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

Published

5 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.

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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

Entertainment

Sarah Harding breast cancer research project is successfully identifying at-risk young women

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3 hours ago

May 19, 2024

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Sarah Harding breast cancer research project is successfully identifying at-risk young women

A groundbreaking breast cancer research project launched in memory of the late Girls Aloud singer Sarah Harding is already successfully identifying young women at increased risk of getting the disease.

The BCAN-RAY (Breast Cancer Risk Assessment in Young Women) was launched a year ago in the singer’s name after she died from the disease in 2021 at the age of 39.

While she was having treatment, the star said she was “really keen” for more research into why young women are being diagnosed without a family history of the disease.

One of the singer’s final hopes was to find ways of spotting the disease early when it’s easier to treat.

The BCAN-RAY is one of the only projects in the world trying to identify which women in their 30s are most at risk.

About 2,300 women under 40 are diagnosed with the disease each year in the UK, according to Breast Cancer Now.

The two-year study is using money from Cancer Research UK, the Christie Charity, and the Sarah Harding Breast Cancer Appeal – backed by her family and former bandmates.

It looks at risk factors most commonly found in young women with the disease and will form a model to identify them in future.

Anna Housley, 39, from Hale, Greater Manchester, is one of the women taking part in the trial. After being tested last year the mother of two was surprised to find she’s at increased risk.

With no history of the disease in her family, she told Sky News: “I’m really grateful that I have been found because now I know that I’m going to be looked after and I can be screened.”

Speaking about the work of Harding, she said: “All I can say really is thanks to her for being such a brave advocate to young women.”

The new information means she’s now eligible for annual mammograms and medication should she want it.

It’s hoped all women will eventually be able to have a risk assessment when they reach 30.

A thousand women in the Greater Manchester area will take part, including 250 with breast cancer who don’t have a family history of the disease.

Saliva samples will hopefully help experts identify certain types and patterns of genes that could raise a woman’s risk.

These will be considered with factors such as period timing, breast tissue density, alcohol consumption and use of the pill.

Harding’s consultant Dr Sacha Howell from Manchester University NHS Foundation Trust, who is leading the study, said of the singer: “I think she’d be absolutely thrilled that she was part of this and her legacy is that we will be helping more and more young women like her.

“But what we’re all hoping is that by detecting those cancers earlier, they won’t unfortunately have that end result that Sarah did, which was to pass away with the disease.”

Harding’s legacy won’t just be her successful music career, it will also be her work in raising awareness around breast cancer and potentially giving many more women in their 30s a future.

Business

Sir Jim Ratcliffe scolds Tories over handling of economy and immigration after Brexit

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3 hours ago

May 19, 2024

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Sir Jim Ratcliffe scolds Tories over handling of economy and immigration after Brexit

Billionaire Sir Jim Ratcliffe has told Sky News that Britain is ready for a change of government after scolding the Conservatives over their handling of the economy and immigration after Brexit.

While insisting his petrochemicals conglomerate INEOS is apolitical, Sir Jim backed Brexit and spent last weekend with Labour leader Sir Keir Starmer at Manchester United – the football club he now runs as minority owner.

“I’m sure Keir will do a very good job at running the country – I have no questions about that,” Sir Jim said in an exclusive interview.

“There’s no question that the Conservatives have had a good run,” he added. “I think most of the country probably feels it’s time for a change. And I sort of get that, really.”

Politics live: ‘We are in existential battle’ over world order, defence secretary warns

Sir Jim was a prominent backer of leaving the European Union in the 2016 referendum but now has issues with how Brexit was delivered by Tory prime ministers.

“Brexit sort of unfortunately didn’t turn out as people anticipated because… Brexit was largely about immigration,” Sir Jim said.

“That was the biggest component of that vote. People were getting fed up with the influx of the city of Southampton coming in every year. I think last year it was two times Southampton.

“I mean, no small island like the UK could cope with vast numbers of people coming into the UK.

“I mean, it just overburdens the National Health Service, the traffic service, the police, everybody.

“The country was designed for 55 or 60 million people and we’ve got 70 million people and all the services break down as a consequence.

“That’s what Brexit was all about and nobody’s implemented that. They just keep talking about it. But nothing’s been done, which is why I think we’ll finish up with the change of government.”

UK needs to get ‘sharper on the business front’

Prime Minister Rishi Sunak has indicated an election is due this year but Monaco-based Sir Jim is unimpressed by the Conservatives’ handling of the economy.

“The UK does need to get a bit sharper on the business front,” he said. “I think the biggest objective for the government is to create growth in the economy.

“There’s two parts of the economy, there’s the services side of the economy and there’s the manufacturing side. And the manufacturing, unfortunately, has been sliding away now for the last 25 years.

“We were very similar in scale to Germany probably 25 years ago.

“But today we’re just a fraction of where Germany is and I think that isn’t healthy for the British economy… particularly when you think the north of England is very manufacturing based, and that talks to things like energy competitiveness, it talks to things like, why do you put an immensely high tax on the North Sea?

“That just disincentivises people from finding hydrocarbons in the North Sea, in energy.

“And what we need is competitive energy. So I mean, in America, in the energy world, in the oil and gas world, they just apply a corporation tax to the oil and gas companies, which is about 30%. And in the UK we’ve got this tax of 75% because we want to kill off the oil and gas companies.

“But if we don’t have competitive energy, we’re not going to have a healthy manufacturing industry. And that just makes no sense to me at all. No.”

‘We’re apolitical’

Asked about INEOS donating to Labour, Sir Jim replied: “We’re apolitical, INEOS.

“We just want a successful manufacturing sector in the UK and we’ve talked to the government about that. It’s pretty clear about our views.”

Sir Jim was keener to talk about the economy and politics than his role at struggling Manchester United, which he bought a 27.7% stake in from the American Glazer family in February – giving him an even higher business profile.

Push for stadium of the North

He is continuing to push for public funds to regenerate Old Trafford and the surrounding areas despite no apparent political support being forthcoming. Sir Keir was hosted at the stadium for a Premier League match last weekend just as heavy rain exposed the fragility of the ageing venue.

“There’s a very good case, in my view, for having a stadium of the North, which would serve the northern part of the country in that arena of football,” Sir Jim said. “If you look at the number of Champions League the North West has won, it’s 10. London has won two.

“And yet everybody from the North has to get down to London to watch a big football match. And there should be one [a large stadium] in the North, in my view.

“But it’s also important for the southern side of Manchester, you know, to regenerate.

“It’s the sort of second capital of the country where the Industrial Revolution began.

“But if you have a regeneration project, you need a nucleus or a regeneration project and having that world-class stadium there, I think would provide the impetus to regenerate that region.”

World

Ukrainian soldiers reveal how they were secretly moved ahead of new Russian invasion

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3 hours ago

May 19, 2024

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Ukrainian soldiers reveal how they were secretly moved ahead of new Russian invasion

Members of a Ukrainian brigade have described how they were secretly relocated to help defend a section of the country’s border with Russia a few days before a new invasion began.

The commander of an artillery unit from 57 Brigade said his guns were even firing at Russian troops the day before the ground incursion into the northeastern region of Kharkiv, which started on 10 May. He said the forces had been “brazenly” amassing on the Russian side of the border.

“We were hitting tanks on the border… it was already a real war,” said Sasha, 26, who uses the callsign “black”.

Follow latest: Ukraine ‘destroys Russian Black Sea minesweeper’

The commander of a second artillery unit similarly confirmed the brigade had been moved early to bolster defences in this direction.

The troops had previously been defending the city of Kupiansk, also in Kharkiv.

The comments offer a sense of how Ukraine attempted – ahead of time – to scramble forces to counter a Russian build-up along its long, northeastern border.

But the move was nowhere near enough to prevent the largest assault into Ukraine since Russia launched its full-scale invasion almost two and a half years ago.

A Ukrainian source, describing the first few days of the Kharkiv offensive just over a week ago, said there had been moments when he feared “we had lost the frontline”.

The source said the situation had since stabilised but warned: “We don’t know how long it could be like this”.

Sky News on Saturday tried to visit an artillery position, manned by soldiers from 57 Brigade, just outside the town of Vovchansk – a key target of the Russian offensive.

As we approached at speed by road, a soldier travelling with us said we had to pull over because he needed to communicate via radio with troops on the gunline.

Suddenly a voice over the radio could be heard saying: “Don’t come here. Don’t come at all.”

We were told it was too dangerous to travel further and we had to leave. It was not immediately clear what was happening on the ground.

At a makeshift base, safely back from the frontline, the artillery unit commander Sasha uses electronic maps on a tablet and laptop to confirm targets for his guns to attack.

He said he and his team relocated from the Kupiansk front on the 4 to 5 May.

“We were indeed moved here earlier,” Sasha said. But he signalled he would have liked longer to prepare.

“I don’t know all the situation and why it happened like this. But I know for sure that to better repel [an attack], we might need either more time or better-prepared positions,” he said.

“Ahead of the assault, we were already hitting targets on Russian territory because we knew they were gathering there. They were brazenly assembling.”

Sasha described the moment the Russians started to advance.

He said it began with three hours of artillery fire against Ukrainian targets before ground troops crossed the border.

“I would love that they [the Russians] had been stopped at the border,” he said.

Instead, a fierce battle erupted, as Russian infantry, backed by airstrikes, drone attacks and artillery fire, pushed forward.

“For the first few days, they [the Russians] were storming our positions – columns of 30 to 50 soldiers. We were hitting them.”

In the chaos, Sasha said he worked to gather information to ensure his troops were able to operate.

“I am proud that my guys managed to do their best,” he said. “All credit to those who stayed on their artillery positions.”

He described the frontline as initially being “fragile” but said reinforcements were now in place. The commander said Russia had lost the opportunity to make a significant breakthrough.

“Until now they had a chance. Even in my area, I knew where we had gaps where they could have slipped through. Now we don’t have such gaps,” he said.

“I am satisfied that we have managed to stabilise the situation.”

At a second artillery position, on a different section of a frontline that has expanded by some 40 miles in the wake of the new attack, a Soviet-era gun, hidden under netting and tree branches, points in the direction of Russia.

Soldiers here said they would be able to inflict a lot more damage on the invaders if they had more ammunition and better weapons.

Nicknamed “grandma”, their D-20 Howitzer artillery piece, which fires 152mm shells, was built in the 1970s.

“We’re saving our artillery shells right now. We fire one, they fire back five,” said one of the servicemen, who – at 50 years old – has the callsign “Grandpa”.

A second soldier said Russia has more weapons than his side.

Asked what difference additional munitions would make, he said with a laugh: “It would increase the number of dead Russians – 100%”.

Additional reporting by Azad Safarov, Ukraine producer