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talks about how Purdue Pharma may have a role in creating and keeping up the deadly opioid crisis that has been going on

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Purdue Pharma, the maker of OxyContin, filed for Chapter 11 bankruptcy protection Sunday night, just days after striking a settlement with more than 2,000 local governments over its alleged role in creating and sustaining the deadly opioid crisis.

The filing in New York follows the Sackler family agreeing to relinquish ownership of the lucrative company. The family also agreed to provide $3 billion in cash over several years and future revenue from the sale of OxyContin to assist communities hardest hit by the opioid epidemic.

On Sunday, Purdue's board of directors approved the settlement, which includes 24 state attorneys general who sued the company, accusing it of fueling the nationwide addiction crisis by aggressively marketing OxyContin while downplaying its potential for addiction.

Following Sunday's bankruptcy filing, the company's board members said the deal struck with the thousands of state and local governments will provide billions to combat the country's opioid crisis.

"This settlement framework avoids wasting hundreds of millions of dollars and years on protracted litigation, and instead will provide billions of dollars and critical resources to communities across the country trying to cope with the opioid crisis," said Steve Miller, chairman of Purdue's board of directors, in a statement to NPR.

"We will continue to work with state attorneys general and other plaintiff representatives to finalize and implement this agreement as quickly as possible," he added.

The drugmaker said the value of the settlement is about $10 billion, but more than two dozen states opposed to the deal have contested that estimate, vowing to take the Sackler family to state courts in an attempt to tap into the family's fortune.

The bankruptcy filing follows a statement by New York's state attorney general, Letitia James, alleging that investigators discovered nearly $1 billion in wire transfers made by Purdue to Swiss bank accounts - allegedly to shield the family's wealth from litigation.

Purdue has pointed out that its products were approved by the federal Food and Drug Administration and that doctors were prescribing them to address patient pain. But the plaintiffs in the suits argue that company officials intensively marketed opioids and downplayed their addictive risks, laying the groundwork for the opioid crisis, which has claimed tens of thousands of lives and is often described as a national emergency.

Purdue Chairman Miller says the company has not admitted any wrongdoing as part of settlement negotiations.

"The resumption of litigation would rapidly diminish all the resources of the company and would be lose-lose-lose all the way around," he said in the statement. "Whatever people might wish for is not on the table now."

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Purdue Pharma, Accused Of Fueling Opioid Crisis, Files For Chapter 11

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Purdue Pharma, the maker of OxyContin, filed for Chapter 11 bankruptcy protection Sunday night, just days after striking a settlement with more than 2,000 local governments over its alleged role in creating and sustaining the deadly opioid crisis. The filing in New York follows the Sackler family agreeing to relinquish ownership of the lucrative company.

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This articles talks about Purdue Pharma and how they filed for bankruptcy

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Purdue Pharma, the company that made billions selling the prescription painkiller OxyContin, filed for bankruptcy days after reaching a tentative settlement with many of the state and local governments suing it over the toll of opioids.

The filing late Sunday night in White Plains, New York, was anticipated before and after the tentative deal, which could be worth up to $12 billion over time, was announced last week.

NBC News confirmed that the company had filed for bankruptcy in the southern district of New York.
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The bankruptcy means Purdue will likely be removed from the first federal opioid trial, scheduled to start in Cleveland on Oct. 21. According to Harvard Law Professor Mark Roe, an expert on corporate bankruptcy, anyone who wants money from Purdue will now have to go through the bankruptcy court.

But long and complicated legal battles still lie ahead for Stamford, Connecticut-based Purdue, which is spending millions on legal costs as it defends itself in lawsuits from 2,600 governments and other entities.

Twenty-four states and the District of Columbia have not signed on to the proposal to settle the suits, according to state officials. Several of them plan to object to the settlement in bankruptcy court and to continue litigation in other courts against members of the Sackler family, which owns the company.

Federal bankruptcy judge Robert D. Drain, who is the only bankruptcy judge in White Plains, is now expected to oversee the massive and incredibly complex bankruptcy case. It will be up to Drain to approve any settlement going forward. Cities, counties and states will also be able to vote on any final settlement deal.

The family agreed to pay at least $3 billion in the settlement plus contribute the company itself, which is to be reformed with its future profits going to the company's creditors.

Northwestern Law Professor Bruce Markell said Purdue's bankruptcy negotiations may be unique in their scale. "I have never seen anything with these numbers," said Markell.

He said creditors would likely be divided up into different classes of cities, counties, and individuals - and possibly each state. Then when a plan is brokered, there would be one vote on the final deal.

In a statement, the families of late company owners Mortimer and Raymond Sackler said they have "deep compassion for the victims of the opioid crisis" and believe the settlement framework "is an historic step toward providing critical resources that address a tragic public health situation."

Objections came over the amount of the deal, which some officials say is valued at closer to $4.5 billion rather than $12 billion, and because it means the company won't be found liable by a jury or judge.

State officials also balked at an arrangement where the states who they say are suffering from the opioid crisis would be in the position to profit from the continued sale of OxyContin.

On Friday, New York Attorney General Letitia James filed new evidence showing the Sackler family had taken at least $1 billion from the company in previously unknown withdrawals through Swiss bank accounts.

The filing on Friday fueled arguments that the Sackler family has been taking money from the company in an effort to shield the family's wealth. A recently unredacted filing from the state of Oregon alleged the family withdrew $11 billion between 2008 and 2018.

A source close to the family disputed this characterization saying the family withdrew money once the 2007 federal criminal and civil charges had been resolved.

But Ellen Rosenblum, Oregon's attorney general, noted that the withdrawals left the company without enough resources to pay the long list of plaintiffs who are demanding the company pay for the opioid crisis.

Purdue chairman Miller said the company has not admitted wrongdoing and does not intend to.

"The alternative is to not settle but instead to resume the litigation," he said on a conference call with reporters.

"The resumption of litigation would rapidly diminish all the resources of the company and would be lose-lose-lose all the way around. Whatever people might wish for is not on the table now."

Because so many states balked at the settlement, it could complicate the bankruptcy process. The Sackler family members said they're still trying to get more states to sign on.

"We are hopeful that in time, those parties who are not yet supportive will ultimately shift their focus to the critical resources that the settlement provides to people and problems that need them," they said.

Key issues that could be decided include whether the suits against the Sacklers in state courts will be able to move ahead, and what will happen to the company itself. Under the tentative settlement deal, it would continue to operate, but with profits used to pay for the settlement. Another option could be for a judge to order it be sold.

Court filings assert that members of the Sackler family were paid more than $4 billion by Purdue from 2007 to 2018. Much of the family's fortune is believed to be held outside the U.S., which could complicate lawsuits against the family over opioids.

The Sacklers have given money to cultural institutions around the world, including the Smithsonian Institution, New York City's Metropolitan Museum of Art and London's Tate Modern.

The lawsuits assert that the company aggressively sold OxyContin as a drug with a low risk of addiction despite knowing that wasn't true.

Since OxyContin, a time-released opioid, was introduced in 1996, addiction and overdoses have surged. In both 2017 and 2018, opioids were involved in more than 47,000 deaths, according to the U.S. Centers for Disease Control and Prevention.

Purdue's drugs are just a slice of the opioids prescribed, but critics assign a lot of the blame to the company because it developed both the drug and an aggressive marketing strategy.

According to a lawsuit filed by the Massachusetts attorney general, the company pushed big sales of OxyContin from the start. Doing so meant persuading doctors who had been reluctant to prescribe such strong painkillers that this one was safe.

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Purdue Pharma, maker of painkiller OxyContin, files for bankruptcy

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Purdue Pharma, the company that made billions selling the prescription painkiller OxyContin, filed for bankruptcy days after reaching a tentative settlement with many of the state and local governments suing it over the toll of opioids.

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In Ohio 2017 there was 4,293 deaths that were caused by overdosing

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Opioid-Involved Overdose Deaths

In 2017, Ohio had the second highest rate of drug overdose deaths involving opioids in the U.S. There were 4,293 reported deaths-a rate of 39.2 deaths per 100,000 persons, compared to the average national rate of 14.6 deaths per 100,000 persons. In 2011, prescription opioids were the main underlying cause of overdose deaths in Ohio, with a total of 710 deaths reported that year. The number of deaths continued to grow and by 2017, prescription drugs accounted for 947 reported deaths.

The greatest increase of deaths, however, involved synthetic opioids other than methadone (predominantly fentanyl) with a nearly twenty-fivefold increase from 139 deaths in 2012 to 3,523 deaths in 2017 (Figure 1). Heroin-involvied deaths also rose during the same period to a peak of 1,478 in 2016. In 2017, however, the number fell to 1,000 deaths, a decrease of 32 percent.

Figure 1. Number of overdose deaths involving opioids in Ohio, by opioid category. Source: CDC WONDER.

Opioid Pain Reliever Prescriptions

In 2017, Ohio providers wrote 63.5 opioid prescriptions for every 100 persons (Figure 2) compared to the average U.S. rate of 58.7 prescriptions ( CDC). This represents a 38 percent decrease from a peak of 102.4 opioid prescriptions per 100 persons in 2010.

The rate of overdose deaths involving opioid prescriptions rose steadily from 0.7 deaths per 100,000 persons in 1999 to a peak of 8.4 deaths per 100,000 persons in 2017 (Figure 2).

Figure 2. Ohio rate of overdose deaths involving prescription opioids and the opioid prescribing rate. Source: CDC and CDC WONDER.

Neonatal Abstinence Syndrome (NAS)

NAS or neonatal opioid withdrawal syndrome (NOWS) may occur when a pregnant woman uses drugs such as opioids during pregnancy. A recent national study revealed a fivefold increase in the incidence of NAS/NOWS between 2004 and 2014, from 1.5 cases per 1,000 hospital births to 8.0 cases per 1,000 hospital births. This is the equivalent of one baby born with symptoms of NAS/NOWS every 15 minutes in the United States. During the same period, hospital costs for NAS/NOWS births increased from $91 million to $563 million, after adjusting for inflation (Figure 3).

To date, there is no standard in NAS/NOWS provider and hospital coding practices ( CDC). As a result, the trends and the rates reported by states varies. The rate of NAS/NOWS in Ohio rose from 2 cases per 1,000 hospital births in 2006 to 14 cases per 1,000 hospital births in 2017 ( Ohio Department of Health).

Figure 3. NAS/NOWS Incidence rate and hospital costs for treatment in the United States. Source: T.N.A. Winkelman, et al., 2018.

HIV Prevalence and HIV Diagnoses Attributed to Injection Drug Use (IDU)

Figure 4. Ohio: Estimated percent of males and females with new HIV diagnoses, by transmission category, 2016. Source: CDC and www.AIDSVU.org.

U.S. Incidence: In 2016, 9 percent (3,480) of the 39,589 new diagnoses of HIV in the United States were attributed to IDU. Among males, 6.3 percent (2,530) of new cases were transmitted via IDU or male-to-male contact and IDU. Among females, 2.3 percent (950) were transmitted via IDU (CDC).

U.S. Prevalence: In 2016, 991,447 Americans were living with a diagnosed HIV infection-a rate of 306.6 cases per 100,000 persons. Among males, 19.9 percent (150,4661) contracted HIV from IDU or male-to-male contact and IDU while 21 percent (50,154) of females were living with HIV attributed to IDU (CDC).

State Incidence: Of the new HIV cases in 2016, 969 occurred in Ohio. Among males, 9.3 percent of new HIV cases were attributed to male-to-male contact and IDU. Among females, 20.7 percent of new HIV cases were attributed to IDU (Figure 4) (AIDSVu).

State Prevalence: In 2015, an estimated 20,709 persons were living with a diagnosed HIV infection in Ohio-a rate of 307 cases per 100,000 persons. Of those, 11 percent of male cases were attributed to IDU or male-to-male contact and IDU. Among females, 16.7 percent were living with HIV attributed to IDU (AIDSVu).

Hepatitis C (HCV) Prevalence and HCV Diagnoses Attributed to Injection Drug Use¹

U.S. Incidence: In 2016, there were an estimated 41,200 new cases of acute HCV² (CDC). Among case reports that contain information about IDU, 68.6 percent indicated use of injection drugs (CDC).

U.S. Prevalence: An estimated 2.4 million Americans are living with HCV based on 2013-2016 annual averages (CDC).

State Incidence: There were approximately 187 new cases of acute HCV (1.6 per 100,000 persons) reported in Ohio in 2016 (CDC).

State Prevalence: In Ohio, there are an estimated 90,600 persons living with Hepatitis C (2013-2016 annual average), a rate of 1,010 cases per 100,000 persons (HepVu).

National Institutes of Health-Funded Research

The National Institute on Drug Abuse (NIDA), in partnership with the Appalachian Regional Commission (ARC) are supporting services planning research grants to address a dramatic increase in adverse outcomes associated with increased opioid injection drug use in Appalachia. The grants will help develop an epidemiologic understanding of opioid injection drug use, HIV and hepatitis C virus (HCV) infection risk, and other adverse health consequences of drug use in any of the 420 Appalachian counties ( http://www.arc.gov/counties).

Additional Resources

FY2018 NIH-funded projects related to opioid use and use disorder in Ohio: 15

Notes

1. Not all states collect or report data on the incidence or prevalence of Hepatitis C or on how Hepatitis C is transmitted. When available, the data will be included.

2. Actual acute cases are estimated to be 13.9 times the number of reported cases in any year.

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Opioid-Involved Overdose Deaths In 2017, Ohio had the second highest rate of drug overdose deaths involving opioids in the U.S. There were 4,293 reported deaths-a rate of 39.2 deaths per 100,000 persons, compared to the average national rate of 14.6 deaths per 100,000 persons.

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Cali and Texas have passed laws so that they can prescribe opioids for chronic pain patients

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J Pain Symptom Manage. 1993 Jul;8(5):297-305. Research Support, U.S. Gov't, P.H.S.; Review

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Kids of the drug abusers are innocent victims of this epidemic

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Ohio foster care system flooded with children amid opioid crisis

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The Company Purdue Pharma were accused of deceptively selling oxycontin and "downplaying its danger"

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Purdue Pharma, accused of fueling opioid crisis, reportedly wanted to capitalize on treatment

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In the video they talk about how it affects everyone wherever you are and whether you're young or old.

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OpioidX: The Opioid Crisis in America | HarvardX on edX | Course About Video