Despite widespread awareness and public health campaigns, the opioid epidemic in this country has reached alarming levels. Due in large part to opioid overdoses, the overall life expectancy in the US fell for the first time since 1993.

The problem has affected every part of the country, with minority communities, like Native American Tribes seeing the worst of the crisis. Because of the widespread nature of the epidemic, governments and tribes are spending exorbitant amounts of money to treat addiction and overdose. Medical Care reported that:

Aggregate costs for prescription opioid overdose, abuse, and dependence were estimated at over $78.5 billion (in 2013 dollars). […]

Overall, nearly one-fourth of the aggregate economic burden was funded by public sources. That included costs funded by public insurance (Medicaid, Medicare, and veterans’ programs) and other government sources for substance abuse treatment.

But, cities, counties, states, and Indian Nations are looking to recoup those expenditures through lawsuits. However, the crisis could have been averted, if it weren’t for the greed of Big Pharma.

In 1986 and in a follow-up a decade later, the World Health Organization recommended drugs like morphine, methadone, and oxycodone to treat moderate to severe cancer-related pain. Though, by the mid-90’s, studies paid for by Big Pharma pushed for the wider use of opioids in treating non-cancer pain.

Dr. Russell Portenoy served as the President of the American Pain Society and was instrumental in bringing about the use of opioids for non-cancer patients. Dr. Portenoy was among many doctors that claimed the risk of opioid addiction was less than 1 percent, despite no real evidence to support the claim. A Wall Street Journal article from 2012 detailed Dr. Portenoy’s work:

“I gave innumerable lectures in the late 1980s and ’90s about addiction that weren’t true,” Dr. Portenoy said in a 2010 videotaped interview with a fellow doctor. […] In it, Dr. Portenoy said it was “quite scary” to think how the growth in opioid prescribing driven by people like him had contributed to soaring rates of addiction and overdose deaths.

Those studies opened the door for a bonanza within Big Pharma. Subsequently, companies shamelessly marketed their drugs to those who did not need it. Perhaps the biggest offender was Purdue with OxyContin. According to research published in the American Journal of Public health:

“The promotion and marketing of OxyContin occurred during a recent trend in the liberalization of the use of opioids in the treatment of pain, particularly for chronic non–cancer-related pain. Purdue pursued an “aggressive” campaign to promote the use of opioids in general and OxyContin in particular. In 2001 alone, the company spent $200 million in an array of approaches to market and promote OxyContin.”

Purdue would host lavish conferences, bringing in more than 5,000 medical professionals and pharmacists between 1996 and 2001. Purdue showered medical workers with promotional items like fishing hats, plush toys, and even a CD full of 1950’s-era music called “Get in the Swing With OxyContin.”

Purdue would also incentivize their growing sales force with massive bonuses. In 2001, Purdue’s average sales representative made $55,000 in salary, but averaged $71,000 in bonuses. The company was also extremely effective in getting patients started on OxyContin with coupons for a free 7-30 day trial of the drug. By 2001, over 34,000 coupons had been redeemed.

Mike Papantonio and his firm, Levin Papantonio are among those leading lawsuits against companies like Purdue. On his show, America’s Lawyer, Papantonio detailed that in 2007 Purdue’s dishonest tactics were exposed in court:

“The drug company Purdue who makes OxyContin, had to pay out more than $600 million dollars in 2007 after a lawsuit proved that executives, lawyers, and medical officers for the company were lying when they told doctors and the public that their pills were less addictive and more effective than other painkillers on the market.

Purdue exaggerated the effectiveness and safety of OxyContin, while covering up all the criticisms and complaints about the drug.”

The lawsuit did little to slow the distribution of opioids. Despite legal trouble, the industry continued to grow. In 2006, pharmaceutical companies sold more than $5.8 billion worth of prescription opioids. In 2011, that number jumped to $8.4 billion.

In 2012, there were 793 million doses of opioids prescribed in Ohio, which is 60-times larger than the entire population of the state. In 2010, 254 million prescriptions for opioids were filled in the United States, which amount was capable of treating every adult in the country 24-hours a day for one month.

As opioid sales increased, a proportional increase was found in opioid-related hospital admissions and subsequently, opioid-related deaths. According to a study published in the Annual Review of Public Health:

Over the past 15 years, the rate of opioid pain reliever (OPR) use in the United States has soared. From 1999 to 2011, consumption of hydrocodone more than doubled and consumption of oxycodone increased by nearly 500%. During the same time frame, the OPR-related overdose death rate nearly quadrupled. According to the United States Centers for Disease Control and Prevention (CDC), the unprecedented increase in OPR consumption has led to the “worst drug overdose epidemic in [US] history”. Given the magnitude of the problem, in 2014 the CDC added opioid overdose prevention to its list of top five public health challenges.

Big Pharma’s efforts have led to widespread abuse of any readily available opioid. When reformulation efforts made it harder to crush oxycodone, users turned to heroine or the potent and deadly synthetic drug, fentanyl.

Those who have abused prescription opioids are 40 times more likely to abuse heroine, according to the Department of Health and Human Services (DHHS). Likewise, the majority of heroine users started with prescription opioids. The Center for Disease Control says that 3 of 4 people who have used heroine, misused opioids first.

The larger issue is that the opioid crisis has disproportionately affected minority communities, especially Native Americans. According to a 2009 survey conducted by the US Substance Abuse and Mental Health Services, 6.2 percent of American Indian or Alaska Natives misused prescription drugs in the last month, compared to just 3 percent of whites. In total, 18.3 American Indians or Alaska Natives used illicit drugs in the last month. Only 8.8 percent of whites could say the same. With the rise in overall opiate use, those numbers are certainly higher now.

Appearing on Ring of Fire Radio, Tom Rodgers, a member of the Blackfeet Tribe and activist and advocate for Native Americans and tribal issues, says that the problem is compounded by a lack of access to affordable health care:

“Medicaid is a huge poverty eliminator. With the proposed reduction in Medicaid across the country, and therefore the collateral impact on the ability to have drug prevention centers, best practices, research, it’s going to have a cascading effect. At the time when we need, our society and Indian country needs more than ever best practices, drug abuse centers, any way to alleviate poverty and provide an environment of hope, we are doing the direct opposite of what should be done. We’re cutting back on Medicaid, which services the poor.”

Indeed, healthcare funding for native populations is scarce. In a budget request, the National Congress of American Indians stated that:

The Indian health care delivery system, in addition to significant health disparities, also faces significant funding disparities, notably in per capita spending between the IHS and other federal health care programs. The IHS has been and continues to be a critical institution in securing the health and wellness of tribal communities. In 2013, the IHS per capita expenditures for patient health services were just $2,849, compared to $7,717 per person for health care spending nationally.

Now, communities across the country are fighting back with litigation. Municipalities, including Indian Nations, have started suing the distributors and manufacturers of opioids. The communities are looking to be repaid for the rising government costs of treating opioid addictions and overdoses.

Numerous defendants have been named in the lawsuits, including companies such as McKesson Corporation, Cardinal Health, AmerisourceBergen, Purdue Pharma, Janssen Pharmaceuticals (a subsidiary of Johnson & Johnson), Endo International, Teva Pharmaceutical, Allergan (formerly Actavis), Watson Pharmaceuticals, and Covidien.

These companies lied about the addictive nature of their drugs, then paid millions of dollars for marketing to get doctors to write unnecessary prescriptions.

Major pharmacies, like Walgreens, CVS Health, and Walmart are also being sued, as they are continuing to profit, while little is done to stop the flow of opioids into communities.

These companies allegedly violated the federal Controlled Substances Act by failing to alert the U.S. Drug Enforcement Administration (DEA) of suspicious opioids purchases, such as orders of unusual size, frequency or pattern.

However, to this point settlements and fines from litigation have not been a significant deterrent in the fight against opioid abuse. Rodgers is frustrated by the small fines, telling Sam Seder:

“Even though we’ve got McKesson and Cardinal to have settlements of $175 million, $40 million here, what an embarrassment. People are dying, and we’re supposed to champion and we’re supposed to be proud of the fact that McKesson, which makes billions of dollars, and Cardinal Health, and we’re supposed to celebrate a $40 million fine? Try again.”

Papantonio agrees that small fines from the lawsuits so far have done very little to curb the spread of the deadly drug:

“The only way to end the suffering is to dry up the money that the manufacturers and distributors who have unleashed this catastrophe on the American public.”

Papantonio discussed the newest litigation to take down Big Pharma with attorney Jeff Gaddy on America’s Lawyer:

For more information about Papantonio’s fight against opioid companies, visit this website:

You can watch Sam Seder’s interview with Tom Rodgers here:

Josh Gay is a political writer for the Ring of Fire Network. He is passionate about civil liberties and defending the Constitution. Josh looks forward to lively discussions via Twitter @ROF_Josh.