Opioid makers thought they had dodged a litigation bullet 6 months ago when a federal judge dismissed a lawsuit by the City of Chicago trying to hold them accountable for an "epidemic" of painkiller, and even heroin, abuse. But the city is being tenacious and has refiled lawsuits claiming 6 drugmakers overstated the claims of the drugs' benefits while downplaying their risks.

The second amended complaint was filed on Thursday in Chicago against Purdue Pharma, Teva Pharmaceutical Industries ($TEVA), Johnson & Johnson's ($JNJ) Janssen unit, Depomed ($DEPO), Endo Health Solutions ($ENDP) and Allergan ($AGN). The 326-page lawsuit says the drugmakers knew "that opioids were addictive and subject to abuse, particularly when used long-term for chronic non-cancer pain" and that products like OxyContin and Percocet, and generics like oxycodone and hydrocodone, should be used as a treatment of last resort. But the city alleges that for more than a decade the drugmakers used sophisticated and highly deceptive and unfair marketing to affect a "sea change" in the perception of their risks in an effort to earn blockbuster profits.

Among other things, the litigation alleges that the drugmakers recruited doctors who would give scripted talks about their benefits and trained their sales forces to push drugs to doctors treating back pain, downplaying their risks for such uses.

It claims the result has been that the U.S., while making up less than 5% of the world population, uses 80% of prescribed opioids while drugmakers are reaping sales projected next year to hit $15.3 billion. It claims the campaign led to abuse, addiction and overdoses and for many users to switch to heroin, which is cheaper. It says the result is that Chicago now ranks first in the nation in emergency room visits for heroin overdoses. The city is asking for the drugmakers to cover its costs for many of the problems it asserts they have created, an amount that would be determined at trial but which could reach into the hundreds of millions, if not billions, of dollars.

The drugmakers, of course, have said their drugs were approved by the FDA and that the litigation is unwarranted. In an emailed statement today, Purdue Pharma said: "As widely documented, these lawsuits are designed to enrich trial attorneys, not improve public health. Patients are hurt by litigation that risks creating inconsistent rules governing access to FDA-approved medicines."

Janssen said in a statement that it had acted responsibly, offering a drug to people who suffer chronic pain. "It is important to note that the court has previously dismissed the allegations against Janssen regarding the marketing of opioids made by the City of Chicago and the lawsuit filed by two counties in California has been stayed by the court." 

Allergan and Teva declined to comment and others did not respond.

Janssen's reference to California has to do with similar litigation filed last year by two California counties. In August, a California state judge put a stay on that litigation based on the briefs. He said that what Orange and Santa Clara counties were asking of him was to regulate the marketing and determine the safety of certain prescription drugs, essentially taking on the authority similar to that of the FDA. He said the Supreme Court has already ruled that is not a role for a judge. He said the cases would be dismissed unless the drugmakers thought they could make a more compelling case orally.

- read the lawsuit (PDF)