One chance to get it right
Opioid settlement must avoid mistakes of squandered 1990s tobacco money
By recklessly and deceptively marketing powerful opioids such as Oxycontin as nonaddictive miracle drugs, major pharmaceutical manufacturers, suppliers and distributors triggered an epidemic of addiction that became the nation’s top public health crisis. Emerging in the the late 1990s, it has killed nearly one million Americans and addicted millions more to prescription painkillers and opioid-related street drugs such as heroin. Today, three million Americans are addicted to opioids, and more than 100,000 die of drug overdoses annually, including 5,000 a year in Pennsylvania. In Allegheny County alone, more than 30,000 people people are addicted to opioids.
The major players in this ordeal, such as the Sackler family who owned Purdue Pharma, were, in effect, the biggest and most dangerous drug dealersin America. Unlike small-time street dealers, who could get a 15-year sentence in Pennsylvania for selling three grams of heroin, the Sacklers didn’tspend a day in prison.
But large pharmaceutical companies such as Purdue Pharma, Johnson and Johnson, Cardinal Health, Ameriscource Bergen and McKesson did have to open their wallets. Over the next two decades, under a 2022 multi-state settlement that resolved thousands of lawsuits, they will pay more than $25 billion to states and counties for their role in creating this lethalepidemic.
Pennsylvania will get more than $1 billion of the money. Roughly $130 million has already entered the recently established Pennsylvania Opioid Misuse and Addiction Abatement Trust, governed by a 13-member boardto distribute settlement funds to thestate and local governments.
Squandering an opportunity
Even so, public health advocates worry the settlement money will go to ineffective or unrelated programs. They note the egregious missteps of a landmark legal settlement in 1998 between major tobacco companies and 46 states, amounting to more than $200 billion, including $11 billion for Pennsylvania.
That money was supposed to cover tobacco-related healthcare costs, including lung cancer, emphysema and low-birth-weight babies, as well as fund anti-smoking campaigns to reduce and prevent tobacco use. Instead, states treated the settlement as a cash cow; only a fraction of it went to anti-tobacco programs. Mississippi took $240 million to plug a Medicaid deficit. Alaska spent millions on shipping docks. A New York county built a jail. Others used the money for tax
relief or fixing potholes. For sheer chutzpah, nothing beats the $42 million that North Carolina tobacco farmers received for modernization andmarketing.
Worse, many states cashed in future payments from the Tobacco Settlement Fund. To balance the 20172018 budget, for example, Pennsylvaniaraised $1.5 billion by leveraging future tobacco payments, an irresponsible scheme that squandered tax dollars and jeopardized programs funded bythe tobacco settlement.
Public health officials had hoped anti-smoking programs funded by the settlement would, over 25 years, virtually end tobacco use in the United States. But cigarette smoking and tobacco use still kill nearly 500,000 Americans a year, reports the Centers for Disease Control and Prevention. They remain a leading cause of preventable disease, disability and death inthe United States.
Avoid past mistakes
Gov. Josh Shapiro, as Pennsylvania’s former attorney general, played a lead role in crafting the opioid settlement. He and other state attorneys general have stated 85% of the money will go to addiction treatment and prevention. But settlement guidelines can’t determine what treatment and prevention services are available locally, nor do they define them. Using “effective treatment and prevention” as a guideline for spending, one county or state could open more treatment sites. Another could buy more police cruisers.
Nor do Pennsylvania and most other states have adequate measures in place to inform the public how the moneyis spent.
The settlement’s lack of specificity and transparency worries public health advocates like Shoshana Aronowitz, an assistant professor in the Department of Family and Community Health at the University of PennsylvaniaSchool of Nursing and a senior fellow at the Leonard Davis Institute.
“When people talk about treatment, they mean different things,” she told the Post-Gazette’s editorial page editor. “There’s a lot of misinformation about what works and what doesn’t, and the parameters for what constitutes quality and effective care arenot very specific and clear.”
Money flowing into opioid settlement trust funds is essentially blood money, paid for by the suffering and deaths of millions of people. Once the money is spent, it’s gone. Governments and communities have a moral obligation to use it for effective, evidence-based programs for treating and preventing opioid addiction — programs that will significantly dent the nation’s leading public health crisis.
They’ll get only one chance to do it right.