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Johnson and Johnson ordered to pay $572m in landmark opioid liability case Owen Dyer An Oklahoma judge has ruled that Johnson and Johnson helped to fuel the state’s opioid crisis, in the first case where a US court has found an opioid maker liable in America’s addiction epidemic. Thad Balkman, Cleveland County district judge, ordered the company to pay Oklahoma $572m (£467m; €516m) to fund treatment programmes, law enforcement, and other costs associated with the epidemic. “The opioid crisis has ravaged the state of Oklahoma and must be abated immediately,” Balkman said, reading his decision. “As a matter of law, I find that defendants’ actions caused harm.” The ruling comes as Purdue Pharma, the maker of OxyContin and a company frequently accused of promoting excessive opioid use by physicians, is mulling a global settlement of over 2000 consolidated lawsuits that could see its owners, the Sackler family, relinquish control of the company. Purdue was originally one of three defendants in the Oklahoma litigation, along with Johnson and Johnson and Teva Pharmaceuticals. But Purdue and Teva both settled before the trial began, paying $270m and $85m, respectively. The $572m awarded against Johnson and Johnson was only a fraction of the $17.5bn that Oklahoma sought to fund its response to the opioid crisis over 30 years. The state had failed to provide enough evidence of its needs beyond the first year, said the judge. Nevertheless, Mike Hunter, Oklahoma attorney general, hailed the ruling as a precedent that other states could follow. “That’s the message to other states: We did it in Oklahoma. You can do it elsewhere,” he said. “Johnson and Johnson will finally be held accountable for thousands of deaths and addictions caused by their activities.” Although Johnson and Johnson’s opioid subsidiary Janssen Pharmaceuticals only made two opioid products that had minimal market share, Oklahoma’s attorneys said that the company was a hidden “kingpin” of the opioid trade because its poppy farming subsidiaries, Noramco and Tasmanian Alkaloids, grew the raw ingredients found in 60% of prescription opioids sold in the United States. The state also argued that Johnson and Johnson actively took part in an industry effort to change doctors’ reluctance to

prescribe opioids by mounting an aggressive misinformation campaign that targeted the least knowledgeable physicians. Lawyers for the company said that they would appeal the ruling. “Johnson and Johnson did not cause the opioid abuse crisis here in Oklahoma or anywhere in this country,” Sabrina Strong, Johnson and Johnson’s attorney, told a news conference after the trial. The extent to which the Oklahoma ruling sets a precedent for other cases remains to be seen. The state made novel use of a law normally used against disruptive neighbours, brothels, and polluters to claim that Johnson and Johnson caused a public nuisance to citizens. A similar suit filed by North Dakota against Purdue Pharma was dismissed in May. Forty states have filed suits against opioid makers in state courts. More than 2000 counties and municipalities have filed federal litigation against opioid makers. Most of these cases have been consolidated in a federal court in Cleveland, Ohio, with hearings set to begin in October. The judge in that case, Dan Polster, has urged the parties to seek settlements outside court. A meeting called by the judge last week drew representatives of Purdue and numerous state attorneys general to Cleveland, where they discussed a global settlement of claims against the company. NBC News and the Washington Post reported that Purdue was offering a settlement of about $10bn, or about $12bn if Purdue’s owners, the Sackler family, sell their international company Mundipharma. The family would contribute $3bn, or $4.5bn if they sell Mundipharma, and would cease running the company. Purdue would declare bankruptcy and be run by a court appointed “public benefit trust.” It would continue selling OxyContin but proceeds would go towards the settlement fund. Purdue did not discuss details but acknowledged in a statement that it was negotiating a settlement: “While Purdue Pharma is prepared to defend itself vigorously in the opioid litigation, the company has made clear that it sees little good coming from years of wasteful litigation and appeals. The people and communities affected by the opioid crisis need help now. Purdue believes a constructive global resolution is the best path forward, and the company is actively working with the state attorneys general and other plaintiffs to achieve this outcome.”

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BMJ 2019;366:l5319 doi: 10.1136/bmj.l5319 (Published 29 August 2019) Page 1 of 1

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