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The opioid epidemic that has so far killed half a million Americans is routinely blamed on greedy drug makers, feckless doctors and lax regulators. But there’s another group that has contributed to the depth and duration of the catastrophe: judges. Judges like Booker T. Stephens. Until his retirement in May, Stephens sat on the West Virginia Circuit Court in Welch, deep in Appalachian coal country, where addiction took early root among miners who were prescribed the blockbuster opioid OxyContin for the pain their jobs inflicted. And it was in his court where the first lawsuit filed by a state against OxyContin’s maker, Purdue Pharma LP, landed in 2001. (6/25)

Tension is emerging between lawyers representing state and local governments over the path forward in a set of lawsuits seeking to hold the drug industry accountable for the toll of the nation’s opioid crisis. A federal judge scheduled a hearing Tuesday in Cleveland on a plan pitched by for lawyers for local governments on distributing money to nearly 25,000 municipal and county governments across the country. The plan would take effect if companies that make and distribute the powerful prescription painkillers agree to one or more legal settlements. (Mulvihill and Gillispie, 6/25)

The request came Tuesday during a hearing in front of U.S. District Judge Dan Polster in Cleveland. Lawyers for the local governments said they wanted to address concerns, including those laid out by dozens of attorneys general for states and U.S. territories who undertook their own litigation and settlement efforts. Polster allowed for a few more weeks of tweaking and input from both sides and said he will hold another hearing on Aug. 6. (Heisig, 6/25)

Setting up this type of class “constitutes a new and novel procedure that could result in a grave miscarriage of justice and do significant harm to the ability of states to protect their own people,” Attorney General Ken Paxton of Texas said in a letter to Polster. Kristin Hunter Chasen, a McKesson spokeswoman, didn’t return a call seeking comment on whether the company opposes the creation of the class. Brandi Martin, a Cardinal Health spokeswoman, didn’t have an immediate comment. (Feeley, 6/25)

The final witness for the state of Oklahoma on Tuesday said Johnson & Johnson's claims that the company bears zero responsibility for the state's opioid epidemic are "absolutely incorrect" and "is one of the most difficult things to swallow." "To hear them say that they bear zero responsibility, it's painful," said Terri White, the Oklahoma mental health commissioner. "That offends my decency." White offered some of the most dramatic testimony in the weekslong trial, shredding Johnson & Johnson and its subsidiaries for distancing themselves from the opioid epidemic. (Drash, 6/25)

For the first time in decades, drug-overdose deaths in the U.S. are on the precipice of declining. Authorities are still counting fatalities around the U.S. from 2018, but provisional data from the Centers for Disease Control and Prevention are pointing lower. Those data predict there were nearly 69,100 drug deaths in the 12-month period ending last November, down from almost 72,300 predicted deaths for 12 months ending November 2017. (Kamp, 6/26)

The number of emergency department visits by people with opioid-related conditions dropped by nearly 6 percent in Massachusetts from 2016 to 2017, according to data providing another hint that the state may be getting some traction in its efforts to halt the opioid crisis. But the findings, to be released Wednesday by the Health Policy Commission, a state agency that monitors health care spending, also show that Massachusetts still has a long way to go. In 2017, the state had by far the country’s highest rate — more than double the national average — of emergency department use by patients diagnosed with opioid-related disorders. (Freyer, 6/26)

In a potential paradigm shift for addiction medicine, New Jersey’s health commissioner this week authorized paramedics to administer the drug buprenorphine to patients almost immediately after reviving them from an opioid overdose. Paramedics would offer patients the drug, often referred to by the brand name Suboxone, after their overdose had been reversed using the opioid antidote naloxone. The first-in-the-nation model has a twofold purpose, health officials said: Beyond treating the withdrawal symptoms that can result from a naloxone revival, administering buprenorphine on scene could serve as an immediate transition to longer-term treatment. (Facher, 6/26)

The Food and Drug Administration recently issued warnings to two businesses that are illegally marketing and making “unproven” claims that their products, which contain a drug called kratom, can treat or cure opioid addiction and withdrawal. Kratom, which is an herbal extract that naturally grows outside of the U.S., is not approved by the FDA. The drug acts as a stimulant at low doses, according to the Mayo Clinic, but can reduce pain and potentially cause euphoria when taken in higher quantities. (Turner, 6/25)