THE OPIOID CRISIS: UPDATE ON OPIOID-RELATED LITIGATION. Orange County Board of County Commissioners November 13, 2018

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1 THE OPIOID CRISIS: UPDATE ON OPIOID-RELATED LITIGATION Orange County Board of County Commissioners November 13, 2018

2 Presentation Outline Background Federal Litigation Florida Epidemic and Litigation Next Steps

3 Presentation Outline Background Federal Litigation Florida Epidemic and Litigation Next Steps

4 Background Nationally in 2017: * 72,000 drug overdose deaths in U.S. * 49,000 of which involved opioids * sharpest increase in use of synthetic opioids such as fentanyl and fentanyl analogue

5 Background Since 2013: * Orange County has seen a 490% increase in Fentanyl-related deaths In Fiscal Year : * Orange County Fire Rescue EMS responded to 1,361 suspected opioid overdoses where Narcan was used 67% male - 33% female * Narcan is a medication used to reverse an opioid overdose. In 2018: * For the first eight months of 2018, Orange County has experienced 131 fentanyl-related deaths.

6 Presentation Outline Background Federal Litigation Florida Epidemic and Florida Litigation Next Steps

7 Federal Litigation December 2017 Massive number of lawsuits filed in federal court throughout U.S. Panel on Federal Multidistrict Litigation was formed and recommended consolidation of pending federal litigation - Consolidation was recommended in order to avoid risk of inconsistent rulings and inefficient pretrial proceedings since a single judge would coordinate the cases. Cases were consolidated in Northern District of Ohio, which is a geographically central and accessible forum for the parties - Judge Daniel Polster presides over the federal litigation

8 Federal Litigation The CEA (County Executives of America) reports: As of August 2018, more than 1,000 cases have been filed in federal court Cases are proceeding down two tracks: - Resolution/settlement talks; and - Trial: three Ohio cases were selected to be the first ones litigated, which are collectively known as Track One Cases - Trial is set for September 3, 2019

9 Presentation Outline Background (Perhaps Carol can help with some background information) Federal Litigation Florida Epidemic and Litigation Next Steps

10 Florida Epidemic 2017 Florida Medical Examiners Commission Report determined: * From 2015 to 2016, there were 5,725 opioidrelated deaths in Florida, which represents an increase of 35%. In May, 2017: * Governor Rick Scott officially declared a State of Emergency in response to the state s epidemic of opioid addiction extended numerous times

11 Florida Litigation The response in Florida through its cities, counties and the State Attorney General s Office, has been to file numerous lawsuits in both state and federal courts. Those lawsuits have been filed against manufacturers, distributors, pharmacies and doctors. Some lawsuits allege only state violations and others allege violations involving federal statutes.

12 Florida Litigation Jurisdiction Alachua County Bay County Broward County City of Dade City City of Delray Beach Escambia County City of Jacksonville/Duval County City of Miami Miami-Dade County Osceola County Palm Beach County City of Panama City Beach Pasco County Pinellas County City of Sarasota Filed Lawsuit

13 Florida Litigation Potential Causes of Action Possible Defendants Florida Deceptive and Unfair Trade Practices Act Distributors: (affiliates and subsidiaries are not all listed) McKesson Corp. Negligence AmerisourceBergen Corp. Cardinal Health, Inc. Misrepresentation Manufacturers: (affiliates and subsidiaries are not all listed) Purdue Pharma, L.P. Public Nuisance Cephalon, Inc. Janssen Pharmaceuticals, Inc. (Johnson & Johnson) Unjust Enrichment Endo Pharmaceuticals, Inc. Actavis, Inc. RICO Insys Therapeutics, Inc. Teva Pharmaceutical Industries, LTD. Fraud Mallinckrodt Pharmaceuticals Pharmacies: (affiliates and subsidiaries are not all listed) Walgreens CVS Walmart Costco

14 Florida Litigation Florida Attorney General Action In May, 2018, Attorney General Pam Bondi filed a civil lawsuit in Pasco County Circuit Court on behalf of the State of Florida parties: Opioid manufacturers: Purdue, Endo, Janssen, Cephalon, Teva, Allergan Opioid distributors: AmerisourceBergen, McKesson, Cardinal Health The lawsuit alleges only state violations: Florida Deceptive & Unfair Trade Practices Act (FDUTPA) Florida RICO Act Common law public nuisance Negligence and Negligence per se (against the distributors only) Action is limited to state violations only and does not seek to be part of the federal multidistrict litigation.

15 Florida Litigation Florida Attorney General Action (Cont d) Relief sought by the State: Damages Restitution Injunctive relief Abatement of the public nuisance Disgorgement Civil forfeiture Civil penalties Other relief

16 Presentation Outline Background Federal Litigation Florida Epidemic and Litigation Next Steps

17 Next Steps 1. Perform an in-house assessment of the economic impact to Orange County associated with the opioid epidemic. 2. Report to the Board the results of the assessment.

18 THE OPIOID CRISIS: UPDATES ON OPIOID-RELATED LITIGATION Orange County Board of County Commissioners November 13, 2018