If a doctor is negligent—for instance, if a surgeon removes the wrong kidney—he or she can be sued for damages. Now, in a decision with widespread implications, the West Virginia Supreme Court has ruled that people suffering from the disease of opioid addiction can sue the doctors and pharmacies who caused or contributed to their addiction.
The decision, issued in May by a 3-2 vote, permits a group of 29 plaintiffs to seek damages from individuals and firms associated with West Virginia’s most notorious “pill mill,” Mountain Medical Center, located near the state’s Kentucky border. The defendants include the state’s former top prescriber of opioids, a doctor singlehandedly responsible for hundreds of thousands of prescriptions. The ruling’s effects are only beginning to be felt and critical questions—in particular, whether responsibility could extend to opioid manufacturers, a faction that has so far eluded culpability—are yet to be untangled.
Still, opioid treatment providers and advocates are calling the opinion a landmark. “I hope this ruling will help reduce the massive overprescribing of opioids for common conditions such as low back pain, fibromyalgia, and headache—conditions where the leading experts who study them strongly recommend against opioid use,” says Andrew Kolodny, M.D., Phoenix House’s Chief Medical Officer, and co-founder of Physicians for Responsible Opioid Prescribing (PROP).
Importantly, West Virginia Chief Justice Margaret Workman rejected the argument that the case should be dismissed because the plaintiffs behaved “immorally or illegally.” (Some admitted to seeking out the prescriptions or engaging in other criminal behavior.) Instead, she recognized the conduct of someone who has become addicted to opioids is often driven by desperation to maintain their supply, and it is secondary to the disease of addiction. In essence, Workman refused to stigmatize or blame the addicts—and through this enlightened act, she set a powerful precedent.
Of course, she didn’t let anyone off the hook. But simply by permitting a jury to sort out the guilt, she set in motion a powerful series of reactions. The head of the state’s pharmacists association suggested members more closely monitor their patients’ opioid prescription history and alert physicians about potential problems. State workers’ compensation folks also urged companies to show greater oversight of addictive painkillers by disabled employees. Pushback has come mainly from the state’s medical association, which among other points, expressed concern that some physicians may curb or stop treating pain altogether. Yet Dr. Kolodny suggests few doctors who prescribe opioids cautiously and appropriately are going to be fearful because of this ruling.
Additionally, he notes the association’s argument falsely assumes two distinct populations of opioid users: pain patients who are being helped by opioids and the so-called “drug abusers” who want to get their hands on pills to use recreationally. “Although some people develop opioid addiction while using pills recreationally, many people also become addicted by taking the pills exactly as prescribed by their doctors,” Dr. Kolodny stresses. “In fact, it appears that the majority of opioid pain reliever overdose deaths are occurring among people who received legitimate prescriptions from doctors for chronic pain.”
That West Virginia continues to lead the nation in such deaths may be a coincidence. Its rate was 34 deaths per 100,000 residents in 2013, according to the U.S. Centers for Disease Control’s most recent statistics. (The national average is 13 per 100,000 people.) Either way, the state has now put providers on notice: If you prescribe a dangerous treatment to me or my loved one with little evidence that that it can help, and as a result, my life is ruined or my family member overdoses and dies, you can no longer shrug and turn away. We can hold you accountable. And this is good news for all of us.
Senior Vice President and Director, Public/Private Partnerships and Business Development