Back in the day, when Monroe County Sheriff Rick Ramsay was a sergeant detective working narcotics, he knew of a man who shot himself in the stomach just to get a prescription for OxyContin.
“He didn’t want to kill himself; his intent was to get Oxy,” said Ramsay. In the 20 years since then, he’s witnessed OxyContin and street heroin ravage lives. “I’m glad Monroe County is taking some action on this.”
Last week, Monroe County filed a complaint that names Purdue Pharma and other opioid manufacturers and distributors on behalf of the county. It is not part of a cookie-cutter class action suit; rather, the case is specific to Monroe County and the impacts of the opioid epidemic in the Keys.
Monroe County joins a long list of entities with similar lawsuits dating back to 2007. According to the Washington Post, there are more than 1,600 entities — cities, counties, states and even Native American tribes suing Purdue — for allegedly creating a drug it knew was addictive and lying about it. OxyContin was first marketed in 1996.
“Lawsuits like this one have been going on with local governments throughout the country for the past years. But each plaintiff will have a different story, provide different medical services and been impacted different,” said Monroe County Attorney Bob Shillinger.
Cynthia Hall, assistant county attorney, cited costs to the county’s self-insured health plan, EMS services and the population of Monroe County availing itself of services connected to the opioid epidemic such as addiction treatment, opioid related investigations, arrests, adjudications, incarceration, the treatment of addicted newborns, burying the dead and the cost of placing children in foster care.
“When we started looking into this, we realized how far-reaching it was. We talked to the sheriff’s office, the medical examiner, court administration, human services advisory board,” Hall said. “We spent about a year on research.”
Monroe County Commissioner David Rice, who has a doctorate in chemical psychology, said the pattern of drug abuse in the Keys has changed.
“Twenty years ago, a heroin addict was a rare bird down here. That has changed,” he said. “Personally, I know people who we’ve lost and the hell they went through because they were prescribed opiates for chronic pain, became addicted to it, and woke up dead one morning. Opiate abuse takes a huge toll on society, across social strata.”
Ramsay is more blunt and said the blame is more widespread: pharmaceutical companies, doctors, pharmacies, pharmacists. “It’s greed,” he said, sharing that he personally approached prescribing doctors years ago and was essentially told to kiss off, that he didn’t understand pain management.
The lawsuit is being handled by outside counsel. Morgan & Morgan is the lead law office, but includes the counsel of lawyers from seven other law firms. The lawsuit alleges that opioid manufacturers made false and deceptive marketing claims to increase the use of opioids and the profits, and grossly understated the addictive risk. The lawsuit also alleges that named opioid distributors failed to fulfill legal obligations regarding monitoring, detecting, reporting, or investigating suspicious orders.
In 2011, the state of Florida cracked down on the popular “pill mills” — or clinics freely prescribing OxyContin and other opioid narcotics. During that time some of the worst abuses involved bus loads of “patients” who would make their way down I-95, collecting prescriptions from various pill mills under a variety of false names, sometimes even stolen identities. And though the state laws curtailed the activity of pill mills for the most part, addicted patients were forced underground.
“These addicted people, they had to turn to something,” said Ramsay. “And that was street heroin. Today they shoot it, snort it or smoke it.”
Ramsay said the rise in crime associated with the opioid epidemic has many faces — burglaries for cash, burglaries with the intent to plunder medicine cabinets, the cost for arrests, investigations, jail time and medical attention. This past week, a Key Largo student, 14, was arrested for bring Xanax to school and giving it to two other students. While not an opioid, it is a drug that makes opioids more dangerous because it also suppresses cardiopulmonary function. It, too, is addictive. And then there’s Fentanyl, which is often mixed into street heroin. Just a few grains is enough to be fatal for some. According to the National Institute of Drug Abuse, Fentanyl is 50 times more powerful than morphine. OxyContin is said to be 10 times more addictive than crack cocaine.
Hall said the lawsuit is not frivolous.
“Opioid addiction has real costs for Monroe County taxpayers and we think it’s important to get the money back,” she said. “So we need to shine the spotlight on the problem and possibly fund recovery and treatment programs that will hopefully reduce the scurges of opioid addiction.”
In Islamorada, 97 doses of Narcan have been ordered since 2016. Fire Chief Terry Abel said some people only need one dose to come back around while others require multiple doses just to keep them breathing.
The county said it collected data for more than a year to make its case from a variety of sources — the sheriff’s office, the medical examiner, court administration, human services … even libraries.
It’s still early days and there are a number of litigation issues that need to be worked out. Whether the defendants will try to separate OxyContin usage from heroin usage, whether other Keys municipalities will join the suit, and whether it will end, if the county is successful, in a one-time settlement or some other type of arrangement. Hall said she expects the case to take years to litigate, but not decades.
As of three months ago, more than 36 states are suing Purdue Pharma. Last month, the pharmaceutical company settled with the state of Oklahoma for $270 million. The company has been embroiled in litigation since 2004.
The case has been filed in the U.S. District Court for Southern District of Florida in Miami. The lawsuit is assigned to Judge Jose Martinez.
There’s no exact way to tabulate OxyContin or heroin abuses, but one set of numbers at least sheds light on the subject — the number of Narcan dosages administered in the Keys. An opioid overdose essentially suppresses the natural instinct to breathe. Narcan, or naloxone HCI, is an FDA-approved emergency treatment of a known or suspected opioid overdose. Narcan kits cost about $90 each. In the Keys, they’re carried by EMS personnel and sheriff’s deputies. On average, EMS delivers about 200 dosages of Narcan to patients experiencing an overdose in the Keys every year.
Since 2017, Monroe County Sheriff’s Office communications center has recorded 11 emergency calls that mention “Narcan,” and 83 calls that mention the keyword “overdose.”
* Year to date