The Year in Opioid Settlements: 5 Things You Need to Know

Published

11 months ago

December 21, 2023

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This year, about $1.5 billion has landed in state and local government coffers from court settlements made with more than a dozen companies that manufactured, sold, or distributed prescription painkillers and were sued for their role in fueling the opioid crisis.

This story also ran on NPR. It can be republished for free.

That money has gone from an emerging funding stream for which people had lofty but uncertain aspirations to a coveted pot of billions of dollars being invested in real time to address addiction.

Altogether, the companies are expected to pay more than $50 billion to state and local governments over nearly two decades.

Meanwhile, more than 100,000 Americans have died of drug overdoses annually in recent years, underscoring the urgent nature of the crisis.

KFF Health News has been tracking the funds all year and covering the windfalls mixed impact in communities across the country. Here are five things weve noticed in 2023 and plan to keep an eye on next year:

1. The total amount of settlement money state and local governments expect to receive is a moving target.

Before the start of the year, national settlements were in place with at least five companies, and several other deals were in the final stages, said Christine Minhee, founder of OpioidSettlementTracker.com.

Today, most states are participating in settlements with opioid manufacturers Johnson & Johnson, Teva Pharmaceutical Industries, and Allergan; pharmaceutical distributors AmerisourceBergen, Cardinal Health, and McKesson; and retail pharmacies Walmart, Walgreens, and CVS. Many are also settling with the national supermarket chain Kroger. More from This InvestigationPayback: Tracking the Opioid Settlement Cash

Opioid manufacturers and distributors are paying more than $54 billion in restitution to settle lawsuits about their role in the overdose epidemic, with little oversight on how the money is spent. Were tracking how state and local governments use or misuse the cash.Read More

Several of these deals began paying out in the second half of this year, leading to bumps in states opioid settlement pots.

But there have been dents and slowdowns too.

Mallinckrodt Pharmaceuticals, a manufacturer of generic opioids, originally agreed to pay $1.7 billion as a result of its 2020 bankruptcy filing to state and local governments, as well as people directly affected by the crisis. But the company filed a second bankruptcy in August, slashing $1 billion from that figure.

Purdue Pharma, perhaps the best known of all the companies for its creation and marketing of OxyContin, had agreed to pay $6 billion as part of its bankruptcy proceedings. But the Biden administration objected to the deal this summer, and the case now lies in the hands of the Supreme Court. At its core is the question of whether its legal for the Sackler family to gain immunity from future civil cases about the opioid crisis under the companys bankruptcy deal when they have not filed for bankruptcy as individuals.

The Supreme Court heard arguments in December and is expected to rule on the case next spring or summer. Until then, no Purdue money will flow. Advocates and victims of the opioid crisis gather outside the U.S. Supreme Court on Dec. 4, while the justices hear a case about Purdue Pharmas bankruptcy deal. The protesters urged justices to overturn the deal, which would give the Sackler family immunity against future civil cases related to opioids.(Aneri Pattani/KFF Health News)

2. Most states still arent being transparent about how the money is used.

In March, KFF Health News and Minhee published a comprehensive investigation showing that only 12 states had promised to publicly report how they were using all their settlement dollars.

Since then, that number has inched up to 16.

But 15 states still have not committed to publicly reporting anything at all, and others have promised to publicize only a portion of their spending.

Many people arent happy about the secrecy.

In Ohio, a local advocacy group, Harm Reduction Ohio, sued the OneOhio Recovery Foundation, which controls most of the states settlement dollars, for violating public records and open-meeting laws. Although a judge ruled in favor of the advocacy group, it became a moot point in July, when the state passed a budget that included language exempting the foundation from such requirements.

In Michigan, the Department of Health and Human Services came under fire for not publicly reporting how it was spending upward of $40 million in settlement funds. In October just hours before a legislative subcommittee hearing in which lawmakers asked critical questions about the money the department launched a website, displaying a breakdown of organizations to which it had awarded funds.

At the national level, a dozen Democratic lawmakers have raised concerns about a lack of transparency and oversight via a Sept. 25 letter to the Office of National Drug Control Policy, which is leading the federal governments response to the opioid crisis.

We urge the Biden administration to closely track opioid settlement fund spending, to ensure that populations in need of additional support receive it, the lawmakers wrote.

The Office of National Drug Control Policy responded this month that it did not have the statutory authority from Congress to do so.

Currently, no mechanism exists that would allow ONDCP to require states to disclose their spending, the office wrote in a letter obtained by KFF Health News. ONDCP cannot effectively monitor how states use these funds. Email Sign-Up

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3. Nationwide, money is being spent in several common areas.

Although there is no national data on how settlement dollars are spent, piecemeal tracking by journalists and advocates has surfaced some favorites.

One of the biggest is investing in treatment. Many jurisdictions are building residential rehab facilities or expanding existing ones. Theyre covering the cost of care for uninsured people and trying to increase the number of clinicians prescribing medications for opioid use disorder, which have been shown to save lives.

Another common expense is naloxone, a medication that reverses opioid overdoses. Wisconsin is spending about $8 million on this effort. Kentucky has dedicated $1 million. And many local governments are allocating smaller amounts.

Some other choices have sparked controversies. Share Your Story

Do you have concerns about how your state or locality is using the opioid settlement funds? Are they doing something effective that other places should replicate? Tell us here.Share Your Story

Several governments used settlement dollars to purchase police patrol cars, technology to help officers hack into phones, and body scanners for jails. Supporters say these tools are critical to crack down on drug trafficking, but research suggests law enforcement efforts dont prevent overdoses.

People are also divided over school-based programs to prevent kids from developing addictions. While they agree on the goal, some people favor programs that teach kids about the dangers of drugs like D.A.R.E. in the 80s while others prefer programs focused on improving mental health, resiliency, and communication skills.

Perhaps the most contentious use, though, is shoring up county budgets and paying back old bills. Even if its legal, many people directly affected by the epidemic say this misses the goal of the settlement money, which is to address todays ongoing crisis.

4. The settlements required companies to change problematic business practices, but that has had unintended consequences.

As part of their settlements, manufacturers like Allergan and Johnson & Johnson agreed not to sell opioids for 10 years and curb marketing and promotion activities. Pharmaceutical distributors were required to step up efforts to identify suspicious orders from pharmacies, under the oversight of an independent third-party monitor. Retail pharmacy chains must condct audits and site visits to their pharmacies, as well as share data with state agencies about problematic prescribers.

The goal of these stipulations is to prevent further misuse of prescription opioids. But some people see unintended consequences.

Distributors have placed stricter limits not only on pharmacy orders of opioids, but on many drugs considered potentially addictive, known as controlled substances. As a result, orders for these medications are being canceled more often and some pharmacies are hesitant to fill prescriptions for new patients. That has left people struggling to obtain medications for chronic pain, anxiety, attention-deficit/hyperactivity disorder and, ironically, even medication that treats opioid addiction.

Bayla Ostrach, a researcher in North Carolina who studies substance use and health policy, said buprenorphine, which is considered a gold-standard treatment for opioid use disorder, was already difficult to obtain at many community pharmacies and in rural areas. But the settlements appear to be making it worse.

Instead of increasing access to treatment which is critical to stemming the number of overdoses I really worry the settlements may be having the opposite effect, Ostrach said. Members of the Washington, D.C., Opioid Abatement Advisory Commission, which will advise on the use of more than $80 million, met for the first time and were sworn in on Oct. 25. Like many other jurisdictions, the District of Columbia has yet to spend any of its settlement funds.(Aneri Pattani/KFF Health News)

5. Many places haven’t decided what to do with the money yet.

Several states, including Montana and Hawaii, have yet to spend any of the settlement funds controlled by their state agencies. In Maine and West Virginia, councils overseeing the lions share of funds are still in the process of identifying priorities and developing processes to award grants.

Across the nation, some county officials say they need more guidance on appropriate uses of the money. Others are surveying residents on what they want before making decisions.

The slow pace has frustrated some advocates, who say there should be greater urgency at a time when the drug supply is becoming increasingly deadly. But others say the money will continue arriving through 2038, so setting up thoughtful processes now could pay off for years to come.

Its a trade-off between putting out current fires and preventing future ones, said Shelly Weizman, project director of the addiction and public policy initiative at Georgetown Universitys ONeill Institute. Shes hopeful officials will strike the right balance.

Is there a vision in each state about where were going to be when the settlement monies are done? she said. My hope is that 18 years from now were not still where we are today.

Aneri Pattani: apattani@kff.org, @aneripattani Related Topics Courts Public Health States Investigation Opioid Settlements Opioids Substance Misuse Contact Us Submit a Story Tip

Sports

CFP Anger Index: Better call Paul — the committee is disrespecting the SEC

Published

3 hours ago

November 13, 2024

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CFP Anger Index: Better call Paul -- the committee is disrespecting the SEC

David Hale, ESPN Staff WriterNov 12, 2024, 09:05 PM ET
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- College football reporter.
- Joined ESPN in 2012.
- Graduate of the University of Delaware.

The committee has released its second crack at the top 25, and it’s (almost) all Big Ten at the top.

That might seem a bit strange to the conference that boasts the most playoff-caliber teams and the most nonconference wins against other Power 4 leagues, and also has Paul Finebaum there to remind everyone just how angry they should be at this affront to good judgment.

With that, we’ll handle much of Finebaum’s homework for him. Here’s this week’s Anger Index.

1. The SEC

Eleven weeks into the 2024 season, and one thing seems abundantly clear: The SEC is the best conference in college football. Take a look at Bill Connelly’s SP+ rankings, for example, where nine of the top 17 teams are from the SEC. Or use ESPN’s FPI metric, where the SEC has spots 1, 2, 4, 5 and 9. Consider that the team currently ninth in the SEC standings, South Carolina, has three wins over SP+ top-40 teams and losses to the committee’s No. 10 and 22 teams by a combined total of five points.

Yes, the SEC’s dominance and depth seem obvious.

So, of course, four of the top five teams in the committee’s rankings this week are from the SEC.

Wait, no, sorry about that. We’re getting late word here that, in fact, it’s the Big Ten with teams No. 1, 2, 4 and 5 in this week’s rankings.

It’s not that those four Big Ten teams aren’t any good. Oregon (No. 1) has chewed up and spit out nearly all comers this season. Ohio State (No. 2) is the best squad the gross domestic product of Estonia can buy. Penn State (No. 4), well, the Nittany Lions still haven’t beaten Ohio State, but we assume the rest of the résumé is OK. Indiana (No. 5) is blowing the doors off people.

But that’s it. The rest of the Big Ten is a mess. You need a magnifying glass to find Michigan‘s QB production. Iowa finally learned how to score and somehow has gotten worse. Minnesota looked like the next-best team in the conference, and the Gophers have losses to North Carolina and Rutgers.

A lack of depth does not inherently mean the teams at the top are not elite. Indeed, the other teams in any conference remain independent variables when addressing the ceiling for any one team. If the Kansas City Chiefs joined the Sun Belt, Patrick Mahomes would still be a magician and Andy Reid would still be saying “Bundle-a-rooskie-doo” in your nightmares.

But the cold, hard facts are these: Indiana’s best win came last week against Michigan (No. 40 in SP+) by 3. Penn State’s best win (by SP+) came by 3 against a below-.500 USC team that just benched its QB. Ohio State is absolutely elite on paper, but on the field, the Buckeyes’ success is entirely buoyed by a 20-13 win at Penn State, a team we also know very little about.

The SEC gets flack for boasting of its greatness routinely, and to be sure, that narrative has often bolstered less-than-elite teams. But this year, every reasonable metric suggests the SEC’s production actually matches its ego, and when Ole Miss (No. 11), Georgia (No. 12), Alabama (No. 10) and Texas A&M (No. 15) — all with two losses — are dogged as a result of playing in a league where every other team warrants a spot in the top 25, it undermines the entire point of having a committee that can use its judgment rather than simply look at the standings.

Let’s compare two teams with blind résumés.

Team A: 8-1 record, No. 14 in ESPN’s strength of record. Best win came vs. SP+ No. 20, loss came to a top-10 team by 3. Has four wins vs. Power 4 teams with a winning record, by an average of 14 points.

Team B: 8-1 record, No. 11 in ESPN’s strength of record. Best win came vs. SP+ No. 28, loss came to a top-15 team by 15. Has one win vs. a Power 4 team with a winning record, by 3.

So, which team has the better résumé?

This shouldn’t take too long to figure out. Team A looks better by almost every metric, right?

Well, Team A is SMU, who checks in at No. 14 in this week’s ranking.

Team B, though? That’d be the Mustangs’ old friends from the Southwest Conference, the Texas Longhorns. Texas checks in at No. 3.

Perhaps you’ve watched enough of both Texas and SMU to think the eye test favors the Longhorns. That’s fair. But should the eye test account for 11 spots in the rankings? At some point, the results have to matter more.

Or, perhaps it’s the brand that matters to the committee. If that same résumé belonged to a school that hadn’t just bought its way into the Power 4 this year, it’s hard to imagine they wouldn’t be in the top 10 with ease.

Let’s dig into three different teams still hoping for a playoff bid, even if the odds are against them at this point.

Team A: 7-2, 1 win over SP+ top 40. No. 28 in ESPN’s strength of record. Losses by a combined 18 points.

Team B: 7-2, 1 win over SP+ top 40. No. 25 in ESPN’s strength of record. Losses by a combined 13 points.

Team C: 7-2, no wins over SP+ top 40. No. 24 in ESPN’s strength of record. Losses by a combined 21 points.

You could split hairs here, but the bottom line is none has a particularly compelling résumé, and they’re all pretty similar.

So, who are they?

Team B is Iowa State, which plummeted from the rankings after losing two straight. But the committee isn’t supposed to care when you lost your games. Losing in September is not better than losing in November. At least that’s what they say.

Team A is Arizona State. Its 10-point loss to Cincinnati came without starting QB Sam Leavitt and was due, at least in part, to a kicking game so traumatic head coach Kenny Dillingham held an open tryout afterward. The Sun Devils and Cyclones are two of three two-loss Power 4 teams unranked this week (alongside Pitt), but unlike Iowa State and Pitt, Arizona State isn’t coming off back-to-back losses. The Sun Devils’ absence seems entirely correlated to the fact that no one believed this team would be any good entering the season, and so few people have looked closely enough to change their minds that the committee feels comfortable ignoring them.

The team the committee can’t ignore, however, is Team C. That would be Colorado. Coach Prime has convinced the world the Buffaloes are for real, even if nothing on their résumé — a No. 77 strength of schedule, worse than 7-2 Western Kentucky‘s — suggests that’s anything close to a certainty.

The Big 12 remains wide open, but it’s to the committee’s detriment that it has so eagerly dismissed two of the better teams just because they’re not as fun to talk about.

Has Missouri played with fire this year? You betcha. Just last week, the Tigers were on the verge of falling to Oklahoma before the Sooners’ woeful QB situation reared its ugly head again and the game ended in a 30-23 Tigers win.

But here’s the thing about playing with fire: So long as you don’t turn your living room into an inferno, it’s actually pretty impressive.

Missouri is 7-2 with wins against SP+ Nos. 26 and 28, and its only losses are to the committee’s No. 10 and No. 15 teams. SP+ has Missouri at No. 17, though we can chalk that up to Connelly’s hometown bias. But No. 23? After a top-10 season in 2023, don’t the Tigers deserve a little benefit of the doubt? They currently trail three three-loss teams (Louisville, South Carolina and LSU) and are behind Boise State, Colorado, Washington State and Clemson, who, combined, have exactly one win over SP+ top-40 teams.

There’s a good chance that, should Brady Cook not return to the lineup, Missouri will get waxed at South Carolina on Saturday, and then the argument is moot. But the committee isn’t supposed to look ahead and take guesses at what it believes might happen (Florida State’s snub last year notwithstanding). It’s supposed to judge based on what’s on the books so far, and putting Missouri this far down the rankings seems more than a tad harsh.

The committee threw a nice bone to the non-Power 4 schools this week, with four teams ranked, including No. 25 Tulane Green Wave. That seems deserved, given Tulane’s recent run. But what is it, exactly, that puts the Green Wave ahead of UNLV?

UNLV has the No. 31 strength of record. Tulane is No. 32.

UNLV has the No. 98 strength of schedule played. Tulane is No. 96.

Tulane has a one-possession loss to a top-20 team. UNLV has a one-possession loss to a top-20 team.

The key difference between the two is UNLV has wins against two Power 4 opponents — Houston and Kansas. Houston, by the way, just knocked off Kansas State, a team that beat Tulane.

So perhaps the committee should spread a bit more love outside the Power 4.

Also Angry: Pittsburgh Panthers (7-2, unranked), Duke Blue Devils (7-3, unranked), Georgia Bulldogs (7-2, No. 12), Utah Utes AD Mark Harlan (the Utes would be ranked if Big 12 Commissioner Brett Yormark hadn’t rigged the system!) and UConn Huskies (7-3, unranked and thus prohibiting us from Jim Mora Jr. giving a “You wanna talk about playoffs?!?” rant).

Environment

Elon Musk Tapped to Lead New ‘DOGE’ Department—Despite the Government Already Having One for Efficiency

Published

4 hours ago

November 13, 2024

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Elon Musk Tapped to Lead New ‘DOGE’ Department—Despite the Government Already Having One for Efficiency

Tesla CEO Elon Musk is to officially join Trump’s administration as the co-head of the new US Department of Government Efficiency – a second federal department with the goal of making government spending more efficient.

You can’t get more ironic than that.

Throughout the elections, Musk, who is already CEO of Tesla, and SpaceX, a well as the defacto head of X, xAI, Neuralink, and the Boring Company, has been floating the idea to add to his workload by joining the Trump’s administration to lead a new department aimed at making the federal government more efficient.

He has been calling it the “Department of Government Efficiency”, which spells out ‘DOGE’, a meme that Musk appears to enjoy.

Well, now Trump appears to want to be going through with this idea.

He announced the new department and Musk as head, along with Vivek Ramaswamy, in a statement today:

I am pleased to announce that the Great Elon Musk, working in conjunction with American Patriot Vivek Ramaswamy, will lead the Department of Government Efficiency (“DOGE”). Together, these two wonderful Americans will pave the way for my Administration to dismantle Government Bureaucracy, slash excess regulations, cut wasteful expenditures, and restructure Federal Agencies – Essential to the “Save America” Movement. “This will send shockwaves through the system, and anyone involved in Government waste, which is a lot of people!” stated Mr. Musk.

What’s most ironic is that there’s already a federal department with the goal of cutting government waste and ensuring efficiency: the Government Accountability Office (GAO).

The GAO’s main objectives are:

auditing agency operations to determine whether federal funds are being spent efficiently and effectively;
investigating allegations of illegal and improper activities;
reporting on how well government programs and policies are meeting their objectives;
performing policy analyses and outlining options for congressional consideration;
issuing legal decisions and opinions;
advising Congress and the heads of executive agencies about ways to make government more efficient and effective

It sounds similar to what Musk described when talking about his DOGE, but Trump hasn’t gone into many details other than it will “cut waste.”

He also has a confusing message as he compares the initiative, which is supposed to cut government spending, to “The Manhattan project”, a massive and expensive government project.

Trump said that DOGE will help the government “drive large scale structural reform”:

It will become, potentially, “The Manhattan Project” of our time. Republican politicians have dreamed about the objectives of “DOGE” for a very long time. To drive this kind of drastic change, the Department of Government Efficiency will provide advice and guidance from outside of Government, and will partner with the White House and Office of Management & Budget to drive large scale structural reform, and create an entrepreneurial approach to Government never seen before.

The statement also noted that DOGE will only operate until July 4, 2026.

Musk has previously claimed that he could cut at least $2 trillion dollars of the $6.5 trillion dollar US federal budget.

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Environment

Oil could plunge to $40 in 2025 if OPEC unwinds voluntary production cuts, analysts say

Published

4 hours ago

November 13, 2024

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Oil could plunge to in 2025 if OPEC unwinds voluntary production cuts, analysts say

A pump jack in Midland, Texas, US, on Thursday, Oct. 3, 2024.

Anthony Prieto | Bloomberg | Getty Images

Oil prices may see a drastic fall in the event that oil alliance OPEC+ unwinds its existing output cuts, said market watchers who are predicting a bearish year ahead for crude.

“There is more fear about 2025’s oil prices than there has been since years — any year I can remember, since the Arab Spring,” said Tom Kloza, global head of energy analysis at OPIS, an oil price reporting agency.

“You could get down to $30 or $40 a barrel if OPEC unwound and didn’t have any kind of real agreement to rein in production. They’ve seen their market share really dwindle through the years,” Kloza added.

A decline to $40 a barrel would mean around a 40% erasure of current crude prices. Global benchmark Brent is currently trading at $72 a barrel, while U.S. West Texas Intermediate futures are around $68 per barrel.

Oil prices year-to-date

Given that oil demand growth next year probably won’t be much more than 1 million barrels a day, a full unwinding of OPEC+ supply cuts in 2025 would “undoubtedly see a very steep slide in crude prices, possibly toward $40 a barrel,” Henning Gloystein, head of energy, climate and resources at Eurasia Group, told CNBC.

Similarly, MST Marquee’s senior energy analyst Saul Kavonic posited that should OPEC+ unwind cuts without regard to demand, it would “effectively amount to a price war over market share that could send oil to lows not seen since Covid.”

However, the alliance is more likely to opt for a gradual unwinding early next year, compared to a full scale and immediate one, the analysts said.

Should the producers group proceed with their production plan, the market surplus could nearly double.

Martoccia Francesco

Energy strategist at Citi

The oil cartel has been exercising discipline in maintaining its voluntary output cuts, to the point of extending them.

In September, OPEC+ postponed plans to begin gradually rolling back on the 2.2 million barrels per day of voluntary cuts by two months in an effort to stem the slide of oil prices. The 2.2 million bpd cut, which was implemented over the second and third quarters, had been due to expire at the end of September.

At the start of this month, the oil cartel again decided to delay the planned oil output increase by another month to the end of December.

Oil prices have been weighed by a sluggish post-Covid recovery in demand from China, the world’s second-largest economy and leading crude oil importer. In its monthly report released Tuesday, OPEC lowered its 2025 global oil demand growth forecast from 1.6 million barrels per day to 1.5 million barrels per day.

The pressured prices were also conflagrated by a perceivably oversupplied market, especially as key oil producers outside the OPEC alliance like the U.S., Canada, Guyana and Brazil are also planning to add supply, Gloystein highlighted.

Bearish year ahead for oil

The market consensus is that there’ll be a “substantial” oil stock build next year, said Citibank energy strategist Martoccia Francesco.

“Should the producers group proceed with their production plan, the market surplus could nearly double… reaching as much as 1.6 million barrels per day,” said Francesco.

Even if OPEC+ doesn’t unwind the cuts, the future ofl prices is still looking break. Citi analysts expect Brent price to average $60 per barrel next year.

Further fueling the bearish outlook is the incoming administration of U.S. President-elect Donald Trump, whose return is associated by some with a potential trade war, said analysts who spoke to CNBC.

“If we do get a trade war — and a lot of economists think that a trade war is possible, and particularly against China — we could see much, much lower prices,” said OPIS’ Kloza.

Trump has also touted a “drill baby drill” policy for U.S. producers, vowing to cut energy prices in half.

For that to happen to retail gasoline prices, oil would need to drop to “below $40” per barrel, said Matt Smith, Kpler’s lead oil analyst.

Right now, retail gasoline prices are at a “sweet spot” at $3 per gallon, where consumers do not feel the pinch and input prices are still sufficiently high for producers, Smith added.