CAUSE NO. DALLAS COUNTY HOSPITAL DISTRICT § D/B/A PARKLAND HEALTH & § IN THE DISTRICT COURT HOSPITAL SYSTEM; PALO PINTO § COUNTY HOSPITAL DISTRICT A/K/A § PALO PINTO GENERAL HOSPITAL; § GUADALUPE VALLEY HOSPITAL A/K/A § GUADALUPE REGIONAL MEDICAL § CENTER; VHS SAN ANTONIO § PARTNERS, LLC D/B/A BAPTIST § OF DALLAS COUNTY, TEXAS MEDICAL CENTER, MISSION TRAIL § BAPTIST HOSPITAL, NORTH CENTRAL § BAPTIST HOSPITAL, NORTHEAST § BAPTIST HOSPITAL, and ST. LUKE’S § BAPTIST HOSPITAL; NACOGDOCHES § MEDICAL CENTER; RESOLUTE § HOSPITAL COMPANY, LLC D/B/A § _____ JUDICIAL DISTRICT RESOLUTE HEALTH; THE HOSPITALS § OF PROVIDENCE EAST CAMPUS; THE § HOSPITALS OF PROVIDENCE § MEMORIAL CAMPUS; THE HOSPITALS § OF PROVIDENCE SIERRA CAMPUS; THE § HOSPITALS OF PROVIDENCE § TRANSMOUNTAIN CAMPUS; VHS § BROWNSVILLE HOSPITAL COMPANY, § LLC D/B/A VALLEY BAPTIST MEDICAL § CENTER - BROWNSVILLE; VHS § HARLINGEN HOSPITAL COMPANY, LLC § D/B/A VALLEY BAPTIST MEDICAL § CENTER; ARMC, L.P. D/B/A ABILENE § REGIONAL MEDICAL CENTER; § COLLEGE STATION HOSPITAL, LP; § GRANBURY HOSPITAL CORPORATION § D/B/A LAKE GRANBURY MEDICAL § CENTER; NAVARRO HOSPITAL, L.P. § D/B/A NAVARRO REGIONAL HOSPITAL; § BROWNWOOD HOSPITAL, L.P. D/B/A § BROWNWOOD REGIONAL MEDICAL § CENTER; VICTORIA OF TEXAS, L.P. § D/B/A DETAR HOSPITAL NAVARRO and § DETAR HOSPITAL NORTH; LAREDO § TEXAS HOSPITAL COMPANY, L.P. D/B/A § LAREDO MEDICAL CENTER; SAN § ANGELO HOSPITAL, L.P. D/B/A SAN § ANGELO COMMUNITY MEDICAL § CENTER; CEDAR PARK HEALTH § SYSTEM, L.P. D/B/A CEDAR PARK § REGIONAL MEDICAL CENTER; NHCI § OF HILLSBORO, INC. D/B/A HILL § REGIONAL HOSPITAL; LONGVIEW § MEDICAL CENTER, L.P. D/B/A § LONGVIEW REGIONAL MEDICAL § CENTER; and PINEY WOODS § HEALTHCARE SYSTEM, L.P. D/B/A § WOODLAND HEIGHTS MEDICAL § CENTER. § § Plaintiffs, § § vs. § § PURDUE PHARMA L.P.; PURDUE § PHARMA, INC.; THE PURDUE § FREDERICK COMPANY, INC.; RICHARD § SACKLER; BEVERLY SACKLER; DAVID § SACKLER; ILENE SACKLER LEFCOURT; § JONATHAN SACKLER; KATHE SACKLER; § MORTIMER SACKLER; THERESA § SACKLER; JOHN STEWART; MARK § TIMNEY; CRAIG LANDAU; RUSSELL § GASDIA; AMNEAL PHARMACEUTICALS, § LLC; AMNEAL PHARMACEUTICALS, § INC.; TEVA PHARMACEUTICALS USA, § INC.; CEPHALON, INC.; JOHNSON & § JOHNSON; JANSSEN § PHARMACEUTICALS, INC.; ORTHO- § MCNEIL-JANSSEN PHARMACEUTICALS, § INC. n/k/a JANSSEN § PHARMACEUTICALS, INC.; JANSSEN § PHARMACEUTICA, INC. n/k/a JANSSEN § PHARMACEUTICALS, INC.; ABBOTT § LABORATORIES; ABBOTT § LABORATORIES, INC.; ASSERTIO § THERAPEUTICS, INC. f/k/a DEPOMED, § INC.; NORAMCO, INC.; ENDO HEALTH § SOLUTIONS, INC.; ENDO § PHARMACEUTICALS, INC.; § MALLINCKRODT, LLC; MALLINCKRODT § PLC; SPECGX LLC; ALLERGAN PLC f/k/a § ACTAVIS PLC; WATSON LABORATORIES, § INC.; ACTAVIS LLC f/k/a ACTAVIS INC.; § ACTAVIS PHARMA, INC. f/k/a WATSON § PHARMA. INC.; ANDA, INC.; H.D. SMITH, § LLC f/k/a H.D. SMITH WHOLESALE § DRUG CO.; HENRY SCHEIN, INC.; § AMERISOURCEBERGEN § CORPORATION; § AMERISOURCEBERGEN DRUG § CORPORATION; CARDINAL HEALTH, § INC.; MCKESSON CORPORATION; CVS § HEALTH CORPORATION; CVS § PHARMACY, INC.; WALGREEN CO.; § WALGREENS BOOTS ALLIANCE, INC.; § WALMART INC.; RICHARD ANDREWS; § THEODORE OKECHUKU; NICOLAS § PADRON; CARLOS LUIS VENEGAS; and § JOHN DOES 1 TO 100. § § Defendants. § § PLAINTIFFS ORIGINAL PETITION, JURY DEMAND AND RULE 194.2 REQUEST FOR DISCLOSURE TABLE OF CONTENTS I. INTRODUCTION ............................................................................................................................. 2 A. The Opioid Crisis in Texas ................................................................................................... 2 B. The Opioid Crisis Nationally ................................................................................................ 6 C. The Impact of Opioids on Hospitals ................................................................................ 13 D. Financial Impact of Defendants’ Activities on Plaintiffs ................................................ 16 E. The Roles of Defendants in Causing and Perpetuating the Opioid Crisis ................... 19 II. RULE 47 STATEMENT OF MONETARY RELIEF SOUGHT ........................................... 21 III. JURISDICTION AND VENUE .................................................................................................... 21 IV. PARTIES ............................................................................................................................................. 22 A. Plaintiffs ................................................................................................................................. 22 1. Public Hospitals ...................................................................................................... 22 2. Private Hospitals ..................................................................................................... 24 B. Defendants ............................................................................................................................ 27 1. Marketing Defendants ............................................................................................ 27 a. Purdue ......................................................................................................... 27 b. Teva and Associated Companies ............................................................ 34 c. Janssen and Associated Companies ........................................................ 38 d. Endo and Associated Companies ........................................................... 40 e. Abbott Laboratories .................................................................................. 42 f. Amneal ........................................................................................................ 43 g. Assertio ....................................................................................................... 44 h. Mallinckrodt Entities ................................................................................ 44 i. Allergan and Associated Companies ...................................................... 47 2. Distributor Defendants .......................................................................................... 47 a. AmerisourceBergen ................................................................................... 48 b. Anda ............................................................................................................ 48 c. Cardinal ....................................................................................................... 49 d. H. D. Smith ................................................................................................ 49 i e. Henry Schein Entities ............................................................................... 50 f. McKesson ................................................................................................... 51 3. National Retail Pharmacies .................................................................................... 52 a. CVS .............................................................................................................. 52 b. Walgreens ................................................................................................... 53 c. Wal-Mart ..................................................................................................... 53 4. “Pill Mill” Defendants ............................................................................................ 54 5. Defendants’ Agents and Affiliated Persons ........................................................ 55 V. FACTUAL BACKGROUND ......................................................................................................... 56 A. The History of Opioids ....................................................................................................... 56 B. The Opioid Epidemic .......................................................................................................... 58 C. Congressional Response to the Opioid Crisis .................................................................. 61 VI. THE MARKETING DEFENDANTS’ FALSE, DECEPTIVE, AND UNFAIR MARKETING OF OPIOIDS ........................................................................................................ 62 The Marketing Defendants’ False and Deceptive Statements About Opioids. .......... 64 1. Falsehood #1: The Risk of Addiction from Chronic Opioid Therapy is Low ................................................................................................................................... 66 Purdue and Abbott’s Misrepresentations Regarding Addiction Risk 66 b. Endo’s Misrepresentations Regarding Addiction Risk ........................ 74 c. Janssen’s Misrepresentations Regarding Addiction Risk ..................... 76 d. Cephalon’s Misrepresentations Regarding Addiction Risk ................. 77 e. Mallinckrodt’s Misrepresentations Regarding Addiction Risk ............ 78 2. Falsehood #2: To the Extent There is a Risk of Addiction, It Can Be Easily Identified and Managed ......................................................................................... 80 3. Falsehood #3: Signs of Addictive Behavior are “Pseudoaddiction” Requiring More Opioids .......................................................................................................... 82 4. Falsehood #4: Blaming Addicted Patients as “Untrustworthy” “Abusers” .. 86 5. Falsehood #5: Opioid Withdrawal Can Be Avoided by Tapering .................. 87 6. Falsehood #6: Opioid Doses Can Be Increased Without Limit or Greater Risk ...........................................................................................................................