The shock may have worn off the numbers that detail the opioid epidemic, but that doesn’t make them any less tragic. In 1999, drug overdoses killed fewer than 17,000 people in the United States. In 2017 alone, that figure exceeded 72,000 — more than the number of U.S. soldiers killed during the Vietnam War, the Korean War, or World War I. Almost half of all Americans are close to someone who is or has been addicted to drugs.

The victims of the opioid epidemic — those who’ve become dependent, their families, and the communities where they live — have largely been left to battle the problem on their own. Small towns triage jail beds to make room for drug arrests. Judges separate children from their addicted parents. For many towns, drug-related crimes now account for the vast majority of police work. The economic costs are enormous. According to figures from the White House, in 2015 the United States spent an estimated $504 billion on health care, criminal justice, and other needs stemming from the epidemic—nearly 3 percent of the country’s total gross domestic product.

Farrell believes his lawsuit can succeed at curbing the epidemic where the federal government has failed. He lives where he was born, in Huntington, West Virginia. About a five-hour drive south from Cleveland, Huntington is in the heart of an Appalachian region that has become synonymous with the opioid epidemic. Farrell knows the trauma personally. Addiction struck several of his high school friends. He has colleagues who are raising their grandchildren because their own children gave up custody after becoming dependent on drugs. Farrell’s children now barely react when they see EMTs once again administering the overdose treatment Narcan to someone overdosing on a Huntington street corner. “It’s not the same place that he calls home,” says Jacqueline Farrell, his wife of 21 years.

“I’m a simple hillbilly lawyer. I’ve been underestimated my entire life.”

Three years ago, Farrell read a story in West Virginia’s Charleston Gazette reporting that from 2007 to 2012, wholesale drug distributors shipped 780 million prescription painkillers into his home state. “The unfettered shipments,” wrote journalist Eric Eyre, who won a Pulitzer Prize for his reporting, “amount to 433 pain pills for every man, woman, and child in West Virginia.”

The facts rankled Farrell, whose family has lived in the state for more than 70 years. “I’m from West Virginia, and I don’t take kindly to that kind of stuff,” he says.

Farrell thinks he can lead the way to a solution, even if his background doesn’t quite match the high-powered pharma attorneys he’ll be up against. “I’m a simple hillbilly lawyer,” he says. “I’ve been underestimated my entire life.” He was student body president at Huntington East High School and won multiple debate tournaments. He left the state for four years to attend the University of Notre Dame but returned to obtain his law degree at the West Virginia College of Law and never left. When he was dissatisfied with the options in the 2016 Democratic presidential primary — formerly a registered Democrat, Farrell recently changed his affiliation to independent — he nominated himself to run against Hillary Clinton and Bernie Sanders, paying $2,500 to have his name on the ballot. He earned 21,000 votes in West Virginia and even beat Clinton in one county before bowing out. “He doesn’t lack for an ego,” says his father, who is also named Paul.

Farrell’s father ran a law firm specializing in medical malpractice defense with his brothers for years before he became a circuit judge in Huntington. Farrell joined his father and uncles there soon after graduation, but the warrior in him ultimately drove Farrell toward plaintiff law. “That’s more his personality,” his father says. “Being the aggressor.” After seven years as a plaintiff lawyer in Morgantown, West Virginia, Farrell returned to Huntington to join the firm Greene Ketchum as a partner in 2006. During his career there, Farrell won a $10 million medical malpractice verdict in 2007 and an $18 million verdict against Boston Scientific in 2016 in one of the first lawsuits filed against the makers of transvaginal mesh, a tissue-repairing device tied to serious injuries. These victories gave Farrell the connections and reputation he needed to garner support—from both his own firm and several top attorneys across the country—when his outrage over the opioid epidemic took shape as a legal strategy: Charge the makers and sellers of painkillers with causing a public nuisance.

The National Prescription Opiate Litigation argues that public nuisance is “an unreasonable interference with a right common to the general public.” The strategy has precedence — successful and not. One historic lawsuit that relied on public nuisance laws is the 1990s litigation against tobacco companies, initiated and led by Mike Moore, then the attorney general of Mississippi. The case argued that cigarette manufacturers had created a public nuisance by selling and advertising a product that they knew made people sick. The lawsuit ended in a $246 billion settlement to be paid out to states in yearly increments over 25 years, with the intention that the money would be used mainly for anti-smoking programs. (Reality has fallen short, with many states redirecting tobacco funds for other purposes, including placing the funds into their general treasury for any use.)

Following the success of the tobacco suit, several states sued handgun manufacturers using the same statutes, though results have been mixed. Public nuisance doesn’t exist as a single statute in federal law and is instead invoked as a common law, something based on legal precedent and custom. Partly because of that history, public nuisance has become what one legal treatise called a “grab bag,” supporting a wide range of complaints — tobacco, guns, environmental threats, and now opioids.

Moore, in private practice since 2004, began investigating the pharmaceutical industry in the mid-2000s, but he believes his further efforts were stymied by what was a growing medical consensus at the time, largely created by drugmakers, that pain was undertreated. “They did a great job of putting this message out there,” Moore says. “It hit me right in the face everywhere I went.”

Moore initially moved on, discouraged by the power of the pharmaceutical industry, but in 2015, he led Mississippi as the first state to file an opioid lawsuit. Since then, at least 35 states have filed similar complaints; Moore is now representing four of them. His approach is similar to Farrell’s and draws heavily on public nuisance statutes. The major difference is that these cases are filed by state attorneys general and litigated locally. For his part, Farrell opted for federal court, because he wanted the power to subpoena the DEA’s records of drug sales for the entire country.

What makes the National Prescription Opiate Litigation unique, Farrell explains, is that the group of cases also takes on the companies that distribute painkillers, not just the companies that make them. McKesson, Cardinal, and AmerisourceBergen are considered the “big three” drug distributors. These companies have not yet been held legally accountable for any contribution they made to the epidemic. (Purdue Pharma, creator of OxyContin, was fined $634 million in 2006 by the Department of Justice for deceptive marketing practices around the opioid — though the case did little to stem the epidemic or the growth of Purdue’s business.) Farrell wants to change that. By widening the net of blame, the case could bring in more money for abatement and set a precedent should the defendants simply continue their practices even after a penalizing verdict, as manufacturers have done in the past.

In early 2017, Farrell presented his idea to sue both painkiller makers and distributors to the Huntington town board. “What if I told you I know where the warehouse is that’s shipping all the opium pills to our hometown?” he recalls saying. “Let’s shut down the source.”

The board agreed, and Farrell filed a suit in federal court for Cabell County, which includes Huntington, against the three major distributors, along with Rite Aid, CVS, Walmart, and other drug sellers. He listed multiple complaints, chief among them that these companies had created a public nuisance. He then began contacting county prosecutors in West Virginia, southern Ohio, and eastern Kentucky — the areas hardest hit by the epidemic. County after county filed suit, and by the end of 2017, more than 1,000 counties, towns, and Native American reservations had filed suits, about 600 of them led by Farrell.

A judicial panel consolidated the cases, at first by region and then into a single suit, known as a multidistrict litigation (MDL). The panel appointed Daniel Polster, a U.S. district judge for the Northern District of Ohio, as the sole justice presiding over the case. (Juries would ultimately decide each trial.) At the end of 2018, the plaintiff attorneys, which now numbered more than 150, met at the Hilton Hotel in downtown Cleveland and nominated Farrell as the co-lead counsel, along with Paul Hanly, a veteran of Mike Moore’s earlier painkiller lawsuits, and Joe Rice, who co-founded one of the country’s most powerful plaintiff litigation firms. “He’s playing in the big leagues with some big-time litigation with big rewards and big risks,” Farrell’s father says.

The defendants are bringing in their own legal heavy hitters. Endo Pharmaceuticals hired Carole Rendon, who served as U.S. attorney for the Northern District of Ohio from 2016 to 2017. During that tenure, she told the Department of Justice that Ohio “must continue to curb the rate at which doctors are prescribing opioids and address the underlying incentives that have led to that practice.” She now works as a defense attorney with the Cleveland-based firm BakerHostetler. The defense counsel also includes Enu Mainigi, who successfully defended Bank of America against the Department of Justice, and Mark Cheffo, one of the country’s top product liability lawyers. (Rendon declined to speak about the case with OneZero. Mainigi and Cheffo did not respond to a request for comment by publication time.)

The first trial of the National Prescription Opiate Litigation is scheduled for September 2019 and includes three of the now 1,500 cases — Cleveland, Akron, and Cuyahoga and Summit counties. This trial will function as a bellwether, hinting at how future juries are likely to rule. If the plaintiffs and defendants don’t settle, that bellwether trial will be followed by a procession of others, each one addressing a handful of the hundreds of plaintiffs included in the consolidated case. Trying each of the cases included in the consolidation would take years.

As the bellwether — and because of the stakes — the trial set for this fall has required months of hearings, conference calls, and round-the-clock emails involving the two sides, Judge Polster, and three special masters he has appointed to help oversee various aspects of the case. “If you go out of pocket for like five hours, there’s like a hundred emails that you missed,” says Mark Pifko, a lawyer for the plaintiffs. Rulings regarding what information each side must provide and when incur hours of detailed arguments from both sides. At an October 23 hearing in Cleveland, the legal teams for the plaintiffs and the defendants spent hours working through what documents and evidence both sides of the lawsuit will be able to access. For example, a lawyer for the drug distributor McKesson said that because Cuyahoga County doesn’t pay for the overdose drug Narcan, the cost shouldn’t be included with the damages. The legal quibbles on that day’s 17-item agenda took eight hours.

Later that night, a few plaintiff attorneys decompressed over martinis and bourbons in a private room at a nearby steakhouse and shared the confidence they had in their case. One lawyer said he had emails from Walgreens employees describing their fear of leaving work at night because drug users whose prescriptions they’d refused to fill lurked in the parking lot. Another said he had information showing that hotel maids were targeted by the pharmaceutical industry because working on their feet all day left them in pain.

“This case is either gonna be magic or tragic,” Farrell says. “One way or the other, there will be a reckoning.”

The lawsuit has swallowed Farrell whole. “It has taken him away from his family for the past year and a half,” Jacqueline Farrell says. Their children ask why he’s not around. Though he stays out of the details, Farrell’s father has witnessed the workload: finding experts, taking depositions, responding to pleadings, “flying to Cleveland on a day’s notice because the judge wants to see him.” Jacqueline has a straightforward explanation to give their children about Farrell’s frequent absences. “It’s necessary because it’s an evil,” she says. “It’s a sacrifice that is not just for this community, but for our nation.”

Of course, all the effort is also an investment. Each of the hundreds of contracts that Farrell’s firm has for the litigation includes a contingency fee of about 25 percent, which the court must approve, in exchange for the legal work and any expenses. “Obviously, if we’re successful, then I stand to gain financially,” Farrell says.