The nationwide opioid epidemic has hit small-town Arizona hard. On July 21, 2019, The Washington Post (“The Post”) published information from the Drug Enforcement Administration’s database that tracked sales of oxycodone and hydrocodone pills in the United States from 2006 through 2012.[i] According to The Post, more than 76 billion oxycodone and hydrocodone pills were distributed in the US during this seven-year period, and nearly 100,000 deaths resulted from these legal pain pills.
According to Jeannette Hinkle reporting on AZCentral, many of these pills were distributed in small Arizona towns. AZCentral reports:[ii]
- More than 6 million prescription opioid pills were dispensed at one Walgreens in Casa Grande from 2006 to 2012;
- Nearly 7 million opioid pills were dispensed at one Walgreens in Prescott in the same period;
- More than 14 million opioids were dispenses at a CVS in Bullhead City;
- Palace Health Mart, a pharmacy in Globe, population 7,346, dispensed 4.3 million opioid pills over seven years. It was sold to CVS in 2016;and
- In Springerville, population 1,982, Western Drug & General Store dispensed 3.1 million opioid pills in that time.
The data disturbingly reveals an extremely high number of pills distributed per capita (albeit not as high as some other places in the nation) at an increasing rate.[iii] Between 2006 and 2012, the total increase in pills distributed between 2006 and 2012 increased nationwide by 51%.[iv] Specific to Arizona, Mohave County had the highest number of pills distributed per capita: 74 pills per person, per year.[v]
In response, some Mohave County distributors and the wholesalers who supply opioid pills have stated they are taking action to reduce the opioid problem.[vi] . For instance, Chris Proffit who owns Uptown Pharmacy in Kingman has stated he has limited the amount of opioids they purchase and will not increase that number no matter what.[vii] He further indicated in response to a call from Cardinal Helath, one of his wholesalers, Uptown Pharmacy would be purchasing fewer opioids.[viii] Between 2006 and 2012, Uptown Pharmacy in Kingman sold 5.6 million hydrocodone and oxycodone pills.[ix] Similarly, CVS has reported it has reduced its sales of controlled substances by 30% in recent years.[x]
In addition to reducing orders, Uptown Pharmacy also informs its customers purchasing opioids they can also purchase the opioid-overdose reversal drug naloxone (brand name: Narcan).[xi] Moreover, each pharmacist at Uptown Pharmacy is trained to administer naloxone, and the pharmacy offers its customers training on its administration.[xii]
Despite the growing awareness and changes in policies of some opioid distributors, the opioid epidemic continues to take its toll on Arizona.[xiii] Doctors still prescribe opioids, and pharmacies still sell them to patients with prescriptions. According to AZCentral, the drug-related deaths continue to climb.[xiv] Since 2013—one year after the subject period of the DEA database—opioid-related deaths in Arizona have increased by 76%.[xv] The National Institute on Drug Abuse reported that in 2012, 454 in Arizona died of an opioid-related overdose.[xvi]I In 2018, on the other hand, preliminary reporting by the Arizona Department of Health Services estimates opioid-related deaths in Arizona at 1,375 people.[xvii]
Based on the DEA database numbers, it is no surprise that Mohave County, specifically, continues to feel the impact of the epidemic. According to Toby Cotter, City Manager of Bullhead City in Mohave County, the opioid epidemic has strained his city’s budget for public safety, schools, and health services.[xviii] Bullhead City will soon be home to a new Catholic Charities homeless shelter as well as an inpatient drug treatment center – signs of the continuing epidemic in the city.
To wit, “Cotter himself has fielded multiple calls from residents saying that prescriptions were stolen from their homes.”[xix] He also received a call from an elderly woman “who pleaded through tears for him to help her fill a prescription at Walmart. . . . she begged Cotter to help her find a way to fill the prescription.”[xx] According to AZCentral, this woman said, “‘I can’t live without them.’”[xxi]
On June 25, 2019, the Mohave Daily News reported Bullhead City officials filed a lawsuit against opioid manufacturers and distributors. AZCentral reports that, in fact, Bullhead City has filed three such lawsuits.[xxii] Among the defendants are:
- Johnson & Johnson;
- Purdue Pharma;
- Allergan PLC;
- Janssen Pharmaceuticals;
- Teva Pharmaceutical Industries Ltd.;
- Cardinal Health; and
- Actavis Pharma Inc.
Further, Bullhead City put out a press release announcing it is seeking damages for “the societal and financial harm it has suffered at the hands of those responsible for the opioid crisis – the manufacturers and distributors of opioids.”[xxiii] The Mohave Daily News reports the release further states, “Bullhead City hasn’t been sitting by idly.” It continues, “Yet, the financial toll of the epidemic runs deep and it will take many years and tremendous resources to fully abate the effect wrought upon our community by the defendants.” The Mohave Daily News reports the allegations Bullhead City makes about the distributors and manufacturers include:
- Downplaying ‘dangerous and deadly potential effects of the misuse of prescription opiods’ to increase profits.
- Scheming by manufacturers to increase the number of prescriptions written across Arizona and, specifically Bullhead City. It describes the city as a place with ‘a multitude of economically band medically vulnerable populations that defendants knew were predisposed to opioid addiction, including the elderly.’
- Increasing the number of opioid prescriptions for people in the city by ‘concealing the truth about the risk of addiction and death associated with long-term use of their products’ and ‘pressuring their respective sales forces to deceive local physicians and other prescribers to flood Arizona – and Bullhead City – with far more opioid prescriptions than were medically necessary.’
- Shipping by distributors of prescription opioids across the country – including addresses in Bullhead City – while ignoring requirements in Arizona law that they report large orders that were shipped into the city and other locations across the state. The actions were ‘willful, motivated by their desire to maximize profits and were committed without consideration of the cost to Bullhead City or its citizens.’
In filing this Arizona Superior Court action, Bullhead City has chosen to forego joining ongoing federal litigation in Ohio against manufacturers and distributors of prescription opioids. Communities nationwide have joined that federal suit, but Bullhead City wanted its case to focus on local issues and the pharmaceutical companies’ alleged violations of state laws. According to AZCentral, Cotter acknowledges that this lawsuit is not likely to have a major impact on big pharma business, but that is not the stated goal.
According to AZCentral, Cotter stated, “All we can hope to do is what’s best for Bullhead City. We’ve had a decade or more of damage, and it might take another decade to recover. You can’t fix the past, but moving forward with these lawsuits, if there are awards, those are the funds that will be used to repair damage and hopefully prevent future damage.”
Although small in the grand scheme, this suit Bullhead City has brought may actually have a lasting and significant impact on the pharmaceutical industry. Major manufacturers and distributors are named as defendants, some of whom are also defendants in the federal lawsuit ongoing in Ohio. The Bullhead City suit now puts these companies, and the pharmaceutical industry as a whole, in front of the Arizona court, subjecting them to state laws. As such, the industry now must answer and face liability in multiple jurisdictions.
While the federal suit is likely to effect change throughout the pharmaceutical industry nationwide (and may result in a major financial dent to the industry), the Bullhead City suit may cause the industry to be more cognizant to state and local laws as well. While this should affect how the manufacturers and distributors conduct business in Arizona, it may also necessitate the companies to examine operations in every state to ensure they are not opening themselves to liability at the state and local level.
Additionally, Bullhead City’s decision to fly solo rather than join the federal suit could influence other cities and towns across the nation to follow suit. Thus, the pharmaceutical industry may be forced to focus its defense on several, or even many, jurisdictions at once. If nothing else, this is likely to impact the industry’s fees and strategies across jurisdictions.
[i] See The Washington Post, Drilling Into the DEA’s Pain Pill Database (July 21, 2019) available at https://www.washingtonpost.com/graphics/2019/investigations/dea-pain-pill-database/?noredirect=on&utm_term=.c1beccb06d9f) (last accessed August 24, 2019).
[ii] See Jeannette Hinkle, Millions of Opioid Pills Flooded Arizona Communities During Prescription Drug Boom, AZCentral. (July 25, 2019) (https://www.azcentral.com/story/news/local/arizona-health/2019/07/25/millions-opioid-pills-flowed-arizona-pharmacies-prescription-drug-boom/1801196001/ (last accessed August 24, 2019).