Case 3:22-cv-04670-CRB Document 1 Filed 08/15/22 Page 1 of 42
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`T. Roe Frazer II
`FRAZER PLC
`30 Burton Hills Blvd., Suite 450
`Nashville, TN 37215
`Telephone: (615) 647-6464
`Roe@frazer.law
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`UNITED STATES DISTRICT COURT
`NORTHERN DISTRICT OF CALIFORNIA
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`Case No. ______
`COMPLAINT
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`JURY TRIAL DEMANDED
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`RED CLIFF BAND OF LAKE SUPERIOR
`CHIPPEWA INDIANS,
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`Plaintiff,
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`vs.
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`MCKINSEY & COMPANY, INC. and
`JOHN DOES 1-100,
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`Defendants.
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`COMPLAINT
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`I.
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`INTRODUCTION
`This case arises from the worst man-made epidemic in modern medical history—
`1.
`the misuse, abuse, and over-prescription of opioids. This crisis arose from the opioid
`manufacturers’ deliberately deceptive marketing strategy to expand opioid use.
`McKinsey and Company, Inc. (“McKinsey” or “Defendant”) played an integral
`2.
`role in creating and deepening the opioid crisis.
`In the years following Purdue Pharma L.P.'s (“Purdue”) 2007 guilty plea for
`3.
`misleadingly marketing OxyContin, McKinsey worked closely with Purdue to dramatically
`increase OxyContin sales to the benefit of McKinsey, Purdue, and the Sackler family, the wealthy
`family that has owned and controlled Purdue for decades. McKinsey specifically sought to
`maximize OxyContin sales by working around the requirements of the Corporate Integrity
`Agreement that Purdue entered as part of its guilty plea. McKinsey also performed related work
`for other manufacturers of opioids, including Johnson & Johnson. Through the conduct described
`in this complaint, McKinsey participated in and helped orchestrate a broad scheme to deceptively
`market opioids.
`McKinsey knew of the dangers of opioids and of Purdue's prior misconduct, but
`4.
`nonetheless advised Purdue to improperly market and sell OxyContin, supplying granular sales
`and marketing strategies and remaining intimately involved throughout implementation of those
`strategies. McKinsey's actions resulted in a surge in sales of OxyContin and other opioids that
`fueled and prolonged the opioid crisis.
`In a series of agreements, McKinsey has recently settled opioid-related claims with
`5.
`49 states, the District of Columbia, and five U.S. territories.
`Plaintiff Red Cliff Band of Lake Superior Chippewa Indians (“Plaintiff” “Red
`6.
`Cliff,” or “Tribe”) is a sovereign Indian tribe responsible for the health and well-being of its
`citizens. Native Americans have disproportionately borne the toll of the opioid crisis. Plaintiff
`brings suit to hold McKinsey responsible for its role in that crisis, which has posed an existential
`threat to tribes and tribal communities.
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`COMPLAINT
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`Case 3:22-cv-04670-CRB Document 1 Filed 08/15/22 Page 3 of 42
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`II.
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`JURISDICTION AND VENUE
`The Tribe brings this action In Re: McKinsey & Co., Inc National Prescription
`7.
`Opiate Consultant Litigation, MDL No. 2996, and files directly in the Northern District of
`California as permitted in Paragraph 10 of this Court’s Case Management Order dated November
`30, 2021 (Doc. #293). The Tribe reserves the right to have this matter transferred to one or more
`State or U.S. District Courts for trial in which it could have originally filed this case.
`This Court has subject matter jurisdiction over this action because the Plaintiff
`8.
`brings a federal cause of action that raises a federal question pursuant to 28 U.S.C. § 1331, and
`because this action is brought by an Indian tribe pursuant to 28 U.S.C. § 1362. The Court also has
`supplemental jurisdiction over the Plaintiff’s state law claims pursuant to 28 U.S.C. § 1367 and
`because the state law claims are part of the same case or controversy.
`The U.S. District Court, Western District of Wisconsin, has personal jurisdiction
`9.
`over Defendants because at all relevant times, McKinsey has purposely availed itself of the
`privilege of doing business in the state of Wisconsin, including by engaging in the business of
`researching, designing, and implementing marketing and promoting strategies for various opioid
`manufacturers, including Purdue, in support of their sales and marketing of opioids in Wisconsin.
`The U.S. District Court, Western District of Wisconsin, also has personal
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`jurisdiction over Defendants under 18 U.S.C. § 1965(b). This Court may exercise nationwide
`jurisdiction over Defendants where the “ends of justice” require national service and the Tribe
`demonstrates national contacts. The interests of justice require the Tribe be permitted to bring all
`members of the nationwide RICO enterprise before the Court in a single trial.
`Red Cliff has inherent sovereignty over unlawful conduct by non- Indians on land
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`that constitutes Indian country within the Red Cliff Band, including on land owned by or held in
`trust for the Red Cliff.
`Red Cliff brings this action against the non-Indian Defendants based on consensual
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`relationships with members of the Red Cliff Band and as the Defendants’ wrongful conduct
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`constitutes and poses an ongoing threat to the political integrity, economic security, and health or
`welfare of the Red Cliff Band.
`Federal law recognizes Red Cliff’s authority in the Red Cliff jurisdictional area
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`for multiple purposes, most of this authority to promote autonomy and the health and welfare of
`the Red Cliff Band.
`Red Cliff’s sovereignty and its jurisdictional area is recognized by the State of
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`Wisconsin as territory in which the Red Cliff Band has governmental authority to administer
`certain state programs and to exercise sovereign rights.
`This Court has personal jurisdiction over Defendant because at all relevant
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`times, McKinsey has purposely availed itself of the privilege of doing business in the State of
`Wisconsin, including by engaging in the business of researching, designing, and implementing
`marketing and promoting strategies for various opioid manufacturers, including Purdue, in support
`of their sales and marketing of opioids in Wisconsin.
`Defendants have substantial contacts and business relationships with Red Cliff,
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`the members of the Red Cliff, employees of the Red Cliff, and/or Red Cliff businesses.
`Defendants have purposefully availed themselves of business opportunities within and affecting
`the Red Cliff jurisdictional area.
`Defendants’ conduct has caused and is causing damages to Red Cliff’s proprietary
`17.
`and sovereign interests by imposing significant costs on the Band’s health and welfare fund and
`system, in addition to undermining the economic productivity of its members, and harming the
`long-term health and welfare of Red Cliff members.
`Venue is proper in the United States District Court for the Western District of
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`Wisconsin, under 28 U.S.C. § 1391(g) and 18 U.S.C. § 1965. Plaintiff hereby asserts that, because
`a substantial part of the events or omissions giving rise to this action occurred in Wisconsin and
`because the Defendant is subject to the jurisdiction of the United States District Court for the
`Western District of Wisconsin, venue is thereby proper. But for the Case Management Order
`permitting direct filing into U.S. District Court, Northern District of California, dated November
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`30, 2021 (Doc. #293), the Tribe would have filed this action in U.S. District Court, Western
`District of Wisconsin.
`PARTIES
`III.
`Plaintiff
`A.
`19.
`Plaintiff, Red Cliff, is a sovereign Indian tribe with over 7,500 tribal members.
`Red Cliff is governed by its organic documents and laws and is principally located in Bayfield
`County, Wisconsin. Red Cliff exercises inherent sovereign governmental authority within the
`Red Cliff’s Lands and on behalf of the health and welfare of the Red Cliff and its members
`(“Tribal Members”), descendant children, and grandchildren and other inhabitants of the Red
`Cliff’s Lands. The Red Cliff’s reservation lands are located in Bayfield County, Wisconsin.
`Members of Red Cliff are adversely affected by the actions and conduct of McKinsey both
`directed at or near the Red Cliff’s Indian lands, as well as areas outside of the Red Cliff’s Indian
`lands. Tribal Members live both on and off the Red Cliff’s lands.
`A substantial number of Red Cliff Members have fallen victim to the opioid
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`epidemic, becoming addicted to prescription opioids or coping with family members who are
`addicted. As a result, Red Cliff has expended and diverted Nation resources towards combatting
`the opioid epidemic created by Defendants. Red Cliff has incurred significant costs in an attempt
`to abate the opioid epidemic that continues to plague its members and Indian lands, providing
`medical services and opioid-related treatments to those in need. Plaintiff has incurred
`extraordinary costs, damages, and financial impact to every department of its Government:
`housing, education, security, services, medical, labor, operations, waste treatment, foster care,
`after school care, etc. Red Cliff brings this suit, in part, to recover these costs and procure the
`additional financial resources required to adequately combat and abate opioid addiction, opioid-
`related injuries, and other problems caused by the opioid crisis.
`This action is brought by Red Cliff in the exercise of its authority as a sovereign
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`government and on behalf of the Plaintiff in its proprietary capacity and under its parens patriae
`authority in the public interest to protect the health, safety, and welfare of all Red Cliff Members
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`to stop the growing prescription opioid epidemic within Red Cliff. Red Cliff also brings this action
`as to recover damages and seek other redress for harm caused by Defendants’ improper, wrongful,
`fraudulent, and tortious conduct with respect to the distribution and sale of prescription opioids.
`Defendants’ actions have caused, and continue to cause, a crisis that threatens the health, safety,
`and welfare of the Nation.
`Red Cliff has standing to recover damages incurred as a result of Defendants’
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`actions and omissions. Red Cliff has standing to bring actions as an enterprise and a “person,”
`including, inter alia, standing to bring claims under the federal RICO statue, pursuant to 18 U.S.C.
`§ 1961(3) and 18 U.S.C. § 1964.
`Nothing herein shall be deemed a waiver of Red Cliff’s sovereign immunity.
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`The opioid crisis is straining the Red Cliff’s ability to provide adequate services
`to its members. With its limited resources, Red Cliff has been forced to divert funds from other
`tribal priorities to staff new positions needed to address the opioid crisis, including substance
`abuse counselors, nurses, and physicians specializing in addiction.
`Defendant
`B.
`25.
`Defendant McKinsey and Company, Inc. is a corporation organized under the laws
`of the state of New York. McKinsey's principal place of business is located at 711 Third Avenue,
`New York, NY 10017.
`26. McKinsey is a worldwide management consultant company. From approximately
`2004-2019, McKinsey provided consulting services to Purdue Pharma L.P., working to maximize
`sales of OxyContin and knowingly perpetuating the opioid crisis. McKinsey has provided related
`consulting services to other manufacturers of opioids.
`Plaintiff presently lacks information sufficient to specifically identify the true
`27.
`names or capacities, whether individual, corporate or otherwise, of the Defendants sued herein
`under the fictitious names JOHN DOES 1-100 inclusive. Plaintiff will amend this Complaint to
`show their true names and capacities if and when they are ascertained. Plaintiff is informed and
`believes, and on such information and belief alleges, that each of the Defendants named as a DOE
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`is responsible in some manner for the wrongful conduct alleged in this Complaint either as an
`employee or board member or equity owner of McKinsey, or as a related company or enterprise,
`and is liable for the relief sought herein. JOHN DOES 1-100 include but are not limited to
`individual partners or members of McKinsey who invested in and/or profited from enterprises
`related to the opioid epidemic and/or opioid addiction.
`FACTUAL ALLEGATIONS
`IV.
`The Corporate Integrity Agreement
`A.
`28.
`In May of 2007, Purdue Frederick Company, the parent company of Purdue
`Pharma L.P. (“Purdue”) pleaded guilty to charges for misleading regulators, doctors, and the
`public regarding Purdue's opioid OxyContin. In pleading guilty, Purdue admitted to falsely
`marketing OxyContin as a less addictive, safer alternative to other pain medications.
`In the global settlement resolution, Purdue and its parent company paid over $600
`29.
`million and entered into a Corporate Integrity Agreement with the U.S. Department of Health and
`Human Services Office of Inspector General.
`Under the Corporate Integrity Agreement, for five years, Purdue was required to
`30.
`refrain from making any deceptive or misleading claims about OxyContin and was obligated to
`submit regular compliance reports regarding its sales and marketing practices. Purdue was also
`required to monitor, report, and attempt to prevent inappropriate prescribing practices.
`B. McKinsey's Role Following the Corporate Integrity Agreement
`The Sacklers seek to divert money to themselves.
`1.
`The Sackler family is among the richest families in the United States. Members of
`31.
`the Sackler family have controlled Purdue at all times relevant to this complaint.
`Following the guilty plea, the Sacklers sought to insulate themselves from the risk
`32.
`they perceived in Purdue. Email threads between the Sacklers in early 2008 indicate that the
`Sacklers had become concerned about personal liability regarding opioid-related misconduct.
`The Sacklers considered selling Purdue or merging with another pharmaceutical
`33.
`company as an option for limiting their risk. Mortimer Sackler Jr. advocated for a sale or merger
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`in a February 21, 2008 email to Dr. Richard Sackler (a former president and co-chairman of
`Purdue) and several others, writing “[t]he pharmaceutical industry has become far too volatile
`and risky for a family to hold 95% of its wealth in. It simply is not prudent for us to stay in the
`business given the future risks we are sure to face and the impact they will have on the shareholder
`value of the business and hence the family's wealth.” The risk he referred to was, at least in
`significant part, further liability related to misconduct in the marketing and sale of OxyContin.
`Alternatively, the Sacklers considered extracting as much wealth as possible from
`34.
`Purdue through distributions to themselves as shareholders. Such distributions would allow the
`Sacklers to diversify their assets and make their wealth less vulnerable to judgments regarding
`Purdue’s sales and marketing of opioids, including OxyContin.
`Either option -- a sale or significant distributions to shareholders -- would require
`35.
`Purdue to increase profitability in the short term. Purdue turned to McKinsey, with which it had
`an existing business relationship, for help maximizing sales of OxyContin given the requirements
`of the Corporate Integrity Agreement and the scrutiny that came along with it.
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`2.
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`McKinsey supplied Purdue with Granular Sales and Marketing
`Strategies and Remained Intimately Involved in Implementation
`36. McKinsey touts its model of engaging in transformational partnerships with its
`clients. Rather than giving one-off advice, McKinsey learns each client's business intimately and
`provides tailored, granular strategies.
`37. McKinsey had begun collaborating with Purdue by June 2009. McKinsey was
`tasked with increasing OxyContin sales despite the Corporate Integrity Agreement, which
`required, among other things, that Purdue comport with FDA requirements and also included
`increased review and reporting obligations.
`38. McKinsey provided sales and marketing strategies designed to sell as much
`OxyContin as possible, at one point in 2010 telling Purdue that the new strategies McKinsey had
`developed could generate as much as $400 million in additional annual sales. McKinsey worked
`with Purdue to implement the strategies, with McKinsey’s ongoing and extensive involvement.
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`OxyContin sales grew dramatically, and the Sacklers diverted the resulting profits
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`into other holdings.
`In a 2009 report, among other sales strategies, McKinsey advised Purdue sales
`40.
`representatives to push the highest dosages of OxyContin, which were the most profitable for
`Purdue. In order to maximize dosages and improve targeting of the coordinated marketing
`strategy, McKinsey investigated the prescribing habits of individual physicians.
`41. McKinsey helped shape Purdue's OxyContin marketing, which misleadingly
`centered on freedom and peace of mind for users. The marketing was tailored to avoid running
`directly afoul of the Corporate Integrity Agreement, but it remained misleading given what
`Purdue and McKinsey knew about opioids. One advertisement said, “we sell hope in a bottle,”
`despite the fact that both McKinsey and Purdue already understood the addiction problems
`associated with opioid use and abuse. McKinsey encouraged Purdue to tell doctors that
`OxyContin would give their patients “the best possible chance to live a full and active life.”
`42. McKinsey urged Purdue to train and incentivize its sales representatives to
`increase sales across the market for opioids, even if sales went to Purdue's competitors. This was
`intended to serve the Sackler family's goal of increasing the marketability of Purdue for potential
`mergers, but it had the effect of worsening the opioid crisis even beyond the portion of the crisis
`directly attributable to sales and use of OxyContin.
`Project Turbocharge
`C.
`43.
`The Corporate Integrity Agreement expired in 2012. With this restriction lifted,
`McKinsey devised additional marketing and sales strategies for Purdue to further increase
`OxyContin sales.
`In the second half of 2013, McKinsey made recommendations to Purdue to
`44.
`increase OxyContin revenue, including “Turbocharging Purdue's Sales Engine.”
`45. McKinsey's “Project Turbocharge” recommendations included revising the
`existing process for targeting high-prescribing physicians, with a shift from targeting solely on
`the basis of prescription deciles to considering additional factors. Based on its analysis, McKinsey
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`told Purdue that “[t]here is significant opportunity to slow the decline of OxyContin by calling
`on more high-value physicians” and that “[t]he revenue upside from sales re-targeting and
`adherence could be up to $250 million.”
`Also as part of the “Project Turbocharge” recommendations, McKinsey
`46.
`determined and advised Purdue that the top half of prescribing physicians “write on average 25
`times more scripts per prescriber” than the lower half. McKinsey was behind the “hyper-
`targeting” of high volume prescribing doctors and “pain clinics” many of which later became
`known as “pill mills.”
`Despite knowing that then-recently-expired Corporate Integrity Agreement
`47.
`required Purdue to refrain from improperly incentivizing OxyContin sales, McKinsey also
`recommended increasing incentive compensation for incremental OxyContin prescriptions,
`advising Purdue that “[r]evision to incentive comp could better align reps to Purdue's economics.”
`The McKinsey plan was to give persons in the sales chain a stake in “bonus” compensation based
`upon the volume of pills prescribed in that sales chain.
`To further turbo charge the opioid pill market, McKinsey recommended
`48.
`decreasing training by six days a year in order to allow employees more time to make sales calls.
`Meanwhile, McKinsey advised Purdue to exercise closer control over its sales staff in order to
`generate more efficient physician targeting.
`Physician targeting paid off. McKinsey advised Purdue that visiting high-
`49.
`prescribing doctors many times per year increased sales, that a “high touch” of “hyper targeted”
`doctors would pay off in profits.
`Armed with knowledge of how opiate pills were being tracked by governments,
`50.
`McKinsey recommended that Purdue circumvent pharmacies entirely with a mail order program
`because enforcement by federal regulators was decreasing OxyContin dispensing through
`Walgreens.
`level, McKinsey urged
`the board
`At
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`“revenue growth goal” on management.
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`52. With McKinsey’s ongoing involvement and advice, Purdue implemented
`McKinsey's recommendations discussed above, but rebranded the program from Project
`Turbocharge to Evolve to Excellence.
`53. McKinsey's efforts had the effect the Sacklers had asked McKinsey to achieve.
`Sales of OxyContin tripled in the years following the 2007 guilty plea, despite the restrictions
`imposed by the Corporate Integrity Agreement. According to the U.S. Department of Justice,
`“[f]rom 2010 to 2018, Purdue's profits were almost entirely driven by its success in selling
`OxyContin.”
`The Sacklers did not sell Purdue or enter into a merger, but their goal of extracting
`54.
`wealth from the business was realized. The Sackler family has withdrawn over $10 billion from
`Purdue since 2008, including $1.7 billion in 2009 alone. These distributions were made possible
`by McKinsey's services and came at the expense of a deepening national opioid crisis.
`
`D. McKinsey knew about dangers of opioids and acted to maximize OxyContin
`prescriptions anyway
`55. McKinsey has a long history of consulting in the pharmaceutical industry. In
`addition to its work with Purdue, McKinsey has performed “opioid-related work” for Johnson &
`Johnson, Endo International, and Mallinckrodt Pharmaceuticals. McKinsey’s sales efforts for
`these companies were tragically similar to the Purdue “TURBO CHARGE.” For instance, a
`McKinsey presentation prepared for Johnson & Johnson recommended that Johnson & Johnson
`aggressively target and influence doctors treating back pain in order to increase opioid sales.
`Purdue’s 2007 guilty plea put McKinsey on notice of Purdue’s misconduct. By
`56.
`that time, McKinsey had access to public information indicating that OxyContin and other opioids
`pose significant risk of addiction and misuse.
`57. McKinsey's presentations to Purdue in 2013 included extensive discussion of
`doctors' concerns about opioid misuse and side effects, demonstrating McKinsey's awareness of
`the dangers of opioids. Rather than working to limit these disastrous effects, McKinsey treated
`doctors' misgivings as obstacles to confront with new messaging.
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`58. McKinsey continued working with Purdue long after the severity of the opioid
`crisis was well known. In 2017, McKinsey proposed that Purdue pay CVS and other distributors
`of OxyContin rebates “for every OxyContin overdose attributable to pills they sold.”
`A former McKinsey consultant described McKinsey's work with Purdue as “the
`59.
`banality of evil, M.B.A. edition...They knew what was going on. And they found a way to look
`past it, through it, around it, so as to answer the only questions they cared about: how to make the
`client money, and when the walls closed in, how to protect themselves.”
`In a 2018 email thread, apparently fearing consequences for McKinsey's work with
`60.
`Purdue, two McKinsey senior partners who had participated in McKinsey’s work advising Purdue
`discussed deleting documents related to opioids.
`Purdue's 2020 Guilty Plea and McKinsey's Recent Statement
`E.
`61.
`In October of 2020, Purdue once again reached an agreement (the “2020
`Settlement Agreement”) with the U.S. Department of Justice to enter a guilty plea related to its
`marketing of OxyContin. The agreement includes $8.3 billion in penalties from Purdue and $225
`million from the Sackler family.
`In the 2020 Settlement Agreement, Purdue pleaded guilty to defrauding health
`62.
`agencies, violating anti-kickback laws, paying illegal kickbacks to doctors, and “using aggressive
`marketing tactics to convince doctors to unnecessarily prescribe opioids--frivolous prescriptions
`that experts say helped fuel a drug addiction crisis that has ravaged America for decades.”
`The 2020 Settlement Agreement was entered by Purdue and the United States
`63.
`government. It explicitly states that it does not release Purdue of “[a]ny liability for claims of the
`states or Indian tribes.”
`The 2020 Settlement Agreement includes a provision specifically reserving claims
`64.
`regarding “[a]ny liability of entities other than the [Purdue Bankruptcy] Debtors, including
`consultants.”
`On December 5, 2020, McKinsey issued the following statement regarding its
`65.
`work with Purdue:
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`Case 3:22-cv-04670-CRB Document 1 Filed 08/15/22 Page 13 of 42
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`December 5, 2020—As we look back at our client service during the
`opioid crisis, we recognize that we did not adequately acknowledge the
`epidemic unfolding in our communities or the terrible impact of opioid
`misuse and addiction on millions of families across the country. That is
`why last year we stopped doing any work on opioid-specific business,
`anywhere in the world.
`
`Our work with Purdue was designed to support the legal prescription
`and use of opioids for patients with legitimate medical needs, and any
`suggestion that our work sought to increase overdoses or misuse and
`worsen a public health crisis is wrong. That said, we recognize that we
`have a responsibility to take into account the broader context and
`implications of the work that we do. Our work for Purdue fell short of
`that standard.
`
`We have been undertaking a full review of the work in question,
`including into the 2018 email exchange which referenced potential
`deletion of documents. We continue to cooperate fully with the
`authorities investigating these matters.
`
`In recent weeks, McKinsey has settled opioid-related claims with 49 states, the
`66.
`District of Columbia, and five U.S. territories. McKinsey complete rebuffed Native Americans
`and Indian tribes.
`67. McKinsey took further action recently by firing its CEO who had agreed to the 49-
`state settlement, with the indication that the CEO had made a mistake in confessing the
`wrongdoing of McKinsey.
`
`F.
`
`Impact of Opioid Abuse, Addiction and Diversion on American Indians and
`Alaska Natives
`There are 574 federally recognized Tribes in the United States, located within the
`68.
`borders of 35 states. They are diverse in terms of their size, geography, culture, and resources,
`but they share a status as sovereign governments responsible for the health and well-being of their
`citizens.
`Native Americans have disproportionately borne the toll of the opioid crisis.
`69.
`Native Americans suffer the highest per capita rate of opioid overdoses.
`70.
`According to the Indian Health Service (“IHS”), there has been a “four-fold
`71.
`increase in opioid overdoses from 1999 to 2013 among American Indians and Alaska Natives . . .
`[T]wice the rate of the general U.S. population.”
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`The CDC reported that the “rates of death from prescription opioid overdose
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`among American Indian or Alaska Natives increased almost four-fold from 1.3 per 100,000 in
`1999 to 5.1 per 100,000 in 2013.” By 2014, the CDC reported “8.4 per 100,000 Native Americans
`were dying of opioid overdoses, the highest number of any racial demographic.”
`In 2014, Native Americans had the highest death rate from opioid overdoses out
`73.
`of any ethnic group in the country.
`The impact on Native American children is particularly devastating. In a study
`74.
`conducted to examine substance-related disorders among adolescents across racial and ethnic
`groups, “Racial/Ethnic Variations in Substance-Related Disorders Among Adolescents in the
`United States,” the authors found, of 72,561 adolescents aged 12 to 17 years:
`
`a.
`
`b.
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`c.
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`d.
`75.
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`Analgesic opioids were the second most commonly used illegal drug after
`marijuana;
`Analgesic opioid use was comparatively prevalent among Native American
`adolescents (9.7%);
`Native Americans have the highest prevalence of use (47.5%) and disorders
`(15.0%); and
`31.5% of Native Americans had substance-related disorders.
`The study concluded:
`Native Americans have the highest prevalence of substance use and
`substance-related disorders, adding to evidence that young Native
`Americans are a vulnerable group facing numerous stressors, trauma,
`and health disparities (e.g., highest rate of suicide, underfunded systems
`of care, and lack of access to appropriate care). The results herein
`highlight a critical need for intervention to reduce their burdens from
`substance use and for policies to address presently underfunded systems
`of care and improve infrastructures linking behavioral and primary
`health care services. [footnotes omitted.]
`The CDC reported that approximately 1 in 10 Native American youths ages 12 or
`76.
`older used prescription opioids for nonmedical purposes in 2012, double the rate for white youth.
`The fact that adolescents are able to easily obtain prescription opioids through the
`77.
`black market created by opioid diversion highlights the direct impact on Plaintiff and its
`community by Purdue and McKinsey’s actions and inactions.
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`COMPLAINT
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`Even the youngest members of tribal communities bear the consequences of the
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`opioid abuse epidemic fueled by McKinsey’s conduct working with Purdue and other
`manufacturers of opioids. Between 2009 and 2012, “American Indian women [were] 8