Following Grafton, Belknap, Rockingham and Strafford counties, Cheshire will be the fifth in New Hampshire to join the mass-tort lawsuit, which has racked up about 1,000 plaintiffs across the country. Unlike a class-action lawsuit — which is filed on behalf of a group and allows the courts to decide all cases through a single claim — mass-tort litigation requires each party to file individually and allows one group of attorneys to represent all of those affected.

The list of New Hampshire cities on the lawsuit includes Concord, Nashua, Manchester and most recently, Londonderry. Keene filed to join the lawsuit in April.

Robert Bonsignore, an attorney with Bonsignore Trial Lawyers, PLLC, presented the details of the lawsuit to county officials at the weekly commissioners meeting in Keene Wednesday morning.

“The focus of this litigation is similar to what we saw with tobacco,” Bonsignore said, referring to a lawsuit in the 1990s by the attorneys general of 46 states against four major U.S. tobacco companies. The lawsuit culminated in a $246 billion agreement that funds smoking cessation and prevention programs, the largest corporate legal settlement in the country’s history, according to Bloomberg News.

The mass-tort lawsuit pertaining to opioids alleges pharmaceutical companies marketed the drugs using false claims that they’re not addictive, Bonsignore said, and that the companies failed to track prescriptions as promised.

“They really played us,” Bonsignore said of the pharmaceutical companies. “They lied through their teeth about the addictive quality.”

Representatives of four of the roughly dozen drug companies named in the lawsuit — Purdue Pharma, Teva Pharmaceuticals, Endo and Janssen Pharmaceuticals — sent emailed statements in April and expressed concern about the opioid crisis and highlighted their efforts to tackle it through education, abuse-deterrent drugs, prescribing guidelines and providing first responders with naloxone, which helps reverse the effects of an overdose. They either denied the lawsuit’s allegations or declined to address them directly.

Though Cheshire County’s three commissioners — Chairman Peter Graves, Charles “Chuck” Weed and Joseph Cartwright — all voted to join the lawsuit, there are additional steps to be taken. Each plaintiff is asked to quantify the cost of the opioid crisis to that municipality.

Bonsignore told the commissioners that any money the county has spent on responding to or managing the epidemic could be counted as incurred costs. Examples include increases in law enforcement or correctional facility personnel, the price of procuring naloxone — often referred to by its brand name Narcan, which helps reverse the effects of an opioid overdose — for officers, ambulance costs and funds for education initiatives or awareness programs.

As long as the costs can be linked to opioid abuse and not alcohol or some other substance, Bonsignore said they can be included.

County Administrator Christopher C. Coates told The Sentinel that there are many factors to consider when determining costs to the county, some of them less obvious than others.

As part of Keene’s filing, city officials estimated that the opioid crisis costs the city hundreds of thousands of dollars per year in municipal services.

Bonsignore said Cheshire County won’t be responsible for legal fees upfront.

The attorneys “advance all the costs,” he said, “and if we lose, we eat them.”

If a judge rules in their favor, he said the costs and lawyers’ fees will be split among the thousands of cities, counties and states in the case, though the method for dividing the fees hasn’t yet been determined.

Coates said local taxpayers would benefit from the lawsuit, since the costs of the epidemic fall to them. But he also noted that it’s a chance for Cheshire County to join municipalities across the country in a bigger fight.

“Why would we not step into that … if there’s a thousand (plaintiffs) already in place?” Coates asked. “… I think it’s about doing right for the people you serve.”

New Hampshire had the third-highest rate of drug-overdose deaths per capita in 2016, according to the Centers for Disease Control and Prevention. Figures from the N.H. Office of the Chief Medical Examiner indicate 486 people died in overdoses that year, 426 of which were caused by heroin, fentanyl or other opioids.

Last year’s numbers aren’t finalized, but the medical examiner’s office projected in January that the final tally would be 485 drug overdose deaths.