The attorneys general of Minnesota and Utah are bringing legal action against two major pharmaceutical companies over the manner in which they have been marketing opioid medications. In addition, Minnesota’s Board of Pharmacy alleges that Insys Therapeutics violated a state law restricting gifts given to physicians.

According to Minnesota AG Lori Swanson, Insys has been illegally promoting the painkiller Subsys for off-label purposes. Subsys has been approved by the FDA for the treatment of severe cancer-related breakthrough pain. However, the lawsuit alleges that the Arizona-based drugmaker has been promoting the fentanyl-based medication for other indications – and in amounts exceeding FDA-approved dosage. In addition, Insys is accused of bribing doctors other than oncologists in order to provide incentives for writing off-label prescriptions for non-cancer patients.

Minnesota law prohibits pharmaceutical companies from giving gifts in excess of $50 to doctors. Swanson says Insys called these gifts “speaker fees” in order to get around the law – but says “The company was unable to provide evidence that some of the supposed ‘speeches’ had any audience other than the sales agent or physician’s office staff.” Those fees, paid to seventeen doctors who were not treating cancer patients, totaled $43,000.

AG Swanson adds that Insys has been “…engaging in some very terrible conduct to make money for themselves without caring for their patients,” describing it as “brazen a conduct as you can imagine from a pharmaceutical company.” It is not the first time Insys has run afoul of state laws.

In 2017, Insys founder and company owner John Kapoor was indicted in Massachusetts and charged with racketeering under RICO statutes for engaging in the same illegal activities. Earlier, the state of Arizona and health care provider Anthem sued the company for consumer fraud, lying about FDA approval status in order to encourage the writing of off-label prescriptions for Subsys.

While Insys has issued a statement claiming that they “are determined to take responsibility for the past and to learn from it,” the company’s record clearly demonstrates a pattern of corporate recidivism.

Meanwhile, Utah state attorney general Sean Reyes has filed a lawsuit against Purdue Pharma, alleging that its failure to comply with state regulations “has led to an epidemic of prescription opioid abuse in Utah.” According to the complaint, 466 Utah residents died in 2016 from opioid overdose, with treatment and related costs running as much as $268 million annually. Reyes told reporters, “For too long manufacturers have grown rich selling harmful prescription drugs, lying about the addictive nature of their products and killing thousands.”

This lawsuit comes at the same time the state has been attempting to reach a settlement with the pharmaceutical industry. Purdue issued a statement expressing disappointment that “after months of good faith negotiations working toward a meaningful resolution to help the state of Utah address the opioid crisis, the attorney general has unilaterally decided to pursue a costly and protracted litigation process.” The company denies the allegations.

AG Reyes says that Purdue has failed to act in good faith and that negotiations with the company were “no longer productive.”

Four counties in the state have already filed lawsuits against the industry.

K.J. McElrath is a former history and social studies teacher who has long maintained a keen interest in legal and social issues. In addition to writing for The Ring of Fire, he is the author of two published novels: Tamanous Cooley, a darkly comic environmental twist on Dante's Inferno, and The Missionary's Wife, a story of the conflict between human nature and fundamentalist religious dogma. When not engaged in journalistic or literary pursuits, K.J. works as an entertainer and film composer.