Lloyd I. Sederer
- Lloyd I. Sederer, MD, is an adjunct professor at Columbia University School of Public Health, founder and director of Columbia Psychiatry Media, chief medical officer of Bongo Media, and chairman of the advisory board of Get Help.
“Of every gin shop in every city in the world” was the first jury trial in the flood of the opioid epidemic in northeastern Tennessee.
Three district attorneys, who represent nine opioid-ravaged counties in northeast Tennessee, are determined to prosecute three drug companies.
At the beginning of July 2022, the jury selection of six local Tennessee “peers” began. This was a lawsuit involving three first defendants, Purdue, Mallinckrodt and Endo Pharmaceuticals.
The case centered on how they misrepresented the risks of opioids, relentlessly marketed their addictive products, and benefited greatly and knowingly from exploiting the large numbers of people and families they had spun into their web.
At the time of the trial, Purdue and Mallinckrodt were bankrupt, leaving only Endo Pharmaceuticals to defend against its role in contributing to the ravages of the opioid epidemic in these nine rural Appalachians.
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Why this case matters
There were three unique and notable aspects to this legal battle: first, it was a colleague-by-jury, not judge, unlike its countless predecessors; second, it was not about compensation; and third, instead, the $ 2.4 billion case (initially) to fund a public health approach to providing basic addiction, mental and physical health services to those affected by the opioid epidemic in northeast Tennessee to establish and maintain and to save others from the same fate.
I became the lead assessor on this case for which I was compensated. This report is my first hand account of the litigation as it unfolded from the summer of 2019 to its conclusion in July 2021.
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This is our approach
My report to the court specifically looked at methods of alleviating the opioid epidemic in five specific populations of people with Opioid Use Disorder (OUD):
- People with HIV or hepatitis C.
- People in the criminal justice system
- Homeless people
- Children and families; and
- Babies with neonatal abstinence syndrome (NAS) and pregnant women.
These were arguably the most vulnerable to the epidemic, illustrating the extent and duration of public health efforts to contain a deadly epidemic.
Public health approaches to epidemics are well established. Think of getting rid of polio, measles (though no more), tuberculosis, and smallpox. How public health methods are driving back the HIV / AIDS epidemic, dramatically reducing car accidents, and tobacco disease and deaths. As well as the enormous number of lives saved or could have been saved by COVID-19.
This study represented an opportunity to establish an effective, sustained public health program for the opioid epidemic in northeast Tennessee. Rather than the usual costly, ineffective, punitive, stigmatizing and criminal justice approaches, this case is about the opioid epidemic.
That was my job: to propose a public health plan to give these affected counties a real chance at recovery.
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A five element approach to recovery
My court report and subsequent filing suggested an approach to the opioid epidemic in northeast Tennessee with five key elements:
- First, primary prevention, namely preventing people from developing an opioid use disorder in the first place.
- Second, secondary prevention with early detection and intervention before a disease or health problem (in this case opioids) is more advanced, deeply rooted and therefore more difficult to remedy.
- Thirdly, a comprehensive, continuous treatment of addiction and its frequent comorbidities, which means that a complex disease like addiction is not subject to a simple, singular intervention and, if the treatment is repeatedly interrupted, no one has a good chance of recovery.
- Fourth, the provision of social support, especially housing, to people with opioid use disorder.
- Fifth, the NE TN program needs to have clear, quantifiable, real-time performance metrics from the start to determine what has worked or not in order to drive continuous improvement and accountability.
What brought this process to a solution?
Unexpectedly, as the trial date drew nearer, the judge issued a “default judgment” holding Endo responsible for the drug-related devastation suffered by people in these nine districts.
He had chosen this as a sanction against the defendant who, in his opinion, had behaved improperly in these proceedings.
With the “default judgment” of the judge, the defendant was unsuccessful.
Then Endo offered to sit down. We won. The settlement was $ 35 million.
I came to this perspective:
- The settlement would be paid out immediately, not over years like in other opioid litigation
- Immediate payment would also reduce the risk of Endo filing for bankruptcy when money is not available.
- $ 35 million for the roughly 590,000 people in northeast Tennessee is $ 600 to $ 700 million for a state like New York (where I worked) with a population of 20 million people. Not enough, but a good start.
What is still ahead of us?
Will there be more jury cases? Will these or other DAs take further steps against Endo as well as Purdue and Mallinckrodt?
Who will have the local, if not national, power to ensure that arbitration awards, including this settlement, are handled effectively and responsibly using quantifiable and meaningful measures of success?
The way is made by walking, as the aphorism says. Science and clinical practice have shown a path that will allow so many to recover (if they don’t die first).
It is within our reach to contain the epidemic of opioid and other drug disorders. That’s why in that first opioid jury trial I said, “Count me,” not for damages, but for solutions.
Lloyd I. Sederer, MD, is an adjunct professor at Columbia University School of Public Health, founder and director of Columbia Psychiatry Media, chief medical officer of Bongo Media, and chairman of the advisory board of Get Help.
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