Debate Swirls Around How to Use Opioid Settlement Funds

Tens of billions of dollars in forthcoming opioid litigation settlement funds have public health policy leaders and elected officials debating over how to use the funds in the most effective and impactful way to address the root causes of opioid addiction and improve access to treatment programs.

One thing is clear: there is a consensus view that officials can and should do better than in the wake of the landmark 1998 tobacco litigation settlement when very little of the money was actually used to support evidence-based strategies that reduce deaths and cancer.

Less than 3% of the $200 billion tobacco settlement was spent on cessation and prevention programs, studies have shown. It was the largest civil litigation settlement in U.S. history, and an enormous missed opportunity to use the funds to improve public health, historians and policy experts say.

Opioid overdose deaths have risen sharply in recent years, in part because of illicit production of synthetic opioids such as fentanyl.

The COVID-19 pandemic has contributed to an acceleration of that trend, with a 38% increase in drug overdose deaths in the year ending in May 2020, according to data from the U.S. Centers for Disease Control and Prevention.

A coalition of 31 professional associations and advocacy groups recently released “Principles for the Use of Funds From the Opioid Litigation,” which is a set of guidelines aimed at helping state and local officials use the settlement money in the most impactful ways to save lives.

Spearheaded by the faculty at the Johns Hopkins Bloomberg School of Public Health, the report urges state and local officials to avoid the mistakes of the 1998 tobacco settlement.

“We are still deep in the midst of an overdose crisis,” Joshua Sharfstein, vice dean for public health practice and community engagement at the Johns Hopkins Bloomberg School of Public Health, said in a statement after the report was issued.

“We don’t want to see a repeat of what happened with the tobacco litigation settlements where the vast majority of the funds weren’t used to address the actual public health issue at hand,” said Sharfstein, who also directs the Bloomberg American Health Initiative at the Bloomberg School.

The report’s five guiding principles for policies and spending of the settlement funds are:

• Spend money to save lives: Rather than fall into the trap of using the settlement money to close gaps in their budgets, jurisdictions should use the funds to expand programs that directly address opioid addiction and treatment.
• Use evidence to guide spending: Rely on the substantial body of evidence from clinicians and researchers that demonstrates what works and what does not, and let this evidence inform funding decisions.
• Invest in youth prevention: Officials must make it a priority to support children, youth, and families by making long-term investments that accomplish meaningful change in local communities.
• Focus on racial equity: Direct significant funds to communities that have been hit hard by systemic discriminatory policies that contributed to higher rates of overdose.
• Develop a fair and transparent process: Deciding where and how to spend settlement dollars should be an open and transparent process guided by public health leaders and including active engagement of people with lived experience as well as clinicians and other stakeholders.

The report is backed by dozens of clinical, professional and advocacy organizations including the American College of Emergency Physicians, American Society of Addiction Medicine, American Public Health Association, National Association for Rural Mental Health and Legal Action Center.

In late 2020, four major defendants in the nationwide litigation — McKesson, Cardinal Health, AmerisourceBergen and Johnson & Johnson — offered a $26 billion settlement that would remove the risk of future opioid lawsuits by the governments involved in the litigation.

Thousands of other cases are pending against additional drug manufacturers and national pharmacy chains.

Hall Booth Smith’s (HBS) Opioid Task Force was created to defend physicians, surgeons, pain management specialists and other health care providers as well as physician groups, hospitals, surgical centers, urgent care clinics and other organizations on the full range of opioid and prescription-related claims they may face. For more information about HBS’s Opioid Task Force, please contact Partner J. Brent Allen.