USA TODAY International Edition
Advocates: Use opioid money on treatment
Experts on addiction and health weigh in on settlement spending
Angela Mallette never saw opioid addiction coming.
The civil engineer from Mississippi was 27 and in her eighth month of pregnancy when she suffered a miscarriage. Doctors performed a cesarean section to remove the deceased baby. She went home with a prescription for OxyContin, a strong opioid for pain management.
“I had no clue how to cope with the situation,” Mallette said, referring to the grief and depression that followed the loss of her child. “I thought, I’m just going to go back to work, pretend this didn’t happen, and move on with my life. The pills helped me do that, and that’s where my addiction began and flourished.”
With help, she was able to stop. But nearly 400,000 people in the U. S. died by overdosing on prescription or illegal opioids between 1999 and 2017.
Today, as the director of a law enforcement diversion program for opioid users who have been arrested, Mallette has a new worry: Will the states and municipalities that are negotiating multimillion- dollar settlements with drugmakers, distributors and other companies use the money to do the most to end the epidemic?
“A huge concern is making sure that this money goes to help the people that have been affected by this crisis and continue to be affected by this crisis,” Mallette said.
The latest settlement was announced Monday: A $ 260 million deal that avoided a federal trial pitting two Ohio counties against three pharmaceutical distribution companies – McKesson, Cardinal Health, and AmerisourceBergen – and Israel- based drugmaker Teva Pharmaceutical Industries.
Mallette and others who have struggled with addiction, along with healthcare providers and addiction experts,
say money from these settlements should go to efforts to reduce harm, including wider distribution of Naloxone, a drug to treat overdoses; programs to prevent drug abuse and help patients reduce or quit their use of opioids; and long- term recovery support services.
“We need to invest in things that show we’re treating addiction like a public health crisis. And we’re just not doing that right now,” said Marcia Lee Taylor, a spokeswoman for the Center on Addiction.
Settlement plans questioned
Directing money to these sorts of efforts might seem obvious. However, plans for some settlements have prompted questions.
A $ 270 million settlement with drugmaker Purdue Pharma, which Oklahoma Attorney General Mike Hunter announced in March, will channel $ 200 million to addiction research by Oklahoma State University. Legislators were dismayed they had no role in the spending decisions. In May, Gov. Kevin Stitt signed a law requiring funds from state lawsuits settled by the attorney general’s office to go into the state treasury.
That same month, West Virginia Attorney General Patrick Morrisey announced a $ 37 million settlement with the drug distributor McKesson. His office said in late July Morrisey believed most of the McKesson funding should go to addiction treatment. However, a portion was earmarked for scanners to stop contraband from being brought into West Virginia’s jails and prisons.
Ryan Hampton, the author of “American Fix: Inside the Opioid Addiction Crisis – and How to End It,” is in recovery from heroin addiction. He says these settlements should be channeled to front- line treatment and support programs after independent studies to identify the greatest local needs.
“I’ve probably received a dozen calls in the last two weeks from state attorney general offices and public health offices in states, saying, ‘ Send us a list with your recommendations on where to spend this money,’ “he said in a September phone interview. “That is not the right way to go about this.”
Recalling the tobacco settlement
The landmark tobacco settlement reached in 1998 is a cautionary tale.
The agreement between the nation’s five largest cigarette manufacturers and 46 states, the District of Columbia and five U. S. territories requires the tobacco industry to pay states billions annually for expected spending on smoking prevention and cessation programs.
However, states use most of the funding to pay for general government services, according to the advocacy group Campaign for Tobacco- Free Kids.
During fiscal year 2019, states will receive a total of $ 27.3 billion from the settlement, not including tobacco taxes, the group said in its most recent report. Just 2.4 percent of that money will fund programs to prevent children from smoking and to help smokers quit.
That experience is playing into calls for government officials to spend opioid settlements carefully. The recommendations are coming from advocates like Mallette and Hampton, whose expertise comes from personal experience, as well as addiction treatment programs and health care experts.
In the report advising how to spend the money, the Center on Addiction and other groups recommended bolstering education about addiction prevention, starting early intervention programs, and expanding access to treatment.
“I think there needs to be an outcry from people who have been impacted by this disease that state legislators have to ensure that the money that comes from any settlements be put toward fixing the addiction problem,” said Taylor, the center’s spokeswoman.
Rebuilding lives, in and out of jail
That outcry has been amplified from a place that might seem unusual – a jail.
Soon after Karl Leonard became the sheriff of Virginia’s Chesterfield County in 2014, he started seeing 10 to 12 heroin addicts sent to jail every day. In March 2016, the county recorded its 10th heroin overdose death of the opioid epidemic.
“We define insanity as doing the same things over and over and over in jails and having the same results and nothing changes,” he said. “It became very frustrating.”
Jails are great places for drug addicts to become sober, he said. But if addicts relapse after release, they can overdose because their bodies can’t cope with the sudden return to highly potent opioids.
Leonard announced the department was “going to release recovered addicts back into the community” with tools to deal with addiction “so they don’t need to go back to drugs.”
The program, based on 12- step recovery, is Helping Addicts Recover Progressively, or HARP. It “really breaks all the standards that we have become used to in running jails,” he said.
The first step, he said, is making sure prisoners struggling with addiction “know that we believe in them, and that they have value in our community.” They receive counseling to identify psychological trauma and deal with triggers that send them back to drugs.
After release, people who have completed the program can come back to the jail “and be with others in recovery” if they think they’re in danger of relapsing, Leonard said. The program also provides medical care and classes in parenting and job skills.
About 900 people have gone through the program, Leonard said. A Virginia Commonwealth University study found that graduates of the jail’s program are less likely to be rearrested.
Asked how the settlement money should be spent, Leonard, who is seeking reelection in November, said the funding “has to make it to recovery programs. It has to make it to treatment centers. It has to make it down to the individuals who are really struggling.”
Mallette offered a similar prescription.
After succumbing to addiction, she went from taking pills to injecting drugs. Ultimately, she turned to heroin. She careened in and out of jail, eventually losing her job and home.
In 2013, Mallette was ordered into a treatment program where she began her recovery. Afterward, she landed a job. She fell in love, and in 2015 gave birth to her daughter, Stella.
She relapsed when Stella was about 6 months old. It started with OxyContin pills. A week later, she was injecting a highly addictive opioid called Dilaudid.
“At that point, I’d been sober for about 18 months,” Mallette said. “I thought I was OK and didn’t realize I could relapse that quickly and that hard.”
She returned to a treatment program, where she decided to devote her life to raising her daughter.
Mallette no longer designs bridges and highways. With the help of grants, she launched Mississippi LEAD ( Law Enforcement Assisted Diversion) in one community. She hopes to expand to a second community in 2020.
The program, based on one pioneered in Seattle, enables police officers to send low- level arrestees who struggle with addiction to treatment and recovery programs, not jails. The program is meant to address a misconception that people simply need treatment to beat addiction. Mallette said they also need locally based, affordable services to help them find housing, navigate the criminal justice system and more.
“I hope that those in charge of allocating funds from opioid settlements realize this as they make their decisions,” she said. “As a country, I hope we don’t miss this opportunity to establish a sustainable, long- term recovery support system that can help people for decades.”