`
`ELECTRONICALLY FILED
`Crittenden County Circuit Court
`Terry Hawkins, Circuit Clerk
`2020-Dec-16 14:41:45
`18CV-18-268
`C02D01 : 133 Pages
`IN THE CIRCUIT COURT OF CRITTENDEN COUNTY, ARKANSAS
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`Case No.: 18CV-2018-268
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`JURY TRIAL DEMANDED
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`STATE OF ARKANSAS, ex rel. SCOTT
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`ELLINGTON, Second Judicial Circuit Prosecuting )
`Attorney; COUNTY OF ARKANSAS,
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`ARKANSAS; COUNTY OF ASHLEY,
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`ARKANSAS; COUNTY OF BAXTER,
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`ARKANSAS; COUNTY OF BENTON,
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`ARKANSAS; COUNTY OF BOONE,
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`ARKANSAS; COUNTY OF BRADLEY,
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`ARKANSAS; COUNTY OF CALHOUN,
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`ARKANSAS; COUNTY OF CHICOT,
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`ARKANSAS; COUNTY OF CLARK,
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`ARKANSAS; COUNTY OF CLAY, ARKANSAS; )
`COUNTY OF CLEBURNE, ARKANSAS;
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`COUNTY OF COLUMBIA, ARKANSAS;
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`COUNTY OF CONWAY, ARKANSAS;
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`COUNTY OF CRAIGHEAD, ARKANSAS;
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`COUNTY OF CRAWFORD, ARKANSAS;
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`COUNTY OF CROSS, ARKANSAS; COUNTY
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`OF DALLAS, ARKANSAS; COUNTY OF
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`DESHA, ARKANSAS; COUNTY OF DREW,
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`ARKANSAS; COUNTY OF FAULKNER,
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`ARKANSAS; COUNTY OF
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`FRANKLIN, ARKANSAS; COUNTY OF
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`FULTON, ARKANSAS; COUNTY OF
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`GARLAND, ARKANSAS; COUNTY OF GRANT,)
`ARKANSAS; COUNTY OF GREENE,
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`ARKANSAS; COUNTY OF HEMPSTEAD,
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`ARKANSAS; COUNTY OF HOT SPRING,
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`ARKANSAS; COUNTY OF HOWARD,
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`ARKANSAS; COUNTY OF INDEPENDENCE,
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`ARKANSAS; COUNTY OF IZARD,
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`ARKANSAS; COUNTY OF JACKSON,
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`ARKANSAS; COUNTY OF JOHNSON,
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`ARKANSAS; COUNTY OF LAFAYETTE,
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`ARKANSAS; COUNTY OF LAWRENCE,
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`ARKANSAS; COUNTY OF LEE, ARKANSAS; )
`COUNTY OF LINCOLN, ARKANSAS;
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`COUNTY OF LITTLE RIVER, ARKANSAS;
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`COUNTY OF LOGAN, ARKANSAS; COUNTY )
`OF LONOKE, ARKANSAS; COUNTY OF
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`MADISON, ARKANSAS; COUNTY OF
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`MARION, ARKANSAS; COUNTY OF MILLER, )
`ARKANSAS; COUNTY OF MISSISSIPPI,
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`ARKANSAS; COUNTY OF MONROE,
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`ARKANSAS; COUNTY OF MONTGOMERY,
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`ARKANSAS; COUNTY OF OUACHITA,
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`ARKANSAS; COUNTY OF PERRY,
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`ARKANSAS; COUNTY OF PHILLIPS,
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`ARKANSAS; COUNTY OF PIKE, ARKANSAS; )
`COUNTY OF POINSETT, ARKANSAS;
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`COUNTY OF POLK, ARKANSAS; COUNTY OF )
`POPE, ARKANSAS; COUNTY OF PRAIRIE,
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`ARKANSAS; COUNTY OF RANDOLPH,
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`ARKANSAS; COUNTY OF ST. FRANCIS,
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`ARKANSAS; COUNTY OF SALINE,
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`ARKANSAS; COUNTY OF SCOTT,
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`ARKANSAS; COUNTY OF SEARCY,
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`ARKANSAS; COUNTY OF SEBASTIAN,
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`ARKANSAS; COUNTY OF SEVIER,
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`ARKANSAS; COUNTY OF SHARP,
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`ARKANSAS; COUNTY OF STONE,
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`ARKANSAS; COUNTY OF UNION,
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`ARKANSAS; COUNTY OF VAN BUREN,
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`ARKANSAS; COUNTY OF WASHINGTON,
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`ARKANSAS; COUNTY OF WHITE,
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`ARKANSAS; COUNTY OF WOODRUFF,
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`ARKANSAS; COUNTY OF YELL, ARKANSAS; )
`COUNTY OF CARROLL, ARKANSAS;
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`COUNTY OF NEWTON, ARKANSAS; COUNTY )
`OF NEVADA, ARKANSAS; COUNTY OF
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`CLEVELAND, ARKANSAS; COUNTY OF
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`CRITTENDEN, ARKANSAS; COUNTY OF
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`PULASKI, ARKANSAS; COUNTY OF
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`JEFFERSON, ARKANSAS; CITY OF LITTLE
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`ROCK, ARKANSAS; CITY OF FORT SMITH,
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`ARKANSAS; CITY OF SPRINGDALE;
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`ARKANSAS; CITY OF JONESBORO,
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`ARKANSAS; CITY OF NORTH LITTLE ROCK; )
`ARKANSAS; CITY OF CONWAY, ARKANSAS; )
`CITY OF ROGERS, ARKANSAS; CITY OF PINE )
`BLUFF, ARKANSAS; CITY OF BENTONVILLE, )
`ARKANSAS; CITY OF HOT SPRINGS,
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`ARKANSAS; CITY OF BENTON, ARKANSAS; )
`CITY OF TEXARKANA, ARKANSAS; CITY OF )
`SHERWOOD, ARKANSAS; CITY OF
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`JACKSONVILLE, ARKANSAS; CITY OF
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`MONTICELLO, ARKANSAS; and CITY OF
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`FAYETTEVILLE, ARKANSAS;
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`Plaintiffs,
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`v.
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`CEPHALON, INC.; TEVA PHARMACEUTICAL )
`INDUSTRIES, LTD; TEVA
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`PHARMACEUTICALS USA, INC.; JANSSEN
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`PHARMACEUTICALS, INC.; ORTHO-MCNEIL- )
`JANSSEN PHARMACEUTICALS, INC.;
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`JOHNSON & JOHNSON; WATSON
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`LABORATORIES, INC.; ACTAVIS PHARMA,
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`INC.; WATSON PHARMA, INC.; ACTAVIS,
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`LLC; ENDO HEALTH SOLUTIONS, INC.;
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`ENDO PHARMACEUTICALS, INC.;
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`WEST-WARD PHARMACEUTICALS CORP.;
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`AMERISOURCEBERGEN DRUG
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`CORPORATION; CARDINAL HEALTH, INC.;
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`McKESSON CORPORATION; KJ MEDICAL
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`MANAGEMENT, LLC;
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`CJN PHARMACY SERVICES, LLC; PERRY
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`COUNTY FOOD & DRUG, INC.; MAHMOOD
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`AHMAD, M.D.; UNITED PAIN CARE, LTD;
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`SHAWN MICHAEL BROOKS, M.D.; KRISTEN )
`HOLLAND; RICHARD DUANE JOHNS; and
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`CHRISTOPHER WATSON;
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`Defendants.
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`TABLE OF CONTENTS
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`I.
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`INTRODUCTION................................................................................................................. 1
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`A.
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`B.
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`Opioids devastate Arkansas public health and welfare. .......................................... 1
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`The Opioid Epidemic emerges from a conspiracy of greed. ................................ 10
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`II. PARTIES ............................................................................................................................. 14
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`A.
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`B.
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`C.
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`D.
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`E.
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`Plaintiffs ................................................................................................................ 14
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`Manufacturer Defendants...................................................................................... 27
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`Distributor Defendants .......................................................................................... 31
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`Retail Defendants .................................................................................................. 33
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`Physician Defendants ............................................................................................ 34
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`III. JURISDICTION ................................................................................................................. 35
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`IV. VENUE................................................................................................................................. 37
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`V. FACTUAL ALLEGATIONS ............................................................................................. 37
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`A.
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`Manufacturer Defendants used multiple avenues to disseminate their false and
`deceptive statements about opioids. ...................................................................... 38
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`B.
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`C.
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`1.
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`2.
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`1.
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`2.
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`3.
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`Key Opinion Leaders (“KOLs”) .................................................................... 41
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`Front Groups .................................................................................................. 45
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`The U.S. Senate Homeland Security and Governmental Affairs Committee
`February 2018 Minority Staff Report recognizes collusive opioid promotion
`between Manufacturer Defendants and Front Groups. ......................................... 54
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`Manufacturer Defendants’ marketing scheme misrepresented the risks and benefits
`of opioids. ............................................................................................................. 56
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`Manufacturer Defendants falsely trivialized or failed to disclose the known
`risks of long-term opioid use. ........................................................................ 56
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`Manufacturer Defendants grossly overstated the benefits of chronic opioid
`therapy. .......................................................................................................... 65
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`Manufacturer Defendants also engaged in other unlawful, unfair, and
`fraudulent misconduct. .................................................................................. 66
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`i
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`D.
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`E.
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`F.
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`G.
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`H.
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`I.
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`Manufacturer Defendants targeted susceptible prescribers and vulnerable patient
`populations. ........................................................................................................... 67
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`Although Manufacturer Defendants knew that their marketing of opioids was false
`and deceptive, they fraudulently concealed their misconduct. ............................. 67
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`By increasing opioid prescriptions and use, Manufacturer Defendants’ deceptive
`marketing scheme has fueled the Opioid Epidemic and devastated Arkansas
`communities. ......................................................................................................... 69
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`Distributor Defendants likewise breached their duties to Plaintiffs. .................... 74
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`Distributor Defendants knew or should have known they were facilitating
`widespread opioid diversion. ................................................................................ 76
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`Distributor Defendants’ misconduct has injured and continues to injure Plaintiffs.
`............................................................................................................................... 81
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`J.
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`UPC, and Ahmad’s Arkansas Scheme. ................................................................. 85
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`1.
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`a.
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`1.
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`The Fraudulent Scheme to Illegally Promote Fentanyl Spray ...................... 85
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`Insys’s Illegal Kickbacks ............................................................................... 85
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`Ahmad’s Kickbacks ...................................................................................... 88
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`K.
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`Additional Arkansas Diversion Schemes Exposed by Operation Pilluted ........... 91
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`1.
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`2.
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`The KJ Medical Clinic, Dr. Shawn Michael Brooks, Dr. Jerry Reifeiss,
`Bowman Curve, and Kristen Holland Opioid Diversion Scheme. ................ 91
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`The Perry County Food & Drug and Christopher Watson Opioid Diversion
`Scheme. ......................................................................................................... 92
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`3.
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`The Dr. Richard Duane Johns Opioid Diversion Scheme ............................. 94
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`L.
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`The Arkansas opioid diversion exposed by federal and state investigation is only
`the tip of the iceberg. ............................................................................................ 95
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`VI. CAUSES OF ACTION ....................................................................................................... 95
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`COUNT I...................................................................................................................................... 95
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`COUNT II .................................................................................................................................. 102
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`COUNT III ................................................................................................................................ 105
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`COUNT IV ................................................................................................................................. 107
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`ii
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`COUNT V .................................................................................................................................. 109
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`COUNT VI ................................................................................................................................. 111
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`COUNT VII ............................................................................................................................... 113
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`COUNT VIII.............................................................................................................................. 114
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`COUNT IX ................................................................................................................................. 116
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`VII. JOINT AND SEVERAL LIABILITY ............................................................................. 119
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`PRAYER FOR RELIEF........................................................................................................... 120
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`iii
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`FOURTHAMENDED COMPLAINT
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`Plaintiffs, the State of Arkansas, Counties of the State of Arkansas (hereinafter “the
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`Counties” or by their respective county names), and Cities of the State of Arkansas (hereinafter
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`“the Cities” or by their respective city names) (hereinafter “Plaintiffs” or identified by their
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`respective names), allege as follows:
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`I.
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`INTRODUCTION
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`A.
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`Opioids devastate Arkansas public health and welfare.
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`1.
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`Drug poisoning is the leading cause of injury and death in the United States,
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`outnumbering those caused by firearms, car crashes, suicide, and homicide.1 Controlled
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`prescription drugs, specifically opioid analgesics (painkillers), have been linked to the largest
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`number of overdose deaths of any illicit drug class, outnumbering cocaine and heroin combined.2
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`Since 1999, the number of overdose deaths involving opioids has quadrupled.3 By 2015, opioids
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`were responsible for 63% of all drug-overdose deaths,4 and that number climbed to 66% in 2016.5
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`The Centers for Disease Control and Prevention (“CDC”) has stated that “[w]e now know that
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`overdoses from prescription opioids are a driving factor in the 15-year increase in opioid overdose
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`deaths,”6 and that opioids are, in fact, the main driver of drug overdose deaths.7
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`1 Drug Enforcement Administration, 2017 National Drug Threat Assessment, at v (Oct. 2017), available at
`https://www.dea.gov/docs/DIR-040-17_2017-NDTA.pdf (last visited Feb. 9, 2018).
`2 Id. at 25.
`3 Centers for Disease Control and Prevention, Understanding the Epidemic (updated Aug. 30, 2017), available at
`https://www.cdc.gov/drugoverdose/epidemic/index.html (last visited Feb. 9, 2018).
`4 Drug Enforcement Administration, supra note 1, at 25.
`5 Centers for Disease Control and Prevention, Opioid Basics, (updated Aug. 30, 2017), available at
`https://www.cdc.gov/drugoverdose/epidemic/index.html (last visited Feb. 9, 2018).
`6 Centers for Disease Control and Prevention, Understanding the Epidemic, supra note 3.
`7 Centers for Disease Control and Prevention, Drug Overdose Death Data (updated Dec. 19, 2017), available at
`https://www.cdc.gov/drugoverdose/data/statedeaths.html (last visited Feb. 9, 2018).
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`2.
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`The national opioid crisis has “reached epidemic levels.”8 The recent Economic
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`Report of the President warns of chilling realities. The 350,000 American deaths from opioid
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`overdose since 1999 amounts to 87% of the 405,399 American lives lost during World War II.9
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`Staggeringly, drug overdose is now the leading cause of death for Americans under 50 years old
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`and has removed 2.5 months from the average American’s life expectancy.10 Since 1999, overdose
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`deaths caused by prescription opioids have skyrocketed, also inducing a massive rise in heroin and
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`other opioid overdose deaths—even as deaths caused by prescription opioids continues to rise.11
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`3.
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`Arkansas has been at the forefront of this trend. Overdose deaths in Arkansas have
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`ballooned 262% from 5.1 per 100,000 citizens in the year 2000 to 13.4 per 100,000 in 2016.12 One
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`8 Chuck Rosenberg, Acting Administrator, Drug Enforcement Administration, 2015 National Drug Threat Assessment
`Summary, at iii, available at https://www.dea.gov/docs/2015%20NDTA%20Report.pdf (last visited Feb. 23, 2018).
`9 Economic Report of the President, February 2018, at 292.
`10 Id.
`11 Id. at 294.
`12 Nate Smith, M.D., M.P.H., Arkansas Department of Health, Opioid Prescribing in Arkansas (July 10, 2017),
`available at http://www.arkleg.state.ar.us/assembly/2017/Meeting%20Attachments/430/I15851/Opioid%20Handout-
`Nate%20Smith.pdf (last visited Feb. 9, 2018).
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`thousand, sixty-seven people died from drug overdose deaths in Arkansas from 2013-2015, and at
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`least half of those deaths were opioid-related.13 In 2016 alone, Arkansas saw the number of drug
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`overdose deaths rise to 401—at least 335 of which are opioid-related.14 In 2017, Arkansas saw the
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`number of drug overdose deaths rise to 446.15
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`4.
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`Increased availability of these drugs corresponds with increased use and
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`overdose.16 As researchers have noted, “[t]he correlation between opioid sales, [opioid pain
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`reliever]-related overdose deaths, and treatment seeking for opioid addiction is striking.”17 It is no
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`surprise, then, that Arkansas’s near-tripling in overdose deaths between 2000 and 2015 coincides
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`with a span in which opioid sales have quadrupled. 18 The overwhelming growth in the supply of
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`these drugs has ravaged the State of Arkansas, destroyed the lives of many of her citizens, and
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`strained the capacity of State and local government to cope with the public-health crisis caused by
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`the drugs’ rapid influx.
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`5.
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`Arkansas has been particularly susceptible to the rapid expansion of opioid
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`availability. There are now more opioid prescriptions in Arkansas than people. In fact, it has the
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`second highest opioid prescription rate in the country, with doctors writing 114.6 opioid
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`13Wesley Brown, Arkansas prescription drug crisis worsens, President Trump addresses national opioid epidemic,
`TALK BUSINESS & POLITICS (Aug. 8, 2017), available at https://talkbusiness.net/2017/08/arkansas-prescription-drug-
`crisis-worsens-president-trump-addresses-national-opioid-epidemic/ (last visited Feb. 12, 2018).
`14 Arkansas Prescription Monitoring Program, Drug Overdose Deaths in Arkansas 2000-2016, available at
`http://www.healthy.arkansas.gov/images/uploads/pdf/Mortality_Report_-_2017_v3.pdf (last visited March 2, 2018);
`Wesley Brown, Gov. Hutchison, Arkansas health officials announce naloxone standards to curb opioid-related
`overdose, TALK BUSINESS & POLITICS (Sept. 6, 2017), available at https://talkbusiness.net/2017/09/gov-hutchinson-
`arkansas-health-officials-announce-naloxone-standards-to-curb-opioid-related-overdose/ (last visited Feb. 9, 2018).
`15 Centers
`for Disease Control and Prevention, 2017 Drug Overdose Death Rates, available at
`https://www.cdc.gov/drugoverdose/data/statedeaths/drug-overdose-death-2017.html (last visited Jan. 22, 2020)
`16 National Institute on Drug Abuse (NIDA), Prescription Opioids and Heroin (updated Jan. 2017), available at
`https://www.drugabuse.gov/publications/research-reports/relationship-between-prescription-drug-abuse-heroin-
`use/increased-drug-availability-associated-increased-use-overdose (last visited Feb. 9, 2018).
`17 Andrew Kolodny, David T. Courtwright, Catherine S. Hwang, Peter Kreiner, John L. Eadie, Thomas W. Clark, &
`Caleb Alexander, The Prescription Opioid and Heroin Crisis: A Public Health Approach to an Epidemic of Addiction,
`36 ANNUAL REV. OF PUB. HEALTH 559, 560-561 (2015).
`18Arkansas Prescription Monitoring Program, Drug Overdose Deaths in Arkansas 2000-2015, available at
`http://www.arkansaspmp.com/files/2017/Mortality_Report_Final_v3.pdf (last visited Feb. 12, 2018).
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`prescriptions for every 100 Arkansans in 2016, while the national rate was 66.5 prescriptions per
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`100 persons.19 In 2017, the national rate was 58.7 opioid prescriptions per 100 persons, while
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`Arkansas maintained the second highest opioid prescription rate in the country at 105.4
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`prescriptions per 100 persons.20 In less than five years, Arkansas’ opioid prescriptions rates have
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`surged from eighth-most in the nation to second.21 Drug companies sold 235,934,613 opioid pills
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`across the state in 2016, making opioids both the top-selling class of prescription drug in Arkansas
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`and more than twice as prevalent as the next highest-selling prescription drug class.22 Drug
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`companies sell enough opioids in Arkansas for every man, woman, and child to each take 80 pills
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`per year.23
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`6.
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`The National Bureau of Economic Research has concluded that economic
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`conditions do not explain the current opioid epidemic and “that efforts to improve economic
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`conditions in distressed locations, while desirable for other reasons, are not likely to yield
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`significant reductions in drug mortality.24 In fact, the current epidemic is “related to the availability
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`and cost of the drugs.”25 In other words, the epidemic was directly caused, and is perpetuated, by
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`the companies that manufacture and distribute opioids.
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`19 Centers for Disease Control and Prevention, U.S. State Prescribing Rates, 2016 (updated July 31, 2017), available
`at https://www.cdc.gov/drugoverdose/maps/rxstate2016.html (last visited Feb. 9, 2018).
`20 Centers
`for Disease Control and Prevention, U.S. State Prescribing Rates, 2017, available at
`https://www.cdc.gov/drugoverdose/maps/rxstate2017.html (last visited Jan. 22, 2020).
`21 Compare Centers for Disease Control, supra note 14 with Centers for Disease Control and Prevention, Vital Signs:
`Variation Among States in Prescribing of Opioid Pain Relievers and Benzodiazepines, United States, 2012, 63
`available
`at
`Morbidity
`and
`Mortality Weekly
`Report
`563
`(July
`4,
`2014),
`https://www.cdc.gov/mmwr/preview/mmwrhtml/mm6326a2.htm (last visited Feb. 13. 2018).
`22 Arkansas Department of Health, Prescription Monitoring Program Annual Report January-December 2016,
`available at http://www.arkansaspmp.com/files/2017/2016_Annual_Report_FINAL.pdf (last visited Feb. 9, 2018).
`23 Wesley Brown, Arkansas at front line of U.S. opioid epidemic, TALK BUSINESS & POLITICS (Sept. 13, 2017),
`available at https://talkbusiness.net/2017/09/arkansas-at-front-line-of-u-s-opioid-epidemic (last visited Feb. 9, 2018).
`24 Christopher J. Ruhm, The National Bureau of Economic Research, Deaths of Despair or Drug Problems? (Jan.
`2018), available at http://www.nber.org/papers/w24188 (last visited Feb. 9, 2018).
`25 Id.
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`7.
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`Drug manufacturers and wholesale distributors have ensured that opioid supplies
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`abound in Arkansas and have made it one of the well-stocked states in the country. According to
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`Retail Summary Reports from the DEA’s Automation of Reports and Consolidated Orders System
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`(“ARCOS”) database, manufacturers and distributors supplied nearly two billion milligrams of
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`opioids to Arkansas pharmacies in 2015, despite the State’s relatively small population.26 The same
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`year, Arkansas ranked number one in meperidine distribution per 100,000 people, number three in
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`codeine and tapentadol distribution, and number four in hydrocodone distribution.27 Overall,
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`Arkansas pharmacies received more milligrams of opioids per citizen than those of all but three
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`other states.28
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`8.
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`Abuse and addiction are the natural by-products of the over-supply of opioids
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`saturating Arkansas. Opioids are highly addictive, and repeated exposure has been noted to cause
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`structural changes in the brain that lead to addiction.29 Research conducted at the University of
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`Arkansas for Medical Sciences has shown just how dangerous even minimal exposure to opioids
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`can be, finding that “[t]he probability of long-term opioid use increases most sharply in the first
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`days of therapy,” and “the chances of chronic use begin to increase after the third day [of opioid]
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`supplied and rise rapidly thereafter.”30
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`26 Department of Justice, Drug Enforcement Administration, Office of Diversion Control, ARCOS 3 – Report 5,
`Statistical Summary for Retail Drug Purchases by Grams WT, Reporting Period: 01/01/2015 to 12/31/2015, available
`at https://www.deadiversion.usdoj.gov/arcos/retail_drug_summary/2015/2015_rpt5.pdf (last visited Feb. 9, 2018).
`27 Department of Justice, Drug Enforcement Administration, Office of Diversion Control, ARCOS 3 – Report 4,
`Cumulative Distribution by State in Grams per 100,000 Population, Reporting Period: 01/01/2015 to 12/31/2015,
`available at https://www.deadiversion.usdoj.gov/arcos/retail_drug_summary/2015/2015_rpt4.pdf (last visited Feb. 9,
`2018).
`28 Department of Justice, supra note 26.
`29 Kolodny, et al., supra note 17, at 560-561.
`30 Anuj Shah, Corey J. Hayes & Bradley C. Martin, Characteristics of Initial Prescription Episodes and Likelihood of
`Long-Term Opioid Use, 66 CDC Morbidity and Mortality Weekly Report 265 (March 17, 2017), available at
`https://www.cdc.gov/mmwr/volumes/66/wr/mm6610a1.htm (last visited Feb. 9, 2018).
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`9.
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`The overwhelming availability of these drugs has taken its toll on Arkansas in a
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`variety of ways. In addition to the direct problems of adult addiction, abuse, and overdose, the
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`opioid epidemic has created a ripple effect, touching lives across all age groups and straining public
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`resources. Increased opioid use has been linked with increased emergency room visits for opioid-
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`related problems and an increase in neonatal abstinence syndrome (“NAS”).31 NAS is a
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`constellation of symptoms resulting from drug use during pregnancy.32 Opioid use by pregnant
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`women increases the risk of NAS,33 which increases the risk of pregnancy complications, including
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`maternal death and stillbirth.34 The rate of NAS diagnosis in Arkansas increased more than ten-
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`fold between 2000 and 2014.35 Babies diagnosed with NAS spend five times more days in the
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`hospital, and medical care costs increase ten-fold as compared to babies born without NAS.36
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`10.
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`Older children have also been affected. According to Arkansas Attorney General
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`Leslie Rutledge, presently “Arkansas ranks first in the nation for ages 12 to 17 in misuse of
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`painkillers.”37 In 2012, former Attorney General Dustin McDaniel noted that prescription drug
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`abuse was plaguing Arkansas’s children, stating that “by the time Arkansas high school students
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`have reached their senior year, roughly one in five has abused prescription drugs.”38 For each age
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`group, Arkansas ranks in the top 20 states for opioid abuse.39
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`31 Kolodny, et al., supra note 17, at 560-561.
`32 Arkansas Department of Health, Neonatal Abstinence Syndrome in Arkansas 2000–2014, available at
`http://www.arkansaspmp.com/files/2017/NAS_Report_Final.pdf (last visited Feb. 9, 2018).
`33 Arkansas Department of Health, supra note 22.
`34 Ayumi Maeda, Brian T. Bateman, Caitlin Clancy, Andreea Creanga, Lisa Leffert, Opioid Abuse and Dependence
`during Pregnancy: Temporal Trends and Obstetrical Outcomes, 121 ANESTHESIOLOGY 1158 (Dec. 2014).
`35 Arkansas Department of Health, supra note 32.
`36 Id.
`37 Wesley Brown, supra note 23.
`38 Dustin McDaniel, Attorney General, Arkansas Prescription Drug Summit, Conference Agenda (Apr. 26, 2012).
`39 Arkansas Department of Human Services, State Targeted Response to Opioid Crisis.
`
`
`
`6
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`11.
`
`In addition, the opioid epidemic is driving a dramatic increase in the number of
`
`children entering foster care.40 The number of children in Arkansas’s foster care system has spiked,
`
`growing from 3,806 in 2015 to 5,209 as of September 28, 2016.41 Drug-endangered children are
`
`at increased risk of injury, death, physical and sexual assault, neglect, and perpetuation of the
`
`cycles of drug and child abuse.42 In the 4th quarter of the State’s 2017 fiscal year, over half of
`
`children placed into the foster care system were placed because of substance abuse by parents—
`
`and the vast majority of which involve drug abuse.43 The same was true each quarter before that—
`
`55% of entries into the foster care system in the 3rd quarter were due to parental substance abuse,44
`
`57% in the 2nd quarter,45 and 53% in the 1st quarter.46
`
`12.
`
`The fallout from the prescription opioid epidemic has also spawned a public health
`
`and criminal justice crisis stemming from increased use of the illegal drug heroin. Heroin use has
`
`been increasing every year.47 Arkansas has seen the number of heroin-related hospitalizations
`
`
`40 Teresa Wiltz, Drug Addiction Epidemic Creates Crisis in Foster Care. STATELINE (Oct. 7, 2016), available at
`http://www.pewtrusts.org/en/research-and-analysis/blogs/stateline/2016/10/07/drug-addiction-epidemic-creates-
`crisis-in-foster-care (last visited Feb. 13, 2018).
`41 State Targeted Response (STR) to Opioid Crisis citing Brawner S. Director: Foster spike’s cause hard to pinpoint;
`some caseworkers erring on side of removal, TALK BUSINESS & POLITICS (Nov. 29, 2016), available at
`https://talkbusiness.net/2016/11/director-foster-spikes-cause-hard-to-pinpoint-some-caseworkers-erring-on-side-of-
`removal/ (last visited Feb. 13, 2018).
`42 Department of Justice, Office of Public Affairs, Keeping Them Safe: The Task Force on Drug Endangered Children
`(Aug. 17, 2010).
`43 Hornby Zeller Associates, Inc., Quarterly Performance Report, 4th Quarter SFY 2017, at 11 (produced for Arkansas
`available
`at
`Department
`of
`Health,
`Division
`of
`Children
`and
`Family
`Services),
`http://humanservices.arkansas.gov/images/uploads/dcfs/4th_Qtr_QPR_SFY_2017_FINAL.pdf (last visited Feb. 9,
`2018).
`44 Hornby Zeller Associates, Inc., Quarterly Performance Report, 3rd Quarter SFY 2017, at 11 (produced for Arkansas
`Department
`of
`Human
`Services,
`Division
`of
`Children
`and
`Family
`Services
`http://humanservices.arkansas.gov/images/uploads/dcfs/3rd_Qtr_QPR_SFY_2017_FINAL.pdf (last visited Feb. 9,
`2018).
`45 Hornby Zeller Associates, Inc., Quarterly Performance Report, 2nd Quarter SFY 2017, at 11 (produced for
`Arkansas Department
`of Human
`Services, Division
`of Children
`and
`Family
`Services
`http://humanservices.arkansas.gov/images/uploads/dcfs/2nd_Qtr_SFY_2017_FINAL.pdf (last visited Feb. 9, 2018).
`46 Hornby Zeller Associates, Inc., Quarterly Performance Report, 1st Quarter SFY 2017, at 11 (produced for Arkansas
`Department
`of
`Human
`Services,
`Division
`of
`Children
`and
`Family
`Services
`http://humanservices.arkansas.gov/images/uploads/dcfs/1st%20Qtr%20SFY%202017%20FINAL.pdf (last visited
`Feb. 9, 2018).
`47 Arkansas Department of Human Services, supra note 39.
`
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`increase more than eight-fold, from 42 in 2011 to 364 in 2015.48 Opioid users graduate from
`
`prescription pills to heroin because it is cheaper, available, and it affects the same brain receptors
`
`to provide feelings of euphoria similar to prescription opioids.49 Three in four heroin users also
`
`report use of prescription opioids,50 and 80% of current heroin users report that their opioid use
`
`began with prescription opioids.51 The CDC reports that overdose deaths involving heroin have
`
`more than tripled in the last four years, and the opioid epidemic is largely to blame.52
`
`13.
`
`Arkansas authorities have been active in attempting to ameliorate the epidemic.
`
`Over the past decade, the Arkansas Medical Board has disciplined over 80 physicians throughout
`
`the State for overprescribing, diverting, and abusing opioids. Medical Board files include the
`
`complaints of numerous Arkansas parents that have lost their children to prescription opioid
`
`overdose.
`
`14.
`
` Recently, the Drug Enforcement Administration (“DEA”)’s Little Rock office and
`
`various Arkansas law enforcement agencies took part in the “Operation Pilluted” campaign
`
`targeting abuse of prescription opioids in Arkansas, which former U.S. Attorney Christopher Thyer
`
`branded as “perhaps the greatest drug problem Arkansas currently faces.”53 As a result of
`
`Operation Pilluted, the DEA and Arkansas law enforcement exposed eminent examples of opioid
`
`diversion throughout the State, including:
`
`a.
`
`Dr. Mahmood Ahmad, who from his Sherwood clinic colluded with Insys
`Therapeutics, Inc., (“Insys”) and internet pharmacy Linden Care to illegally
`prescribe Subsys fentanyl spray—one of the deadliest opioids and 100 times more
`
`
`48 Id.
`49 Id.
`50 Id.
`51 Kolodny, et al., supra note 17, at 560-561.
`52 Theodore Cicero, Matthew Ellis, Hilary Surratt, The Changing Face of Heroin Use in the United States, 71 J. AM.
`MED. ASSOC. 821 (July 2014).
`53 Department of Justice, U.S. Attorney’s Office, Eastern District of Arkansas, 140 Charged In Arkansas As Part of
`National Prescription Drug Initiative (May 20, 2015), available at https://www.justice.gov/usao-edar/pr/140-
`charged-arkansas-part-national-prescription-drug-initiative (last visited Feb. 4, 2018).
`
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`powerful than morphine—in exchange for kickbacks, committing at least 121
`violations of the Controlled Substances Act in the process;
`
`KJ Medical Clinic of Little Rock, from which federal prosecutors indicted 16
`individuals in connection with the clinic’s long term hydrocodone diversion,
`including illegitimate prescriptions for approximately 287,500 10mg hydrocodone
`pills in a 10-month period, most of which were filled at local Bowman Curve
`Pharmacy.54 Between just December 15, 2014 and March 6, 2015, Bowman Curve
`Pharmacy filled 1,484 prescriptions—only six of which were not from KJ Medical
`Clinic55;
`
`Dr. Richard Johns of Little Rock and at least 38 others’ oxycodone diversion
`enterprise in Lonoke, Pulaski, and White Counties, in which the doctor and his
`accomplices distributed at least 39,000 oxycodone and OxyContin pills with a street
`val