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September 19, 2017

Media Contact: Liz Brocker (701) 328-2213

BISMARCK, ND – Attorneys generals across the nation have joined together on two separate actions to address the opioid epidemic that has reached crisis proportions, announced  Attorney General Wayne Stenehjem.

“The unnecessary over-prescription of opioid pain killers is a significant factor contributing to the problem. Although the amount of pain reported by Americans has remained steady since 1999, prescriptions for opioid painkillers have nearly quadrupled over the same timeframe. This four-fold increase in prescriptions has contributed to a commensurate increase in the number of opioid overdose deaths,” said Stenehjem.  

Nationwide and in North Dakota, opioids—prescription and illicit—are the main driver of drug overdose deaths. According to the Centers for Disease Control and Prevention, opioids were involved in 33,091 deaths nationwide in 2015.

“In North Dakota, there were 20 drug overdose deaths in 2013, and that number tripled to 61 in 2015,” said Stenehjem. “And it’s getting worse.”

Stenehjem and a bipartisan coalition of attorneys general initiated an investigation of manufacturers and distributors of prescription opioids for alleged unlawful practices in the marketing, sales, and distribution of opioids, which are narcotic pain medications. The coalition of forty-one Attorneys General has issued subpoenas for documents and information to Endo, Janssen, Teva/Cephalon, Allergan, and their related entities, as well as an investigative demand on Purdue Pharma.  Likewise, the Attorneys General sent information demand letters to opioid distributors AmerisourceBergen, Cardinal Health, and McKesson, requesting documents about their opioid distribution business.

A number of states have already sued some or all of those companies, alleging that manufacturers failed to disclose that opioids are highly addictive and may result in overdose or death, and that the manufacturers’ claims regarding the benefits of chronic opioid therapy lack scientific report, and abuse-deterrent formulations have no effect on the most common form of abuse and may actually increase abuse.

The multistate investigation seeks to determine what role the opioid manufacturers and distributors may have played in creating or prolonging this epidemic and determine the appropriate course of action for the attorneys general to help resolve this crisis. 

“After we have obtained the requested information, we will be able to determine if North Dakota should pursue litigation as well,” Stenehjem said.

Yesterday, Stenehjem also joined a coalition of 37 states in a letter urging health insurance companies to examine financial incentives that contribute to the opioid epidemic. It urges insurers to review their coverage policies as the starting point in focusing on incentive structures across the insurance industry. Calling the opioid epidemic “the preeminent public health crisis of our time,” the attorneys general announced the two-step strategy intended to identify and encourage increased use of non-opioid alternatives for treatment of chronic, non-cancer pain.

The Attorneys General noted the American Academy of Neurology has explained that “while the use of opioid painkillers can provide ‘significant short-term pain relief,’ there is ‘no substantial evidence for maintenance of pain relief or improved function over long periods of time.’ Another recent study concluded that the use of opioids to treat chronic, non-cancer related pain lasting longer than three months is ‘ineffective and can be life-threatening.’”

The attorneys general acknowledged the important role insurance companies play in reducing opioid prescriptions, hope to assess the effect insurance coverage has on the opioid epidemic. They contend incentives that promote use of non-opioid techniques will increase medical providers’ use of other treatments, including physical therapy, acupuncture, massage, chiropractic care and non-opioid medications.

“We hope that this process will highlight problematic policies and spur increased use of non-opioid pain management treatment techniques. The status quo, in which there may be financial incentives to prescribe opioids for pain which they are ill-suited to treat, is unacceptable,” the Attorneys General stated.

North Dakota Insurance Commissioner Jon Godfread applauded the efforts of the Attorneys General in taking proactive steps to combat the opioid epidemic. 

"It is imperative that state leaders and insurance regulators work together with health insurance companies to stave off the prolonged and sometimes unnecessary prescription of opioids," Godfread said. "Consumers in North Dakota and across the nation also need to understand what treatment options are available to them through their health insurance if they have a substance abuse problem. The Insurance Department is dedicated to continuing to work with the Office of the Attorney General, along with other state leadership, to combat this epidemic and do what's right for North Dakotans."

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