Last month, states reached a $26 billion national settlement with three wholesalers and one drug maker that distributed and manufactured opioid painkillers during the worsening addiction crisis.
State officials soon began suggesting that this influx of cash could bring “substantial funds” and “significant resources” to their communities — along with a major opportunity to support people struggling with opioid use disorder (OUD).
Moving quickly to provide this support could not be more critical: 93,000 Americans are estimated to have died from a drug overdose in 2020, nearly a 30 percent jump from 2019. The stress and isolation that’s accompanied COVID-19 is at least partly to blame for this big increase in overdose deaths.
Where settlements should go
The settlement money can — and should — be channeled to programs and services that have proved to reduce overdose deaths and help people with OUD recover. This has not always happened following similar multistate lawsuits. For example, the landmark 1998 settlement with tobacco companies resulted in states receiving billions of dollars annually. But in the absence of strong requirements that the funds be spent on tobacco use prevention and cessation programs, as originally envisioned, only a small percentage has been used for these public health purposes.
Now, policymakers can prevent a similar diversion by adopting clear policies and plans for use of the opioid funds. The deal does require 70 percent of the money to go toward abatement activities, such as providing the overdose reversal drug naloxone and education programs about opioid addiction, but that is not enough to ensure that current and future leaders will use the money to make meaningful and sustained progress on OUD.
Policymakers setting up dedicated funds must focus on boosting access to the most effective treatments available, which research shows are FDA-approved medications for OUD. Years of study and evidence-based data show that methadone, naltrexone, and buprenorphine increase treatment retention and reduce illicit drug use and the risk of overdose and death. Through a public, transparent process, policymakers should identify and fund prevention, harm reduction, treatment, and recovery programs that are supported by that evidence. Officials then need to fund and implement a plan to collect detailed data — by geography, race and ethnicity, and other characteristics — to track progress and assess whether the programs are accomplishing their objectives.
Medications aid recovery
Despite stigma that causes some members of the public, lawmakers, and even healthcare providers to see OUD as a moral failing, the disorder is a chronic medical condition that alters the brain’s reward system, motivation, memory, and related circuitry. Medications for OUD aid in recovery as other prescription drugs do for heart disease or diabetes. When taken under the care of a health professional, they do not simply “replace one drug for another,” which is common misperception. Instead, they allow people to manage withdrawal symptoms without providing a “high.” And because the three medications work differently and are available in different settings, the right one will vary for each person and should all be accessible.
Yet they have not been, and the opioid overdose crisis rages on. Fewer than 20 percent of Americans with OUD receive medication despite its demonstrated effectiveness, too often because the very programs geared toward people with the disease do not provide it. In 2020, only 3.8 percent of substance use treatment facilities that treated OUD offered all three medications — totaling 545 programs across the country.
But ensuring access to these medications for everyone who needs them is exactly where policymakers can make the best use of their settlement funds. That means supporting programs that provide effective care, and for programs that don’t, expanding their use of all proven treatments. The science and data are clear.
Now is the time for states to invest the settlement money in ways that will help curb the tragic OUD epidemic — or risk squandering the funds and this chance to save lives.