A group of 39 state attorneys general are taking steps to investigate the opioid crisis by cracking down on the pharmaceutical industry’s presentation of prescription opioids.

The bipartisan group of attorneys general is targeting five companies and their subsidiaries — Purdue Pharmaceuticals, Endo International, Janssen Pharmaceuticals, Teva Pharmaceuticals and Allergan, Inc. — to look for information about how prescription opioids have been manufactured and distributed. Connecticut’s Attorney General George Jepsen announced on Sept. 19 that he and his counterparts across the nation are also subpoenaing internal documents from three major distributors of opioids: AmerisourceBergen, Cardinal Health and McKesson Corp.

Jepsen said in an email to the News that the investigation stems from concerns about how opioid manufacturers represent the safety of opioid drugs and their marketing regarding the drugs. The probe also seeks to determine whether the distributors failed to control opioid distribution properly, including through illegally failing to report and detect unusual opioid orders.

“The companies and distributors that are subject to the investigation are a focus because of their conduct and/or their current or historic market shares in the sale and distribution of opioid drugs,” Jepsen said.

The argument in the case is that pharmaceutical industries marketed prescription opioids as risk-free cures for pain, said Yale Law School professor Abbe Gluck, an expert in health law. Doctors would have made an effort to prescribe opioid painkillers in lower quantities to fewer patients if the risks of those medications were accurately portrayed, Gluck said.

For the companies under investigation, the legal implications are far-reaching. The money from any settlement will presumably go toward helping states combat the opioid crisis and any settlement would likely force the defendants to change their behavior significantly, Gluck added.

Director of the Emerging Infections Program Robert Heimer said he believes that if the companies are found guilty, it could have an adverse effect on what drugs they choose to make available to the public. A guilty verdict may have a chilling effect, he said, making the pharmaceutical companies withhold new treatments because of fear of lawsuits.

Solely targeting drug companies for their marketing practices is not the most effective approach to combatting the opioid crisis, Heimer said. Rather, governments should expand access to medications that treat opioid addiction alongside targeting the supply-side problems that the pharmaceutical companies bring to the epidemic, he added.

According to Connecticut’s Office of the Chief Medical Examiner, 1,079 people are expected to die of opioid-related deaths this year. This number is higher than the previous year, in which 917 people died of opioid-related deaths, and 2015, in which opioids claimed 729 lives.

With an increasing number of people dying from opioid-related causes, Jepsen said his office will continue searching for ways to provide relief and pursue policy changes that will mitigate the epidemic.

“In considering appropriate relief, we will be mindful of the financial strains this crisis has caused to state and local governments,” Jepsen said. “We are also acutely aware that this opioid crisis is an urgent, worsening and ongoing public health crisis and so will look for opportunities — through settlement discussions or otherwise — for meaningful policy changes within the relevant industries.”

He added that it is too early to gage the outcome of the investigation and the relief it will produce.

Connecticut ranks among the top 25 percent of states for opioid-related inpatient hospital stays according to the Agency for Healthcare Research and Quality.

Anusha Manglik | anusha.manglik@yale.edu