How much money will it take to prevent one opioid overdose death? How about 10, or 10,000?
Across the country, state, local and tribal governments are filing suit against the pharmaceutical industry and are trying to answer this question. U.S. District Court Judge Dan. A. Polster of the Northern District of Ohio, who is presiding over many of these cases, earlier this year ordered the parties to begin discussing a settlement. His hope was to avoid protracted litigation, an important goal considering that the opioid epidemic claimed the lives of more than 40,000 people in 2016 and continues to claim more than a hundred every day.
State and local governments have shouldered much of the financial and societal burden created by the opioid epidemic. Rahul Gupta, the commissioner of the West Virginia Department of Health and Human Resources, told a U.S. House committee last month that the epidemic is costing his state's economy $8.8 billion every year. A settlement of the opioid litigation is likely to provide substantial funding for addressing the epidemic. Spending that money wisely will require governments to look across the board for solutions by applying a continuum of care model to prevent and treat opioid abuse and sustain recovery for individuals with opioid-use disorders.
Parallels can be drawn between today's opioid litigation and the litigation against the tobacco industry that resulted in the 1998 master settlement with 46 states. A report on the tobacco settlement found that just 1.9 percent of settlement funds and tobacco taxes in 2015 were spent on tobacco cessation or prevention programs. The tobacco settlement agreement did not specify how the funds should be spent, but rather left it to states to spend settlement money as they saw fit. While much of it was spent on general health care related costs, some states used the money to plug budget holes during economic downturns.
The Addiction Solutions Campaign recently released a comprehensive policy document with recommendations for how funds from a settlement of the opioid litigation should be invested to address the epidemic. An important complement is a community engagement strategy so communities and their members are fully engaged in the policies and programs that are implemented. The document lists important steps that local governments should take:
• Begin with an inventory of community resources. The opioid epidemic resulted from broad national forces, but sustainable solutions must consider a local community's strengths and weaknesses. This community inventory would include a list of all local prevention, treatment, recovery and harm reduction programs. This information will expose gaps in the system and inform a community response that builds on unique capacity in a local area.
• Second, examine the data. Local public health resources, as well as local public safety data, can help inform a community-based solution. For example, if prescribing data from the Centers for Disease Control and Prevention indicates that a county has higher-than-average rates of opioid prescribing, local prescribers may require training in pain management as well as in how to screen and care for people with substance-use disorders. In addition, a higher-than-average rate of overdoses in an area could indicate a need for community-based naloxone distribution.
• Third, follow the science. There is an extensive body of research on how to prevent, treat and care for people with substance-use disorders. The 2016 Surgeon General's Report on Alcohol, Drugs and Health provides an excellent overview of evidence-based policies. The research contained in this report, along with the Addiction Solutions Campaign recommendations, should guide a local approach.
The opioid epidemic is a community challenge, and the entire community can provide valuable insights into solutions. Health care providers, public safety agencies, schools, businesses and the faith community should all be involved. Just as important are families and friends of those with substance-use disorders, as well as those in recovery and current drug users. Each has a unique perspective and can provide important insights.
Arriving at a legal settlement is key to addressing the opioid epidemic. But a legal solution that fails to address the human side of the equation will leave communities without sustainable solutions. Building a plan that recognizes a community's unique challenges, as well as its strengths, will reduce opioid misuse and overdose deaths and ultimately build stronger, healthier communities.