‘THE GATEWAY DRUG was OXYCONTIN’
For many overdose victims, trouble started with prescription opioids
Chris Yoder was born on Oct. 12, 1995. Two months after the New York boy’s birth, a pharmaceutical company based in neighboring Connecticut gained the federal government’s approval to start selling its latest prescription pain drug: OxyContin. After knee surgeries as a teenager, Chris would be prescribed painkillers, his mother said, and a couple of years later, he started experimenting with an illicit opioid: heroin. In April 2017, an overdose of synthetic opioids tragically ended his life at the age of 21.
Today, Purdue Pharma, the Stamford-based company that makes OxyContin, is facing a reckoning for its purported role in the deaths of Chris and many other Americans. Chris’ mother, Norwalk resident Dede Yoder, is one of several-hundred thousand individuals, private-sector groups and
Chris, 21, died from an overdose of two synthetic opioids: fentanyl and carfentanil. The latter is 10K times more potent than morphine and 100 times more potent than fentanyl, which itself is 50 times more powerful than heroin.
government bodies that have filed claims against Purdue. Through its bankruptcy, Purdue is trying to reach a comprehensive settlement of the litigation — which is underpinned by allegations that the company fueled the national opioid crisis with deceptive and reckless marketing of its signature drug.
“The gateway drug was OxyContin,” Yoder told Hearst Connecticut Media. “Chris had never taken opioids before, so it was OxyContin that introduced opioids to his brain.”
Purdue has denied the lawsuits’ accusations that it engaged in misconduct that contributed to the opioid epidemic. But it said in a statement provided to Hearst Connecticut Media that “we express our deepest sympathies to the families of any individual who died from a drug overdose after previously taking OxyContin at some point.”
Seeking a high
Chris grew up in Irvington, N.Y. His mother told Hearst that he was an energetic teenager who loved snowboarding, skateboarding and mountain biking. He was also a musician who played guitar and listened to The Rolling Stones, Jimi Hendrix, Bob Dylan and Nirvana.
After injuring his knee snowboarding, 14-yearold Chris underwent surgery in April 2010. In November 2010, he underwent a second surgery after re-injuring the knee. After both operations, he was prescribed a number of opioids, according to Yoder. She is not certain about the number of times that Chris was prescribed OxyContin, but she said that a wrongful-death claim she filed through Purdue’s bankruptcy is based on her recollection of him being prescribed OxyContin at least once.
“He was given a death sentence at the age of 14, which was handed down by doctors’ scripts for OxyContin, Purdue Pharma’s ‘blockbuster’ drug,” Yoder wrote in the claim.
By 2010, OxyContin had become one of the country’s most widely prescribed opioids, which the Centers for Disease Control and Prevention define as “substances that work in the nervous system of the body or in specific receptors in the brain to reduce the intensity of pain.”
Oxycodone is the active ingredient in OxyContin. The drug’s extended release delivers pain relief that can last up to about 12 hours, enabling it to be taken less often than shorter-lasting forms of oxycodone such as Endo’s Percocet.
“Several factors may have contributed to the abuse and diversion of OxyContin,” the U.S. Government Accountability Office said in a 2003 report on the drug. “The active ingredient in OxyContin is twice as potent as morphine, which may have made it an attractive target for misuse.”
The GAO also noted the drug’s susceptibility to being misappropriated for non-medical purposes.
“Rapid growth of OxyContin sales, which increased the drug’s availability in the marketplace, may have made it easier for abusers to obtain the drug for illicit purposes,” the report said.
Yoder believes that Chris’ experience with OxyContin set off the “addictive part of his brain” and contributed to his heroin use, which she said started in his senior year of high school. Most people who have a substance-use disorder started using before age 18 and developed their disorder by age 20, according to the National Institute on Drug Abuse.
“From then on, he was seeking different types of drugs to help get the same high,” she said.
For several years, Chris struggled with heroin addiction despite many attempts to quit using the drug. He attended eight in-patient rehabilitation centers across Colorado; Connecticut; Florida; New York; Pennsylvania; Utah; and Cancun, Mexico. Even with insurance, Yoder said she ended up incurring more than $100,000 in out-of-pocket costs.
Chris died on April 19, 2017, at age 21, from an overdose of two synthetic opioids: fentanyl and carfentanil. The latter, which is used as a tranquilizer for elephants and other large mammals, is 10,000 times more potent than morphine and 100 times more potent than fentanyl, which itself is 50 times more powerful than heroin, according to the Drug Enforcement Administration.
At the time of his death, Chris was working as a restaurant server in Bradenton Beach, Fla.
Yoder said her son wanted to live and overcome his addiction to heroin.
She cited an appointment Chris had scheduled for April 20, 2017 to receive an injection of Vivitrol, whose indications include prevention of relapse to opioid dependence following opioid detoxification.
A massive toll
Nearly 500,000 people in the U.S. died from overdoses involving prescription and illicit opioids between 1999 and 2019, according to the CDC. Opioid-involved overdoses killed nearly 50,000 people in 2019, accounting for about 70 percent of drug-overdose deaths that year.
During the COVID-19 pandemic, the epidemic has not abated. In 2020, 1,273 people in Connecticut died from opioidinvolved overdoses, a 13 percent increase from 2019, according to the state Office of the Chief Medical Examiner. In comparison, 298 people in the state died from opioid-related overdoses in 2012, the earliest data that Connecticut currently makes publicly available.
The approximately 3,000 local and state lawsuits against Purdue that have been consolidated in its bankruptcy case generally share the same allegations. They accuse Purdue of fueling the opioid crisis with years of false and misleading marketing about the benefits and risks of treating pain with its opioids, namely OxyContin.
Hundreds of people in Connecticut have “died or overdosed after obtaining prescriptions for Purdue opioids,” according to the state’s lawsuit, which was filed in December 2018.
“By getting patients addicted, the defendants greatly increased the patients’ risk of harm from many drugs in the opioid class — including heroin, fentanyl and generic oxycodone — which share the same addictive chemistry as Purdue opioids,” Connecticut’s lawsuit said.
Taking into account health care and law enforcement costs and economic disruption, the epidemic cost Connecticut more than $10 billion in 2016, according to the lawsuit. Across the country, state-led claims against Purdue add up to more than $2.2 trillion.
Purdue officials deny the lawsuits’ allegations. They also said OxyContin comprises a small share of the market for pain drugs. Citing statistics from health care data firm Iqvia, they said OxyContin accounts for less than 2 percent of opioids dispensed from retail pharmacies in the U.S., based on both the number of pills and number of prescriptions.
“They created the playbook that other opioid manufacturers followed in pushing these drugs,” countered Edward Neiger, a New York-based attorney who represents the Ad Hoc Group of Personal Injury Victims of Purdue in the company’s bankruptcy, with Yoder among his clients. “They helped create the market for it, even though ultimately they weren’t the biggest supplier.”
In recent years, many other opioid makers and distributors such as Allergan, AmerisourceBergen, Cardinal Health, Endo, Johnson & Johnson, Mallinckrodt, McKesson and Teva have also been sued by government bodies across the country for their alleged roles in stoking the opioid epidemic.
Some defenders of the pharmaceutical industry have compared deaths from prescription opioids with the number of fatalities for heroin and illegally manufactured fentanyl and fentanyl analogs.
Drugs containing oxycodone were involved last year in 95 fatal overdoses in Connecticut, compared with 71 in 2012. The Office of the Chief Medical Examiner does not break out data for the brands of prescription opioids involved in fatalities.
In comparison, fentanyl was involved in 1,159 deaths and heroin was involved in 262 deaths last year in the state.
Addiction to multiple opioids, however, is widespread. Connecticut’s lawsuit cites CDC statistics showing that people addicted to prescription opioids are 40 times more likely than the general population to be addicted to heroin. Fortyfive percent of peoplewho used heroin also were addicted to prescription opioids, according to the CDC.
“The specific opioid that you find in the toxicology report is not that important,” said Dr. Andrew Kolodny, the medical director of opioid policy research at Brandeis University’s Heller School for Social Policy and Management. “What’s killing people is the disease of opioid addiction. Many of them got this disease taking prescription opioids.”
(Kolodny has been a paid expert for some of the plaintiffs who have sued Purdue, but he said that his views on opioids are consistent with the positions he held before the pending lawsuits were filed.)
Eyes on a settlement
Last November, Purdue pleaded guilty to three criminal charges of conspiring to defraud the government and violate antikickback law as part of an approximately $8 billion settlement with the Department of Justice. With the exception of a $225 million direct payment to the Justice Department, the payouts outlined in that agreement are being processed through the company’s bankruptcy.
As part of the plea, Purdue admitted that from May 2007 through at least March 2017 that it “conspired to defraud the United States by impeding the lawful function of the DEA by representing to the DEA that Purdue maintained an effective anti-diversion program when, in fact, Purdue continued to market its opioid products to more than 100 health care providers whom the company had good reason to believe were diverting opioids and by reporting misleading information to the DEA to boost Purdue’s manufacturing quotas,” according to a Justice Department release on the settlement.
In its statement to Hearst, the company said it “deeply regrets, and has accepted responsibility for, specified misconduct that took place before June 2017.”
The Sackler family members who own Purdue reached their own $225 million civil settlement with the Justice Department to resolve allegations of financial and marketing misconduct. The Sacklers, however, did not admit any wrongdoing as part of that deal.
Through the bankruptcy, Purdue is trying to reach a comprehensive settlement of the lawsuits, which cumulatively cover a broader range of allegations and a longer time span than the Justice Department settlement.
“Our goal is to achieve a global settlement that would deliver more than $10 billion in value, including 100 percent of Purdue’s assets, to address the opioid crisis,” Purdue said in its statement. “Our proposed settlement structure would provide needed funds, as well as millions of doses of life-saving opioidaddiction treatment and overdose-reversal medicines, to states, local communities and tribes to help abate the opioid crisis.”
Connecticut and 23 other “non-consenting” states have rejected that offer because they see it as an inadequate response to the opioid epidemic. They have vowed to keep fighting for settlement terms that are acceptable to them — even if the judge overseeing Purdue’s bankruptcy approves its settlement plan.
To support a prospective settlement, Purdue conducted last year a national ad campaign telling Americans how they could file claims against the company if they believed they or family members had been hurt by its opioids. Informing those with potential claims is a regular feature of corporate bankruptcies.
Nearly 624,000 claims had been filed by June 24. The total includes more than 130,000 claims filed on personal-injury forms, as well as the lawsuits filed by local and state governments. There are 550 submissions from Connecticut.
Connecticut and other states have committed to using any funds they receive for programs to tackle the opioid crisis — in contrast with the lack of restrictions on the funds generated from states’ 1998 settlement of their lawsuits against major tobacco companies. In the 2021 fiscal year, the states will collect about $27 billion from that settlement and tobacco taxes, according to the nonprofit Campaign for Tobacco-Free Kids. But they will spend only about 2 percent on programs to prevent kids from smoking and help smokers quit, the nonprofit said.
“States need to establish a dedicated fund for the opioid settlement dollars and ensure that they are spent on evidence-based programs that will save lives,” said Courtney Gallo Hunter, vice president of state policy at the Norwalkbased nonprofit Shatterproof, which is working to end the addiction crisis in the U.S. “This should include treatment quality and anti-stigma initiatives. We advise states to not supplant current funding, but supplement existing resources. We also advise that states have diverse stakeholders at the table to decide where the funding goes and report back to the public on how it is being spent.”
Before attorneys’ fees and costs are deducted, individual claimants such as Yoder would each receive a settlement amount between approximately $3,000 and $48,000, according to Purdue officials.
Assuming she receives a settlement payment, Yoder said she would donate a portion to Shatterproof.
Settlement funds would also alleviate the fiscal pressure for victims’ family members. Yoder, who is in her mid-60s and formerly worked as an executive in the cosmetics industry, is concerned about her financial future. She said she spent most of her retirement savings on rehabilitation expenses and other medical costs to help Chris in his efforts to recover from addiction.
“Several of Chris’ rehabs were not covered at all by insurance, so I do hope to get some monetary compensation,” Yoder said. “But there’s no amount of money that can bring back my only child.”
“We express our deepest sympathies to the families of any individual who died from a drug overdose after previously taking OxyContin at some point.”
—Purdue Pharma, the Stamford-based company that makes the prescription pain drug, in a statement to Hearst Connecticut Media