Most opioid addicts had history of drug abuse, doctor testifies

Most patients who became addicted to prescription opioids already had a history of abuse before receiving a prescription, an addiction psychiatrist called by Johnson & Johnson's defense counsel testified in the state's $50 billion opioid trial Wednesday in Orange County.

Johnson & Johnson subsidiary Janssen Pharmaceuticals INC, the second of four drug company defendants to present its case this week, called California addiction psychiatrist Dr. Douglas Tucker, seemingly to bolster its argument that previous addictive behavior in patients, not opioid marketing, was to blame for any opioid crisis in California.

The government's star witness, Dr. Anna Lembke of Stanford School of Medicine, who was recently featured in the HBO documentary "The Crime of the Century," testified last month that one in four patients will become addicted to opioids after receiving a prescription for chronic pain. However, testifying via Zoom Wednesday, Tucker said the study she relied on did not make a distinction between newly addicted individuals and those with a history of drug abuse.

"That '21 to 29% of patients who misused opioid medications,' is not necessarily referring to new cases but could be old cases that existed before the opioid prescription," Tucker said. "The study is irrelevant because ... it is a prevalence study which is not relevant to the question of whether the diagnosis of opioid misuse disorder was caused by the opioid prescription. That would involve a study of new cases."

Two reputable studies found that when patients with a history of drug abuse were first screened out, the number of patients who suffered from opioid use disorder after being prescribed opioids for chronic pain, was 1% or less, Tucker told Washington, D.C. defense attorney Steve Brody of O'Melveny & Myers LLP.

On cross examination, South Carolina plaintiffs' attorney Kristen Hermiz of Motley Rice LLC, pointed out that the National Institute on Drug Abuse cited the study Lembke used for her testimony in its figures about opioid misuse disorder but did not use the studies Tucker had for his testimony.

Janssen's defense case comes after it agreed to a $230 million settlement last week in a similar opioid suit brought by New York Attorney General Letitia Ann James. That case, which began opening arguments Tuesday, focuses on the entire opioid supply chain.

California's false advertising, unfair competition and public nuisance suit accuses Janssen, Purdue Pharma, Teva Pharmaceuticals, Endo Pharmaceuticals, and Allergan PLC of fueling an opioid crisis in the state by downplaying the risks of addiction in their marketing. Purdue, perhaps the most often named drug company in thousands of suits filed since 2014, is sitting out the trial, pending the completion of a bankruptcy case in New York.

The suit in California, which is the first government-initiated action in the nation seeking to hold opioid manufacturers accountable for their alleged role in creating the opioid epidemic, is being tried remotely before Superior Court Judge Peter Wilson. It will likely affect some 3,000 settlements in lawsuits filed nationwide by states and municipalities that claim Purdue and other opioid producers fueled an opioid crisis. Another opioid bench trial wrapping up in Charleston, West Virginia could also affect settlements.

In addition to civil penalties, the plaintiff counties of Los Angeles, Orange and Santa Clara, and the city of Oakland seek $50 billion to abate an opioid crisis in their jurisdictions, according to attorneys involved in the lawsuit. People v. Purdue Pharma et al., 14-00725287 (Orange Super. Ct., filed May 21, 2014).