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l <br />�. <br />Herein, we identify causes of action available under North Carolina jurisprudence that <br />would allow the Counties of North Carolina to hold responsible the distributors which have <br />fueled the opioid epidemic within North Carolina. <br />I. Wholesale Distributors Are Required under Federal and North Carolina and <br />Federal Law to Monitor for and Report Suspicious Orders of Opioids. <br />A. The Role of Wholesale Distributors in the Opioid Distribution Chain. <br />Pharmaceutical distributors are supposed to play the role of "beat cops" in preventing the <br />flow of controlled substances to abusers. <br />Congress enacted the Controlled Substances Act ( "CSA ") in 1970 with the express <br />purpose of creating a "closed system" for the distribution of controlled substances designed to <br />prevent the diversion of legally produced controlled substances into illicit markets.2 Through the <br />CSA, Congress stripped the manufacturers of the ability to sell directly to retailers, intentionally <br />creating a link in the chain of distribution between Big Pharma and the pharmacies. This link is <br />the wholesale distributor. <br />There are only 800 registered wholesale distributors in the United States. Three Fortune <br />500 companies own 85% of the market share: Cardinal Health, AmerisourceBergen, and <br />McKesson Corporation. Each company generates over $100 billion in revenue annually. <br />Because the CSA creates a "closed system" in which opioid dispensers — like pharmacies <br />— must obtain opioids from opioid distributors, these distributors are "uniquely situated" to spot <br />red flags in the opioid chain, as they note in their own industry guidelines. The distributors are <br />the first line of defense against the diversion of these drugs that can lead to abuse, addiction, and <br />blight. <br />2 See 21 U.S.C.A. §§ 801 -971 (2006); 21 U.S.C.A. §§ 1300 -1321 (2009); H.R. Rep. No. 91- <br />1444; 1970 U.S.C.C.A.N. 4566, 4572 (Sept. 10, 1970). <br />North Carolina County Opioid Litigation - Privileged and Confidential 3 <br />