The endgame of the spreading mass of opioid lawsuits comes into focus: Already a settlement with Johnson & Johnson and three major drug dealers pouring billions of dollars into communities to tackle the addiction crisis, and more to come.
But what exactly that looks like differs from place to place. States will likely see lump sums of money handed out for years and it will be up to them to decide how to spend it according to the signposts posted in the settlements. It could easily be subject to competing interests: lawmakers could argue with governors over priorities, while counties in some places could demand more autonomy. Some public health experts also raise questions about the quality of addiction programs that states could fund.
“This is extremely complicated, and it will be difficult to get it right,” said Kelly Dineen, director of the health law program at Creighton University Law School.
The lawyers leading the lawsuits promise the bulk of the billions will be used on addiction prevention and treatment. They say they are building safeguards into the agreements to ensure the money gets to the root of the problem that led states, cities, counties, and tribes to file these cases in the first place – a crisis that only reached new depths during the Covid-19 pandemic.
It’s a direct response to the 1998 more than $ 200 billion worth of historic tobacco settlement in which money advocates argued that they should go into smoking cessation and instead put prevention into the general funds of the states – and on some Places used for services that were as independent as filling potholes.
“This money has to go down and fight addiction,” Louisiana Attorney General Jeff Landry said last week when a group of attorneys general announced the $ 26 billion deal with the three distributors and Johnson & Johnson. “We’re here for an addiction.”
More deals could follow as plaintiffs and defendants in the opioid supply chain – including manufacturers, distributors, and pharmacies – negotiate ways to resolve the thousands of lawsuits alleging the companies sparked the country’s opioid epidemic .
State officials often look to available sources of income to supplement their limited budgets. If the settlements stipulate that the money should be used for control programs, a state could potentially skim some of the funds to build a general addiction care hospital, even if it wasn’t just an opioid addiction facility, some speculated Experts.
“There is always room in these matters for states to perhaps wriggle out of their original intent,” said Nicolas Terry, executive director of the Hall Center for Law and Health at Indiana University’s law school.
And when the money gets moving, different parties could argue about how to spend it.
When Oklahoma settled an isolated case against Purdue Pharma in 2019, the money was raised helped found an addiction treatment center at Oklahoma State University, in an initiative led by Attorney General Mike Hunter. But the members of the state parliament were outraged that the money hadn’t been put in the treasury so that they could decide what to do with it. You have been changed the law This gives them the authority to split funds from future settlements.
Other states are trying to get ahead of the process. Tennessee has set up an opioid defense council that will help steer any funding, while New York has set up a “lock box” for funds from the settlements to make sure it goes to addiction services.
“Yes, we reached an agreement after many months and years of negotiations, but it will not bring back the loss of life,” New York attorney general Letitia James said last week. “What it will do is prevent this tragedy from happening again. It will provide prevention and education, as well as prevention and beds, to the organizations and hospitals who need them now more than ever. “
New York has also set up a body to advise lawmakers on how to allocate the money, made up of health officials and people who have had addictions either themselves or in their families, which Melissa Moore, state director of the Drug Policy Alliance, “is really crucial Level of accountability. “
In Oregon, county officials argue that most of the settlement money the state receives should go to them because the county governments are largely responsible for addiction relief, said Brad Anderson, senior assistant counsel in Washington County, the state’s second largest.
“These were local government lawsuits,” said Anderson. “Local governments have felt the effects of the opioid epidemic disproportionately and are best placed to be part of the solution.”
The county plans to use the funds received to build its planned addiction treatment and treatment center.
“People go to the emergency room, they often go to jail,” said Kristin Burke from the district’s health department. “But what we really want is for people to be treated.”
There are still many details to clarify before much of the money reaches the state coffers. More states and municipalities are considering the deal with the distributors and Johnson & Johnson and have an opportunity to sign up, but Washington State Attorney General Bob Ferguson has already done so refused the compact, argues that the $ 26 billion over 18 years – and the estimated $ 527.5 million the state would receive over that period – is insufficient to take the toll on the addiction crisis. (Nearly $ 24 billion from the deal will go to the states, with the remaining $ 2 billion covering fees and expenses, attorneys general said.)
Public health experts have credited attorneys with describing the types of addiction programs the settlement money can be used for. In the agreement made with the distributors and Johnson & Johnson last week, the agreement lists a number of avoidance strategies aligning with public health approaches to combating addiction, including distribution of the opioid reversal drug overdose drug naloxone; Offer drug treatment to people without insurance and to people imprisoned; and expansion of syringe exchange programs.
Still, experts have raised concerns about how exactly states will allocate their dollars, with concerns about what types of programs they may or may not fund. Political and law enforcement agencies sometimes reject some of the most effective treatments for opioid addiction – the drugs methadone and buprenorphine – because they are opioids themselves, preferring instead to programs that encourage abstinence but are less successful and not endorsed by addiction health professionals.
“We want ways for states to adjust settlement funds to meet the needs of the people in their state,” said Dineen of Creighton. “But we also know that when it comes to drug policy, states do not always make evidence-based health decisions.”
For example, in Louisiana, lawmakers have passed Landry-sponsored bill direct any settlement money to drug courts. (The governor vetoed the measure, saying it had too vaguely defined an acceptable use of the money.) Many Public health advocates argue that drug courts are an extension of the criminal justice system that often fail to help people get evidence-based treatment and instead call on medical experts to guide addiction treatment.
While the settlement deal suggests what experts say are the best types of intervention, the deals are also expected to spend millions of dollars as officials in some states cut back on damage control programs. Local officials in Indiana and New Jersey Communities recently voted for closure syringe exchange programs, which can serve as avenues for addiction treatment and have been shown to reduce the transmission of viruses such as hepatitis C and HIV among people who inject drugs.
“You have to put your money where your mouth is,” Dineen said of the officers who will oversee the billing dollars. “If you really want to help or help prevent people with opioid use disorder, then you need to support programs and services that have a track record.”