Opinion: With the tobacco settlement, the U.S. missed its moment to fortify public health. We can’t make that mistake with the opioid settlement

States, counties, cities, and tribes have brought thousands of lawsuits seeking to hold players in the drug industry accountable for their roles in igniting the opioid epidemic.

These lawsuits have come as nearly 500,000 Americans have died from overdoses of prescription and illicit opioids in the past two decades. Many more have suffered nonfatal overdoses, and an estimated 20 million Americans struggle with substance use disorders.

Between 2006 and 2014, drug manufacturers, distributors, and pharmacies inundated every corner of the country with more than 100 billion pain pills. My home state of Illinois was sent 2.7 billion pills, with Hardin County in southern Illinois awash with enough opioids for each resident to have a nearly three-month supply. Some counties in West Virginia and Kentucky had almost twice that level of oversupply.

advertisement

Major players in the drug industry misled patients and providers about the risks of opioids, illegally promoted these addictive products, and recklessly distributed unjustifiable volumes of them.

The Covid-19 pandemic has made the problem worse, with a record 93,000 Americans fatally overdosing in 2020. Advocates call it a perfect storm: addiction thriving in the shadows of isolation, reduction of services, economic stress, trauma, and racial injustice.

advertisement

In March, Congress passed President Biden’s American Rescue Plan, which sent nearly $4 billion in addiction and mental health treatment grants into communities across the country. It also included a provision I authored to provide $1 billion through the National Health Service Corps and Nurse Corps to address shortages of health professionals such as addiction and mental health specialists. But more must be done.

Last month, a bipartisan group of state attorneys general announced the framework of a litigation settlement involving Johnson & Johnson and the nation’s three largest drug distributors — Cardinal Health, AmerisourceBergen, and McKesson — in which the companies would pay a total $26 billion over 18 years to resolve the suits. The work is not yet over, but I applaud the state attorneys general for their extensive work to reach this stage.

Legal proceedings continue for several other key industry stakeholders that have yet to be held accountable for their roles. This includes the Sackler family of Purdue Pharma and OxyContin infamy, who are trying to engineer a legal scheme to escape liability through bankruptcy court.

When a landmark master settlement agreement was reached in 1998 on another public health scourge — tobacco — cigarette makers provided states with an estimated $246 billion in compensatory payments.

Unfortunately, most of those billions of dollars were diverted from public health to roads, bridges, stadiums, and other state projects. The country missed its moment to fortify public health.

As opioid settlements are reached, we must learn from the missed opportunity with tobacco. That means dedicating the funds from opioid settlements to build the public health systems our nation needs to respond to the opioid crisis and prevent future addiction. This includes devoting resources to residential and community-based treatment and recovery services; expanding access to medication-assisted treatment, naloxone, and other harm reduction strategies; and bolstering the nation’s behavioral health workforce capacity.

Funds from opioid settlements should also be focused on underlying structural problems, including childhood trauma; the need to improve training and address the stigma associated with addiction; investing in mental health and supportive housing; and better policing the practices of the pharmaceutical industry.

The opioid epidemic was not started by an infectious virus. It started with business decisions to enhance profits. Far too many families have suffered as a result of corporate greed and malfeasance. As legal efforts continue to seek accountability, we must heed the tobacco settlement lesson and help our communities heal.

Dick Durbin, the senior United States senator from Illinois, has been Senate Democratic Whip since 2005 and is now the Senate Majority Whip and chair of the Senate Judiciary Committee.

Source: STAT