“Of all the gin joints in all the towns in the world,” it happens that the first jury trial in the deluge of the opioid epidemic happened in northeast Tennessee.
Three district attorneys representing nine northeast Tennessee counties ravaged by the opioid epidemic determined to prosecute three pharmaceutical companies.
In early July 2021, the jury selection of six local Tennessean “peers” had begun. This was a litigation with three initial defendants, Purdue, Mallinckrodt and Endo Pharmaceuticals.
The case was about how they misrepresented the risks of opioids, relentlessly marketed their addicting products, and profited, greatly and knowingly, by exploiting the vast numbers of people and families they spun into their web.
By the time of the trial, Purdue and Mallinckrodt declared bankruptcy, leaving only Endo Pharmaceuticals to defend against its role in contributing to the ravages of the opioid epidemic in these nine, rural Appalachian.
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There were three unique and noteworthy aspects of this litigation: first, it was a jury trial by peers, not judges, unlike its countless predecessors; second, the case was not for damages; and third, instead, the case (at its onset) for $2.4 billion to fund a public health approach to establishing and sustaining basic addiction, mental and physical health services to those impacted by the northeast Tennessee opioid epidemic, and prevent others from the same fate.
I became the principal expert witness for this case, for which I was compensated. This report is my first-hand account of the litigation as it unfolded from the summer of 2019 to its conclusion in July of 2021.
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My report to the court specifically addressed methods for remediating the opioid epidemic in five special populations of people with opioid use disorder (OUD):
These were, arguably, the most vulnerable to the epidemic, and, thus, illustrative, of the extent and duration of a public health endeavor to mitigate a deadly epidemic.
Public health approaches to epidemics are well established. Consider, the elimination of polio, measles (though no longer), tuberculosis, and smallpox. How public health methods beat back the HIV/AIDS epidemic, substantially reduced motor vehicle accidents, and illness and death from tobacco. As well as the enormous number of lives saved – or could have been saved – from COVID-19.
This trial represented an opportunity to put forth an effective, enduring public health program for the opioid epidemic in northeast Tennessee. Rather than customarily pursuing costly, ineffective, punitive, stigmatizing and criminal justice approaches, in this case, to the opioid epidemic.
That was my assignment: propose a public health plan to give these impacted counties a real chance at recovery.
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My court report, and subsequent deposition, proposed an approach to the opioid epidemic in northeast Tennessee with five essential elements:
Unexpectedly, as the trial date drew near, the judge issued a “default judgment”, declaring that Endo was culpable, to blame, for the drug-related ravages experienced by the people of these nine counties.
He had so ruled as a sanction on the defendant, whom he had decided had failed to properly conduct themselves in this trial.
With the judge’s “default judgment,” the defendant was defeated.
Then Endo offered to settle. We had won. The settlement was for $35 million dollars.
I came to this perspective:
Will there be other jury cases? Will these, or other, DAs pursue further action against Endo, as well as Purdue and Mallinckrodt?
Who will have the mantle, locally, if not nationally, to assure that litigation awards, including this settlement, will be managed effectively and responsibly, with quantifiable and meaningful measures of success?
The road is made by walking it, as the aphorism goes. Science and clinical practice have illuminated a road that will enable so many to recover (if they don’t die before that happens).
It’s in our reach to beat back the epidemic of opioid and other drug disorders. That’s why I said, “Count me in,” on this first opioid jury trial, not for damages but for solutions.
Lloyd I. Sederer, M.D., is adjunct professor at Columbia University School of Public Health, founder and director of Columbia Psychiatry Media, chief medical officer of Bongo Media and chair of the advisory board at Get Help.
