When Paul Cherashore first heard about Philly’s lawsuit against drug companies, three words popped into his head: Low. Hanging. Fruit.
Wednesday morning, the city announced it would sue several national pharmaceutical companies in an attempt to hold them accountable for the part they played in Philly’s opioid epidemic. City officials argued that the companies used “deceptive marketing” tactics to push prescription painkillers, causing people to develop substance use disorder.
Filing a lawsuit sounds impressive. But the act might be more show than substance.
Some Philly harm reduction advocates say the lawsuit probably won’t be effective in reducing the crisis. It puts the blame entirely on prescription opioid manufacturers, when in reality, advocates maintain, the causes of substance use are far more complex.
So what part did pharmaceutical companies really play in Philly’s opioid epidemic? Cherashore, a member of the Philadelphia Overdose Prevention Initiative and a harm reduction advocate, said prescription opioid use only tells a small part of the story.
“There’s an element of truth to it,” Cherashore said of prescription opioid companies worsening the epidemic. “But it’s also scapegoating. Everybody’s got a hand in what happened.”
This isn’t the first lawsuit of its kind — Ohio and Mississippi attorneys general sued prescription opioid companies last year in response to the crisis. Since then, a slew of counties and cities have filed similar suits, including Jacksonville City, Florida and Cook County, Illinois. Judging from lack of any news reports on the subject, there’s been no apparent effect of these lawsuits so far.
According to the National Institute on Drug Abuse, between 8 and 12 percent of people develop substance use disorder after being prescribed opioids, and an estimated 4 to 6 percent of people who misuse prescription opioids transition to heroin.
That prescribing opioids for a medical problem leads to heroin use has become a popular narrative, said Brooke Feldman, a master’s of social work student at Penn, but “the reality is, very few people who take prescription opioids for medical conditions develop opioid use disorder.”
Feldman believes pharmaceutical companies should be held accountable for what she called “flooding the supply” of opioids and “unleashing” prescription painkillers into some communities.
But Feldman also agreed with Cherashore — the idea that prescription opioids caused Philly’s substance use epidemic is too “convenient.”
Feldman said suing pharmaceutical companies could challenge the supply of opioids to Philadelphia by preventing the companies from over-prescribing. But it is more effective to crack down on the demand.
“Prohibition-style drug policy, we know it does not reduce substance use or substance use disorders,” Feldman said. “It is problematic to simply focus on the supply.”
Instead, Feldman said the city should address substance abuse by addressing more complex factors that might cause it, like poverty and homelessness.
Last month, the city announced expanded efforts to improve quality of life and reduce substance use in Kensington and Fairhill, including 10 additional winter homeless shelter beds and a van that will travel through the neighborhoods to offer recovery services and treatment.
There’s a lot that goes into developing a substance use disorder, Feldman explained. “There’s some reason why people have developed this coping behavior of using drugs,” she said, “despite negative consequences.”
In the meantime, Feldman does hope Philly wins the lawsuit. And if it does, that local politicians put the money toward harm-reduction initiatives in Philly. Programs she’d like to see funded include:
- Supervised injection facilities
- Clean needle exchanges
- Assertive outreach and engagement
- Housing that does not require abstinence
- Removal of barriers to employment for people with felony drug convictions
It’s those things that will have a much bigger impact than than alleviating prescription opioids, per Feldman. “There’s a role that pharmaceutical companies have to be accountable for,” she said, but to skip addressing addiction is “really short-sighted.”
Cherashore agreed. “This is a way to point fingers,” he said, “and it kind of keeps us from having a meaningful conversation. It ignores the root causes of all this.”