Uncontested : The devastation caused by prescription opioids was deadly and overly expensive.

Contested : Who must pay the bill?

A little over a year ago, opioid lawsuits against manufacturers and distributors of painkillers had been so fast that a court had ruled all federal cases under the direction of a single judge. One January morning, Judge Dan Aaron Polster, from the North District of Ohio, delivered his opening address to the lawyers of nearly 200 municipal governments gathered in his hearing room in Cleveland . He wanted the national opioid crisis to be resolved within a year by proclaiming: "We do not need briefs or trials."

This year is over.

Far from being settled, the litigation escalated to 1,548 cases in federal courts, 77 tribes, hospitals, contingency funds, children with neonatal abstinence syndrome, and others , that is to say millions of people. With a pay potential of several tens of billions of dollars, it has become one of the most complicated and gigantic legal battles in American history.

Negotiations for a settlement amputating the court, the judge endorsed a parallel proceeding involving, yes, briefs, focused on, yes, lawsuits. He will preside over three consolidated lawsuits in Ohio under what is called a "witness," or test. Purdue Pharma, Mallinckrodt PLC, CVS RX Services Inc. and Cardinal Health, Inc. are among the accused. The verdict of the jury could determine whether the parties will seriously negotiate or continue to fight.

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The date of the trial has already been postponed twice. It is now scheduled for October 21st.

"I knew it would be complex and complicated," Judge Polster said in an interview, "but that turned out to be far more important than I thought."

To help you understand the complexity, here are some important developments and their meanings:

Manufacturers, Distributors and pharmacies are expected to track and report prescription opioids to the Drug Enforcement Administration and trigger alarms when orders appear suspicious.

After considerable judicial skirmishes, the D.E.A. complied with the orders of Judge Polster and provided more than 400 million lines of data. This is a detailed history, from 2006 to 2014, showing the number of opioids manufactured by each manufacturer, trucked by each distributor and sold in pharmacies across the country.

The complainants have long argued that corporations deliberately considered improbable quantities in the opposite direction. But the lawyers did not have the hard numbers on hand to back up their claims.

Now they do it.

For the moment, the judge will not disclose the data to the public. But an excerpt from a congressional report gives an idea of ​​the detailed information contained in the data: during a 10-month period in 2007, a distributor, McKesson, had shipped three million prescription opioids in a single pharmacy in a city of 400 residents in West Virginia.

The data proved to be a modest help for some of the defendants, too: because the DEA reports show that some drugs have not been sold in large quantities in some communities, companies who manufacture and distribute them have been abandoned in some cases. In the lawsuit filed in Cuyahoga County, Ohio, for example, the company Kroger, which owns grocery stores that include pharmacies, was discontinued because it turned out not to have of place in the region.

In a 39-page decision last month, Judge Polster dismantled the efforts of the drug industry to overturn the trial of the drug. ;Ohio. Instead, he gave the lawyers the green light to test just about all the legal theories raised by the plaintiffs.

They include: that corporations conspired; fraud committed; were careless; has violated public nuisance laws – the latter being a relatively new and innovative way to address health crises.

Of course, legal theory is one thing. Then comes the difficult part: the plaintiffs will actually have to prove their allegations before a jury.

As a general rule, patients who sue for malpractice or professional liability must turn against them. on their own medical records as evidence. They renounce the right to conventional privacy.

In this case, the vast majority of complainants are government entities and not individuals. They seek reimbursement for the cumulative costs of drug addiction and collateral damage. The defendants want them to provide clear evidence of how these costs are calculated, including the chain of events – for example, from the development of a drug to its issuance, through a prescription filled in pharmacy and, possibly, hospital and other bills.

This means that the pharmaceutical industry requests patient records and for each prescription, complainants are considered "suspect" in medical terms. The complainants recoil, claiming that the municipal budgets exhausted for health, social services and law enforcement picture more eloquent.

But they give ground.

The plaintiffs have now returned millions of coded insurance claims related to opioids. The fight focused on the extent and quantity of patients' medical records.

At the same time, the plaintiffs look for the internal documents of the drug. Sectors related to development, marketing and sales strategies.

They are also looking for documents showing companies' efforts to prevent the illegal diversion of their drugs. Years ago, some companies settled cases promising to take such measures. The plaintiffs want to know if they have actually done it.

Defense lawyers say they have already handed over about 67 million documents.

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An operated knee patient returns home with opioids. Her teenage son finds the drugs in the bathroom medicine cabinet and engages on a jagged road that ends with a heroin addiction.

Should companies that manufactured, distributed, and sold prescription pain medications be held accountable?

What if the son sold them to a friend who had taken illegal drugs and overdosed? Are pharmaceutical companies then responsible?

Multiply these examples by many years and generations of similar scenarios. Now calculate the accumulated losses on municipal budgets for emergency responders; hospitals; incarceration; drug courts; rehab; mental health services; Child care.

The question of whether companies should have forecast the growth of a second illicit market – including pills, heroin, and fentanyl – is one of the thorny issues currently under consideration.

But, to make things even more difficult, if several judges were to be tried, the answers to these questions and many others could differ from one jurisdiction to another.

Lawyers on both sides agree that: This litigation presents a series of new legal issues.

If the bellicose culminates in a victory for the plaintiffs, the courts of appeal, increasingly filled with conservative judges, would have little chance of granting all the decisions of Judge Polster on these unverified legal issues, let alone at a huge price moved by a jury. Complexity favors defense.

And in the negotiations for a settlement, the long match is the best friend of the defense: she can afford to move forward.

According to Andrew S. Pollis, litigation expert who teaches In Case Western Reserve Law School case, in Ohio, the complainants also have advantages.

"Polster Judge's unusual level of commitment to settlement" is powerful, he said. The judge continues to press for a relatively quick resolution, with funds directed to help remedy the crisis and put in place preventive measures.

The main argument of the judge who could lead the accused to the negotiating table is the trial before them. imminent date. A lawsuit could not only bring in much more money than a settlement, but the documents of companies currently under seal would be made public blatantly, telling more fully the relationship of the accused with the crisis.

And, in this regard, Mr. Pollis added: Do not neglect the power of public pressure on the perception and pressure on defense – "all the more so that plaintiffs are, in fact, all of us ".

The defendants want a comprehensive settlement – a comprehensive agreement that will compensate them for further prosecution. Multiparty litigation, with all federal cases, is well positioned to achieve this goal.

But to achieve this, Judge Polster needs the cooperation of the state courts. About 332 other cases have been filed in state courts. The coordination of data sharing between state cases and federal cases is an achievement in itself. Indeed, with Purdue documents from the federal litigation, Massachusetts has made progress on its own record; Following Purdue's objections, the Massachusetts judge made public much more than Judge Polster.

So there is a baroque dance going on between Judge Polster and the states. It can not be perceived as a big foot. State judges must be considered independent. And yet, Judge Polster needs the cooperation of the states to reach this comprehensive settlement.

In a recent interview, Justice Polster repeatedly pointed out, "I do not control state court judges or attorneys general, but I greatly appreciate their participation. They are indispensable. "

The eyes will be at the first trial in another state, which should begin before Judge Polster: the state of Oklahoma c. Purdue Pharma, currently set for May 28th.