I struggle for words periodically. The old memory is . . ., well . . , you know . . .

Let's just say I struggle for words. I landed in this instance on "contemptuous" - "manifesting, feeling, or expressing deep hatred or disapproval : feeling or showing contempt." Perhaps there is a better description, but I landed on this.

Opioids are not new to these pages, but it has been a while since they have come up. See Opioids, the Hot Seat, and More (November 2020). That post notes that overdose continues to haunt this country. The volume increased in 2020, with some concluding that the impacts of COVID-19 on people, the medical system, and support or treatment systems may have played a role. There have no doubt been great strides in the effort to address opioids, however the crisis remains.

In September, the Associated Press reported that a "sweeping settlement" has received "conditional approval" from a bankruptcy judge. This "will remove the Sackler family from ownership of OxyContin maker Purdue Pharma and devote potentially $10 billion to fighting the opioid crisis." That sounds like a lot of money. Keep reading. This settlement will "resolve a mountain of 3,000 lawsuits from state and local governments." Purdue Pharma will become a "charity-oriented company" that will "funnel its profits into . . . efforts to prevent and treat drug addiction."

What has received less attention, is the tenor of communications about opioid prescribing. In a West Virginia courtroom last spring, there was disclosure of emails in a lawsuit against drug distributors. A representative of one of the involved companies testified that these business emails were "for business purposes," and that the culture at his company "is of the highest calibers," as reported by CBS News.

One of the "business purpose" emails "contained parody lyrics about "pillbillies" (to the tune of the Beverly Hillbillies) traveling to find opiate prescriptions." In another, someone joked about "oxycontin for kids." Noting a news report regarding the shipment by distributors, the representative noted in an email "There is a whole lot of pain in the Appalachian area." The emails might be perceived as insensitive, unsympathetic, perhaps even contemptuous.

Florida came up in the matter. There was discussion of a 2011 effort to address opiate abuse. The company spokesperson sent a "business purpose" email to a lobbyist regarding that legislation and warned "Watch out Georgia and Alabama, there will be a mass exodus of pillbillies heading north." There are also jokes about the people who were seeking opiates, in one the spokesperson says "one of the hillbillies must have learned how to read." Insensitive, unsympathetic, perhaps even contemptuous? The company spokesperson complained that the emails were considered "out of context," and were merely "a way to express frustration as the company worked to crack down on the opioid epidemic."

The Daily Mail provides more detail. It provides lyrics in an email including "a rhyme to the tune of The Beverly Hillbillies theme song in which a 'poor mountaineer' named Jed 'barely kept his habit fed' and traveled to Florida to buy 'Hillbilly Heroin'." In another, A Jimmy Buffet song was parodied with a description of Kentucky as "OxyContinville."

In trial, the company spokesperson explained that "pillbillies" is a "reference to drug dealers, not to the patients." There were a volume of patients. Reportedly, Cabell County, where the trial was held, has a population of about 90,000; "Over the course of nine years, three drug distributors . . . delivered about 100 million opioid doses" there. That is about 11 million doses a year, or over 100 doses per resident per year (11M/90,000).

NPR noted, when the trial concluded in July, that there were two "legally thorny questions." First, was it unreasonable to send so much oxycontin into "one small Rust Belt city?" And, is the present "addiction crisis" in that area a "'public nuisance' that the companies must help remedy?" The county asked for $2.5 billion in damages. That is one county, in one state. Note the $10 billion discussed above as regards the Purdue bankruptcy. There are 3,006 counties in America, according to the Census Bureau. If each one has suffered damages of $2.5 billion, the total is $7,515,000,000,000. As Dirkson might remind us "a trillion here, a trillion there, and pretty soon you are talking about real money."

Does it matter whether patients or drug dealers were being denigrated? How do we spell contempt? Are we willing to excuse contempt and conclude that it was only drug dealers? That is, do we agree that "a mass exodus of pillbillies heading north" translates to "a mass exodus of drug dealers heading north?" Or, is it more likely that this reference is to the people addicted to this opioid flow that we see?

The National Institutes of Health published disturbing news in September 2021. It noted that "Non-Hispanic Black individuals in four U.S. states experienced a 38% increase in the rate of opioid overdose deaths from 2018 to 2019." The "rates for other race and ethnicity groups held steady or decreased." It concludes this evidences a "widening of disparities in overdose deaths in Black communities." We cannot argue that the increase is not bad news. But, 841,000 people have died of overdose since 1999. That is more than have died in this country from SARS-CoV-2.

The NIH concedes that much effort and money have been devoted to battle the opioid issues, but "Unfortunately, these interventions have largely failed to gain widespread implementation in community settings." Translation: the money we are spending is not reversing the trends. It is perhaps slowing growth, but not reversing the trend. How much? It is at least $1.8 billion per year over the past decade, or $18 billion. Dirkson again "real money."

And, there are already predictions that the figures for 2020 will be troublesome. Recently released data, according to Commonwealth Fund, suggests that overdose deaths in 2020 will be 93,331. This, it notes, is a 20,000 (+28%) increase last year. Death from drugs is not decreasing, it is increasing.

In the end, we continue to face a crisis. We invest piles of money and at best the results suggest some slowing of the growth rate. Almost 100,000 overdose deaths in one year. Are we as a society concerned about those people and their families? Or, are we contemptuous and dismissive? Is there a way to reduce the overdosing, the cost, the suffering and the death? Or shall we just make fun of them?

By Judge David Langham

Courtesy of Florida Workers' Comp