Summary of Argument

The nation’s leading public-health organizations support Lake and Trumbull Counties because the pharmacies’ over-dispensing of prescription opioids created an ongoing public-health nuisance that cannot be solved simply by ending wrongful conduct today. Ohio—and particularly Lake and Trumbull Counties—has endured staggering overdose rates, with deaths far exceeding national averages and continuing to climb through 2021, contributing to historic declines in U.S. life expectancy. The nation’s largest pharmacy chains flooded these communities with nearly 110 million doses from 2006 to 2019, repeatedly ignoring “red flags” of misuse such as doctor shopping and pharmacy shopping, and choosing profit over their duty to monitor prescriptions. Pharmacists occupy a pivotal position in the opioid supply chain, and their failure to act directly fueled widespread access, dependence, and diversion. Under Ohio law, a public nuisance is an unreasonable interference with public health and safety, and the oversupply of opioids squarely fits this definition. Prescription oversupply did not merely harm individual patients but created a cascade of community-wide effects: widespread addiction, transition to heroin and fentanyl use, unprecedented numbers of overdose deaths, and heavy burdens on hospitals, emergency rooms, first responders, morgues, law enforcement, courts, and jails. The epidemic has driven homelessness, strained foster-care systems, harmed infants born with neonatal abstinence syndrome, and devastated families across racial and socioeconomic lines, with disproportionate impacts on Black, American Indian, and Alaska Native communities. Crucially, stopping oversupply does not remedy these ongoing harms, just as halting toxic discharges does not clean contaminated land. Thousands of residents in these counties now live with opioid-use disorder and require treatment and recovery services. The only adequate remedy is abatement: a court-supervised plan funding proven, evidence-based interventions. Medication-assisted treatment with methadone or buprenorphine reduces overdose deaths, criminal activity, and infectious disease transmission, while expanding access to naloxone saves lives in seconds. Other essential measures include screening and referral programs, maternal and infant care, youth prevention, recovery housing, justice-system supports, stigma reduction, and building an addiction-treatment workforce. Because the pharmacies’ oversupply created a continuing public nuisance that will persist without meaningful intervention, the Court should affirm the district court’s judgment and uphold an abatement remedy that empowers local governments to fund treatment, prevention, and recovery, and to repair the extensive harms caused by the opioid epidemic.

Summary of Argument

Prominent public health organizations support the position of Lake and Trumbull Counties, asserting that the excessive dispensing of prescription opioids established a persistent public health nuisance, which cannot be adequately addressed merely by ceasing current misconduct. Ohio, particularly Lake and Trumbull Counties, has experienced severe overdose rates, with mortality significantly surpassing national averages and increasing through 2021, thereby contributing to historic reductions in U.S. life expectancy. Major pharmacy chains disseminated approximately 110 million opioid doses within these communities between 2006 and 2019, consistently disregarding indicators of misuse, such as multiple prescribers or pharmacies, and prioritizing financial gain over professional obligations to monitor prescriptions. Pharmacists hold a critical role in the opioid supply chain; their inaction directly facilitated broad access, dependence, and illicit distribution.

Within Ohio legal frameworks, a public nuisance is defined as an unreasonable interference with public health and safety. The excessive provision of opioids directly aligns with this definition. The oversupply of prescription opioids generated not only individual patient harm but also a series of community-wide consequences, including widespread addiction, subsequent transition to heroin and fentanyl, unprecedented overdose fatalities, and substantial strain on healthcare systems (hospitals, emergency services), public safety entities (first responders, law enforcement), and correctional facilities (morgues, courts, jails). The epidemic has contributed to homelessness, overburdened foster care systems, resulted in harm to infants with neonatal abstinence syndrome, and severely impacted families across various racial and socioeconomic demographics, with particularly significant effects observed in Black, American Indian, and Alaska Native populations.

Significantly, merely ceasing the oversupply does not resolve these persistent harms, akin to how stopping toxic emissions does not remediate contaminated environments. Thousands of residents within these counties currently experience opioid use disorder and necessitate access to treatment and recovery services. The sole sufficient remedy involves abatement, which is a court-supervised plan to fund validated, evidence-based interventions. Medication-assisted treatment, utilizing methadone or buprenorphine, is proven to decrease overdose fatalities, criminal behavior, and the transmission of infectious diseases, while broader access to naloxone offers immediate life-saving potential. Additional crucial interventions comprise screening and referral programs, comprehensive maternal and infant care, youth prevention initiatives, recovery housing, support within the justice system, efforts to reduce stigma, and the development of a specialized addiction treatment workforce.

Given that the pharmacies’ excessive dispensing established a continuous public nuisance, which will endure without significant intervention, the Court is urged to affirm the district court’s ruling. This affirmation would uphold an abatement remedy, thereby enabling local governments to finance treatment, prevention, and recovery efforts, and to mitigate the widespread damages resulting from the opioid epidemic.

Summary of Argument

Leading public health organizations support Lake and Trumbull Counties. They argue that pharmacies over-supplied prescription opioids, creating a public health problem that continues to affect these areas even if the over-supply stopped today. Ohio, especially Lake and Trumbull Counties, has experienced very high overdose rates. Deaths are much higher than the national average and increased until 2021, contributing to a drop in U.S. life expectancy. Large pharmacy chains supplied almost 110 million opioid doses to these communities between 2006 and 2019. These pharmacies often ignored clear signs of misuse, such as people getting prescriptions from multiple doctors or pharmacies. They prioritized profit instead of their responsibility to monitor prescriptions. Pharmacists play a key role in how opioids are distributed, and their lack of action directly led to more people getting opioids, becoming dependent, and diverting drugs for illegal use.

Under Ohio law, a public nuisance is defined as an unreasonable interference with public health and safety. The oversupply of opioids clearly meets this definition. The large supply of prescription opioids did more than just harm individual patients. It caused many problems across communities, including widespread addiction, people switching to heroin and fentanyl, record numbers of overdose deaths, and heavy strain on hospitals, emergency rooms, first responders, morgues, police, courts, and jails. The opioid crisis has led to more homelessness, put stress on foster care systems, harmed babies born with neonatal abstinence syndrome, and deeply affected families from all backgrounds. It has had a greater impact on Black, American Indian, and Alaska Native communities.

It is important to understand that simply stopping the oversupply does not fix the harm already done, much like stopping pollution does not clean up polluted land. Thousands of people in these counties now have opioid-use disorder and need treatment and recovery support. The only proper solution is "abatement," which means a court-managed plan that funds effective, evidence-based programs. Treatment using medications like methadone or buprenorphine helps reduce overdose deaths, criminal activity, and the spread of infectious diseases. Providing more access to naloxone can save lives quickly during an overdose. Other key actions include screening and referral services, care for mothers and babies, prevention programs for youth, housing for those in recovery, support within the justice system, efforts to reduce the stigma of addiction, and creating more addiction treatment professionals.

Since the pharmacies' oversupply created an ongoing public nuisance that will continue without real action, the Court should agree with the district court's decision. This would support an abatement plan that allows local governments to fund treatment, prevention, and recovery efforts, and to fix the widespread damage caused by the opioid epidemic.

Summary

Major public health organizations support Lake and Trumbull Counties in their argument. They state that pharmacies giving out too many prescription opioids created a public health problem that is still ongoing and cannot be fixed just by stopping those actions today. Ohio, especially Lake and Trumbull Counties, has experienced extremely high rates of overdose deaths. These deaths were much higher than national averages and continued to rise through 2021, contributing to a historical drop in U.S. life expectancy. The country's largest pharmacy chains sent nearly 110 million opioid doses into these communities between 2006 and 2019. They often ignored clear warning signs of misuse, such as people getting prescriptions from multiple doctors or pharmacies, choosing profits over their duty to monitor prescriptions. Pharmacists play a critical role in the opioid supply chain. Their failure to act responsibly directly led to widespread access to opioids, dependence on them, and illegal drug use.

Under Ohio law, a public nuisance is defined as an unreasonable interference with public health and safety. The excessive availability of opioids clearly fits this definition. The oversupply of prescriptions did not just harm individual people; it caused a series of problems for the entire community. These include widespread addiction, people switching to heroin and fentanyl, record numbers of overdose deaths, and heavy strains on hospitals, emergency rooms, first responders, morgues, law enforcement, courts, and jails. The opioid crisis has also led to more homelessness, stressed foster care systems, harmed infants born with drug withdrawal symptoms, and devastated families across all racial and economic backgrounds, with Black, American Indian, and Alaska Native communities being particularly affected.

It is crucial to understand that simply stopping the oversupply of opioids will not fix the harm that has already been done, just as stopping toxic waste from being released does not clean up contaminated land. Thousands of residents in these counties now suffer from opioid addiction and need treatment and recovery services. The only proper solution is "abatement." This means a court-managed plan that funds proven, evidence-based methods to help. Treatments that combine medication with counseling, such as methadone or buprenorphine, can lower overdose deaths, reduce crime, and prevent the spread of infectious diseases. Also, making naloxone more available can save lives quickly. Other important actions include programs to screen people for addiction and refer them to help, care for mothers and babies, prevention programs for young people, housing for those in recovery, support within the justice system, efforts to reduce the negative views around addiction, and increasing the number of people working in addiction treatment.

Because the pharmacies' oversupply created an ongoing public health problem that will continue without real action, the Court should agree with the lower court's decision. This would mean upholding a solution that allows local governments to fund treatment, prevention, and recovery efforts, and to repair the extensive damage caused by the opioid crisis.

Summary

Health groups support Lake and Trumbull Counties. They say pharmacies gave out too many pain pills. This caused a big, lasting health problem. These Ohio counties had many overdose deaths. Deaths were much higher than in other places. Big pharmacies sent almost 110 million pills from 2006 to 2019. They did not stop when people misused the pills. They cared more about money than safety. Pharmacists played a key role. Their actions led to many people getting hooked on pills and misusing them.

Ohio law says a "public nuisance" is something that causes problems for everyone's health and safety. Giving out too many pain pills fits this. This did not just hurt single people. It hurt whole towns. Many people became addicted. Some then used heroin or fentanyl. Many people died from overdoses. Hospitals, doctors, police, and jails became very busy. This problem also caused people to become homeless. It made the foster care system work harder. Babies born to mothers using opioids were also hurt. Families of all backgrounds suffered, but Black, American Indian, and Alaska Native families were hurt the most.

Just stopping the pharmacies from giving out too many pills now does not fix the problems already caused. It's like stopping a factory from making pollution; it doesn't clean up the dirty land. Thousands of people in these counties still struggle with addiction to opioids. They need help to get better. The only way to truly fix this is a plan called "abatement." This means a court must make sure money is used to pay for proven ways to help. Treatments with medicine like methadone or buprenorphine help lower deaths, crime, and the spread of sickness. Giving out naloxone quickly saves lives. Other important things include finding people who need help, caring for mothers and babies, teaching young people how to avoid drugs, safe homes for people getting better, support from the law, making it easier to talk about addiction, and having enough workers to help people overcome addiction.

Pharmacies giving out too many pills caused a long-lasting public problem. This problem will stay unless steps are taken to fix it. So, the Court should agree with the first decision. It should support the plan to fix the problem. This plan would let local governments pay for treatment, ways to stop addiction, and help people recover. It would help mend the great harm caused by the opioid problem.