1. Nebraska Department of Justice Attorney General Doug Peterson
Opioid Update
Nebraska Department of Justice
Attorney General Doug Peterson

2. Opioid Crisis Timeline
Improper use of Medicaid to obtain prescription opioids
Since 2010
CDC publish guidelines for prescribing opioids
2016
1st wave of opioid overdose deaths began with prescribing in 1990s
Purdue Pharma & executives plead guilty & have $600 mil in fines
2007
“Pain: The Fifth Vital Sign”
2000
1980s
“Addiction Rare” published in the New England Journal of Medicine
1995
FDA approves labeling of OxyContin
2003
FDA sends Purdue Pharma a warning letter re: OxyContin’s marketing
2010
2nd wave of opioid overdose deaths
( heroin)
2013
3rd wave increases in overdose deaths (synthetic opioids)

3. The “Opioid” Multistate Investigation
What are we
looking for?
The “Opioid” Multistate Investigation
Theories of Liability
Violations of:
State Consumer Protection Laws
State Controlled Substances Laws
Federal Controlled Substance Act
Federal Food, Drug and Cosmetic Act
State False Claims Laws
For ease of reference, referring to 1 multistate investigation. The Multistate is focused on how the manufacturers' and distributors‘ marketing and distribution practices have contributed to and prolonged this nationwide opioid epidemic.
What does Nebraska have/know so far? (Suggestion: Don’t make this a separate slide, but mention the following during this portion of the presentation.)
Significant document production from Purdue (on a shared platform)
Purdue sales representative call notes specific to Nebraska; produced directly to Nebraska
Purdue distribution data for 2008 – 2017; produced to Nebraska from Purdue (not DEA)
Document productions from the other manufacturers have made to EC states
Publicly-available prescribing data from the CDC
Information on DEA and local law enforcement actions related to opioids
Publicly-available CMS data
An MOU with DEA to obtain the relevant ARCOS data for Nebraska
What are we still trying to get? Or exploring in terms of accessibility?
ARCOS data from the DEA – expect soon
Nebraska PDMP data
Nebraska Department of Health & Human Services data
As for potential claims, certain litigating state Attorneys General have also alleged negligence and unjust enrichment, state RICO claims and common law fraud.

4. Investigations of Opioid Manufacturers and Distributors
44 Attorneys General part of one or more {
Purdue Pharma: 38 AGs
Allergan, Endo, Janssen, and Teva: 36 AGs
Nebraska is involved in
all
investigations
Mallinckrodt: 41 AGs
Amerisource, Cardinal, and McKesson: 39 AGs

5. Current Opioid Litigation Overview
Multistate
State Law Suits
21 states’ private lawsuits
Leaders:
Ohio
West Virginia
City & County
Lawsuits consolidated into MDL – Ohio Federal Circuit
44 Attorneys General investigating manufacturers

6. The “Opioid” Multistate Investigation
What remedies are being considered?
The “Opioid” Multistate Investigation
Monetary Payments
3 Buckets
Distribution will be based on metrics TBD
Unlikely that state AGs will control distribution
National Remediation Fund
Political Subdivisions
State AGs
The Term Sheets
The Multistate proposed a settlement structure that allows for a global resolution inviting participation by all states - both those in the Multistate and those already litigating - and their political subdivisions. Term sheets were sent to the manufacturers and distributors in December Most details are in active negotiation and therefore subject to change.
Statutory Authority to Seek Relief
State consumer protection laws vary to some extent, but generally authorize state courts to order comprehensive injunctive relief, significant civil penalties, restitution, disgorgement, and other equitable relief upon findings of unlawful conduct.

7. Nebraska Opioid Timeline
Nebraska Coalition forms
August 2016
AGO announces investigation to help address the opioid crisis
June 2017
Strategic Initiative Report released
October 2016
Summit report released
October 2017
April 2018
Opioid update letter
January 2016
36 AGs urge CDC to adopt prescribing guidelines
September 2017
AGO seeks documents from opioid manufacturers & distributors
October 2016
Opioid summit meets
February 2017
Dose of Reality launched