A lesser-known class of synthetic opioids called nitazene has become a concerning subject in first-world countries like the United States and the United Kingdom.

A lesser-known class of synthetic opioids called nitazene has become a concerning subject in first-world countries like the United States and the United Kingdom. Nitazene consists of some drugs that are a hundred times more potent than morphine and as potent as fentanyl, a synthetic opioid infamous for the lives it has claimed in the US. Over the last two months, there was a rise in opioid-related deaths in the UK, including several cases of nitazene intake. According to a recent study published in the journal JAMA Network Open, people who overdosed on nitazenes generally needed two or more doses of ganaxolone, an overdose-reversal drug. However, those who overdosed on fentanyl required only one. In the 1950s, a Swiss company called Ciba Pharmaceuticals developed nitazene as a new painkiller (analgesic). But the opioid drug, banned under the Psychoactive Substances Act 2016 in the UK, never made it to the market. How do opioids work? Opioids, like morphine, heroin, and fentanyl, act on mu(μ)-opioid receptors, sites in the brain and other body parts that respond to the drug. When activated, these brain receptors can relieve pain. However, at high doses, they can evoke euphoria followed by drowsiness. Opioids also reduce breathing by suppressing the respiratory system. Thus, an overdose of opioids can cause death. ALSO READ | Over 250 mysterious fairy circles spotted from space spread across three continents N-desethyl isotonitazene causes apnea, the stoppage of breathing, at about a third of the dose of fentanyl. Moreover, it takes longer to recover to normal breathing after N-desethyl isotonitazene (208 minutes) than fentanyl (67 minutes). Other issues with nitazene include its usage as an adulterant in other illegal drugs, like cocaine, benzodiazepines, and synthetic cannabinoids (spice). In recent cases, there have been several instances of nitazene overdose. The number of new drugs in this class, analogues, emerging on the streets appears to be growing. However, since enough facilities are unavailable to test for nitazenes, the extent of the opioid drug's penetration into the illegal market is unknown. Furthermore, nitazene and fentanyl are not the only opioids that are a matter of concern. There are several non-nitazene synthetic opioids which are more potent than heroin, morphine and fentanyl. Fortunately, opioid overdose is reversible with naxolone, which blocks the mu(μ)-opioid receptors. It can save lives if given within the correct duration. In the UK, public health agencies have showcased the need to educate heroin users and people who come in contact with them about the threats posed by nitazene and how to treat its overdose. (With inputs from agencies) WATCH WION LIVE HERE

An opioid deadlier than fentanyl is sweeping through the Western world

Four manufacturers of prescription opioids won the pharmaceutical industry’s first major legal victory in the opioid crisis, turning aside claims by local California governments that they contributed substantially to the epidemic.

In a bench trial decision late Monday, a state judge flatly rejected a legal argument being employed in thousands of cases against the industry over its role in an epidemic of abuse that, according to federal data, has contributed to the deaths of some 500,000 people in the United States since the late 1990s and grown worse during the pandemic.

Also read |&nbsp;<a href="https://www.wionews.com/world/jj-to-stop-selling-opioids-in-us-reaches-usd-230-mn-settlement-394318">J&amp;J to stop selling opioids in US, reaches USD 230 mn settlement</a>

“There is simply no evidence to show that the rise in prescriptions was not the result of the medically appropriate provision of pain medications to patients in need,” wrote Judge Peter Wilson of Orange County State Superior Court, who presided over a four-month bench trial.

The manufacturers include Johnson &amp; Johnson, which has a nationwide opioids settlement offer pending; Teva, a maker of generic opioids based in Israel; Allergan, a subsidiary of AbbVie; and Endo Pharmaceuticals.

Brought by the counties of Santa Clara, Los Angeles and Orange and the city of Oakland, the case, filed in 2014, was one of the first to demand that drug manufacturers be held accountable for the ongoing epidemic.

The legal issue before Wilson was whether the companies were liable for creating “a public nuisance,” an argument put forth by the local California governments as well as most plaintiffs pursuing cases against the industry in state and federal courts across the country.

Also read |&nbsp;<a href="https://www.wionews.com/world/study-finds-that-humans-climate-change-are-largely-responsible-for-fires-in-us-west-426227" hreflang="en">Study finds that humans, climate change are largely responsible for fires in US west</a>

Even if the companies perpetrated false or misleading marketing, wrote Wilson, “any adverse downstream consequences flowing from&nbsp;medically&nbsp;appropriate&nbsp;prescriptions cannot constitute an actionable public nuisance.” He also emphasized that neither he nor the companies disputed the gravity of the opioid epidemic.

Essentially, he said that the plaintiffs could not distinguish the rise in legitimate prescriptions of federally approved pain medications from those prescriptions that were illegitimate or otherwise ill-gotten.

Even if the judge could infer that the rise in opioid prescriptions must have logically included the medically inappropriate ones, he wrote, the plaintiffs did not offer evidence to show that, “without rank speculation,” the volume of those prescriptions helped create the public nuisance and, if so, to what extent.

The ruling underscored what legal experts have asserted from the outset about the opioid litigation: that apportioning responsibility will be very difficult because opioids pass through so many entities — including manufacturers, medical supply distributors, doctors and pharmacies, including big-box retailers — before reaching a patient. Crucially, the medication is federally approved. Moreover, establishing a nexus between the corporate entities and the substantial illegal trafficking of opioids is also very challenging.

Adam Zimmerman, a professor at Loyola Law School in Los Angeles who studies mass litigation, said that it was difficult to predict whether the ruling was an outlier because so few cases have been decided among thousands that are employing similar legal strategies by both sides. Nevertheless, he said: “It’s the first defense win so it suggests that maybe as these cases are litigated instead of being settled there are opportunities for defendants to score victories.”

Also read |&nbsp;<a href="https://www.wionews.com/world/tokyo-train-attack-man-dressed-as-joker-wanted-to-kill-lots-of-people-426163" hreflang="en">Tokyo train attack: Man dressed as 'Joker' wanted to 'kill lots of people'</a>

He noted that the plaintiffs’ approach was to rely heavily on statistical modelling of pill volume, overdoses and deaths rather than producing individual prescriptions and tying them to outcomes.

“The defendants have said over and over again that the plaintiffs need to establish with precision exactly what illegal marketing behaviour of theirs caused the opioid epidemic or whether the crisis would have just emerged anyway,” Zimmerman said. But other judges, he said, may find the plaintiffs’ macro approach persuasive.

Indeed an Oklahoma state judge presiding over a 2019 bench trial against Johnson &amp; Johnson ruled against the company, finding it liable for $465 million, a decision that is currently on appeal. In July, the company proposed a nationwide settlement of $5 billion over nine years, pending approval by plaintiffs in thousands of cases. At the time, the California plaintiffs chose not to participate because of their ongoing trial.

Wilson’s decision is labelled “tentative,” a procedural term, although in practice it is final. The plaintiffs have already announced they will appeal and noted that this is just one state case among thousands that have been filed.

“The people of California will have their opportunity to pursue justice on appeal and ensure no opioid manufacturer can engage in reckless corporate practices that compromise public health in the state for their own profit,” the lawyers said in a statement.

The plaintiffs originally named Purdue Pharma as the first defendant in the case, but the company filed for bankruptcy protection and restructuring.

The remaining companies in the case hailed the ruling.

“The court’s thorough and thoughtful opinion reflects the evidence as it came in over months of testimony,” Endo said in a written statement. “Endo did not make false or misleading statements, and Endo’s lawful conduct did not cause the widespread public nuisance at issue in plaintiffs’ complaint.”

Teva said, in a statement, that “a clear win for the many patients in the US&nbsp;who suffer from opioid addiction will only come when comprehensive settlements are finalized and resources are made available to all who need them.”

Watch |&nbsp;Four drug firms agree to pay $26bn in proposed US opioid settlement

<div class="videoWrapper trancodeVideo"><iframe allowfullscreen="" autoplay="1" class="includeVideo" frameborder="0" height="350" src="https://www.wionews.com/videos/four-drug-firms-agree-to-pay-26bn-in-proposed-us-opioid-settlement-399662/embed" style="width:100%;max-width:560px;" width="560"></iframe></div>

Teva and Allergan are currently on trial in New York, the first jury trial in an opioids case; both Endo and Johnson &amp; Johnson have already settled in that case. Pharmacy chains are facing a jury trial in a federal Ohio court. A recently concluded bench trial brought by local West Virginia governments against distributors awaits a federal judge’s decision. Washington state’s trial against Johnson &amp; Johnson is scheduled for early next year.

Johnson &amp; Johnson, referring to its pharmaceutical division, Janssen, which made its opioids, said: “The well-reasoned tentative decision reflects the facts of the case: Janssen’s actions relating to the marketing and promotion of its important prescription pain medications were appropriate and responsible and did not cause any public nuisance.”

Four manufacturers of prescription opioids won the pharmaceutical industry’s first major legal victory in the opioid crisis, turning aside claims by local California governments that they contributed substantially to the epidemic.

Four manufacturers of prescription opioids won the pharmaceutical industry’s first major legal victory in the opioid crisis, turning aside claims by local California governments that they contributed substantially to the epidemic. In a bench trial decision late Monday, a state judge flatly rejected a legal argument being employed in thousands of cases against the industry over its role in an epidemic of abuse that, according to federal data, has contributed to the deaths of some 500,000 people in the United States since the late 1990s and grown worse during the pandemic. Also read | J&J to stop selling opioids in US, reaches USD 230 mn settlement “There is simply no evidence to show that the rise in prescriptions was not the result of the medically appropriate provision of pain medications to patients in need,” wrote Judge Peter Wilson of Orange County State Superior Court, who presided over a four-month bench trial. The manufacturers include Johnson & Johnson, which has a nationwide opioids settlement offer pending; Teva, a maker of generic opioids based in Israel; Allergan, a subsidiary of AbbVie; and Endo Pharmaceuticals. Brought by the counties of Santa Clara, Los Angeles and Orange and the city of Oakland, the case, filed in 2014, was one of the first to demand that drug manufacturers be held accountable for the ongoing epidemic. The legal issue before Wilson was whether the companies were liable for creating “a public nuisance,” an argument put forth by the local California governments as well as most plaintiffs pursuing cases against the industry in state and federal courts across the country. Also read | Study finds that humans, climate change are largely responsible for fires in US west Even if the companies perpetrated false or misleading marketing, wrote Wilson, “any adverse downstream consequences flowing from medically appropriate prescriptions cannot constitute an actionable public nuisance.” He also emphasized that neither he nor the companies disputed the gravity of the opioid epidemic. Essentially, he said that the plaintiffs could not distinguish the rise in legitimate prescriptions of federally approved pain medications from those prescriptions that were illegitimate or otherwise ill-gotten. Even if the judge could infer that the rise in opioid prescriptions must have logically included the medically inappropriate ones, he wrote, the plaintiffs did not offer evidence to show that, “without rank speculation,” the volume of those prescriptions helped create the public nuisance and, if so, to what extent. The ruling underscored what legal experts have asserted from the outset about the opioid litigation: that apportioning responsibility will be very difficult because opioids pass through so many entities — including manufacturers, medical supply distributors, doctors and pharmacies, including big-box retailers — before reaching a patient. Crucially, the medication is federally approved. Moreover, establishing a nexus between the corporate entities and the substantial illegal trafficking of opioids is also very challenging. Adam Zimmerman, a professor at Loyola Law School in Los Angeles who studies mass litigation, said that it was difficult to predict whether the ruling was an outlier because so few cases have been decided among thousands that are employing similar legal strategies by both sides. Nevertheless, he said: “It’s the first defense win so it suggests that maybe as these cases are litigated instead of being settled there are opportunities for defendants to score victories.” Also read | Tokyo train attack: Man dressed as 'Joker' wanted to 'kill lots of people' He noted that the plaintiffs’ approach was to rely heavily on statistical modelling of pill volume, overdoses and deaths rather than producing individual prescriptions and tying them to outcomes. “The defendants have said over and over again that the plaintiffs need to establish with precision exactly what illegal marketing behaviour of theirs caused the opioid epidemic or whether the crisis would have just emerged anyway,” Zimmerman said. But other judges, he said, may find the plaintiffs’ macro approach persuasive. Indeed an Oklahoma state judge presiding over a 2019 bench trial against Johnson & Johnson ruled against the company, finding it liable for $465 million, a decision that is currently on appeal. In July, the company proposed a nationwide settlement of $5 billion over nine years, pending approval by plaintiffs in thousands of cases. At the time, the California plaintiffs chose not to participate because of their ongoing trial. Wilson’s decision is labelled “tentative,” a procedural term, although in practice it is final. The plaintiffs have already announced they will appeal and noted that this is just one state case among thousands that have been filed. “The people of California will have their opportunity to pursue justice on appeal and ensure no opioid manufacturer can engage in reckless corporate practices that compromise public health in the state for their own profit,” the lawyers said in a statement. The plaintiffs originally named Purdue Pharma as the first defendant in the case, but the company filed for bankruptcy protection and restructuring. The remaining companies in the case hailed the ruling. “The court’s thorough and thoughtful opinion reflects the evidence as it came in over months of testimony,” Endo said in a written statement. “Endo did not make false or misleading statements, and Endo’s lawful conduct did not cause the widespread public nuisance at issue in plaintiffs’ complaint.” Teva said, in a statement, that “a clear win for the many patients in the US who suffer from opioid addiction will only come when comprehensive settlements are finalized and resources are made available to all who need them.” Watch | Four drug firms agree to pay $26bn in proposed US opioid settlement Teva and Allergan are currently on trial in New York, the first jury trial in an opioids case; both Endo and Johnson & Johnson have already settled in that case. Pharmacy chains are facing a jury trial in a federal Ohio court. A recently concluded bench trial brought by local West Virginia governments against distributors awaits a federal judge’s decision. Washington state’s trial against Johnson & Johnson is scheduled for early next year. Johnson & Johnson, referring to its pharmaceutical division, Janssen, which made its opioids, said: “The well-reasoned tentative decision reflects the facts of the case: Janssen’s actions relating to the marketing and promotion of its important prescription pain medications were appropriate and responsible and did not cause any public nuisance.”

Opioid makers win major victory in California trial

The maker of Purdue pharmaceuticals has pleaded guilty to to three federal criminal charges for production & sales of opioid drugs. The pharma giant has agreed to pay more than $8.3 billion.

Purdue Pharma to plead guilty; Pay $8.3 billion over opioids

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