerably more widespread than the number of deadly overdoses suggests because there are around 14 non-fatal overdoses for every fatal one, according to specialists.

According to the Hawaii Island Fentanyl Task Force, Hawaii Island is home to various high-end, exclusive programs geared to persons on the mainland with the financial means to join.

Most Big Islanders of average means—as well as those who are homeless, don't have houses, or don't have health insurance—are directed to Oahu or the mainland for detox.

Due to insurance and transportation concerns, responsibilities to their families and jobs, waiting lists, and other obstacles, many people choose not to attend. According to the task team, rehabilitation is either delayed or impossible without access to detox.

The task force's initiatives in the areas of education and prevention, such as trainings, school presentations, community fairs, and yearly conferences, will receive some of the monies made public. The task team also prioritizes expanding treatment options and early intervention. 15% of the $81.4 million that Hawaii would get as part of the settlement will go to the counties, leaving 85% with the state.

A $3.1 billion settlement with Walmart over claims that the store contributed to the opioid epidemic by improperly monitoring the distribution of opioids at its pharmacies was announced in November by the attorney general of Hawaii. How much Hawaii will receive has not been made publicly known by the attorney general.

Over the next 20 years, companies that produced, sold, or distributed opioids will pay more than $50 billion in settlements to states, counties, and cities.

Nevada’s top attorney stated that the state of Nevada and Walgreens have negotiated a $285 million settlement over the pharmacy chain's contribution to the opioid crisis.

The final of many multiyear agreements with drug makers, merchants, and other parties, it brings Nevada's estimated payouts for opioid claims to $1.1 billion, according to a news release from the state's attorney general. The number of states that have achieved settlements, which now exceed $50 billion nationwide, includes Nevada.

According to the attorney general, one of his main concerns when he initially assumed office as attorney general was to seek justice for people who had been injured by the opioid crisis.

An email from a business spokesman stated that Walgreens had no comments on the settlement. The state sued in 2019, and Walgreens is the last defendant listed.

The state and the signatories of the One Nevada Agreement, a partnership of Nevada county and local governments, will share the $285 million settlement over 15 years.

About $98.1 million will be kept by the state, and it will go into a fund established to aid in funding opioid rehabilitation programmes run by the state Department of Health and Human Services. About $116.2 million will be given to the coalition.

The state agreed to pay Teva Pharmaceuticals $193 million in June, and CVS $152 million in May. A significant portion of the more than $50 billion acquired via countrywide settlements will be utilised to address an overdose issue connected to more than 100,000 fatalities each year in the United States.

In order to resolve litigation about the harm caused by opioids, CVS agreed to pay roughly $5 billion to state and municipal governments last year. But in order to seek the single-state settlement, Nevada chose not to participate in that case.

In April 2022, Nevada signed another multistate deal worth $232 million over almost two decades with three of the major opioid producers in the country.

A lawyer for the plaintiffs in the lawsuit said the first U.S. trial over allegations that the heartburn medication Zantac, which has since been withdrawn, causes cancer will now happen in California state court on November 13.

Nine different cancers, including colon, breast, and bladder cancer, are allegedly brought on by Zantac, according to the lawsuit's plaintiffs. The single defendant in the case, British pharmaceutical company GSK Plc (GSK.L), which manufactured the medication, reached a settlement for an unknown sum without admitting culpability, postponing the trial that had been scheduled for next month in a lawsuit brought by a separate plaintiff.

Numerous companies that sold Zantac at different times, including GSK, Sanofi SA, Pfizer Inc., and Boehringer Ingelheim, have been named in thousands of cases in California. The trial is intended to evaluate the validity of the claims, and the results may influence future settlement discussions.

Each lawsuit does not identify every company that has vehemently disputed that Zantac can cause cancer. A GSK spokesman said that it has not yet been decided which particular case will go to trial in November.

Zantac, which received its first approval in 1983, rose to become one of the first medicines to achieve annual sales of $1 billion and the best-selling medication in the world by 1988. An antecedent of GSK sold it at first.

Due to worries that the key component in Zantac, ranitidine, may deteriorate over time and turn into a substance called NDMA, several manufacturers stopped selling the drug in 2019. Although NDMA may be found in small concentrations in food and water, research has shown that bigger doses can cause cancer.

The FDA removed all remaining brand-name and generic Zantac products from the market in 2020.

The pharma companies won a significant win in December when a federal judge dismissed all 50,000 Zantac lawsuits in U.S. federal court after concluding that the plaintiffs' expert witnesses' assertions tying the medication to cancer were not supported by reliable evidence.

More than 70,000 cases are still outstanding in Delaware's state courts, which handle the majority of the remaining cases.

Pharmacies and drug firms have agreed to pay state and local governments billions of dollars in order to lower the alarming number of drug overdose deaths that have been brought on by the careless marketing of opioid painkillers for the past ten years.

However, it could end up being a waste of money or at least spread money around without doing anything to address the record-breaking rise in drug overdoses brought on by synthetic opioids like fentanyl, which are being incorporated into a variety of other narcotics to entice new generations of users to a lethal high.

That is exactly what occurred when the tobacco industry paid billions to the state, federal, and municipal governments, the majority of which disappeared into government budgets with little to no impact on smoking rates in the US.

In light of this, the Board of Supervisors approved a broad plan that might send a significant portion of the unexpected funds to regional community organizations actively engaged in drug addiction, overdose prevention, and education.

In 2020–21, opioid overdoses caused 406 Apache County people and 913 Navajo County inhabitants to end up in the hospital. That cost around $66 million, much above what the settlement will cover in a single year. Drug use is more prevalent than the state norm in Navajo and Apache counties, while mortality rates are about average. That's largely due to the fact that when it comes to providing Naloxone, which may swiftly reverse the symptoms of an opioid overdose, police and paramedics are performing far better than most of the rest of the state.

The county is negotiating with the local communities to combine the funding they get to have the greatest impact. Although the pharma corporations and the tribes are currently working on financial details, the tribes will mostly run their own programs.

More than half of the area and people of Navajo and Apache counties are located on reservations, respectively. The rates of drug addiction and death have usually been higher among the tribes. On the board of supervisors, three of the five seats are held by people from tribal communities. Numerous county programs, nevertheless, don't run on tribal territories.

According to the settlement agreement, the counties and municipalities must invest the majority of the funds in initiatives that directly combat the opioid overdose problem. During the pandemic, there were 30% more overdose fatalities, with fentanyl being the primary cause of most of them. The settlement's clauses were designed to prevent the failure of the tobacco settlements, wherein, according to a federal Centres for Disease Control estimate, less than 14% of the $256 billion settlement was allocated to decreasing smoking.

Another illustration is the use of government pandemic funds worth millions of dollars. The majority of the funding Navajo County received was used to fund county operations and initiatives. Early on, the funds were used to fund a surge of clinics and vaccine campaigns, but such efforts subsided after a few months. It hasn't altered in months, but less than 60% of the county's non-reservation population is immunized. However, several studies show that vaccines, which are free and widely available, have saved more lives than any other measure.

In a case where it was alleged that the pharmacy was selling risky medicine combinations, including opioids and disobeying prescriptions, an Andover-based drugstore agreed to pay $10 million.

According to the U.S. Attorney's Office District of Massachusetts, the Injured Workers Pharmacy (IWP), the nation's largest purchaser of opioids, has agreed to pay $10 million to settle a lawsuit alleging that the business violated the Controlled Substances Act by improperly filling prescriptions for controlled substances, including opioids, and submitting false claims for payment to the Department of Labour.

Prescriptions are mailed to wounded employees by the corporation. The CEO of the business said in a statement that federal investigators had incorrectly identified IWP as the top buyer of opioids among all pharmacies in the nation.

IWP sends medication to wounded employees throughout the nation, whereas retail pharmacies only dispense to patients in a limited geographic region. Hence, it is unfair to compare IWP to national retail pharmacy businesses. IWP only dispenses prescriptions that have been sent directly from prescribers or that have been confirmed with prescribers before being filled. The CEO stated in a statement that IWP's volume of opioid distribution is really less than 0.5 percent of that of Walgreens and CVS Pharmacy, respectively.

A five-year remedial action plan with the Drug Enforcement Administration was also required, according to a federal order given to IWP.

IWP acknowledged as part of the settlement that between 2014 and 2019, the business neglected to manage prescriptions with "red flags" including excessive opioid dosages, early refills, and risky medication combinations before distributing them to wounded employees, according to regulators.

"'Red flags' indicate prescriptions that may not have been issued for a legitimate medical purpose, such as abuse or diversion," according to a release from federal officials.

The complaint asserts that IWP failed to pay attention to prescriptions that the Department of Labour had noted. IWP acknowledged that from 2017 to 2019, the business informed the Department of Labor that staff members spoke with prescribers about prescriptions that were deemed to be worrisome. Actually, the prescribers weren't consulted by the corporation. IWP authorities said that staff submitted codes declaring "Prescriber consulted" without contacting IWP pharmacists or prescribers because they lacked clinical pharmacy knowledge and training.

Federal prosecutors claim that under the provisions of the settlement, DEA is permitted to examine IWP without an administrative inspection warrant during the course of the following five years.

IWP has subsequently improved its pharmacy practices "to address issues uncovered in the investigation," authorities stated. For instance, "the company established protocols to reduce losses of prescriptions shipped through the mail, developed additional procedures to review high-risk prescribing, increased training for all employees, eliminated production quotas for pharmacists and staff, implemented a drug diversion team to implement, establish, and maintain diversion controls throughout the pharmacy."