SUBROGATION AND THE OPIOID EPIDEMIC

1. SUBROGATION AND THE OPIOID EPIDEMIC Richard D. Gerber, Member and Leader of Subrogation Group

2. OPIOID EPIDEMIC IN U.S. • Opioid Prescriptions Up 400% Since 1999 • In 2016 • 42,249 People Died From Overdosing on Opioids • 11.5 Million Misused Prescription Opioids • 2.1 Million People Misused Prescription Opioids For The First Time • $504,000,000,000 In Economic Costs • All statistics provided by U.S. Dept. of Health and Human Services

3. OPIOID EPIDEMIC & WORKERS’ COMPENSATION • Workers’ Compensation Industry Spends Approximately $3 Billion a Year on Pain Medication. • Of the $3 Billion a Year; $2 Billion a Year are Spent Specifically on Opioid Prescriptions. • Prior to 2016 When C.D.C. Guidelines Recommended Doctors Avoid Issuing Opioid Prescriptions for Longer than 3 Days; 99% of Doctors Were Prescribing Opioids for Longer Than 3 Days. • A 2012 Hopkins-Accident Research Fund Study Found that Employees Prescribed Even One Opioid Had Average Total Claim Costs 4 to 8 Times Great Than Employees with Similar Claims Who Did Not Take Opioids. • Washington’s Department of Labor and Industries Found that 42% of Employees with Back Injuries Received an Opioid Prescription. After 1 Year, 16% of Those Employees Were Still Taking Opioids. • All Non-Cited Statistics from Effective Cost Based Management, Jeffrey Forbes, August 31, 2017

4. OPIOID EPIDEMIC & WORKERS’ COMPENSATION • Opioid RX and/or Abuse Leads to: • Greater opioid Prescriptions for Workers • Addiction Treatment • Additional TTD • Additional Time Off Work • Additional Medical Care Related to Addiction • Death Benefits & Burial Costs Associated With Overdose and Related Medical Conditions

5. Opioid Lawsuits • Multi District Litigation, Federal Ct. Northern District of Ohio • Parties: • Manufacturers: Purdue, Teva, AmerisourceBergen, Johnson & Johnson, Cephalon • Distributors, Endo, Actavis • Causes of Action • Rico, Deceptive Marketing

6. Opioid Lawsuits • Here’s What the Manf’sKnew: • Opioids had minimal therapeutic efficacy • Addictive • Tolerances built, more needed • Withdrawal, treatment needed • Addiction, then treat that with other drugs • In mid 1990’s, med professional used opioids cautiously because of addiction concerns • Salesman/Distributors, via deceptive marketing campaigns, convinced Doctor’s they were safe

7. Opioid Lawsuits • Sample from 350 Count Complaint: • “Over half of Purdue’s revenue stems from the sale of prescription opioids” • “OxyContin is Purdue's best-selling opioid. Since 2009, Purdue 's national annual sales of OxyContin have fluctuated between $2.47 billion and $2.99 billion, up four-fold from 2006 sales of $800 million, despite Purdue and its top executives pleading guilty in 2007 to criminal charges in connection with Purdue’s deceptive OxyContin marketing practices”

8. Opioid Lawsuits • Counts/Language From the Complaint: • “Plaintiff brings this suit against the manufacturers of prescription opioids. The manufacturers promoted, marketed, and advertised prescription opioids which have been determined to be addictive, unnecessary in certain cases, and dangerous by falsely representing to doctors that patients’ risk of drug addiction was low. These pharmaceutical companies advertised to and persuaded healthcare providers to prescribe addictive and unnecessary opioids. • Plaintiff also brings this suit against the wholesale distributors of prescription opioids. The distributors and manufacturers unlawfully breached their legal duties under federal law to monitor, detect, investigate, and report suspicious orders of prescription opiates.”

9. Opioid Lawsuits • Counts/Language From the Complaint: • “Each of the Manufacturer Defendants' documents and other materials outlined below was to promote opioid sales and use so that doctors would prescribe them, patients would actively seek them, and insurers and health plan administrators would approve the drugs for inclusion in - and payment or reimbursement from - private and public health plans. These materials also encouraged doctors and others to continue or approve continuation of opioid therapy in the belief that failure to improve pain, function, or quality of life with initial doses of opioids could be overcome by increasing doses or prescribing additional short-acting opioids on an as-needed basis for breakthrough pain.” • “In addition, and as set forth above, Manufacturer Defendants ignored, however, not only that there was no evidence that opioids improved long-term functioning, but also a 2006 study of other studies that found that "[f]or functional outcomes ... other [non-opioid] analgesics were significantly more effective than were opioids.”

10. Opioid Lawsuits • WHAT WE ARE SUING FOR: • 2 Categories of Damages • All opioid rx longer than 3 days • All expenses incurred on addiction, such as treatment, aftercare, drugs for treatment, additional injuries caused by addiction (if paid for by insurer)

11. EVANS & DIXON AND SUBROGATION • Nationwide Subrogation Practice. • Multi-District Litigation in the Northern District of Ohio Including Cities, Counties, States & Third Party Payors (Different Tracks). • We are Inviting Workers Compensation Insurers to Join the Litigation. • The MDL is in it’s second year, discovery well underway • First Settlements have Occurred • The more insurers the better