about $7 billion per year. The social effects of the opioid epidemic include the costs associated with healthcare and the criminal justice system. In regards to healthcare, costs can be attributed to Neonatal Abstinence Syndrome treatment and emergency services. Neonatal Abstinence Syndrome or NAS occurs when a woman abuses opioids during pregnancy, thus causing the baby to experience withdrawal symptoms when born. According to the National Institute on Drug Abuse, in 2017 out of every 1000 hospital births, 13.7 of those births involved an infant born with NAS. Additionally, the responses to opioid related incidents involve costs related to Narcan, transport to the hospital, and first responders. In 2016 and 2017, the total cost of all these factors was $43 million. Meanwhile, in patient and ICU costs were $538 million and $271 million, respectively. In regards to the criminal justice system, a report from the Massachusetts Health Policy Forum states that the effect of the opioid issue on the criminal justice system is estimated to be $500 million. The Middlesex sheriff's office notes that of the 73% of the prisoners with alcohol or drug addiction are involved in opioids. The analysis by the Massachusetts Taxpayers' Foundation notes that handling prisoners battling opioid use disorders costs $470 million each year. Legal action In May 2019, in the first successful prosecution of top pharmaceutical executives for crimes related to the prescribing of opioids, the founder and four former executives of Insys Therapeutics Inc. were convicted by a federal jury in Boston in connection with bribing medical practitioners to prescribe Subsys, a highly-addictive sublingual fentanyl spray intended for cancer patients experiencing breakthrough pain, and for defrauding Medicare and private insurance carriers. The company declared bankruptcy about two weeks after they lost the case. Dozens of states are suing pharmaceutical companies, accusing them of causing the epidemic. Suits filed by almost 2,000 cities, counties, and tribal lands have been rolled into a single federal case scheduled to be heard in Fall 2019. In the first state case to reach a decision, on August 26, 2019, Oklahoma district court judge Thad Balkman found the pharmaceutical company Johnson & Johnson responsible for creating a "public nuisance" under state law, and ordered the company to pay a fine of $572 million. The company said they will appeal. Two other drug makers had previously settled with the state of Oklahoma. Purdue Pharma, the maker of OxyContin, agreed to