FACTBOX-Billion-dollar lawsuits accuse drugmakers, distributors of fueling U.S. opioid crisis

On Monday, two Ohio counties will face off in a U.S. courtroom with five companies they accuse of fueling the nationwide opioid epidemic. The counties are seeking billions of dollars to cover the cost of addiction treatment programs, healthcare, and other services.

Opioids were involved in almost 400,000 overdose deaths in the United States from 1999 to 2017, according to the U.S. Centers for Disease Control and Prevention. The following is a summary of where and how the opioid litigation is playing out across the United States:

Ohio's Cuyahoga and Summit counties are seeking around $8 billion from the three largest U.S. drug distributors - McKesson Corp, AmerisourceBergen Corp, and Cardinal Health Inc - and Israel-based drugmaker Teva Pharmaceutical Industries Ltd and pharmacy chain Walgreen Boots Alliance Inc. The defendants have denied wrongdoing. The case is among some 2,600 lawsuits brought by states, towns, cities, counties and tribal governments over the opioid epidemic.

Monday's trial is considered a bellwether, or test, a case that could help determine how much companies pay to reach a global settlement of all opioid litigation. The lawsuits generally allege drug manufacturers carried out marketing campaigns that deceptively promoted the benefits of using opioids to treat chronic, rather than short-term pain. The lawsuits also claim wholesale drug distributors failed to monitor for suspicious orders of painkillers, which were then diverted for improper uses.

The suits seek to recover money communities throughout the country say they have spent and will incur to address drug abuse and overdoses. Drugmakers argue their products carried U.S. Food and Drug Administration-approved labels that warned of the addictive risks of opioids. They say they did not cause the damage the public health crisis has had on states and localities. The distributors deny wrongdoing and say they have implemented programs to detect suspicious drug orders.

The majority of cases - 2,300 - are consolidated before U.S. District Judge Dan Polster in Cleveland. Polster has pushed for a global settlement of the litigation, saying at a hearing in January 2018 that he wanted to "do something meaningful to abate this crisis." Many other lawsuits are pending in state courts, particularly ones brought by state attorneys general. The vast majority of these suits are against Purdue Pharma, considered to be one of the main culprits in triggering and fueling the opioid crisis. Purdue launched OxyContin in 1996 and filed for bankruptcy in September. Many also name members of the wealthy Sackler family, which owns Purdue. Purdue and the Sacklers have denied wrongdoing.

In August, an Oklahoma judge ordered Johnson & Johnson to pay $572 million after finding the company had deceptively marketed painkillers. J&J has said it will appeal and has asked Judge Thad Balkman of Cleveland County District Court in Norman, Oklahoma to reduce the award. Balkman has acknowledged making a $107 million error when he calculated the award.

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