Advocates and victims of the opioid disaster collect exterior the U.S. Supreme Court docket on Dec. 4, 2023, whereas the justices hear a case about Purdue Pharma’s chapter deal. The protesters urged justices to overturn the deal, which might give the Sackler household immunity in opposition to future civil instances associated to opioids.
Aneri Pattani/KFF Well being Information
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Aneri Pattani/KFF Well being Information
Advocates and victims of the opioid disaster collect exterior the U.S. Supreme Court docket on Dec. 4, 2023, whereas the justices hear a case about Purdue Pharma’s chapter deal. The protesters urged justices to overturn the deal, which might give the Sackler household immunity in opposition to future civil instances associated to opioids.
Aneri Pattani/KFF Well being Information
In 2023, state and native authorities obtained about $1.5 billion in settlement funds from greater than a dozen corporations that manufactured, bought, or distributed prescription painkillers and were sued for his or her position in fueling the opioid disaster.
That cash has gone from an rising funding stream for which individuals had lofty however unsure aspirations to a coveted pot of billions of {dollars} being invested in actual time to handle dependancy.
Altogether, the businesses are anticipated to pay greater than $50 billion to state and native governments over almost 20 years.
In the meantime, greater than 100,000 Individuals have died of drug overdoses every year in current years, underscoring the pressing nature of the disaster.
Discover the sequence
Opioid producers, distributors, and retailers are paying tens of billions of {dollars} in restitution for his or her position in the overdose epidemic. We’re monitoring how state and native governments use — or misuse — the money. Discover the sequence right here.
KFF Well being Information has been monitoring the funds all yr and overlaying the windfall’s combined influence in communities throughout the nation. Listed below are 5 things we have discovered in 2023 and plan to regulate subsequent yr:
1. The full quantity of settlement cash coming to state and native governments is a transferring goal
Earlier than the beginning of the yr, nationwide settlements were in place with no less than 5 corporations, and several other different offers were in the ultimate levels, stated Christine Minhee, founding father of OpioidSettlementTracker.com.
At the moment, most states are taking part in settlements with opioid producers Johnson & Johnson, Teva Pharmaceutical Industries, and Allergan; pharmaceutical distributors AmerisourceBergen, Cardinal Well being, and McKesson; and retail pharmacies Walmart, Walgreens, and CVS. Many are additionally settling with the nationwide grocery store chain Kroger.
A number of of those offers started paying out in the second half of this yr, main to bumps in states’ opioid settlement pots.
However there have been dents and slowdowns too.
Mallinckrodt Prescribed drugs, a producer of generic opioids, initially agreed to pay $1.7 billion on account of its 2020 chapter submitting to state and native governments, in addition to folks instantly affected by the disaster. However the firm filed a second chapter in August, slashing $1 billion from that determine.
Purdue Pharma, maybe the most effective recognized of all the businesses for its creation and advertising of OxyContin, had agreed to pay $6 billion as a part of its chapter proceedings. However the Biden administration objected to the deal this summer season, and the case now lies in the palms of the Supreme Court docket. At its core is the query of whether or not it is authorized for the Sackler household to acquire immunity from future civil instances concerning the opioid disaster below the corporate’s chapter deal once they haven’t filed for chapter as people.
The Supreme Court docket heard arguments in December and is predicted to rule on the case subsequent spring or summer season. Till then, no Purdue cash will move.
Advocates and victims of the opioid disaster collect exterior the U.S. Supreme Court docket on Dec. 4, 2023, whereas the justices hear a case about Purdue Pharma’s chapter deal. The protesters urged justices to overturn the deal, which might give the Sackler household immunity in opposition to future civil instances associated to opioids.
Aneri Pattani/KFF Well being Information
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Aneri Pattani/KFF Well being Information
Advocates and victims of the opioid disaster collect exterior the U.S. Supreme Court docket on Dec. 4, 2023, whereas the justices hear a case about Purdue Pharma’s chapter deal. The protesters urged justices to overturn the deal, which might give the Sackler household immunity in opposition to future civil instances associated to opioids.
Aneri Pattani/KFF Well being Information
2. Most states nonetheless aren’t being clear about how the cash is used
In March, KFF Well being Information, NPR and Minhee printed a complete investigation displaying that solely 12 states had promised to publicly report how they were utilizing all their settlement {dollars}. Since then, that quantity has inched up to 16.
However 15 states nonetheless haven’t dedicated to publicly reporting something in any respect, and others have promised to publicize solely a portion of their spending.
Many individuals aren’t completely satisfied concerning the secrecy.
In Ohio, a neighborhood advocacy group, Hurt Discount Ohio, sued the OneOhio Restoration Basis, which controls a lot of the state’s settlement {dollars}, for violating public data and open-meeting legal guidelines. Though a choose dominated in favor of the advocacy group, it grew to become a moot level in July, when the state handed a funds that included language exempting the muse from such necessities.
In Michigan, the Division of Well being and Human Companies got here below fireplace for not publicly reporting the way it was spending upward of $40 million in settlement funds. In October — simply hours earlier than a legislative subcommittee listening to in which lawmakers requested important questions concerning the cash — the division launched a web site, displaying a breakdown of organizations to which it had awarded funds.
On the nationwide degree, a dozen Democratic lawmakers have raised issues a couple of lack of transparency and oversight through a Sept. 25 letter to the Workplace of Nationwide Drug Management Coverage, which is main the federal authorities’s response to the opioid disaster.
“We urge the Biden administration to intently monitor opioid settlement fund spending, to be certain that populations in want of extra help obtain it,” the lawmakers wrote.
The Workplace of Nationwide Drug Management Coverage responded this month that it didn’t have the statutory authority from Congress to accomplish that.
“At present, no mechanism exists that will permit ONDCP to require states to disclose their spending,” the workplace wrote in a letter obtained by KFF Well being Information. “ONDCP can’t successfully monitor how states use these funds.”
Carrie Spears misplaced her 23-year-old nephew, Tanner, to an overdose two years in the past. She paused close to a cardboard memorial marker for him at a Path of Reality occasion in Washington, D.C., on Sept. 23, 2023.
Aneri Pattani/KFF Well being Information
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Aneri Pattani/KFF Well being Information
Carrie Spears misplaced her 23-year-old nephew, Tanner, to an overdose two years in the past. She paused close to a cardboard memorial marker for him at a Path of Reality occasion in Washington, D.C., on Sept. 23, 2023.
Aneri Pattani/KFF Well being Information
3. Cash is being spent on remedy, overdose prevention, and controversially, on legislation enforcement
Though there is no such thing as a nationwide information on how settlement {dollars} are spent, piecemeal monitoring by journalists and advocates has surfaced some favorites.
One of many largest is investing in remedy. Many jurisdictions are constructing residential rehab amenities or increasing current ones. They’re overlaying the price of look after uninsured folks and making an attempt to improve the variety of clinicians prescribing medicines for opioid use dysfunction, which have been proven to save lives.
One other widespread expense is naloxone, a drugs that reverses opioid overdoses. Wisconsin is spending about $eight million on this effort. Kentucky has devoted $1 million. And lots of native governments are allocating smaller quantities.
Another decisions have sparked controversies.
A number of governments used settlement {dollars} to buy police patrol vehicles, expertise to assist officers hack into telephones, and physique scanners for jails. Supporters say these instruments are important to crack down on drug trafficking, however analysis suggests legislation enforcement efforts do not forestall overdoses.
Persons are additionally divided over school-based applications to forestall youngsters from growing addictions. Whereas they agree on the objective, some folks favor applications that educate youngsters concerning the risks of medicine — like D.A.R.E. in the ’80s — whereas others desire applications centered on bettering psychological well being, resiliency, and communication expertise.
Maybe probably the most contentious use, although, is shoring up county budgets and paying again previous payments. Even when it is authorized, many individuals instantly affected by the epidemic say this misses the objective of the settlement cash, which is to handle immediately’s ongoing disaster.
4. The settlements require corporations to change problematic enterprise practices, however that is having unintended penalties
As a part of their settlements, producers like Allergan and Johnson & Johnson agreed not to promote opioids for 10 years and curb advertising and promotion actions. Pharmaceutical distributors were required to step up efforts to determine suspicious orders from pharmacies, below the oversight of an unbiased third-party monitor. Retail pharmacy chains should conduct audits and web site visits to their pharmacies, in addition to share information with state companies about problematic prescribers.
The objective of those stipulations is to forestall additional misuse of prescription opioids. However some folks see unintended penalties.
Distributors have positioned stricter limits not solely on pharmacy orders of opioids, however on many medication thought of probably addictive, often known as “managed substances.” Because of this, orders for these medicines are being canceled extra usually and a few pharmacies are hesitant to fill prescriptions for brand spanking new sufferers. That has left folks struggling to get hold of medicines for persistent ache, nervousness, attention-deficit/hyperactivity dysfunction — and, paradoxically, even treatment that treats opioid dependancy.
Bayla Ostrach, a researcher in North Carolina who research substance use and well being coverage, stated buprenorphine, which is taken into account a gold-standard remedy for opioid use dysfunction, was already troublesome to get hold of at many group pharmacies and in rural areas. However the settlements seem to be making it worse.
As a substitute of accelerating entry to remedy — which is important to stemming the variety of overdoses — “I actually fear the settlements could also be having the other impact,” Ostrach stated.
Members of the Washington, D.C., Opioid Abatement Advisory Fee, which is able to advise on the usage of greater than $80 million, met for the primary time and were sworn in on Oct. 25, 2023. Like many different jurisdictions, the District of Columbia has but to spend any of its settlement funds.
Aneri Pattani/KFF Well being Information
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Aneri Pattani/KFF Well being Information
Members of the Washington, D.C., Opioid Abatement Advisory Fee, which is able to advise on the usage of greater than $80 million, met for the primary time and were sworn in on Oct. 25, 2023. Like many different jurisdictions, the District of Columbia has but to spend any of its settlement funds.
Aneri Pattani/KFF Well being Information
5. Many locations have not determined what to do with the cash but
A number of states, together with Montana and Hawaii, have but to spend any of the settlement funds managed by their state companies. In Maine and West Virginia, councils overseeing the lion’s share of funds are nonetheless in the method of figuring out priorities and growing processes to award grants.
Throughout the nation, some county officers say they want extra steering on applicable makes use of of the cash. Others are surveying residents on what they need earlier than making selections.
The gradual tempo has pissed off some advocates, who say there ought to be higher urgency at a time when the drug provide is changing into more and more lethal. However others say the cash will proceed arriving via 2038, so establishing considerate processes now might repay for years to come.
It is a trade-off between placing out present fires and stopping future ones, stated Shelly Weizman, undertaking director of the dependancy and public coverage initiative at Georgetown College’s O’Neill Institute. She’s hopeful officers will strike the suitable steadiness.
“Is there a imaginative and prescient in every state about the place we’re going to be when the settlement monies are carried out?” she stated. “My hope is that 18 years from now we’re not nonetheless the place we’re immediately.”
KFF Well being Information, previously often known as Kaiser Well being Information (KHN), is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working applications at KFF — the unbiased supply for well being coverage analysis, polling, and journalism.