Several of Minnesota’s largest counties and cities are on the verge of joining a national wave of government lawsuits targeting pharmaceutical manufacturers and distributors for the public cost of the opioid crisis.

Commissioners of at least a half dozen county boards authorized their attorneys this month to enter into agreements with private law firms to either sue or consider litigation, including Hennepin, Ramsey, St. Louis, Chisago, Mower and Steele counties. On Friday, the Minneapolis City Council decided to file suit. St. Paul also plans to do so, a mayoral spokesman said.

They are joining scores of county and local governments throughout the country alleging manufacturers and distributors of prescription opioids are largely responsible for an epidemic of dangerous addiction that has caused thousands of deaths and strained public resources.

“The county attorneys are trying to figure out how, collectively, we can be responsible and be aggressive about supporting folks in our communities against this opiate crisis,” said Hennepin County Attorney Mike Freeman, who said his county’s board discussed the issue in a closed legal briefing earlier this month. “We’re all trying to unite together to quietly but forcefully say ‘Enough is enough.’ They’ve got to stop this crap.”

With a federal hearing on such litigation scheduled for the end of the month, some Minnesota counties and municipalities are scrambling to consider filing suit before then. Freeman and other attorneys expect a substantial portion of the state’s 87 counties will eventually sue.

Too much pain medication

In lawsuits reminiscent of actions against tobacco companies in the 1990s, governments in other states have alleged that pharmaceutical companies used deceptive marketing practices and misrepresented the addictive nature of the drugs, flooding communities with the addictive prescription pills. Distributors are being blamed for failing to report suspiciously large orders of opioids in certain areas.

The suits seek damages for the governments’ costs in handling the opioid epidemic, including law enforcement, medical treatment and social services.

In response to other lawsuits, representatives for the defendants have denied any wrongdoing.

Ramsey County Attorney John Choi, who said his County Board met in a closed session Tuesday to discuss pending litigation, said the county plans to file its lawsuit before the end of the month seeking “monetary and non-monetary remedial damages.”

“This isn’t just about money,” Choi said. “This is about also other things that could be done to ensure that we’re truly addressing this epidemic moving forward ... clearly there’s way more pain medication than is actually necessary for our populations throughout Minnesota.”

Prescription painkillers have been blamed for starting the opioid epidemic and driving those addicted to illegal street drugs such as heroin. A Star Tribune analysis of state death certificate data found 402 opioid-related deaths in Minnesota in 2016, up from 344 in 2015 and more than double the number in 2006.

Nationally, overdose deaths from opioids, including prescription opioids and heroin, have more than quadrupled since 1999, according to the CDC. From 1999 to 2015, more than 183,000 people died from overdoses related to prescription opioids.

In St. Louis County in northeast Minnesota, where the opioid crisis has hit communities especially hard, commissioners voted unanimously Tuesday to authorize a lawsuit.

St. Louis County had the second-highest rate of opioid-involved overdose mortality in the state from 2011 to 2015, with 10.7 deaths per 100,000 people. Neighboring Carlton County had the highest rate with 12.4 deaths. The state average was 5.7 during that time.

“It’s been very significant in our neck of the woods,” said Commissioner Patrick Boyle, a nurse practitioner who has seen the epidemic in his work.

Unlike many states, counties in Minnesota are responsible for out-of-home placement of children — a cost that accounts for more than 10 percent of St. Louis County property taxes, Boyle said.

“We have just under 800 kids in out-of-home placement and we are predicting a majority of those kids are due to the opiate heroin crisis from their parents,” he said.

The county has also poured money into getting overdose patients into treatment faster, helping to fund a new opioid detox center.

Minneapolis City Attorney Susan Segal said that since the Minneapolis Fire Department began carrying the opioid antidote naloxone in May of 2016, firefighters have responded to 363 opioid overdose emergencies and administered more than 500 doses.

“It has just been a devastating epidemic,” Segal said. The city’s lawsuit will help send a message to companies, she said, to “stop these deceptive … marketing and distribution practices.”

Part of a strategy

The lawsuits are part of a strategy to combat the opioid crisis through various means, including prescription drug turn-in programs and prosecution of illegal drug dealers.

In September, state attorneys general from around the country served subpoenas on companies that produce and distribute opioids.

A state task force recently set new limits on opioid prescriptions by doctors who participate in the state’s Medicaid program.

Julie Ring, executive director of the Association of Minnesota Counties, said that in talking with county leaders throughout the state over the past few weeks, she found “there is a fair amount of interest” in lawsuits against the companies that make and distribute the prescription drugs.

While the law firms are taking the cases on contingency — meaning they assume the cost of investigating and presenting the case, but then collect attorney’s fees out of any damage awards they might win — Ring said counties are considering how much staff time may be needed to help document the government costs involved in dealing with the opioid crisis.

“We’re concerned with making sure that counties are thinking through all the pros and cons,” Ring said. “There is a certain amount of data gathering that has to go into building these cases. That will require some county resources. … If a large number of counties decide to move forward, we might be able to help them streamline that data.”

A federal panel of judges in St. Louis, Mo., is slated to hear arguments Nov. 30 on whether similar suits around the country should be transferred and consolidated to go before a single judge in multidistrict litigation. Some experts feel it would be advantageous for governments to file suit before that hearing, though others say there is little harm in taking more time to decide.

The push for lawsuits in Minnesota has “come up fairly rapidly,” Ring said. “We’ve told folks … they should take the time they need to determine that it’s the right choice for them.”