COURT SAE COLUMBIA OF RCOUVER REGISTRY S. 189395 AUG 29 2018 No : : Vancouver Registry In the Supreme’ ‘of British Columbia HER MAJESTY THE QUEEN IN RIGHT OF THE PROVINCE OF BRITISH COLUMBIA Between Plaintiff and APOTEX INC., APOTEX PHARMACEUTICAL HOLDINGS, INC., BRISTOL- MYERS SQUIBB CANADA, BRISTOL-MYERS SQUIBB COMPANY, PALADIN LABS, ENDO PHARMACEUTICALS INC., ENDO INTERNATIONAL PLC, JANSSEN INC., JOHNSON & JOHNSON, PHARMASCIENCE INC., JODDES LIMITED, PRO DOC LIMITEE, THE JEAN COUTU GROUP (PJC) INC., MYLAN PHARMACEUTICALS ULC, MYLAN N.V., PURDUE PHARMA INC., PURDUE PHARMA L.P., THE PURDUE FREDERICK COMPANY, PURDUE FREDERICK INC., RANBAXY PHARMACEUTICALS CANADA INC., SUN PHARMACEUTICAL INDUSTRIES LTD., HIKMA LABS INC., HIKMA. PHARMACEUTICALS PLC, WEST-WARD COLUMBUS INC., SANIS HEALTH INC., SANDOZ CANADA INC., SANDOZ INTERNATIONAL GMBH, TEVA CANADA LIMITED, TEVA PHARMACEUTICALS USA, INC., TEVA PHARMACEUTICAL INDUSTRIES LTD., ACTAVIS PHARMA COMPANY, VALEANT CANADA LP/ VALEANT CANADA S.E.C., BAUSCH HEALTH COMPANIES INC., GAMMA WHOLESALE DRUGS LIMITED, IMPERIAL DISTRIBUTORS CANADA INC., AMERISOURCEBERGEN CANADA CORPORATION, KOHL & FRISCH LIMITED, KOHL & FRISCH DISTRIBUTION INC., MCKESSON CORPORATION, MCKESSON CANADA CORPORATION, NU-QUEST DISTRIBUTION INC., ABBOTT LABORATORIES INC., UNITED PHARMACISTS MANITOBA INC., PROCURITY INC., PROCURITY PHARMACY SERVICES INC.,SHOPPERS DRUG MART INC., LOBLAW COMPANIES LIMITED, UNIPHARM WHOLESALE DRUGS LTD., and LPG INVENTORY SOLUTIONS Defendants Brought pursuant to the Class Proceedings Act, RSBC, 1996 c 50 NOTICE OF CIVIL CLAIM This action has been started by the plaintiff(s) for the relief set out in Part 2 below.If you intend to respond to this action, you or your lawyer must (a) __ file a response to civil claim in Form 2 in the above-named registry of this court within the time for response to civil claim described below, and (b) serve a copy of the filed response to civil claim on the plaintif. If you intend to make a counterclaim, you or your lawyer must (c) file a response to civil claim in Form 2 and a counterclaim in Form 3 in the above-named registry of this court within the time for response to civil claim described below, and (d) serve a copy of the filed response to civil claim and counterclaim on the plaintiff and on any new parties named in the counterclaim. JUDGMENT MAY BE PRONOUNCED AGAINST YOU IF YOU FAIL to file the response to civil claim within the time for response to civil claim described below. Time for response to civil claim A response to civil claim must be filed and served on the plaintif(s), (a) _ if you were served with the notice of civil claim anywhere in Canada, within 21 days after that service, (b) _ if you were served the notice of civil claim anywhere in the United States of America, within 35 days after that service, (c) if you were served with the notice of civil claim anywhere else, within 49 days after that service, or (d) ifthe time for response to civil claim has been set by order of the court, within that time. PART 1: STATEMENT OF FACTS. The Representative Plainti 1. The plaintiff is Her Majesty the Queen in Right of the Province of British Columbia. Through the Minister of Health, the Ministry of Health of the Province of British Columbia oversees British Columbia's health system. Through the Minister of-3- Health, the Ministry of Health has overall responsibility for ensuring that quality, appropriate, cost-effective and timely health services are available in British Columbia. In the course of the Minister of Health's mandate, the Ministry of Health supports and funds the activities of all regional health authorities and the Provincial Health Services Authority in British Columbia, including all public health programs and services, and funds and operates the provincially funded drug benefit plans in British Columbia. 2. Her Majesty the Queen in Right of the Province of British Columbia also oversees and funds all other ministries and agencies in the Province of British Columbia. 3. The plaintiff spends billions of dollars each year to fund healthcare services, including a provincial medical insurance plan, pharmaceutical care, drug benefit plans and other services to residents of British Columbia, including (but not limited to) medically necessary physician services, hospitalization, and other medical treatment costs for prevention as well as acute and chronic conditions. The amounts spent by the plaintiff to fund health services are in large part derived from taxpayer contributions. The Defendants 4, The Defendants manufacture, market, distribute, and sell Opioid Drugs or Opioid Products (individually or collectively, “Opioids") in Canada, including in British Columbia “Opioid Drugs” are a class of drugs that are defined by a chemical compound that is naturally found in the opium poppy plant or which are synthetically made using the same chemical structure, and include (but are not limited to) Butorphanol, Fentanyl, Hydrocodone, Hydromorphone, Meperidine, Methadone, Morphine, Normethadone, Opium, Oxycodone, Oxymorphone, Pentazocine, Tapentadol, and Tramadol. “Opioid Products” are products that contain any Opioid Drugs. A “controlled release” Opioid Product formulation is a system that delivers an agent at a controlled rate for an extended time. Different terms such as extended-release (ER, XR, XL), sustained- release (SR), time-release (TR), long-acting (LA), sustained-action (SA) and controlled delivery (CD) may also be used to describe a controlled release formulation.-4- 5. The Manufacturer Defendants (as defined below in paragraph 54) marketed and promoted Opioids in Canada as less addictive than was actually known to the Manufacturer Defendants and for conditions the Manufacturer Defendants knew the drugs were not effective in treating. Such marketing and promotion efforts by the Manufacturer Defendants resulted in an increase in prescription and use of all Opioids, including long and short-acting Opioids 6. The Distributor Defendants (as defined below in paragraph 76) delivered the Opioids manufactured and marketed by the Manufacturer Defendants to pharmacies and hospitals in Canada in quantities that they knew or should have known exceeded any legitimate market. Such distribution efforts by the Distributor Defendants intensified the crisis of Opioid abuse, addiction and death in Canada. Where a particular entity within a corporate family of Defendants engaged in unlawful conduct, it did so on behalf of all entities within that corporate family. 7. Various persons, partnerships, sole proprietors, firms, corporations and individuals not named as defendants in this lawsuit, the identities of which are presently unknown, have participated with the Defendants in the unlawful behaviour alleged in this Notice of Civil Claim, and have performed acts and made statements in furtherance of the unlawful conduct for which the Defendants are vicariously liable. Manufacturer Defendants The Apotex Defendants 8. Apotex Inc. is a Canadian company. During the Class Period (as defined below in paragraph 77), Apotex Inc. manufactured, marketed, and sold Opioids in Canada. 9. Apotex Pharmaceutical Holdings, Inc. is a Canadian company. During the Class Period, Apotex Pharmaceutical Holdings, Inc., directly or through its subsidiaries or affiliates, manufactured, marketed, and sold Opioids in Canada 10. The businesses of each of the Defendants Apotex Inc. and Apotex Pharmaceutical Holdings, Inc. (collectively, “Apotex’) are inextricably interwoven with“5 that of the other and each is the agent of the other for the purposes of the manufacture, marketing, and sale of Opioids in Canada. The Bristol-Myers Defendants 11. Bristol-Myers Squibb Canada is a Canadian company. During the Class Period, Bristol-Myers Squibb Canada manufactured, marketed and sold Opioids in Canada. 12. Bristol-Myers Squibb Company is an American company. During the Class Period, Bristol-Myers Squibb Company, directly or through its subsidiaries or affiliates, manufactured, marketed, and sold Opioids in Canada. 13, The businesses of each of the Defendants Bristo-Myers Squibb Canada and Bristol-Myers Squibb Company (collectively, “Bristol-Myers") are inextricably interwoven with that of the other and each is the agent of the other for the purposes of the manufacture, marketing, and sale of Opioids in Canada, The Endo Defendants 14. Paladin Labs is a Canadian company. It is affiliated with and/or controlled by Endo Pharmaceuticals Inc. (‘Endo USA") and Endo International PLC ("Endo International’). During the Class Period, Paladin Labs manufactured, marketed, and sold Opioids in Canada. 15. Endo USA is an American company. During the Class Period, Endo USA, directly or through its subsidiaries or affiliates, manufactured, marketed, and sold Opioids in Canada. 16. Endo International is an Irish company, with its principal place of business in Dublin, Ireland. Paladin Labs and Endo USA are subsidiaries of Endo International. During the Class Period, Endo International, directly or through its subsidiaries or affiliates, manufactured, marketed, and sold Opioids in Canada. 17. The businesses of each of the Defendants Paladin Labs, Endo USA and Endo International (collectively, “Endo”) are inextricably interwoven with that of the other and6- each is the agent of the other for the purposes of the manufacture, marketing, and sale of Opioids in Canada. The Janssen Defendants 18. Janssen Inc. (formerly known as Janssen-Ortho Inc.) is a Canadian company. During the Class Period, Janssen Inc. manufactured, marketed, and sold Opioids in Canada. 19. Johnson & Johnson is an American company. Janssen Inc. is a subsidiary of Johnson & Johnson. During the Class Period, Johnson & Johnson, directly or through its subsidiaries or affiliates, manufactured, marketed, and sold Opioids in Canada. 20. The businesses of each of the Defendants Janssen Inc. and Johnson & Johnson (collectively, “Janssen’) are inextricably interwoven with that of the other and each is the agent of the other for the purposes of the manufacture, marketing, and sale of Opioids in Canada. The Pharmascience Defendants 21. Pharmascience Inc. is a Canadian company. During the Class Period, Pharmascience Inc. manufactured, marketed, and sold Opioids in Canada. 22. — Joddes Limited is a Canadian company. Pharmascience Inc. is a subsidiary of Joddes. During the Class Period, Joddes Limited, directly or through its subsidiaries or affiliates, manufactured, marketed, and sold Opioids in Canada. 23. The businesses of each of the Defendants Pharmascience Inc. and Joddes Limited (collectively, “Pharmascience’) are inextricably interwoven with that of the other and each is the agent of the other for the purposes of the manufacture, marketing, and sale of Opioids in Canada. Pro Doc/ Jean Coutu 24. Pro Doc Limitee is a Canadian company. During the Class Period, Pro Doc Limitee manufactured, marketed, and sold Opioids in Canada.ie 25. The Jean Coutu Group (PJC) Inc. ("Jean Coutu’) is a Canadian company. Pro Doc Limitee is a subsidiary of Jean Coutu. During the Class Period, Jean Coutu, directly or through its subsidiaries or affiliates, manufactured, marketed, and sold Opioids in Canada. 26. The businesses of each of the Defendants Pro Doc Limitee and Jean Coutu are inextricably interwoven with that of the other and each is the agent of the other for the purposes of the manufacture, marketing, and sale of Opioids in Canada. The Mylan Defendants 27. Mylan Pharmaceuticals ULC is a Canadian company. During the Class Period, Mylan Pharmaceuticals ULC manufactured, marketed, and sold Opioids in Canada. 28. Mylan N,V. is a Dutch company. Mylan Pharmaceuticals Inc. is a subsidiary of Mylan N.V. During the Class Period, Mylan N.V., directly or through its subsidiaries or affiliates, manufactured, marketed, and sold Opioids in Canada. 29. The businesses of each of the Defendants Mylan Pharmaceuticals ULC and Mylan NV. (collectively, “Mylan") are inextricably interwoven with that of the other and each is the agent of the other for the purposes of the manufacture, marketing, and sale of Opioids in Canada. The Purdue Defendants 30. Purdue Pharma Inc. is a Canadian company. During the Class Period, Purdue Pharma Inc. manufactured, marketed, and sold Opioids in Canada. 31. Purdue Pharma L.P. is an American company. During the Class Period, Purdue Pharma L.P. directly or through its subsidiaries or affiliates, manufactured, marketed, and sold Opioids in Canada. 32. The Purdue Frederick Company is an American company. It is a signatory to a plea agreement in the United States District Court for the Wester District of Virginia in which it admitted to the felony of misbranding the Opioid Product OxyContin with the intent to defraud or mislead.oe 33. Purdue Frederick Inc. is a Canadian company. During the Class Period, Purdue Frederick Inc., directly or through its subsidiaries or affiliates, manufactured, marketed, and sold Opioids in Canada. 34, The businesses of each of the Defendants Purdue Pharma Inc., Purdue Pharma L.P., Purdue Frederick Company and Purdue Frederick Inc. (collectively, “Purdue”) are inextricably interwoven with that of the other and each is the agent of the other for the purposes of the manufacture, marketing, and sale of Opioids in Canada. The Ranbaxy Defendants 35. — Ranbaxy Pharmaceuticals Canada Inc. is a Canadian company. During the Class Period, Ranbaxy Pharmaceuticals Canada Inc. manufactured, marketed, and sold Opioids in Canada. 36. Sun Pharmaceutical Industries Ltd. ("Sun") is an Indian company. Ranbaxy Pharmaceuticals Canada Inc. is a subsidiary of Sun. During the Class Period, Sun, directly or through its subsidiaries or affiliates, manufactured, marketed, and sold Opioids in Canada. 37. The businesses of each of the Defendants Ranbaxy Pharmaceuticals Canada Inc. and Sun (collectively, "Ranbaxy’) are inextricably interwoven with that of the other and each is the agent of the other for the purposes of the manufacture, marketing, and sale of Opioids in Canada. The Roxane Defendants 38. — Hikma Labs Inc. (formerly known as Roxane Laboratories Inc.) is an American company. During the Class Period, Hikma Labs Inc. directly or through its subsidiaries or affiliates, manufactured, marketed, and sold Opioids in Canada. 39, West-Ward Columbus Inc. (formerly known as Boehringer Ingelheim Roxane Inc.) is an American Company. During the Class Period, West-Ward Columbus Inc., directly or through its subsidiaries or affiliates, manufactured, marketed, and sold Opioids in Canada.-9- 40, Hikma Pharmaceuticals PLC is a Jordanian company. During the Class Period, Hikma Pharmaceuticals PLC, directly or through its subsidiaries or affiliates, manufactured, marketed, and sold Opioids in Canada. 41. The businesses of each of the Defendants Hikma Labs Inc., West-Ward Columbus Inc. and Hikma Pharmaceuticals PLC (collectively, “Roxane") are inextricably interwoven with that of the other and each is the agent of the other for the purposes of the manufacture, marketing, and sale of Opioids in Canada. Sanis 42, Sanis Health Inc. (“Sanis") is a Canadian company. During the Class Period, Sanis manufactured, marketed, and sold Opioids in Canada. The Sandoz Defendants 43. Sandoz Canada Inc. is a Canadian company. During the Class Period, Sandoz Canada Inc. manufactured, marketed, and sold Opioids in Canada. 44, Sandoz International GmbH is a German company. Sandoz Canada Inc. is a subsidiary of Sandoz International GmbH. During the Class Period, Sandoz International GmbH, directly or through its subsidiaries or affiliates, manufactured, marketed, and sold Opioids in Canada. 45. The businesses of each of the Defendants Sandoz Canada Inc. and Sandoz International GmbH (collectively, “Sandoz”) are inextricably interwoven with that of the other and each is the agent of the other for the purposes of the manufacture, marketing, and sale of Opioids in Canada. The Teva Defendants 46. Teva Canada Limited is a Canadian company. During the Class Period, Teva Canada Limited manufactured, marketed, and sold Opioids in Canada.-10- 47. Actavis Pharma Company (formerly Cobalt Pharmaceutical Company) is a Canadian company. During the Class Period, Actavis Pharma Company manufactured, marketed, and sold Opioids in Canada. 48. Teva Pharmaceuticals USA, Inc., (“Teva USA”) is an American company. During the Class Period, Teva USA, directly or through its subsidiaries or affiliates, manufactured, marketed, and sold Opioids in Canada. 49. Teva Pharmaceutical Industries Ltd. ("Teva Pharmaceutical’) is an Israeli company. Teva Canada Limited, Actavis Pharma Company and Teva USA are subsidiaries of Teva Pharmaceutical. During the Class Period, Teva Pharmaceutical, directly or through its subsidiaries or affiliates, manufactured, marketed, and sold Opioids in Canada 50. The businesses of each of the Defendants Teva Canada Limited, Actavis Pharma Company, Teva USA and Teva Pharmaceutical (collectively, “Teva") are inextricably interwoven with that of the other and each is the agent of the other for the purposes of the manufacture, marketing, and sale of Opioids in Canada. The Valeant Defendants 51. Valeant Canada LP/ Valeant Canada S.E.C. ("Valeant Canada’) is a Canadian company. During the Class Period, Valeant Canada manufactured, marketed, and sold Opioids in Canada. 52. Bausch Health Companies Inc. ("Bausch") is a Canadian company. Valeant Canada is a division of Bausch. During the Class Period, Bausch directly or through its subsidiaries or affiliates, manufactured, marketed, and sold Opioids in Canada. 53. The businesses of each of the Defendants Valeant Canada and Bausch (collectively, “Valeant’) are inextricably interwoven with that of the other and each is the agent of the other for the purposes of the manufacture, marketing, and sale of Opioids in Canada.Ate 54. Apotex, Bristol-Myers, Endo, Janssen, Pharmascience, Pro Doc, Jean Coutu, Mylan, Purdue, Ranbaxy, Roxane, Sanis, Sandoz, Teva, and Valeant (collectively, the “Manufacturer Defendants") do now or have at some point in time during the Class Period manufactured, marketed and sold in Canada prescription pain medications that contained the Opioid Drugs oxycodone, fentanyl, morphine, or hydromorphone. These Opioid Products include brand-name drugs such as OxyContin, OxyNeo, and Percocet, as well as their generic counterparts Distributor Defendants Gamma 55. The Defendant, Gamma Wholesale Drugs Limited (‘Gamma’), is a Canadian company. During the Class Period, Gamma distributed Opioids to pharmacies, hospitals and other dispensaries across Canada. Imperial Distributors 56. The Defendant, Imperial Distributors Canada Inc. (“Imperial Distributors"), is @ Canadian company. During the Class Period, Imperial Distributors distributed Opioids to pharmacies, hospitals and other dispensaries across Canada. The Kohl & Frisch Defendants 57. The Defendant, Kohl & Frisch Limited, is a Canadian company. During the Class Period, Koh! & Frisch Limited distributed Opioids to pharmacies, hospitals and other dispensaries across Canada. 58. Onor about March 28, 2013, Kohl & Frisch Limited acquired AmerisourceBergen Canada Corporation (“Amerisource”). During the Class Period, Amerisource distributed Opioids to pharmacies, hospitals and other dispensaries across Canada. 59. The Defendant, Kohl & Frisch Distribution Inc., is a Canadian company. During the Class Period, Kohl & Frisch Distribution Inc. distributed Opioids to pharmacies, hospitals and other dispensaries across Canada.eis 60. The businesses of each of the Defendants Kohl & Frisch Limited, Amerisource, and Kohl & Frisch Distribution Inc.(collectively “Kohl & Frisch”), are inextricably interwoven with that of the other and each is the agent of the other for the purposes of the distribution of Opioids in Canada. The McKesson Defendants 61. The Defendant, McKesson Canada Corporation, is a Canadian company. During the Class Period, McKesson Canada Corporation distributed Opioids to pharmacies, hospitals and other dispensaries across Canada. 62. The Defendant, McKesson Corporation, is an American company. McKesson Canada is a subsidiary of McKesson Corporation. During the Class Period, McKesson Corporation, directly or through its subsidiaries or affiliates, distributed Opioids to pharmacies, hospitals and other dispensaries across Canada. 63. The businesses of each of the Defendants McKesson Canada Corporation and McKesson Corporation (collectively, "McKesson’) are inextricably interwoven with that of the other and each is the agent of the other for the purposes of the distribution of Opioids in Canada. Jean Coutu 64, During the Class Period, Jean Coutu (as defined above in paragraph 25) distributed Opioids to pharmacies, hospitals and other dispensaries across Canada Nu-Quest 65. The Defendant, Nu-Quest Distribution Inc. ("Nu-Quest’), is a Canadian company. During the Class Period, Nu-Quest distributed Opioids to pharmacies, hospitals and other dispensaries across Canada. Abbott 66. The Defendant, Abbott Laboratories Inc. ("Abbott") is an American Company, with Canadian Offices in Ontario and Quebec. During the Class Period, Abbott distributed Opioids to pharmacies, hospitals and other dispensaries across Canada.13> The Procurity Defendants 67. The Defendant, Procurity Inc. is a Canadian Company. During the Class Period, Procurity Inc. distributed Opioids to pharmacies, hospitals and other dispensaries across Canada. 68. _Procurity Inc. was formerly known as United Pharmacists Manitoba, Ltd. In 2003, it became Procurity Pharmacy Services, Inc. 69. During the Class Period, Procurity Pharmacy Services, Inc. and United Pharmacists Manitoba, Ltd. directly or through their subsidiaries or affiliates, distributed Opioids to pharmacies, hospitals and other dispensaries across Canada. 70. The businesses of each of the Defendants Procurity Inc., Procurity Pharmacy Services, Inc., and United Pharmacists Manitoba, Ltd. (collectively, “Procurity”) are inextricably interwoven with that of the other and each is the agent of the other for the purposes of the manufacture, marketing, and sale of Opioids in Canada. uniPHARM 71. The Defendant, uniPHARM Wholesale Drugs Ltd. (“uniPHARM") is a Canadian Company. During the Class Period, uniPHARM distributed Opioids to pharmacies, hospitals and other dispensaries across Canada LPG 72. The Defendant, LPG Inventory Solutions (‘LPG’) is a Canadian Company. During the Class Period, LPG distributed Opioids to pharmacies, hospitals and other dispensaries across Canada The Shoppers Drug Mart Defendants 73. The Defendant, Shoppers Drug Mart Inc., is a Canadian company. During the Class Period, Shoppers Drug Mart Inc. distributed Opioids to pharmacies, hospitals and other dispensaries across Canada.14 74, The Defendant, Loblaw Companies Limited (‘Loblaws’), is a Canadian company. ‘Shoppers Drug Mart Inc. is a subsidiary of Loblaws. During the Class Period, Loblaws directly or through its subsidiaries or affiliates, distributed Opioids to pharmacies, hospitals and other dispensaries across Canada. 75. The businesses of each of the Defendants Shoppers Drug Mart Inc. and Loblaws (collectively, “Shoppers Drug Mart’) are inextricably interwoven with that of the other and each is the agent of the other for the purposes of the distribution of Opioids in Canada. 76. The Defendants, Gamma, Imperial Distributors, Kohl & Frisch, McKesson, Jean Coutu, Nu-Quest, Abbott, Procurity, uniPHARM, LPG and Shoppers Drug Mart (collectively, the “Distributor Defendants’, together with the Manufacturer Defendants, the “Defendants") do now distribute or have at some point in time during the Class Period distributed Opioids to pharmacies, hospitals and other dispensaries across Canada. The Classes and the Class Period 77. This action is brought on behalf of members of a class consisting of the plaintiff and all federal, provincial and territorial governments and agencies (collectively, the “Class Members’) that, during the period from 1996 to the present (the “Class Period”), paid healthcare, pharmaceutical and treatment costs related to Opioids. 78. The Class Period began in 1996, when Purdue first introduced and began to market OxyContin in Canada, as further described below. The plaintiff asserts that the Class Period definition for the purpose of this proposed class proceeding is 1996 to present day. The Opioid Epidemic Introduction 79. Prescription Opioids are powerful narcotics that work by binding to receptors on the spinal cord and in the brain, lessening the perception of pain, In addition to pain controlling effects, Opioids can also induce an addictive, euphoric high-15- 80. With continued use, patients grow tolerant to Opioids and require progressively higher doses over time. This increases the risks of withdrawal, addiction and overdose. At higher doses, Opioids can slow a user's breathing, causing potentially fatal respiratory depression. Patients who delay or discontinue long-term Opioid use often experience extended withdrawal symptoms including nausea, muscle pain, depression, anxiety, diarrhea, vomiting, restlessness, and chills. 81. Until the mid-1990s, prescription Opioids were not widely used because they were thought to be too addictive to treat chronic pain conditions which would require long-term use of such drugs. Opioids were prescribed primarily for use in treatment of palliative conditions or for short-term acute pain, which required brief use. 82. In 1996, Purdue introduced a time-release formulation of the Opioid Drug oxycodone, branded as the Opioid Product OxyContin in Canada. The OxyContin formulation slowly releases oxycodone, which means patients can take the drug less often. As Purdue developed OxyContin, it sought to encourage the long-term use of Opioids for widespread chronic conditions, like back pain, migraines and arthritis in order to expand its market and profits. 83. As described in greater detail below, Purdue and the other Manufacturer Defendants subsequently developed and promoted a narrative that pain was undertreated and should be made a higher priority by healthcare practitioners. At the same time, the Manufacturer Defendants began vigorously marketing long-acting Opioids as less addictive, less subject to abuse and diversion and less likely to cause tolerance and withdrawal than other pain medications. The Manufacturer Defendants promoted these Opioids as safe, effective and appropriate for long-term use for routine pain conditions. 84. For example, a 1996 Purdue press release on OxyContin stated that the “fear of addiction is greatly exaggerated” and “largely unfounded” and “there is very litle risk of addiction.”" "The Los Angeles Times, “OxyContin Press Release, 1996,” The Los Angeles Times (5 May, 2016) online: The Los Angeles Times ,Age 85. _ By 1998, certain medical professionals were ringing alarm bells over concerns of prescription Opioid Products on the black market.” While the Manufacturer Defendants were arguing that controlled-release Opioids were less desirable as drugs of abuse than immediate-release Opioids, reports of the high street price of controlled-release Opioids clearly indicated that these drugs were coveted on the street. Findings also confirmed anecdotal observations that legally obtained Opioids were being illegally sold on the streets of Vancouver. 86. The marketing efforts of the Manufacturer Defendants targeted family physicians who were the most likely to see patients with chronic pain conditions and least likely to have the training necessary to be in a position to verify the Manufacturer Defendants’ marketing representations about the safety and effectiveness of Opioids. 87. Specifically, in the late 1990s and early 2000s, pharmaceutical companies, including the Manufacturer Defendants, spent hundreds of millions of dollars to “educate” doctors on the use of Opioids for treating chronic pain over the long term and stated that the risk of addiction was less than one percent. Purdue, the company behind OxyContin, had a yearly promotional budget of $14 million in Canada for its Opioid Products.° In 2016, Purdue gave Canadian doctors more than $2 million as part of marketing efforts — double the amount per capita that the drug company gave to prescribers in the US.* 88. The Manufacturer Defendants’ marketing campaigns also targeted students training to enter the medical profession. For example, a speaker funded by Purdue was an instructor in the University of Toronto's inter-faculty pain curriculum course. For years, medical students received free copies of a pain management textbook paid for and copyrighted by Purdue. By 2007, companies selling Opioids had given more than ? Brian Goldman, MD, “The News on the Street: Prescription Drugs on the Black Market” (1998) 195:2 Can Med Assoc J at 149, online: (http://www.cmaj.ca/content/cmaj/159/2/149 full. pdf). * The Council of Canadians, A Prescription for Better Medicine: Why Canadians need a national pharmacare program (18 October 206), online: The Counel of Canadians ‘. * Jesse McLean, “Why did the maker of OxyContin pay Canadian doctors nearly three-and-a-half times more money per capita than it doled out to U.S. Preseribers?" The Star (3 May 2018) online: The Star -.ae $500,000 in funding to the University of Toronto. Course material in medical programs contained information aligned with the interests of the Manufacturer Defendants by minimizing Opioid related harms relative to those of other analgesics, overstating the evidence of their effectiveness.® 89. Further, inaccuracies and false claims were disseminated in print advertisements in medical journals, such as the Canadian Medical Association Journal, which is mailed to almost every physician in Canada.° 90. The aggressive marketing efforts of the Manufacturer Defendants were incredibly successful. By the mid-2000s, the attitudes of healthcare professionals toward prescribing Opioids had changed and there was a dramatic increase in prescriptions of both long-acting and short-acting Opioids in Canada, including for treatment of chronic pain. 91. As a result of the Defendants’ conduct, Canadians have become addicted to Opioids. More than 20,000 Canadians are estimated to have died of Opioid overdoses in the past two decades. These numbers continue to climb. In 2017, at least 3,987 Canadians died of apparent Opioid-related deaths, according to the Government of Canada.’ This represents a 34% increase in apparent Opioid-related deaths, up from 2,978 in 2016. The highest percentage of accidental apparent Opioid-related deaths occurred among individuals between the ages of 30 and 39 years. 92. Of the 3,987 Canadians who died of an apparent Opioid overdose in 2017, 1,399 were British Columbia residents. British Columbia has the highest rate of apparent ® Sheryl Ubelacker, “Pain course revised over concems about drug company influence,” The Globe and Mail (December 23, 2010, updated April 28, 2018) online: The Globe and Mail . See also The Council of Canadians, A Prescription for Better Medicine: Why Canadians need a national pharmacare program (18 October 2016), online: The Council ¢9f Canadians © Canada, Parliament, House of Commons, Standing Committee on Health, Minutes of Proceedings and Evidence, 41st Parl, 2nd Sess, No 14 (February 13, 2014) online: . Public Health Agency of Canada, National Report: Apparent opioid-related deaths in Canada (January 2016 to December 2017) (2017) online: Government of Canada .-18- Opioid related deaths of any province in Canada, at a rate of 20.5 per 100,000 population in 2016, and 29 per 100,000 population in 2017. 93. In 2017, Opioid poisonings resulted in more than 17 hospitalizations per day in Canada.° British Columbia has the highest provincial age-adjusted rate of hospitalization due to Opioid poisoning, at a rate of 29.3 per 100,000 population."° This represents an increase of 5.1 hospitalizations in British Columbia since 2016. 94. Between 2007-2008 and 2016-2017, the rate of hospitalizations due to Opioid poisoning increased 53%, with more than 40% of the increase occurring over the past 3 years." 95. Comprehensive data on emergency department visits, available for Ontario and Alberta, indicate a substantial increase in visits due to Opioid poisoning. In the year 2010-2011, emergency department visits for Opioid poisoning occurred at a rate of 14.2 and 17.8 per 100,000 population in Ontario and Alberta, respectively. In the year 2014- 2015 these rates increased to a rate of 17.4 and 27.3 per 100,000 population, respectively."? 96. Between 2000 and 2012, there has been a five-fold increase in the prevalence of neonatal abstinence syndrome ("NAS") in Canada and other western countries. NAS affects infants who were exposed to Opioids in utero, causing physical dependence on ® Government of Canada, National report: Apparent opioid-related deaths in Canada (released June 2018) . * According to the Canadian Institute for Health Information, in 2017 the number was 17 Canadians per day, with British Columbia accounting for 29.3, behind the Northwest Territories (33.7) and Yukon Territory (31.8). “Canadian Institute for Health Information, Canadian Centre on Substance Abuse, Hospitalizations and: Emergency Department Visits Due to Opioid Poisoning in Canada (2016) online: Canadian Institute for Health Information . Canadian Institute for Health Information, Opioid-Related Harms in Canada (2017) online: Canadian Institute for Health Information "* Canadian Centre on Substance Use and Addiction, Canadian Drug Summary, Prescription Opioids (September 2017) online: Canadian Centre on Substance Use and Addiction ; see also Canadian Institute for Health Information, Canadian Centre on Substance Abuse, Hospitalizations and Emergency Department Visits Due to Opioid Poisoning in Canada (2016) online: Canadian Institute for Health Information .ia Opioids, and often leads to withdrawal symptoms after birth. One article, citing numbers provided by the Canadian Institute for Health Information, reported 1,744 hospitalizations for NAS in 2015-2016, a 20% increase from 2012-2013."* 97. Overall costs of Opioid use include healthcare costs, low productivity costs, criminal justice costs, and other direct costs. 98. Canada’s Chief Public Health Officer has called the state of Opioid addiction a “major public health crisis"."* 99. The Defendants have created or assisted in the creation of an epidemic of addiction in British Columbia and throughout each and every province and territory. The actions of the Defendants have caused deaths and serious and long-lasting injury to public peace, health, order and safety, significantly harming the plaintiff and impacting its ability to deliver health care to the citizens of British Columbia The Aggressive and Successful Marketing Efforts of the Manufacturer Defendants 100. Opioids had historically been primarily used for treatment of terminal cancer patients. In order to broaden the market for Opioid prescriptions, the Manufacturer Defendants spent hundreds of millions of dollars on promotional activities and materials that denied or downplayed the risk of addiction and overstated benefits of Opioid use. The Manufacturer Defendants created marketing and educational materials that appeared to contain credible scientific evidence. These materials were regularly distributed to healthcare professionals to promote and nurture a narrative that Opioids should be much more widely used. 101. Paid advertisements were placed in medical journals, such as the Canadian Medical Association Journal, by the Manufacturer Defendants. These advertisements ° Canadian Centre on Substance Use and Addiction, Canadian Drug Summary, Prescription Opioids (September 2017) online: Canadian Centre on Substance Use and Addiction ‘. ™ Canadian Institute for Health Information: Opioid crisis having “significant” impact on Canada’s health care system (June 2018) online: ,-20- marketed Opioids as a safer alternative to other pain medications and appropriate for anyone who needed long-term pain relief. 102. For example, an advertisement for the Opioid Product OxyContin in the Canadian Medical Association Journal published in 2001, included a photograph of a fit looking jogger, with the tag line “one to start and stay with”."° Another full-page advertisement in the same journal depicted a runner climbing stairs next to the slogan “When you know... acetaminophen will not be enough — Take the next step in pain relief”."° 103, The Manufacturer Defendants funded patient advocacy groups, which produced educational materials containing information that appeared independent and reliable, but was in fact false and misleading. Groups such as the Canadian Pain Coalition, the Chronic Pain Association of Canada, and People in Pain Network received funding from the Manufacturer Defendants. 104. The Manufacturer Defendants relied heavily on sales representatives to convey marketing messages and materials to healthcare professionals during in-person meetings. Sales representatives gave false information about Opioids to healthcare professionals and claimed that Opioids had less potential for abuse and fewer withdrawal symptoms than other pain medication currently available. 105. The Manufacturer Defendants facilitated presentations by paid experts known as “Key Opinion Leaders” who were paid for presentations and studies that encouraged more liberal prescribing of Opioids. Key Opinion Leaders were also paid to serve on boards and committees of professional associations and patient advocacy groups that supported chronic Opioid therapy. 106. The Manufacturer Defendants took healthcare professionals out for expensive meals and on all-expenses-paid trips to medical conferences that promoted the use of “Tom Blackwell, “The Selling of OxyContin,” National Post (November 12, 2011) online: National Post © Grant Robertson and Karen Howiett, “How a lttie-known patent sparked Canada's opioid crisis," The Globe and Mail (December 30, 2016, last updated May 19, 2017) online: ,oie Opioids. The Manufacturer Defendants routinely paid Canadian doctors to attend drug industry meetings and become members of industry advisory boards. 107. Healthcare professionals in Canada were also subjected to and influenced by promotional material produced by the Manufacturer Defendants in the United States. 108. The pattem of false and deceptive marketing by the Manufacturer Defendants contained misrepresentations, as further explained at paragraphs 112 - 133, such as: (a) (b) (co) (d) (e) (f) (9) (h) patients using Opioids for pain would experience improvement to function and quality of life without adverse effects; patients using Opioids for pain generally would not become addicted and that doctors could use screening tools to exclude patients who might; withdrawal from Opioid use was easily managed; Opioid use relieved pain when used long-term without significant risk; there was little risk of adverse effects of Opioid use; certain long-acting Opioids provided 12 hours of pain relief; Opioids could be taken in higher and higher doses without increased risk to patients; and abuse-deterrent Opioid formulations were safer and lowered the potential of abuse (collectively, the “Opioids Misrepresentations") 109. The Manufacturer Defendants knew or ought to have known that their representations regarding the risks and benefits of Opioids were not supported by or were contrary to scientific evidence. The Manufacturer Defendants also knew that doctors and patients rely heavily on educational materials, such as treatment guidelines,-~22- continuing medical education seminars, articles and websites to inform their treatment decisions. 110. The Manufacturer Defendants’ false, reckless, and deceptive marketing campaign was carried out through the following acts: (a) (b) (c) (a) (e) } (9) creating and distributing marketing and educational materials containing the Opioids Misrepresentations; funding promotional activities designed to promote and spread awareness of the Opioids Misrepresentations, particularly among healthcare professionals; placing advertisements in medical journals containing the Opioids Misrepresentations; funding patient advocacy groups which produced and distributed educational materials containing the Opioids Misrepresentations that appeared to be independent and reliable sources of information; hiring and training sales representatives to convey the Opioids Misrepresentations in in-person meetings with healthcare professionals; facilitating presentations by Key Opinion Leaders that contained the Opioids Misrepresentations; and encouraging Key Opinion Leaders to draft misleading studies on Opioids to support the assertion that the Opioids Misrepresentations were true and accurate. 111. As a result of the Manufacturer Defendants’ successful marketing activities, the prescribing of Opioids as a long-term means to treat chronic pain became routine and widespread.-23- The Opioids Misrepresentations Misrepresentations of Improved Function 112. The Manufacturer Defendants claimed that long-term Opioid use would improve patients’ function and quality of life. The Manufacturer Defendants reinforced this message by creating and sponsoring materials that were distributed or made available to prescribers. These claims were unsupported by clinical evidence. 113. The Manufacturer Defendants generated marketing materials that omitted known risks of chronic Opioid therapy and emphasized or exaggerated risks of competing products so that prescribers and patients would be more likely to choose Opioids over other therapies such as over-the-counter acetaminophen or nonsteroidal anti- inflammatory drugs, like ibuprofen (NSAIDs). These claims were not supported by scientific evidence. Misrepresentations of the Risk of Addiction 114. Through their marketing efforts, the Manufacturer Defendants were able to persuade healthcare professionals any risk of addiction to Opioids could be alleviated by careful supervision by doctors and use of Opioids by appropriate patients. The risks of Opioid abuse and addiction were presented by the Manufacturer Defendants as modest, manageable, and limited to illegitimate patients, as opposed to those with genuine pain. 115. The Manufacturer Defendants encouraged healthcare professionals that Opioids should be used to treat patients who took the drugs as directed to treat their pain, rather than abusers seeking to snort or inject the drugs. The Manufacturer Defendants represented that even high-risk patients could be prescribed Opioids if closely managed. This led healthcare professionals to believe that they could safely prescribe Opioids to appropriate patients without fear that these patients would become addicted 116. The Manufacturer Defendants advised healthcare professionals to ignore signs of addiction on the basis of an unfounded condition they called “pseudoaddiction”. The Manufacturer Defendants explained that healthcare professionals may inappropriately-24- stigmatize patients as addicts, when they were in fact experiencing unrelieved pain. Pseudoaddiction generally stopped once the pain was relieved, often through an increase in Opioid dosage. 117. There are no scientific studies to back up the theory of pseudoaddiction. This concept was created by the Manufacturer Defendants to encourage healthcare professionals to misinterpret signs of addiction in patients as untreated pain to be addressed with more Opioids. Misrepresentations of Simple Management of Withdrawal 118. The Manufacturer Defendants promoted misleading messages regarding the ease of patients’ withdrawal from Opioids. These misrepresentations were made with the expectation that healthcare professionals would be more willing to start patients on chronic Opioid therapy if withdrawal was not problematic. 119. The Manufacturer Defendants asserted that long-acting Opioids were less likely to cause withdrawal symptoms than other pain medications. The Manufacturer Defendants also claimed that while patients may become “physically” dependent on Opioids, this dependence can be easily addressed by gradually decreasing dosages to avoid the adverse effects of withdrawal. The Manufacturer Defendants failed to disclose the actual symptoms of withdrawal from Opioids which include nausea, muscle pain, depression, anxiety, diarrhea, vomiting, restlessness, and chills and can continue long after use is discontinued. These symptoms make it less likely that patients will be able to stop using Opioids. Misrepresentations of Benefits of Long-Term Use 120. To convince prescribers and patients that Opioids should be used to treat chronic pain, the Manufacturer Defendants touted significant upsides to long-term Opioid use, which falsely and misleadingly suggested that these benefits were supported by scientific evidence.-25- 121. The Manufacturer Defendants also published misleading studies to enhance the perception that Opioids provide effective long-term treatment for chronic pain conditions. Misrepresentations of Adverse Effects 122. In addition to failing to disclose risks of addiction, overdose and respiratory depression in marketing materials, the Manufacturer Defendants routinely ignored the risks of hyperalgesia linked to Opioid use, in which the patient becomes more sensitive to pain over time and may experience hormonal dysfunction, decline in immune function, mental clouding, confusion and dizziness, increased falls and fractures in the elderly, neonatal abstinence syndrome, and potentially fatal interactions with alcohol or benzodiazepines. 123. The Manufacturer Defendants frequently contrasted the lack of a maximum dosage for Opioids with the risks of NSAIDs. The Manufacturer Defendants deceptively described the risks from NSAIDs while failing to disclose the risks of Opioids. Misrepresentations of Duration of Pain Relief 124. The Manufacturer Defendants marketed long-acting Opioids as providing 12 hours of pain relief. The Manufacturer Defendants knew that this representation was false and that OxyContin and other similar long-acting Opioids did not last for 12 hours in many, if not most, patients. 125. The Manufacturer Defendants told healthcare professionals that the solution to patients experiencing loss of pain control prior to their next scheduled dose (referred to as “end-of-dose failure”) was not more frequent dosing, but higher dosing, which poses greater risks to patients. When patients experience end-of-dose failure, they begin to experience withdrawal symptoms, including an intense craving for Opioids which is followed by a euphoric rush with the next dose. This cycle promotes addiction. Many patients will exacerbate this cycle by taking their next dose ahead of schedule or taking a dose of another short-acting Opioid, increasing the overall amount of Opioids they are taking. Supplementing long-acting Opioids with short-acting Opioids to alleviate end-of--26- dose failure (referred to as “rescue medication") was promoted to doctors by the Manufacturer Defendants in order to increase the prescription and use of short and long-acting Opioids. 126. ‘The Manufacturer Defendants also instructed doctors who complained about the duration of long-acting Opioids to prescribe stronger but not more frequent doses, putting patients at greater risk of addiction, overdose and death. 127. The Manufacturer Defendants maintained assurances of 12-hour dosing, as those assurances were integral to the market dominance and comparatively high price of long-acting Opioids. Without this advantage, long-acting Opioids have little to offer over less expensive, short-acting Opioids. 128. The Manufacturer Defendants’ promotion of 12-hour dosing was misleading, as they knew that each supplied dose did not last 12 hours for many, if not most, patients. The Manufacturer Defendants had a responsibility to correct their labels to reflect appropriate dosing, to disclose to prescribers what they knew about the actual duration of long-acting Opioid doses, and not to promote more dangerous higher dosing, rather than increased frequency of use. Misrepresentations of Risks of Increased Doses 129. The Manufacturer Defendants falsely claimed to healthcare professionals and patients that Opioids could be taken in increasing dosages to obtain pain relief, without disclosing that higher doses increased the risk of addiction and overdose. The Manufacturer Defendants also represented that there was no upper limit to increasing doses of Opioids given to patients. 130. Using Opioids for more than a short time leads to tolerance, requiring increasingly high doses to achieve pain relief. The Manufacturer Defendants sought to encourage healthcare professionals to prescribe higher doses rather than prescribe long-acting Opioids more frequently than twice a day, despite knowing that these long- acting Opioids frequently did not provide 12 hours of relief. This advice ensured that-27- doctors maintained patients on Opioids even at high doses and was not supported by scientific evidence. Misrepresentation of Efficacy of Abuse-Deterrent Formulations 131. In 2012, Purdue removed OxyContin from the Canadian market. This was just before the OxyContin patent was set to expire and generic versions could be marketed in Canada. Purdue replaced OxyContin with OxyNeo which had an abuse-deterrent formulation ("ADF"). OxyNeo is harder to crush or chew and was marketed as safer and with less abuse potential than other long-acting Opioids. Purdue claimed that ADF Opioids prevent tampering and that its ADF products could not be crushed or snorted. Purdue held out to healthcare professionals that ADF products would reduce Opioid abuse and diversion. 132. Purdue knew that the ADF features of their Opioids could be easily defeated, did not affect oral use, which is the most common means of abuse, Purdue's misleading claims reassured healthcare professionals who were concemed about addiction that they not only could continue to prescribe Opioids, but in fact needed to switch to Purdue-brand Opioids, thus preserving and expanding the market for OxyNeo. 133. Purdue knew or ought to have known that reformulated ADF OxyNeo is not more tamper resistant than other long-acting Opioids and is still regularly tampered with and abused, Distribution of Opioids in Canada 134. During the Class Period, the Distributor Defendants delivered the Opioids manufactured and marketed by the Manufacturer Defendants to pharmacies and hospitals in Canada. The Distributor Defendants have supplied Opioids in quantities that they knew or should have known exceeded any legitimate market, deepening the crisis of Opioid abuse, addiction and death in Canada. 135. By supplying the market with more Opioids than could be used for legitimate medical purposes and failing to report loss and/or theft of Opioids, the Distributor-28- Defendants and the Manufacturer Defendants created, increased and failed to prevent a foreseeable risk of harm to the Class Members. 136. The Defendants knew or ought to have known there was a suspicious rise in distribution of Opioids to retailers in Canada, The Defendants were in a unique position, as they had extensive data on the extent of manufacturing and sales of Opioids in Canada. However, the Defendants failed to do anything about suspicious orders of Opioids or to prevent or reduce distribution. Purdue's Guilty Plea in US Criminal Proceeding 137. On May 10, 2007, the United States Attorney's Office for the Western District of Virginia announced that Purdue plead guilty to misleading marketing in the United States. Purdue paid $600 million in criminal and civil settlements. Three executives pleaded guilty as individuals to the criminal misbranding and were fined $34.5 million. 138. As part of the plea agreement, an Agreed Statement of Facts was issued and signed by Purdue executives. The Agreed Statement of Facts states that “Purdue supervisors and employees, with the intent to defraud or mislead, marketed and promoted OxyContin as less addictive, less subject to abuse and diversion, and less likely to cause tolerance and withdrawal than other pain medications...” Damages 139. As a result of the Opioid epidemic caused by the Defendants’ conduct described above, the plaintiff and the Class Members have suffered damage in the amount of the substantial expense in paying for Opioid prescriptions and other healthcare costs related to the use of Opioids, including but not limited to: (a) secondary effect medications resulting from side effects of Opioid use, such as medications for constipation and lack of sleep; (b) medical treatment for side effects of Opioid use; (c) medications used to treat addiction;(a) (e) (f) (9) (h) (i) -29- the cost of harm reduction services and programs, including overdose prevention sites, the distribution of Naloxone and the Take Home Naloxone Program; drug-addiction treatment, including the costs of any mandated counselling; emergency medical treatment for overdose and symptoms of withdrawal, including ambulance services, emergency department visits and hospitalizations; associated medical costs for co-morbidities arising from use of Opioids, such as treatment of Hepatitis C and AIDS; coroner's costs associated with Opioid overdose deaths; and in-office visits to obtain refills and/or monitor abuse. 140. The plaintiff and the Class Members bring this action against the Defendants pursuant to the provisions of statutes including, but not limited to, section 8 of the Health Care Costs Recovery Act, SBC 2008, c 27 and parallel legislation in other provinces, to recover: (a) (b) the present value of the total expenditure by the Class Members for health care benefits provided for their respective residents resulting from Opioid use, side effects and/or addiction; and the present value of the estimated total expenditure by the Class Members for health care benefits that could reasonably be expected to be provided for their respective residents resulting from Opioid use, side effects and/or addiction 141. The plaintiff pleads that the Defendants’ conduct as particularized in paragraphs 79-136 was high-handed, outrageous, reckless, wanton, entirely without care, deliberate, callous, disgraceful, wilful, and in disregard of the plaintiff's rights and the-30- rights of each Class Member and, as such, renders the Defendants jointly and severally liable to pay punitive damages. PART 2: RELIEF SOUGHT 142. The plaintiff, on its own behalf, and on behalf of the Class Members, claims against the Defendants: (a) (b) (c) (d) (e) () (9) (h) 0 an order certifying this action as a class proceeding against the Defendants and appointing the plaintiff as representative plaintiff in respect of the Class Members; a declaration that the Defendants were negligent in the development, manufacture, distribution, marketing and sale of Opioids; a declaration that the Defendants engaged in conduct contrary to Part VI of the Competition Act, RSC 1985, c C-34; a declaration that the Defendants were unjustly enriched at the expense of the Class Members and that the Defendants account for, disgorge and make restitution for their enrichment; damages pursuant to s 8 of the Health Care Costs Recovery Act; general damages for loss or damage suffered as a result of conduct contrary to Part VI of the Competition Act; general damages for fraudulent misrepresentation, negligence, and fraudulent concealment; punitive damages; investigation costs and costs of this proceeding on a full-indemnity basis pursuant to s 36 of the Competition Act; prejudgment and post-judgment interest pursuant to the Court Order Interest Act, RSBC 1996, c 78, s 128; and-31- (k) such further and other relief as to this Honourable Court may deem just. PART 3: LEGAL BASIS 143. The plaintiff pleads and relies upon the Class Proceedings Act, RSBC, 1996 c 50, the Health Care Costs Recovery Act, SBC 2008, c 27 and equivalent provincial or territorial cost recovery legislation across Canada, the Competition Act, RSC 1985, c 34, and the Court Jurisdiction and Proceedings Transfer Act, RSBC 2003, c. 28 (the “CJPTA’) Causes of Action Breach of the Competition Act 144. Each of the Manufacturer Defendants, as a result of their conduct in actively marketing Opioids as less addictive, less subject to abuse, and less likely to cause severe withdrawal symptoms than other pain medications, as particularized in paragraphs 112 - 133 above, are liable under sections 36 and 62 of the Competition Act for knowingly or recklessly making a representation to the public that is false or misleading in a material respect. 145. By making the Opioids Misrepresentations to the public the Defendants breached 's 52 of the Competition Act, and thereby committed an unlawful act because the Opioids Misrepresentations: (a) were made for the purpose of promoting the business interests of the Manufacturer Defendants; (b) were made to the public; and (c) were false and misleading in a material respect. 146, The plaintiff and Class Members suffered damages as a result of the Defendants’ unlawful breach of s 52 of the Competition Act and seek those damages, as well as their costs of investigation, pursuant to s 36 of the Competition Act.=32- Fraudulent Misrepresentation and Deceit 147. Each of the Manufacturer Defendants made the Opioids Misrepresentations despite knowing that the Opioids Misrepresentations were false. Alternatively, the Manufacturer Defendants were reckless as to whether the Opioids Misrepresentations were true or false. 148. The Opioids Misrepresentations constitute fraudulent misrepresentation and deceit. 149. The Manufacturer Defendants made the Opioids Misrepresentations to the public at large as the core of a uniform and consistent sales, advertising and marketing campaign. 150. The Opioids Misrepresentations caused the plaintiff and the Class Members to. suffer a loss, including the total amount paid for Opioids prescriptions and healthcare costs related to the use of Opioids. Negligence of Manufacturer Defendants 151. At all material times, the Manufacturer Defendants owed a duty of care to the plaintiff and the Class Members. The Manufacturer Defendants had a duty to exercise reasonable care in manufacturing, marketing and selling Opioids. 152. The plaintiff alleges that the Manufacturer Defendants were negligent in the development, manufacture, marketing and sale of Opioids in Canada and that the Manufacturer Defendants knew at all material times that the Opioids Misrepresentations were false, or were reckless as to whether the Opioids Misrepresentations were true or false. 153. The Manufacturer Defendants breached the standard of care owed to the plaintiff and Class Members and the harm they created, including the increase of health care costs due to addiction, overdoses and related illnesses, was foreseeable. 154. The Manufacturer Defendants knew or ought to have known that Opioids pose serious health risks, including addiction, which risks were not disclosed.-33- 156. A reasonably prudent manufacturer knows, or ought to know, that aggressively marketing highly addictive Opioids for chronic pain would result in the severe harm of addiction, foreseeably causing citizens to seek increasing levels of Opioids and to tum to the illegal drug market as a result of a drug addiction that was foreseeable to the Manufacturer Defendants. 156. The plaintiff alleges that the Manufacturer Defendants, as manufacturers of prescription medication, owed a duty of care to it and to the other Class Members, breached the standard of care expected in the circumstances, and were therefore negligent in the development, manufacture, and sale of prescription Opioid medication. Such negligence includes but is not limited to: (a) asserting false statements and omitting material facts regarding the benefits of and evidence for the use of Opioids for chronic pain, while understating their very serious risks, including the risk of addiction. These false statements include but are not limited to the Opioid Misrepresentations; (b) marketing and promoting Opioids for the treatment of long-term pain without any or adequate research proving that such use is safe and effective, and/or that the benefits of such use outweigh the risks; (c) failing to monitor feedback from the market, including reports as early as in or around 1997-1998 that Opioids were being abused and were associated with the high risk of addiction; (d) failing to warn doctors and the general public about the risks associated with Opioid use, even after it became apparent that the Opioid Misrepresentations were false and misleading; {e) failing to conduct the necessary research and testing to determine the risks associated with Opioid use, particularly for the treatment of long-term pain;paar (f) failing to conduct follow up testing or monitor Opioid use once Opioids began to be consistently prescribed for long-term pain; (9) failing to adequately train sales representatives to provide accurate information regarding appropriate use of Opioids and risks associated with their use; (h) deliberately or recklessly misstating research findings regarding the risks and benefits of Opioids; and (i) knowingly misstating research findings, knowing that the plaintiff and its’ residents would rely on their misrepresentations and omissions, and knowing that such reliance would cause the plaintiff to suffer damages. Negligence of Distributor Defendants 157. As licenced dealers permitted to distribute Opioids in Canada, the Distributor Defendants owed a duty of care to the plaintiff, the Class Members and the general public in the safe distribution of Opioids to pharmacies and hospitals given the foreseeability of harm and expense associated with the use of Opioids, 158. The Distributor Defendants had a duty to exercise reasonable care in the distribution and sale of Opioids. 159. The Distributor Defendants breached the standard of care owed to the plaintiff and Class Members and the harm they created was foreseeable. 160. The Distributor Defendants breached the standard of care expected in the circumstances, and were therefore negligent in the distribution of Opioids in Canada. Such negligence includes but is not limited to: (a) failing to exercise proper judgment in reporting the loss andior theft of units; (b) failing to provide effective controls and procedures to guard against theft and diversion of Opioids;-35- (c) failing to exercise proper judgment in reporting suspicious orders or refusing to fill them; (4) failing to report orders from customers which deviated from previous order patterns or ordering methods, which they knew or ought to have known could lead to the diversion of Opioids; (e) __ using unsafe distribution practices; (f) failing to acquire or utilize special knowledge or skills that relate to the dangerous activity of selling opioids in order to prevent or ameliorate such significant dangers; and, (g) failing to review prescription orders for red flags. 161. Reasonably prudent Distributors would know that failing to report suspicious orders would exacerbate problems of diversion and non-medical use of Opioids. 162. The foreseeable harm from a breach of these duties includes, but is not limited to, the sale, use, abuse and diversion of Opioids. 163. The foreseeable harm from a breach of these duties includes, but is not limited to, abuse, addiction, and mortality in the plaintiffs and the Class Members’ communities. Unjust Enrichment and Waiver of Tort 164. Further, and in the alternative, the plaintiff waives any tort pleaded above, and pleads that it and the Class Members are entitled to claim and recover based on equitable and restitutionary principles. 165. As an expected and intended result of their unlawful conduct, the Manufacturer Defendants have profited and benefited from Opioid purchases made by the plaintiff and the Class Members. 166. In exchange for the Opioid purchases, at the time the plaintiff and the Class Members made these payments, the plaintiff and the Class Members expected that the-36- Manufacturer Defendants had provided all of the necessary and accurate information and had not misrepresented any material facts. 167. By illegally and deceptively promoting Opioids, directly, through their control of third parties, and by acting in concert with third parties, the Manufacturer Defendants have been unjustly enriched by the receipt of the revenue from the sale of Opioids. 168. The plaintiff and the Class Members have suffered a corresponding deprivation in the amount of the cost of Opioids purchased from the Manufacturer Defendants. Because of their deceptive promotion of Opioids, the Manufacturer Defendants obtained enrichment that they would not otherwise have obtained. 169. Since the revenue from the sale of Opioids that was received by the Manufacturer Defendants from the plaintiff and the Class Members resulted from the Manufacturer Defendants’ wrongful and unlawful acts, there is and can be no juridical reason justifying the Manufacturer Defendants retaining any part of it. In particular, there is no contract, disposition of law, donative intent or other valid legal obligation that justifies the enrichment. 170. The Manufacturer Defendants must disgorge its unjustly acquired profits and other monetary benefits resulting from its unlawful conduct and provide restitution to the plaintiff and the Class Members. Fraudulent Concealment 171. The Defendants intentionally and fraudulently concealed the existence of their unlawful conduct from the public, including the plaintiff and the Class Members. The Defendants represented to the plaintiff, the Class Members, and the general public that the Opioids Misrepresentations were true and accurate, thereby misleading the plaintiff and the Class Members. The affirmative acts of the Defendants alleged herein were fraudulently concealed and carried out in a manner that precluded detection. 172. Because the Defendants’ conduct was kept secret, the plaintiff and the Class Members were unaware of the Defendants’ unlawful conduct.a Jurisdiction 173. There is a real and substantial connection between British Columbia and the facts alleged in this proceeding. The plaintiff and the Class Members plead and rely upon the CJPTA in respect of the Defendants. Without limiting the generality of the foregoing, a real and substantial connection between British Columbia and the facts alleged in this proceeding exists pursuant to sections 10 (f) — (i) of the CJPTA because this proceeding: (a) _ concems restitutionary obligations that, to a substantial extent, arose in British Columbia; (b) concerns a tort committed in British Columbia; (c) _ concems a business carried on in British Columbia; and (4) _ is a claim for an injunction ordering a party to do or refrain from doing anything in British Columbia Plaintiff's address for service: BRANCH MACMASTER LLP #1410 - 777 Hornby Street Vancouver, BC V6Z 1S4 Tel: (604) 631-6299 Fax: (604) 631-3429 Email: Ibrasil@branmac.com ‘CAMP FIORANTE MATTHEWS MOGERMAN #400 — 856 Homer Street Vancouver, BC V6B 2W5 Tel: (604) 689-7555 Fax: (604) 689-7554 Email: service@cimlawyers.ca-38- HOWIE SACKS AND HENRY LLP 20 Queen Street West, Suite 3500 Toronto, ON MSH 3R3 Tel: Fax: (416) 646-3901 (416) 361-0083 Email: pmiller@hshlawyers.com Defendants’ address for service: AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: APOTEX INC. 2700-700 West Georgia Street Vancouver, BC V7Y 1B8 APOTEX PHARMACEUTICAL HOLDINGS, INC. 150 Signet Drive Weston, ON M9L 1T9 BRISTOL-MYERS SQUIBB CANADA 1959 Upper Water Street, Suite #900 Halifax, NS B3J 2X2 BRISTOL-MYERS SQUIBB COMPANY 1209 Orange Street Wilmington, Delaware, USA 19801 PALADIN LABS. Suite 1800-510 West Georgia Street Vancouver, BC V6B 0M3 ENDO PHARMACEUTICALS INC. 1400 Atwater Drive Malvern, Pennsylvania, USA 19355 ENDO INTERNATIONAL PLC First Floor, Minerva House Simmonscourt Road Ballsbridge Dublin 4, Ireland JANSSEN INC. 595 Burrard Street Suite 2600, PO Box 49214 Vancouver, BC V7X 1L3 JOHNSON & JOHNSON 1 Johnson & Johnson Plaza New Brunswick, New Jersey, USA 08933‘AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: page PHARMASCIENCE INC. 6111 Royalmount Avenue, Suite 100 Montreal, QC H4P 2T4 JODDES LIMITED 6111 Royalmount Avenue, Suite 100 Montreal, QC H4P 274 PRO DOC LIMITEE 2925 Boulevard Industriel Laval, QC H7L 3w9 THE JEAN COUTU GROUP (PJC) INC. 245, rue Jean Coutu Varennes, QC J3X 0E1 MYLAN PHARMACEUTICALS ULC 85 Advance Road Etobicoke, ON M8Z 2S6 MYLAN N.V. Building 4, Trident Place Mosquito Way, Hatfield Hertfordshire AL10 9UL PURDUE PHARMA INC. 1200 Waterfront Centre 200 Burrard Street, PO Box 48600 Vancouver, BC V7X 1T2 PURDUE PHARMA L.P.. One Stamford Forum 201 Tresser Boulevard Stamford, Connecticut, USA 06901-3431 THE PURDUE FREDERICK COMPANY One Stamford Forum 201 Tresser Boulevard Stamford, Connecticut, USA 06901-3431 PURDUE FREDERICK INC. 40 King Street West, Suite 4400 Toronto, ON M5H 3¥4 RANBAXY PHARMACEUTICALS CANADA INC. 2680 Matheson Blvd. East, Suite 200 Mississauga, ON L4W OASAND TO: ‘AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: - SUN PHARMACEUTICAL INDUSTRIES LTD. Sun Pharma Advanced Res.Centre, Tandalja, Vadodara, India GJ-390020 HIKMA LABS INC. 1809 Wilson Road Columbus, Ohio, USA 43228-9579 HIKMA PHARMACEUTICALS PLC. King Abdullah II street, Building 357 P.O. Box 182400 11118 Amman Jordan WEST-WARD COLUMBUS INC. 1809 N Wilson Road Columbus, Ohio, USA 43228 SANIS HEALTH INC. Suite 200, Phoenix Square 371 Queen Street Fredericton, NB E3B 1B1 SANDOZ CANADA INC. 800-885 West Georgia Street Vancouver BC V6C 3H1 SANDOZ INTERNATIONAL GMBH Sandoz International GmbH Industriestrasse 25 83607 Holzkirchen Germany TEVA CANADA LIMITED Suite 2200, 1055 West Hastings Street Vancouver, BC V6E 2E9 TEVA PHARMACEUTICALS USA, INC. 1090 Horsham Road North Wales, Pennsylvania USA 19454 TEVA PHARMACEUTICAL INDUSTRIES LTD. 5 Basel St., Petach Tikva Israel, 49131 ACTAVIS PHARMA COMPANY 30 Novopharm Court Toronto, ON M1B 2K9AND TO: ‘AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: AND TO: -M1- VALEANT CANADA LP/ VALEANT CANADA S.E.C. 2700-700 West Georgia Street Vancouver, BC V7Y 1B8 BAUSCH HEALTH COMPANIES INC. 25th floor 700 West Georgia Street Vancouver, BC V7Y 1B3 GAMMA WHOLESALE DRUGS LIMITED 1283 Horseshoe PI Richmond, BC V7A 4X5 IMPERIAL DISTRIBUTORS CANADA INC. 1500 Royal Centre, 1055 West Georgia Street, Vancouver, BC V6E 4N7 AMERISOURCEBERGEN CANADA CORPORATION 200 Bay Street, Suite 3800 Royal Bank Plaza, South Tower Toronto, ON M5J 224 KOHL + FRISCH LIMITED Suite 1700, Park Place 666 Burrard Street Vancouver, BC V6C 2X8 KOHL & FRISCH DISTRIBUTION INC. 7622 Keele Street Concord, ON L4K 2R5 MCKESSON CORPORATION 1 Post Street San Francisco, California, USA 94104 MCKESSON CANADA CORPORATION Suite 3600, Three Bentall Centre P.O, Box 49314 595 Burrard Street Vancouver, BC V7X 1L3 NU-QUEST DISTRIBUTION INC. 96 Clyde Ave Mount Pearl, NFL A1N 4S2 ABBOTT LABORATORIES INC. 8625 TransCanada Highwayae Saint-Laurent, QC H4S 126 AND TO: UNITED PHARMACISTS MANITOBA INC. 160 Eagle Drive Winnipeg, MB R2R 1V5 AND TO: PROCURITY PHARMACY SERVICES INC. 160 Eagle Drive Winnipeg, MB R2R 1V5 AND TO: PROCURITY INC. 160 Eagle Drive Winnipeg, MB R2R 1V5 AND TO: SHOPPERS DRUG MART INC. 3189 Grandview Hwy Vancouver, BC V5M 2E9 AND TO: LOBLAW COMPANIES LIMITED 3189 Grandview Hwy Vancouver, BC V5M 2E9 AND TO: UNIPHARM WHOLESALE DRUGS LTD. 800-885 West Georgia Street Vancouver, BC V6C 3H1 AND TO: LPG INVENTORY SOLUTIONS 40 Milburn Road Unit B Hamilton, ON L8E 3L9 Place of trial: Vancouver Law Courts Address of the registry: 800 Smithe Street, Vancouver, BC V6Z 2E1-43- Date: 29/Aug/2018 ‘Signature of lawyer for Plaintitf Reidar M. Mogerman Signature of eet : ae for plaintiff Luciana P. Brasil ENDORSEMENT ON ORIGINATING PLEADING OR PETITION FOR SERVICE OUTSIDE BRITISH COLUMBIA There is a real and substantial connection between British Columbia and the facts alleged in this proceeding and the plaintiff and other Class Members plead and rely Court Jurisdiction and Proceedings Transfer Act RSBC 2003 Ch 28 (the in respect of these defendants. Without limiting the foregoing, a real and substantial connection between British Columbia and the facts alleged in this proceeding exists pursuant to ss10 (f) — (i) of the CUPTA because this proceeding: (f) concems restitutionary obligations that, to a substantial extent, arose in British Columbia; (g) concems a tort committed in British Columbia; (h) concems a business carried on in British Columbia; and (i) is a claim for an injunction ordering a party to do or refrain from doing anything in British Columbia.-44- Rule 7-1 (1) of the Supreme Court Civil Rules states: (1) Unless all parties of record consent or the court otherwise orders, each party of record to an action must, within 35 days after the end of the pleading period, (a) prepare a list of documents in Form 22 that lists (i) all documents that are or have been in the party's possession or control and that could, if available, be used by any party at trial to prove or disprove a material fact, and (ii) all other documents to which the party intends to refer at trial, and (b) serve the list on all parties of record. APPENDIX CONCISE SUMMARY OF NATURE OF CLAIM: This proposed class action claim involves allegations regarding the marketing and distribution of certain drugs in Canada, causing harm to Canadian provincial and territorial governments, THIS CLAIM ARISES FROM THE FOLLOWING: A personal injury arising out of: (1 amotor vehicle accident (medical malpractice OO another cause A dispute concerning: OD __ contaminated sites 1 __ construction defects Creal property (real estate)ele) el 2) ele al -45- personal property the provision of goods or services or other general commercial matters investment losses the lending of money an employment relationship will or other issues concerning the probate of an estate a matter not listed here THIS CLAIM INVOLVES: et ele St) sl tele) N a class action maritime law aboriginal law constitutional law conflict of laws none of the above do not know Class Proceedings Act, RSBC, 1996 c 50. Negligence Act, RSBC, 1996 c 333. Competition Act, RSC, 1985, c. C-34. Health Care Costs Recovery Act, SBC 2008, c 27. Crown's Right of Recovery Act, SA 2009, c C-35. The Health Administration Act, RSS 1978, c H-0.0001 (formerly known as the Department of Health Act). Health Services Insurance Act, CSSM s H35.10, 1 12. 13. 14. 15. 16. 47. 18, 19. 20. age Health Insurance Act, RSO 1990, c H.6. Home Care and Community Services Act, 1994, SO 1994, c 26. Health Insurance Act, COLR c A-29. Health Services and Insurance Act, RSNS 1989, c 197. Medical Services Payment Act, RSNB 1973, c M-7. Hospital Services Act, RSNB 1973, c H-9. Family Services Act, SNB 1980, c F-2.2. Hospital and Diagnostic Services Insurance Act, RSPEI 1988, c H-8. Health Services Payment Act, RSPEI 1988, c H-2. Medical Care and Hospital Insurance Act, SNL 2016, ¢ M-5.01 Hospital Insurance and Health and Social Services Administration Act, RSNWT 1988, cT-3, Hospital Insurance and Health and Social Services Administration Act, RSNWT (Nu) 1988, ¢ T-3. Medical Care Act, RSNWT (Nu) 1988, c M-8.