Opioid companies are being forced to pay for their grave mistakes and misdeeds in helping fuel the overdose epidemic in the United States. The total in settlements — including Purdue Pharma’s $8.3 billion agreement in a federal case and a consulting company paying more than a half-billion dollars for its role — now stands at approximately $10 billion, with many cases and billions more dollars still pending.
It’s imperative that these funds are allocated wisely — and as soon as possible — to ensure better access to addiction treatment and recovery support.
Before Covid-19 swept across the U.S., the country was in the midst of the worst addiction and mental health crises in memory, with overdoses, suicides and other troubling indicators rising dramatically over two decades and contributing to the first three-year decline (from 2014 to 2017) in life expectancy in the United States in nearly a century. Then the pandemic added a devastating new layer to this extremely challenging time in America’s behavioral health history.
As needs mount, overdose deaths reach new record highs, and public coffers come under additional strain, proceeds from opioid lawsuits — including the huge multidistrict litigation in Ohio — are needed now more than ever.
At the nonprofit Hazelden Betty Ford Foundation, where I work, we have seen firsthand the growing tragedy initiated by the opioid industry’s calculated, profit-driven overselling of the benefits of prescription painkillers and downplaying of their risks. We appreciate efforts to hold these companies accountable for the tremendous pain and damage they have inflicted upon so many people.
Just as important as legal accountability is the opportunity to infuse our long-neglected behavioral health care system — underresourced for generations due to stigma and discrimination against people with misunderstood diseases of the brain — with much-needed funds so it can better address the current crisis and isn’t so vulnerable to future ones.
As state attorneys general and other public officials begin to think more urgently about how to deploy the proceeds from opioid litigation, I support the guiding principles published by a Johns Hopkins-coordinated coalition, and offer three recommendations:
Support comprehensive, quality care. People with substance use disorders deserve access to a full continuum of quality care — just like those with heart disease or diabetes or any other health condition. For patients with opioid use disorders, that means access to the full range of FDA-approved medications, including buprenorphine, extended-release naltrexone, and methadone, along with evidence-based psychosocial therapies, peer support, and medical and mental health care. People will not get the personalized, patient-centered care and positive outcomes they need if funding and solutions are biased toward medications, or to one particular medication; that support psychosocial therapies but not medications; or that neglect the importance of peer support or physical and mental health care.
Widen the lens beyond opioids. Underlying the opioid overdose epidemic is a broader crisis of addiction. Most people with addiction are vulnerable to multiple substances, and most opioid-related overdose deaths involve the concurrent use of other substances. Just as we could never end diabetes or heart disease by zeroing in on one particular fast-food restaurant, we can’t expect to successfully confront addiction by focusing on one drug. History confirms the folly of trying to play whack-a-mole. Among the people that Hazelden Betty Ford serves, alcohol is part of the problem for 90% of them and use of several substances and co-occurring mental health conditions are the norm.
Death is one of many outcomes our clients want to avoid. So addressing the opioid crisis means that public health strategies and funding must be focused on comprehensive treatment for — and recovery from — all substance use disorders, not just opioids and overdoses.
Expand access to care. Addiction affects 1 in 7 people and 1 in 3 families. Yet only 1 in 10 people who needs help gets it. And with millions losing their insurance, and behavioral health programs struggling to stay open amid financial stress, access to care is trending the wrong way.
Officials charged with allocating opioid settlement funds need to focus on solutions that expand access to care, including telemedicine and regulatory reforms that eliminate discriminatory barriers such as rules that preclude prescriptions via telehealth and outdated restrictions on insurance payments for necessary care. We must work toward ensuring that all Americans, regardless of location, ethnicity, gender identity, or economic status, have access to the full spectrum of prevention, treatment, and recovery resources they and their families need.
As large opioid settlements are struck, attorneys general and other state officials will play a huge role in ensuring that we do not repeat the mistakes of the tobacco industry settlements in the late 1990s. Money from those settlements have not been consistently targeted to help reduce the negative impact of tobacco and other nicotine products, which have now exploded in popularity again with the advent of vaping.
Money from opioid settlements should never cover general budget shortfalls. They should be dedicated now, and long-term, to addressing the enormous and growing needs of our family members, friends, and neighbors who struggle with addiction and co-occurring mental health disorders.
Marvin D. Seppala is a psychiatrist with expertise in addiction medicine and the chief medical officer of the Hazelden Betty Ford Foundation.