As a possible $ 26 billion settlement with opioid producers looms, some public health experts cite the 1998 agreement 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.”
A group of state attorneys general and the companies involved presented key details of the settlement on Wednesday, a day after lawyers representing local governments nationwide said they were set to settle down .
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.
States – with the exception of West Virginia, which has already settled with the companies – will have 30 days to approve the agreements. After that, local governments will have four months to sign. Each company will decide whether enough jurisdictions accept the deal to go ahead.
“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-largest 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. Stein said there is a strong will to comply due to the opioid devastation.
“We are all suffering the consequences in communities in North Carolina, across the country,” Stein said in a video press conference Wednesday.
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.
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”.
Another concern is that some government officials have been too busy dealing with the coronavirus to fully determine where the settlement funds should go.
“I’m concerned that in some places there just isn’t a lot of attention (being paid to it) and that it can be put back into the general fund,” said Marcus Plescia, Chief Medical Officer of the Association. of State and Territorial health officials. “It’s not that there aren’t people doing it. But leaders are struggling to commit to it because they are so caught up in the pandemic. ”
Stein of the RAND Corporation said it was important to spend the money on efforts that have been shown to be effective, including addiction treatment and the use of drugs to stop overdoses.
“We know the treatment is working,” he said. “We know that naloxone appears to be very important in preventing overdose deaths. … There will be no quick fixes. It may vary, community by community. ”
Thinking back to the tobacco regulations, Stein said guide rails were not in place to ensure all the money was used as intended.
“I think, or at least I hope, we’ve learned from history,” he said.
The tobacco regulations were the result of states trying 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 settlement “continues to be a missed opportunity every year where payments are made and money is spent on other things,” Lester 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.”