As a $ 26 billion settlement on the opioid toll looms, some public health experts cite the 1998 deal with tobacco companies as a warning against rampant government spending and missed opportunities to save. more lives.
Simple fractions of the more than $ 200 billion tobacco regulations have been used to prevent smoking and help people quit smoking in many states. Instead, much of the money helped balance state budgets, lay fiber optic cables, and repair roads.
And while the regulation has been successful in many ways – smoking rates have dropped dramatically – cigarettes are still responsible for more than 480,000 American deaths a year.
“We saw a lot of these dollars spent in ways that didn’t help people who had been injured by tobacco,” said Bradley D. Stein, director of the Opioid Policy Center at RAND Corporation. “And I think it’s critical that opioid settlement dollars are spent wisely.”
Lawyers for state and local governments and businesses presented key details of the settlement on Wednesday and said there were provisions to ensure the money is used as intended.
The deal sees drugmaker Johnson & Johnson pay up to $ 5 billion, in addition to billions more from major national drug distribution companies. AmerisourceBergen and Cardinal Health will each contribute $ 6.4 billion. McKesson has to pay $ 7.9 billion.
Almost $ 2 billion of the funds would be earmarked for private lawyers who have been hired by governments to work on their lawsuits against the industry. The state attorney general’s offices could also keep some of the money.
States – with the exception of West Virginia, which already has a deal with the companies but could receive more through the deal – will have 30 days to approve the deals. After that, local governments will have four months to sign. Each company will decide whether enough jurisdictions accept the deal to go ahead. The more governments sign, the more companies will pay.
“While the companies strongly disagree with the allegations made in these lawsuits, they believe the proposed settlement agreement and the settlement process it establishes … are important steps towards a comprehensive resolution of government opioid claims and relief. meaningful communities across the United States, ”the distribution companies said in a statement.
Connecticut Attorney General William Tong said it would be the second such cash settlement in U.S. history behind the tobacco deal in the 1990s.
North Carolina Attorney General Josh Stein said the opioid deal requires state and local governments to use the vast majority of the money for the reduction – and this will be subject to a court order. The agreement provides that at least 70% of the money will be allocated to a list of reduction activities, such as the provision of naloxone, a drug that reverses overdoses; help homeless people at home with addictions; or educating the public about the dangers of drugs, among many other possibilities.
“We are all suffering the consequences in communities in North Carolina, across the country,” Stein said in a video press conference Wednesday.
Not all states are ready to agree. Washington State Attorney General Bob Ferguson said he would dismiss the deal as “insufficient” and go ahead with a lawsuit over the claims against the distributors scheduled to begin in September.
Grant Woods, a former Arizona attorney general who has been involved in both tobacco and opioid lawsuits, said the difference this time around is that “everyone wants this money to go to opioids and nationwide reduction ”
The deal would be part of ongoing efforts to tackle the nation’s opioid addiction and overdose crisis. Prescription drugs and illegal drugs like illicitly produced heroin and fentanyl have been linked to more than 500,000 deaths in the United States since 2000. The number of cases reached an all-time high in 2020.
If approved, the settlement will likely be the largest of many nationwide opioid litigation. It is expected to contribute more than $ 23 billion in reduction and mitigation efforts to help secure treatment for people with drug addiction as well as other programs to deal with the crisis. The money would come in 18 annual installments, with the largest amounts over the next several years.
This is probably the largest group of regulations, but other companies, including OxyContin maker Purdue Pharma, generic drug maker Mallinckrodt, and consulting firm McKinsey, have also all entered or nearly met national regulations. on opioids. Some drug manufacturers, small distributors and pharmaceutical companies are still sued by thousands of government entities.
A group of advocacy organizations, public health experts and others are pushing for governments to adhere to a set of principles on how settlement money should be used. They include creating a dedicated epidemic fund with money from the settlement and making sure it doesn’t just replace other sources of funding in the budget.
The group pointed out that many state and local governments have already cut back on substance use and behavioral health programs due to the economic downturn caused by the coronavirus pandemic. And government officials may be tempted to fill the gaps in budgets with money.
Joshua Sharfstein, associate dean of the Johns Hopkins Bloomberg School of Public Health, said it was crucial that money be spent to fight the opioid scourge as the overdose epidemic rages on.
Last year there was a record 93,000 fatal overdoses of all drugs in the United States. The majority of these involved fentanyl, a potent synthetic opioid that has medical uses but is also produced illegally.
“Everyone is both excited and a little worried,” Sharfstein said of the expected funds, “a little worried that they are wasted”.
Paul Geller, a lawyer representing local governments, said the structure of the settlement ensures that the money will be used as intended.
“It won’t be used to fill potholes or build libraries or balance budgets,” Geller said.
These are the kinds of things that a significant chunk of the tobacco regulation money has been spent on, according to the Campaign for Tobacco-Free Kids, which tracks the money.
Campaign Chairman Matthew L. Myers said the tobacco regulations are “one of the greatest missed public health opportunities of our lives.”
“We would have saved a lot more lives,” he said if more money had been spent on withdrawal and prevention.
The regulation was the result of states’ willingness to recoup the health costs associated with tobacco-related illnesses, while alleging that the industry had misled the public.
Joelle Lester, director of commercial tobacco control programs at the Public Health Law Center in Minnesota, said the tobacco regulations were “both a huge success and a warning.”
This has resulted in higher prices for cigarettes, which has resulted in lower smoking rates. Marketing, especially to children, has been cut. And smoking among adults fell from 24.1% in 1998 to 13.7% in 2018, according to the American Lung Association.
But the money that was embezzled could still have made a bigger difference, she said.
“The people who negotiate these agreements must remain focused on the destruction of health and communities caused,” she said of the industry agreements in general. “Every element of the settlement should either try to repair the damage done or prevent it from continuing.”