Advocates and victims of the opioid disaster collect outdoors 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 circumstances associated to opioids.
Aneri Pattani/KFF Well being Information
cover caption
toggle caption
Aneri Pattani/KFF Well being Information
Advocates and victims of the opioid disaster collect outdoors 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 circumstances associated to opioids.
Aneri Pattani/KFF Well being Information
In 2023, state and native authorities acquired 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 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 habit.
Altogether, the businesses are anticipated to pay greater than $50 billion to state and native governments over practically twenty years.
In the meantime, greater than 100,000 People have died of drug overdoses every year in recent times, underscoring the pressing nature of the disaster.
Discover the collection
Opioid producers, distributors, and retailers are paying tens of billions of {dollars} in restitution for his or her position within the overdose epidemic. We’re monitoring how state and native governments use — or misuse — the money. Discover the collection right here.
KFF Well being Information has been monitoring the funds all 12 months and overlaying the windfall’s combined impression in communities throughout the nation. Listed below are 5 issues we have realized in 2023 and plan to control subsequent 12 months:
1. The full quantity of settlement cash coming to state and native governments is a transferring goal
Earlier than the beginning of the 12 months, nationwide settlements have been in place with no less than 5 corporations, and a number of other different offers have been within the remaining phases, mentioned Christine Minhee, founding father of OpioidSettlementTracker.com.
In the present day, 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 within the second half of this 12 months, resulting in bumps in states’ opioid settlement pots.
However there have been dents and slowdowns too.
Mallinckrodt Prescription drugs, a producer of generic opioids, initially agreed to pay $1.7 billion because of its 2020 chapter submitting to state and native governments, in addition to individuals immediately affected by the disaster. However the firm filed a second chapter in August, slashing $1 billion from that determine.
Purdue Pharma, maybe one of the best 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 time, and the case now lies within 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 achieve immunity from future civil circumstances concerning the opioid disaster beneath the corporate’s chapter deal after 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 time. Till then, no Purdue cash will stream.
Advocates and victims of the opioid disaster collect outdoors 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 circumstances associated to opioids.
Aneri Pattani/KFF Well being Information
cover caption
toggle caption
Aneri Pattani/KFF Well being Information
Advocates and victims of the opioid disaster collect outdoors 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 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 displaying 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 comfortable concerning the secrecy.
In Ohio, a neighborhood advocacy group, Hurt Discount Ohio, sued the OneOhio Restoration Basis, which controls many 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 grew to become a moot level in July, when the state handed a price range that included language exempting the muse from such necessities.
In Michigan, the Division of Well being and Human Companies got here beneath 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 during 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 degree, a dozen Democratic lawmakers have raised considerations a couple of 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 carefully monitor opioid settlement fund spending, to make sure 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 take action.
“At present, no mechanism exists that might 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 Reality occasion in Washington, D.C., on Sept. 23, 2023.
Aneri Pattani/KFF Well being Information
cover caption
toggle caption
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 therapy, overdose prevention, and controversially, on regulation enforcement
Though there isn’t any nationwide information on how settlement {dollars} are spent, piecemeal monitoring by journalists and advocates has surfaced some favorites.
One of many greatest is investing in therapy. Many jurisdictions are constructing residential rehab amenities or increasing present ones. They’re overlaying the price of take care of uninsured individuals and attempting to extend 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 $8 million on this effort. Kentucky has devoted $1 million. And plenty of native governments are allocating smaller quantities.
Another selections have sparked controversies.
A number of governments used settlement {dollars} to buy police patrol automobiles, know-how 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 forestall overdoses.
Persons are additionally divided over school-based packages to stop children from creating addictions. Whereas they agree on the purpose, some individuals favor packages that train children concerning the risks of medicine — like D.A.R.E. within the ’80s — whereas others choose packages centered on bettering psychological well being, resiliency, and communication expertise.
Maybe essentially the most contentious use, although, is shoring up county budgets and paying again previous payments. Even when it is authorized, many individuals immediately affected by the epidemic say this misses the purpose of the settlement cash, which is to handle right this moment’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, beneath the oversight of an unbiased third-party monitor. Retail pharmacy chains should conduct audits and website visits to their pharmacies, in addition to share information with state companies about problematic prescribers.
The purpose 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 medicine thought of probably addictive, often known as “managed substances.” Consequently, orders for these medicines are being canceled extra usually and a few pharmacies are hesitant to fill prescriptions for brand new sufferers. That has left individuals struggling to acquire medicines for power ache, anxiousness, attention-deficit/hyperactivity dysfunction — and, sarcastically, even medicine that treats opioid habit.
Bayla Ostrach, a researcher in North Carolina who research substance use and well being coverage, mentioned buprenorphine, which is taken into account a gold-standard therapy for opioid use dysfunction, was already troublesome to acquire at many neighborhood pharmacies and in rural areas. However the settlements look like making it worse.
As a substitute of accelerating entry to therapy — which is essential to stemming the variety of overdoses — “I actually fear the settlements could also be having the alternative impact,” Ostrach mentioned.
Members of the Washington, D.C., Opioid Abatement Advisory Fee, which can advise on using 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
cover caption
toggle caption
Aneri Pattani/KFF Well being Information
Members of the Washington, D.C., Opioid Abatement Advisory Fee, which can advise on using 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 means of figuring out priorities and creating processes to award grants.
Throughout the nation, some county officers say they want extra steerage on applicable makes use of of the cash. Others are surveying residents on what they need earlier than making choices.
The sluggish tempo has pissed off some advocates, who say there ought to 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 means of 2038, so organising considerate processes now might repay for years to return.
It is a trade-off between placing out present fires and stopping future ones, mentioned Shelly Weizman, venture director of the habit and public coverage initiative at Georgetown College’s O’Neill Institute. She’s hopeful officers will strike the fitting stability.
“Is there a imaginative and prescient in every state about the place we will be when the settlement monies are achieved?” she mentioned. “My hope is that 18 years from now we’re not nonetheless the place we’re right this moment.”
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 packages at KFF — the unbiased supply for well being coverage analysis, polling, and journalism.
