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STATE OF VERMONT SUPERIOR COURT CIVIL DIVISION CHITTENDEN UNIT DOCKET NO. ) STATE OF VERMONT, ) ) Plaintiff, ) ) v. ) ) RICHARD S. SACKLER, BEVERLY ) SACKLER, DAVID A. SACKLER, ) ILENE SACKLER LEFCOURT, ) JONATHAN D. SACKLER, KATHE ) SACKLER, MORTIMER D. A. ) SACKLER, AND THERESA ) SACKLER, ) ) Defendants. ) COMPLAINT TABLE OF CONTENTS INTRODUCTION .......................................................................................................................... 1 A. Defendants Succeeded in Mainstreaming Opioids Prescribing .............................. 1 B. Vermont Is Leading the Nation with Its Innovative and Effective Approach to Combating the Opioid Crisis. ............................................................. 6 PARTIES ...................................................................................................................................... 13 A. Plaintiff ................................................................................................................. 13 B. Defendants ............................................................................................................ 13 JURISDICTION AND VENUE ................................................................................................... 16 GENERAL ALLEGATIONS COMMON TO ALL COUNTS. ................................................... 16 A. Cementing the Foundation: From the Late 1990s to 2007, Purdue – with the Sacklers at Its Helm – Engaged in a Campaign of Deception to Create and Sustain a Market for Its Opioids .................................................................... 16 1. Purdue Mainstreamed Opioids for Chronic Pain ...................................... 17 2. Purdue’s Pervasive and Deceptive Unbranded Marketing ....................... 20 B. The Sacklers Drove the Misconduct that Led to the 2007 Convictions and Settlements ............................................................................................................ 31 C. After the 2007 Settlements, The Sacklers Devised New Unconscionable Practices and Directed the Purdue Sales Force to Carry Them Out ..................... 40 D. In Carrying Out the Sacklers’ Instructions, Purdue’s Sales Force Misrepresented the Risks and Benefits of Opioids and Deployed Unfair Tactics to Maximize Profits. ............................................................................... 131 1. To Fulfill the Sacklers’ Directions and With the Sacklers’ Awareness and Approval, Purdue Falsely Minimized or Failed to Disclose the Known, Serious Risk of Addiction ..................................... 136 2. Purdue Misleadingly Promoted OxyContin as Supplying 12 Hours of Pain Relief. ......................................................................................... 152 3. Purdue Pushed Higher and Higher Doses of Opioids Without Disclosing the Risks ................................................................................ 157 4. Purdue Encouraged Long-term Use of Opioids—Including With Savings Cards—Despite the Known Risks and Absence of Benefits of Such Use ............................................................................................. 162 5. Purdue Targeted Elderly and Opioid-Naïve Patients .............................. 171 E. The Proliferation of Prescription Opioids Has Been Devastating to Vermont .............................................................................................................. 177 F. The Sacklers, Who Knew that Purdue’s Marketing of Opioids Was False and Misleading, Instructed the Company to Fraudulently Conceal Its Misconduct and Hide their Own Involvement. ................................................... 185 i CAUSES OF ACTION ............................................................................................................... 191 COUNT ONE Deceptive Acts and Practices .............................................................................. 191 COUNT TWO Unfair Acts and Practices ................................................................................... 192 COUNT THREE Public Nuisance .............................................................................................. 194 COUNT FOUR Unjust Enrichment ............................................................................................ 196 PRAYER FOR RELIEF ............................................................................................................. 197 JURY DEMAND ........................................................................................................................ 198 ii The Vermont Attorney General brings this suit against Richard Sackler, Beverly Sackler, David Sackler, Ilene Sackler Lefcourt, Jonathan Sackler, Kathe Sackler, Mortimer Sackler, and Theresa Sackler (collectively, the “Sacklers” or “Defendants”) for violations of Vermont’s Consumer Protection Act, unjust enrichment, and creating a public nuisance. Defendants have violated the Vermont Consumer Protection Act by engaging in unfair and deceptive trade practices, Purdue unjustly enriched themselves by accepting and keeping ill-gotten gains, and created a public nuisance in the State of Vermont through the deceptive marketing of opioids, for which the Attorney General seeks civil penalties, injunctive relief, disgorgement, fees and costs, and other appropriate relief. INTRODUCTION A. Defendants Succeeded in Mainstreaming Opioids Prescribing 1. For 20 years, Purdue Pharma L.P. (“Purdue”),1 a privately-held company, has been a leading force in the prescription opioid market, both nationwide and in Vermont. During this time, the pharmaceutical giant Purdue manufactured, sold, and aggressively marketed prescription opioids, including the brand-name drugs OxyContin, Butrans, and Hysingla ER. 2. Before the 1990s, opioids were not widely prescribed because it was correctly believed that their use involved serious risks—including addiction, withdrawal, and overdose— that were not justified by the benefits. Opioids typically were used only to treat short-term, acute pain (e.g., trauma and post-surgical) or for palliative care (e.g., end-of-life) because they were considered too addictive and debilitating for long-term use. This prevailing medical and popular understanding operated as an appropriate constraint on the market for prescription opioids. 1 Technically, Purdue is a group of three related companies: Purdue Pharma, L.P., Purdue Pharma Inc., and The Purdue Frederick Company. 3. Beginning in the late 1990s, Purdue set out to effect a sweeping change in the public and medical community’s perception of opioids—by downplaying the risks and aggressively encouraging much broader use. Purdue orchestrated and enacted a plan of massive expansion— designed to change opioids’ limited use from acute and palliative care to a wide-ranging and often front-line option for long-term, chronic conditions like back pain, migraines, and arthritis. Purdue executed this scheme at the direction of eight people in a single family that owned the company and controlled a majority of the seats on the company’s board of directors: the Sacklers. 4. The Sacklers’ ambition was to become unimaginably rich from the sale of opioids. To that end, they masterminded a strategy, carried out by Purdue, that changed the way the medical profession viewed opioid prescribing. The Sacklers exploited newly-emerging concerns in the profession that pain was an undertreated priority. Purdue helped to institutionalize this patient- centric shift, and then capitalized on the platform it had created to push its message that health care providers should prescribe more opioids to treat this undertreated chronic pain. Purdue designed an array of deceptive messages that reduced concerns about opioids generally, and that promoted Purdue’s opioids specifically as safe, effective, and appropriate for long-term use and for moderate pain conditions. Purdue’s massive marketing scheme, which occurred alongside similar efforts of other industry players, was profoundly successful at shifting the medical and public consensus regarding the use of opioids. 5. The Sacklers fully understood the addictive and dangerous qualities of the drugs they manufactured, but the risks presented by their drugs to individual consumers and public health did not constrain their marketing and promotional plans. The Sacklers shaped the marketing campaigns that Purdue carried out, and they set sales objectives. The Sacklers directed and approved the hiring of hundreds of workers to carry out their wishes and blanketed the country 2 and Vermont with disinformation about opioids. The Sacklers directed Purdue employees to get doctors to write more prescriptions for higher doses for more patients, and the company did exactly these things. And over the years, the Sacklers distributed billions of dollars earned from the sale of Purdue opioids to themselves and other family members. 6. Before the introduction of OxyContin in 1996, the opioid market was for post- surgical, end-of-life, or cancer pain. By 2012, opioids were among the most prescribed drugs; approximately 90% of prescription opioids were given for chronic pain conditions, and only 10% of prescription opioids were dispensed for post-surgical, palliative, and cancer pain treatments.2 This was an almost complete reversal of long-standing medical practice. 7. According to the U.S. Centers for Disease Control and Prevention (“CDC”), nearly 3 62 million Americans received at least one opioid prescription in 2016. 8. In the late 1990s, federal