Advocates and victims of the opioid disaster collect outdoors the U.S. Supreme Courtroom 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 circumstances 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 outdoors the U.S. Supreme Courtroom 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 circumstances 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 have been sued for his or her function 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 twenty years.
In the meantime, greater than 100,000 People have died of drug overdoses every year lately, 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 function within 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 masking the windfall’s blended affect in communities throughout the nation. Listed below are 5 issues we have discovered in 2023 and plan to keep watch over subsequent yr:
1. The whole quantity of settlement cash coming to state and native governments is a transferring goal
Earlier than the beginning of the yr, nationwide settlements have been in place with at the least 5 corporations, and several other different offers have been within the ultimate levels, stated Christine Minhee, founding father of OpioidSettlementTracker.com.
At present, most states are collaborating 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 within the second half of this yr, resulting in 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 individuals straight affected by the disaster. However the firm filed a second chapter in August, slashing $1 billion from that determine.
Purdue Pharma, maybe the perfect identified 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 within the arms of the Supreme Courtroom. At its core is the query of whether or not it is authorized for the Sackler household to realize immunity from future civil circumstances concerning the opioid disaster underneath the corporate’s chapter deal once they haven’t filed for chapter as people.
The Supreme Courtroom heard arguments in December and is anticipated 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 outdoors the U.S. Supreme Courtroom 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 circumstances 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 outdoors the U.S. Supreme Courtroom 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 circumstances 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 exhibiting that solely 12 states had promised to publicly report how they have been 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 happy 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 information and open-meeting legal guidelines. Though a choose dominated in favor of the advocacy group, it turned a moot level in July, when the state handed a finances that included language exempting the muse from such necessities.
In Michigan, the Division of Well being and Human Providers got here underneath 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 by which lawmakers requested essential questions concerning the cash — the division launched an internet site, displaying a breakdown of organizations to which it had awarded funds.
On the nationwide stage, a dozen Democratic lawmakers have raised considerations a few lack of transparency and oversight by way of 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 observe opioid settlement fund spending, to make sure that populations in want of further assist 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 take action.
“At the moment, no mechanism exists that will enable ONDCP to require states to reveal 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 Fact 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 Fact 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 regulation 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 services or increasing present ones. They’re masking the price of look after uninsured individuals and making an attempt to extend the variety of clinicians prescribing drugs for opioid use dysfunction, which have been proven to save lives.
One other widespread expense is naloxone, a medicine that reverses opioid overdoses. Wisconsin is spending about $8 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 automobiles, expertise to assist officers hack into telephones, and physique scanners for jails. Supporters say these instruments are essential to crack down on drug trafficking, however analysis suggests regulation enforcement efforts do not stop overdoses.
Persons are additionally divided over school-based packages to stop youngsters from growing addictions. Whereas they agree on the aim, some individuals favor packages that educate youngsters concerning the risks of medicine — like D.A.R.E. within the ’80s — whereas others favor packages targeted on enhancing psychological well being, resiliency, and communication expertise.
Maybe probably the most contentious use, although, is shoring up county budgets and paying again outdated payments. Even when it is authorized, many individuals straight affected by the epidemic say this misses the aim of the settlement cash, which is to handle right now’s ongoing disaster.
4. The settlements require corporations to vary problematic enterprise practices, however that is having unintended penalties
As a part of their settlements, producers like Allergan and Johnson & Johnson agreed to not promote opioids for 10 years and curb advertising and promotion actions. Pharmaceutical distributors have been required to step up efforts to establish suspicious orders from pharmacies, underneath 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 aim of those stipulations is to stop additional misuse of prescription opioids. However some individuals see unintended penalties.
Distributors have positioned stricter limits not solely on pharmacy orders of opioids, however on many medication thought-about probably addictive, referred to as “managed substances.” Because of this, orders for these drugs are being canceled extra typically and a few pharmacies are hesitant to fill prescriptions for brand spanking new sufferers. That has left individuals struggling to acquire drugs for persistent ache, anxiousness, attention-deficit/hyperactivity dysfunction — and, satirically, even remedy 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 tough to acquire at many group pharmacies and in rural areas. However the settlements seem like making it worse.
As an alternative of accelerating entry to remedy — which is essential to stemming the variety of overdoses — “I actually fear the settlements could also be having the alternative impact,” Ostrach stated.
Members of the Washington, D.C., Opioid Abatement Advisory Fee, which can advise on the usage of greater than $80 million, met for the primary time and have been 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 can advise on the usage of greater than $80 million, met for the primary time and have been 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 within the technique of figuring out priorities and growing processes to award grants.
Throughout the nation, some county officers say they want extra steerage on acceptable makes use of of the cash. Others are surveying residents on what they need earlier than making selections.
The sluggish tempo has annoyed some advocates, who say there must be higher urgency at a time when the drug provide is turning into more and more lethal. However others say the cash will proceed arriving by way of 2038, so organising considerate processes now may repay for years to come back.
It is a trade-off between placing out present fires and stopping future ones, stated Shelly Weizman, mission director of the dependancy and public coverage initiative at Georgetown College’s O’Neill Institute. She’s hopeful officers will strike the precise steadiness.
“Is there a imaginative and prescient in every state about the place we’ll be when the settlement monies are executed?” she stated. “My hope is that 18 years from now we’re not nonetheless the place we’re right now.”
KFF Well being Information, previously referred to as Kaiser Well being Information (KHN), is a nationwide newsroom that produces in-depth journalism about well being points and is among the core working packages at KFF — the unbiased supply for well being coverage analysis, polling, and journalism.