Though opioid prescriptions and overdoses have declined in Marin since new rules were established in 2014, the county has taken to litigation to hold drug companies accountable for the epidemic.
Last week, Marin filed a lawsuit in San Francisco district court against 12 pharmaceutical manufacturers and wholesalers, alleging they misled the public about the dangers of opioid addiction and caused sales and overdose rates to soar.
The move came shortly after around 30 other California counties filed a similar but separate lawsuit against many of the same companies. County counsel Brian Washington said the suits will be tried in a coordinated manner in federal court in Ohio.
“The opioid epidemic has caused a real public health crisis, and we are hoping to get funds that the Marin County Health Department can use to help abate the problems we are all facing,” Mr. Washington said.
According to the county’s suit, the companies “engaged in a concerted, coordinated strategy to shift the way in which doctors and patients think about pain and, specifically, to encourage the use of opioids to treat not just the relative few who suffer from acute post-surgical pain and end-stage cancer pain, but the masses who suffer from common chronic pain conditions.”
Drug overdose is the leading cause of accidental death in Marin, and the majority of those deaths are due to prescription drugs.
Between 2012 and 2016, there were 61 deaths from motor vehicle accidents and 100 drug overdose deaths, according to county statistics.
The county also reports that most drug overdoses are linked to opioids, including prescription pain medications such as vicodin, codeine and fentanyl as well as street drugs like heroin. The epidemic peaked locally in 2012 and 2013, when a Marin resident died from an accidental overdose every two weeks.
After 2014, when the county established opioid prescribing standards for local doctors, prescriptions declined, with a 30 percent reduction between 2014 and 2016. Overdose death rates declined 27 percent during that time. Though Marin was faring better than the nation—opioid overdoses accounted for 42,000 deaths in 2016—it nevertheless had the second-highest rate of drug overdose deaths among the nine Bay Area counties in 2016, with 40 deaths.
To tackle the problem, the county launched in 2014 RxSafe Marin, a coalition of health providers and pharmacists as well as the county’s Office of Education, Health Department, district attorney’s office and public defender’s office.
“We’re doing a lot of work locally to re-educate our prescribers about the risks of opioids,” Dr. Matt Willis, a county public health officer, said in a recent county press release. “The epidemic has its roots in prescribing practices. For three out of four people using heroin, their addiction began with prescription opioids.”
In its suit, the county alleged that the defendants said the risk of becoming addicted to prescription opioids was less than 1 percent, when according to more realistic estimates, up to 56 percent of patients receiving long-term opioid prescriptions are at risk.
“The defendants infiltrated academic medicine and regulatory agencies to convince doctors that treating chronic pain with long-term opioids was evidence-based medicine when it was not,” the county’s press release states.