For opiate addiction, study finds drug-assisted treatment is more effective than detox

Say you’re a publicly-insured Californian with an addiction to heroin, fentanyl or prescription narcotics, and you want to quit.

New research suggests you can do it the way most treatment-seeking addicts in the state do — by undergoing a medically-supervised “detoxification” that’s difficult, expensive and highly prone to failure.

Or you can try to quit the way that addiction researchers now widely agree it should be done (but rarely is): by combining abstinence programs with long-acting opioid medications such as methadone and buprenorphine, which allow patients to slowly wean themselves off their dangerous habit.

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Using drugs to treat opiate addiction is more effective and cheaper than detox programs, a new study says.

Neither method is easy, nor by any means failure-proof. But for each patient funneled into the second form of treatment, known as opioid agonist treatment, instead of the first, a study published Monday shows that taxpayers could reap substantial savings — $78,257 a person. And the patients themselves stand to gain longer and better lives.

Deep into a crisis of opioid addiction that claims 91 lives a day and holds close to 2.6 million Americans in its grip, the United States continues to suffer a yawning gap between what it knows about treatment and how the opiate-addicted are actually treated.

Close to 80% of those with an opioid-use disorder weren’t getting any treatment at all in 2015. Of the small sliver of those who did get some treatment, fewer than half in California got the kind of open-ended opioid agonist treatment that addiction researchers widely agree is most likely to lead to abstinence.

In fact, California, the state with the nation’s largest population of people with opiate addiction, still has regulations on the books that favor detox over opioid agonist treatment. For patients who are publicly insured, the state requires proof that a patient has tried detoxing two times or more and subsequently relapsed before it will pay for treatment with methadone or buprenorphine.

California’s Society of Addiction Medicine has said that medically managed withdrawal by itself should not be considered treatment of opioid use disorder. And exemptions to the state’s requirement are thought to be widely granted. Still, the language remains.

Published Monday in the Annals of Internal Medicine, the new study underscores that public policies that limit access to treatments such as methadone or buprenorphine don’t just shortchange patients who need help quitting; they’re costly to taxpayers footing the bill for their treatment as well.

If just one year’s worth of treatment-seeking opiate addicts were to get opioid agonist therapy instead of detox, the societal savings over the patients’ lifetimes would amount to $3.869 billion, the new study estimates.

Those patients would be in treatment longer, and the immediate cost of their treatment would increase, the new research finds. But over time, their increased likelihood of getting and staying clean would translate into lower downstream healthcare costs, a decreased likelihood of HIV infection (along with the costs of treating it), and less costly involvement with the criminal justice system.

“We believe our findings really do represent the reality in California,” said the study’s senior author, Bohdan Nosyk, a health economist with British Columbia’s Center of Excellence in HIV/AIDs. “The findings were really robust and, as new people come in, the savings will accumulate. So the numbers are conservative.”

Nosyk’s co-authors included addiction and epidemiological experts from UCLA’s Integrated Substance Abuse Programs and the Veterans Affairs Greater Los Angeles Healthcare System of Los Angeles.

In an editorial published alongside the study Monday, Drs. Jeanette M. Tetrault and David A. Fiellin said the new research strongly suggests that lawmakers should be using their policy clout to promote outpatient clinics that treat opiate addicts in their communities rather than costly inpatient units where patients go to detox.

“Threats to healthcare funding may have lasting consequences, especially if lawmakers do not heed the most science-based and policy-applicable data as decisions are being made,” wrote Tetrault and Fiellin, both Yale University internists with interests in addiction medicine.

Written by: Melissa Healy

Link to original article here: For opiate addiction, study finds drug-assisted treatment is more effective than detox

Study highlights unmet treatment needs among adults with mental health and substance use disorders

Despite current treatment guidelines, fewer than 10 percent of adults with co-occurring mental health and substance use disorders receive treatment for both disorders, and more than 50 percent do not receive treatment for either disorder. The findings highlight a large gap between the prevalence of co-occurring disorders and treatment rates among U.S. adults and the need to identify effective approaches to increasing treatment for those with these conditions. An analysis of data from U.S. adults with both a mental health disorder and a substance use disorder indicates that only 9.1 percent of those adults received both types of care over the past year, and 52.5 percent received neither mental health care nor substance use treatment.

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The study, based on data collected from the 2008-2014 National Survey on Drug Use and Health, reports that 3.3 percent of the adult U.S. population, or some 7.7 million individuals, suffers from both a mental health and substance use disorder. Those adults with co-occurring disorders who did receive both types of treatment tend to have more serious psychiatric problems and accompanying physical ailments and were more likely to be involved with the criminal justice system compared to individuals who did not receive both types of care. The primary reasons for not seeking care were inability to afford treatment, lack of knowledge about where to get care, and a low perceived need among those with both disorders.

For more information about mental health and substance use disorders, go to: https://www.drugabuse.gov/related-topics/mental-health

Link to article here: Study highlights unmet treatment needs among adults with mental health and substance use disorders

Here’s The Real Reason Why Some People Become Addicted to Drugs

Why do they do it? This is a question that friends and families often ask of those who are addicted.

It’s difficult to explain how drug addiction develops over time. To many, it looks like the constant search for pleasure. But the pleasure derived from opioids like heroin or stimulants like cocaine declines with repeated use. What’s more, some addictive drugs, like nicotine, fail to produce any noticeable euphoria in regular users.

So what does explain the persistence of addiction? As an addiction researcher for the past 15 years, I look to the brain to understand how recreational use becomes compulsive, prompting people like you and me to make bad choices.

Myths about addiction

There are two popular explanations for addiction, neither of which holds up to scrutiny.

The first is that compulsive drug taking is a bad habit – one that addicts just need to “kick.”

However, to the brain, a habit is nothing more than our ability to carry out repetitive tasks – like tying our shoelaces or brushing our teeth – more and more efficiently. People don’t typically get caught up in an endless and compulsive cycle of shoelace tying.

Another theory claims that overcoming withdrawal is too tough for many addicts. Withdrawal, the highly unpleasant feeling that occurs when the drug leaves your body, can include sweats, chills, anxiety and heart palpitations.

For certain drugs, such as alcohol, withdrawal comes with a risk of death if not properly managed.

The painful symptoms of withdrawal are frequently cited as the reason addiction seems inescapable. However, even for heroin, withdrawal symptoms mostly subside after about two weeks. Plus, many addictive drugs produce varying and sometimes only mild withdrawal symptoms.

This is not to say that pleasure, habits or withdrawal are not involved in addiction. But we must ask whether they are necessary components of addiction – or whether addiction would persist even in their absence.

Pleasure versus desire

In the 1980s, researchers made a surprising discovery. Food, sex and drugs all appeared to cause dopamine to be released in certain areas of the brain, such as the nucleus accumbens.

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Rat receiving optogenetic stimulation of the brain using laser light to produce focused and compulsive reward-seeking. 

This suggested to many in the scientific community that these areas were the brain’s pleasure centres and that dopamine was our own internal pleasure neurotransmitter. However, this idea has since been debunked. The brain does have pleasure centres, but they are not modulated by dopamine.

So what’s going on? It turns out that, in the brain, “liking” something and “wanting” something are two separate psychological experiences.

“Liking” refers to the spontaneous delight one might experience eating a chocolate chip cookie. “Wanting” is our grumbling desire when we eye the plate of cookies in the centre of the table during a meeting.

Dopamine is responsible for “wanting” – not for “liking.” For example, in one study, researchers observed rats that could not produce dopamine in their brains. These rats lost the urge to eat but still had pleasurable facial reactions when food was placed in their mouths.

All drugs of abuse trigger a surge of dopamine – a rush of “wanting” – in the brain. This makes us crave more drugs. With repeated drug use, the “wanting” grows, while our “liking” of the drug appears to stagnate or even decrease, a phenomenon known as tolerance.

In my own research, we looked at a small subregion of the amygdala, an almond-shaped brain structure best known for its role in fear and emotion.

We found that activating this area makes rats more likely to show addictive-like behaviors: narrowing their focus, rapidly escalating their cocaine intake and even compulsively nibbling at a cocaine port. This subregion may be involved in excessive “wanting,” in humans, too, influencing us to make risky choices.

Involuntary addicts

The recent opioid epidemic has produced what we might call “involuntary” addicts. Opioids – such as oxycodone, percocet, vicodin or fentanyl – are very effective at managing otherwise intractable pain. Yet they also produce surges in dopamine release.

Most individuals begin taking prescription opioids not for pleasure but rather from a need to manage their pain, often on the recommendation of a doctor. Any pleasure they may experience is rooted in the relief from pain.

However, over time, users tend to develop a tolerance. The drug becomes less and less effective, and they need larger doses of the drug to control pain. This exposes people to large surges of dopamine in the brain. As the pain subsides, they find themselves inexplicably hooked on a drug and compelled to take more.

The result of this regular intake of large amounts of drug is a hyperreactive “wanting” system. A sensitised “wanting” system triggers intense bouts of craving whenever in the presence of the drug or exposed to drug cues.

These cues can include drug paraphernalia, negative emotions such as stress or even specific people and places. Drug cues are one of an addict’s biggest challenges.

These changes in the brain can be long-lasting, if not permanent. Some individuals seem to be more likely to undergo these changes.

Research suggests that genetic factors may predispose certain individuals, which explains why a family history of addiction leads to increased risk. Early life stressors, such as childhood adversity or physical abuse, also seem to put people at more risk.

Addiction and choice

Many of us regularly indulge in drugs of abuse, such as alcohol or nicotine. We may even occasionally overindulge. But, in most cases, this doesn’t qualify as addiction. This is, in part, because we manage to regain balance and choose alternative rewards like spending time with family or enjoyable drug-free hobbies. 185418346

However, for those susceptible to excessive “wanting,” it may be difficult to maintain that balance. Once researchers figure out what makes an individual susceptible to developing a hyper reactive “wanting” system, we can help doctors better manage the risk of exposing a patient to drugs with such potent addictive potential.

In the meantime, many of us should reframe how we think about addiction. Our lack of understanding of what predicts the risk of addiction means that it could just as easily have affected you or me.

In many cases, the individual suffering from addiction doesn’t lack the willpower to quit drugs. They know and see the pain and suffering that it creates around them. Addiction simply creates a craving that’s often stronger than any one person could overcome alone.

The ConversationThat’s why people battling addiction deserve our support and compassion, rather than the distrust and exclusion that our society too often provides.

Article written by: Mike Robinson, Assistant Professor of Psychology, Wesleyan University.

Link to article here: Here’s The Real Reason Why Some People Become Addicted to Drugs

Imprisoning Drug Offenders Doesn’t Affect Use, Study Says

Sending more people to prison for drug offenses won’t have an effect on drug use and deaths, according to a new analysis released this week.

Researchers from the Pew Charitable Trusts crunched state-by-state data on drug imprisonment, drug use, overdoses and drug arrests and found no evidence that they affected one another.

That lack of a pattern shows the flaw in a central philosophy in the war on drugs: That doling out harsh penalties makes people less inclined to use drugs or join the drug trade, said Adam Gelb, director of Pew’s public safety performance project, which works to reform state-level drug policies.

“There seems to be this assumption that tougher penalties will send a stronger message and deter people from involvement with drugs. This is not borne out by the data,” Gelb said.

He included the entire analysis in a letter Monday to Chris Christie, who is both governor of New Jersey and head of President Donald Trump’s Commission on Combating Drug Addiction and the Opioid Crisis.

The commission held its first public meeting on Friday. It is responsible for coming up with a plan to help the federal government tackle an addiction crisis that killed more than 50,000 people last year. The growing number of overdoses is being driven by runaway rates of addiction to prescription painkillers and heroin, researchers say.

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A line of inmates at the Los Angeles County Sheriff’s Department’s Men’s Central Jail, on October 27, 2011. Reed Saxon / ASSOCIATED PRESS

Meanwhile at the Justice Department, Attorney General Jeff Sessions is carving out his own approach — focused on punishment.  He issued a memo to federal prosecutors in May ordering them to seek the maximum punishment for drug offenses, a return to harsh policies that predate former President Barack Obama.

Pew’s study was relatively simple: gather data from each state in four categories: incarceration of drug offenders, overdose deaths, drug arrests and drug use. The latest year for which all the data was available was 2014.

The theory, Gelb said, was that if deterrence worked, the states with the highest incarceration rates would have lower rates of drug use.

But that’s not what they found.

For example, Louisiana, the state with the highest incarceration rate, was in the middle of the pack on overdoses, drug arrests and drug use. Massachusetts, with the lowest incarceration rate, was toward the bottom in arrests and use, but near the top in overdoses. West Virginia, with the highest overdose rate, was 21st in incarcerations. And Colorado, with the highest rate of drug use, was 37th in incarcerations.

Gelb said he hoped the commission and other policy makers would use it to chart their course forward.

“This is fresh data that should inform the important conversation happening in Washington and around the country about what the most effective strategies are for combatting the rise in opioid addiction and other substance abuse,” Gelb said.

by posted June 20, 2017

Link to original article here: Imprisoning Drug Offenders Doesn’t Affect Use, Study Says

The New England Journal of Medicine

NEWENGLANDJOURNALMEDOpioid misuse and addiction is an ongoing and rapidly evolving public health crisis, requiring innovative scientific solutions. In response, and because no existing medication is ideal for every patient, the National Institutes of Health (NIH) is joining with private partners to launch an initiative in three scientific areas: developing better overdose-reversal and prevention interventions to reduce mortality, saving lives for future treatment and recovery; finding new, innovative medications and technologies to treat opioid addiction; and finding safe, effective, nonaddictive interventions to manage chronic pain. Each of these areas requires a range of short-, intermediate-, and long-term research strategies.

OVERDOSE-REVERSAL INTERVENTIONS

Every day more than 90 Americans die from opioid overdoses. Overdoses result from an opioid’s agonist effects at the mu-opioid receptor (MOR), located on brainstem neurons that control breathing. The MOR antagonist naloxone can reverse an overdose, if it is administered shortly after the overdose occurs. Although naloxone has saved tens of thousands of lives, overdoses frequently occur when no one else is around, and often no one arrives in time to administer it.

Overdose fatalities have also been fueled by the increased availability of very potent synthetic opioids such as fentanyl and carfentanil (50 and 5000 times as potent as heroin, respectively). Misuse of or accidental exposure to these drugs (e.g., laced in heroin) is associated with very high overdose risk, and naloxone doses that could reverse prescription-opioid or heroin overdoses may be ineffective. New and improved approaches are needed to prevent, detect, and reverse overdoses.

Through a successful partnership, the National Institute on Drug Abuse (NIDA) and industry developed a user-friendly intranasal naloxone formulation (Narcan Nasal Spray) that results in blood naloxone levels equivalent to those achieved with parenteral administration; it was approved by the Food and Drug Administration (FDA) in 2015. The NIH will now work with private partners to develop stronger, longer-acting formulations of antagonists, including naloxone, to counteract the very-high-potency synthetic opioids that are now claiming thousands of lives each year.

In the intermediate and longer term, alternative interventions against opioid-induced respiratory depression, such as 5-hydroxytryptamine type 1A (5-HT1A) agonists, ampakines, and phrenic-nerve-stimulation devices, could protect persons at particularly high risk for overdose. Research is also under way to characterize the physiological signals that can predict an impending overdose, which would allow wearable devices to detect an overdose when it is occurring and signal for help, automatically inject naloxone, or both.

TREATMENTS FOR OPIOID ADDICTION

This partnership will also focus on opioid addiction (the most severe form of opioid use disorder [OUD]), which is a chronic, relapsing illness. Abundant research has shown that sustained treatment over years or even a lifetime is often necessary to achieve and maintain long-term recovery. Currently, there are only three medications approved for treating OUD: methadone, buprenorphine, and extended-release naltrexone. These medications coupled with psychosocial support are the current standard of care for reducing illicit opioid use, relapse risk, and overdoses, while improving social function. However, limited access to providers and programs can create barriers to treatment.

The NIH has successfully partnered with industry to help develop new formulations of existing medications to improve compliance and reduce the potential for diversion. To facilitate compliance with buprenorphine treatment, NIDA worked with Titan and Braeburn Pharmaceuticals to produce a long-lasting (6-month) implant, Probuphine, which the FDA approved in 2016. Initial clinical trials testing the safety, efficacy, and pharmacokinetics of buprenorphine formulations that deliver therapeutic doses over 1-week or 1-month periods have also been completed; such formulations may be particularly valuable for patients in emergency departments after nonfatal opioid overdoses, to facilitate engagement in long-term treatment.

There is a clear need to develop new treatment strategies for opioid-use disorders. New pharmacologic approaches aim to modulate activity of the reward circuit through antagonists of the neurokinin-1 receptor and counteract the aversive state of withdrawal through antagonists of kappa-opioid receptors. The selective 5-HT2C-receptor agonist lorcaserin, an FDA-approved diet drug, was found to reduce opioid seeking in a rodent model. NIDA has also helped fund clinical trials of lofexidine, an α2A-adrenergic-receptor agonist not currently approved in the United States. Lofexidine was originally developed as an antihypertensive drug and is currently used in the United Kingdom for opioid detoxification, since it controls withdrawal symptoms (although not cravings).

Vaccines against prescription opioids, heroin, and fentanyl, which induce antibodies to opioids in the bloodstream to keep them from entering the brain, have shown great promise in preclinical studies. Similarly, long-lasting monoclonal antibodies against very potent synthetic opioids (e.g., fentanyl and its analogues) have the potential to prevent overdoses and relapses.

NONADDICTIVE TREATMENTS FOR CHRONIC PAIN

The third area of focus is chronic pain treatment: overprescription of opioid medications reflects in part the limited number of alternative medications for chronic pain. Thus, we cannot hope to prevent opioid misuse and overdose without addressing the treatment needs of people with moderate-to-severe chronic pain. Though more cautious opioid prescribing is an important first step, there is a clear need for safer, more effective treatments.

One short-term goal is the development of formulations of opioid analgesics with abuse-deterrent properties that are more difficult to manipulate for snorting or injecting, the routes of administration most frequently associated with misuse because of their rewarding effects. Such formulations, however, can still be misused orally and still lead to addiction. Thus, a more promising longer-term avenue to advancing pain treatment is developing a new generation of powerful, nonaddicting opioid analgesics. Recent x-ray crystallography studies of the MOR have provided insight into two separate intracellular signaling pathways: a pathway originating with the Gi protein is believed to underlie analgesia, while a separate pathway involving β-arrestin is believed to underlie the rewarding and respiratory-depressing effects of opioid agonists. One MOR-biased agonist (TRV130) has successfully completed phase 2 clinical testing. If the trials show that TRV130 is not associated with rewarding or respiratory effects, it could energize industry to accelerate development of other MOR-biased agonists.

Ongoing research is also exploring compounds that target other opioid receptors. Through the NIH Blueprint Neurotherapeutics Program, a team of researchers is working to optimize a recently discovered series of selective and orally available kappa-opioid antagonists as nonaddictive medications for stress-induced pain disorders, such as headache and fibromyalgia. Antagonists of the kappa-opioid system are also therapeutic targets for OUD. Encouraging pharmacokinetic studies suggest that these compounds have the potential to be safe and effective drugs for pain, and perhaps also for opioid addiction.

Compounds that target nonopioid pain pathways, such as the endocannabinoid system, are also being evaluated for chronic pain management. There is strong evidence of the efficacy of cannabinoids, including tetrahydrocannabinol (THC), in treating pain. Medications that target the endocannabinoid system without producing the cognitive impairment and rewarding effects of marijuana could provide a powerful new tool. Other targets being investigated include a dopamine D3 antagonist, which was shown to reduce morphine tolerance and dependence without inhibiting analgesia when administered in conjunction with morphine, making this a potentially promising approach to enhancing the safety of existing opioids.Genetic mutations in the sodium channel Nav1.7 in humans modulate pain; loss-of-function mutations result in congenital insensitivity to pain, and gain-of-function mutations cause pain syndromes. Several Nav1.7 antagonists are being explored as analgesics.

Therapeutics that antagonize inflammatory signals involved in pain have led to FDA-approved treatments for specific pain conditions, such as tumor necrosis factor inhibitors for rheumatoid arthritis and monoclonal antibodies to nerve growth factor for osteoarthritis; researchers are exploring their value in other pain conditions. In parallel, clinical trials are testing the efficacy of antibodies to calcitonin gene–related peptide for treating migraine.

Nonpharmacologic approaches including brain-stimulation technologies such as high-frequency repetitive transcranial magnetic stimulation (rTMS, already FDA-approved for depression) have shown efficacy in multiple chronic pain conditions. At a more preliminary stage are viral-based gene therapies and transplantation of progenitor cells to treat pain. NIH researchers are investigating the use of gene therapy to deliver a potent antiinflammatory protein to painful sites. Preclinical studies show powerful and long-lasting effects in reducing pain without side effects such as numbness, sedation, addiction, or tolerance.

Development of new pain treatments builds on a foundation of basic research on the complex pathophysiology of chronic pain and the mechanisms underlying the transition from acute to chronic pain. The NIH is committed to working with industry partners to advance basic research in this area and to identify and validate biomarkers for pain and pain relief. Biomarkers can move the field away from reliance on subjective pain assessments, and will facilitate medication development and individualized clinical management. Precision-medicine research is expected to help identify the pain-management interventions likely to be most effective for specific patients.

PUBLIC–PRIVATE PARTNERSHIPS

Recent NIH–industry partnerships, such as the Accelerating Medicines Partnership, demonstrate the power of public–private collaboration in speeding the development of new medications. Ending the opioid crisis will require this kind of collaboration. In April 2017, the NIH began discussions with pharmaceutical companies to accelerate progress on identifying and developing new treatments that can end the opioid crisis. Some advances may occur rapidly, such as improved formulations of existing medications, opioids with abuse-deterrent properties, longer-acting overdose-reversal drugs, and repurposing of treatments approved for other conditions. Others may take longer, such as MOR-biased agonists, opioid vaccines, and novel overdose-reversal medications. For all three areas, our goal is to cut in half the time typically required to develop new safe and effective therapeutics.

As we have seen repeatedly in the history of medicine, science is one of the strongest allies in resolving public health crises. Ending the opioid epidemic will not be any different. In the past few decades, we have made remarkable strides in our understanding of the biologic mechanisms that underlie pain and addiction. But intensified and better-coordinated research is needed to accelerate the development of medications and technologies to prevent and treat these disorders. The scope of the tragedy of addiction and overdose deaths plaguing our country is daunting. With our partners, the NIH will take an “all hands on deck” approach to developing and delivering the scientific tools that will help end this crisis and prevent it from reemerging in the future.

This article was published on May 31, 2017, at NEJM.org.

SOURCE INFORMATION

From the National Institute on Drug Abuse (N.D.V.), and the Office of the Director (F.S.C.), National Institutes of Health, Bethesda, MD.

Link to article here: The Role of Science in Addressing the Opioid Crisis

Ohio Attorney General Sues 5 Drug Companies Related to Opioid Crisis

The Ohio attorney general sued five drugmakers on Wednesday, accusing the companies of perpetrating the state’s addictions epidemic by intentionally misleading patients about the dangers of painkillers and promoting benefits of the drugs not backed by science.

Attorney General Mike DeWine said the companies created a deadly mess in Ohio that they now need to pay to clean up.

“This lawsuit is about justice, it’s about fairness, it’s about what is right,” DeWine said in announcing the complaint filed in Ross County, a southern Ohio community slammed by fatal drug overdoses from painkillers and heroin.

A record 3,050 Ohioans died from drug overdoses in 2015, a figure expected to jump sharply once 2016 figures are tallied.

DeWine wants an injunction stopping the companies from their alleged misconduct and damages for money the state spent on opiates sold and marketed in Ohio. The attorney general also wants customers repaid for unnecessary opiate prescriptions for chronic pain.

“These drug companies knew that what they were doing was wrong and they did it anyway,” DeWine said.

The drugmakers sued by DeWine are Purdue Pharma; Endo Health Solutions; Teva Pharmaceutical Industries, and its subsidiary, Cephalon; Johnson & Johnson and its subsidiary Janssen Pharmaceuticals; and Allergan.

They variously manufacture OxyContin, Percocet and a host of other painkillers that DeWine said represent the heart of the problem.

Christina Arredondo said her 24-year-old pregnant daughter, Felicia Detty, died after a painkiller addiction led to heroin and overdose. She said she’s hopeful the Ohio lawsuit can begin to curtail the epidemic by fighting it “from the top.”

“It’s not like they’re going out to buy some cocaine on the street,” she said. “They’re going to the doctor for a torn ligament in their shoulder, or migraines, or having a tooth pulled.”

Janssen on Wednesday called the lawsuit’s accusations legally and factually unfounded. The company said it acted appropriately, responsibly and in the best interests of patients.

Another defendant, Purdue Pharma, said it shares DeWine’s concerns about the opiate crisis and is committed to working together on a solution. It won’t say if it’s challenging the lawsuit.

Teva Pharmaceuticals says it’s still reviewing the lawsuit and is unable to comment.

Endo declined comment. A message was left seeking comment with Allergan.

DeWine, a Republican expected to run for governor next year, joins other states that have filed similar lawsuits. His move comes after years of calls for such action by Ohio Democrats.

Democratic candidate Nan Whaley, Dayton’s mayor, is airing online video spots in which she criticizes sitting Republicans for doing too little to solve the heroin and opioid epidemic. Whaley says taking on drug companies for their role in the crisis will be her highest priority as governor.

Another gubernatorial contender, Democratic state Sen. Joe Schiavoni, said he had previously called for such an action.

“I hope that whatever financial settlement this lawsuit might bring will be put toward helping the victims of this epidemic,” he said. “In the meantime, the General Assembly must do more to provide the resources our counties desperately need now for drug treatment and other services.”

In 2015, Kentucky settled a similar lawsuit with Purdue Pharma for $24 million.

Oregon reached a settlement in 2015 with opioid painkiller manufacturer Insys for off-label promotion of Subsys, a fentanyl spray more powerful than heroin. It was also among 27 states that reached a settlement with Purdue, the maker of OxyContin, in 2007.

Link to article here: Ohio attorney general sues 5 drug companies related to opioid crisis