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Opioid Settlement Money Is Coming. How We Spend It Is Critical.

Billions of dollars will soon begin to flow to state, local and tribal governments. It should be used in ways that reflect each community's needs, and we need systems of accountability.

(Steve Heap/Shutterstock)
State, local and tribal governments will soon begin receiving a massive influx of funds as legal actions brought against the manufacturers and distributors of opioids reach a resolution. Given this, governance structures must be in place so that the litigation funds are spent on evidence-based practices that reflect the needs of local communities and include accountability for any expenditures.

A great deal of national attention has centered on the bankruptcy of Purdue Pharma and the efforts by the company’s owners, the Sackler family, to be shielded against future legal action. In the end, that case resulted in an agreement to pay nearly $6 billion, over time, to plaintiffs. However, this amount pales in comparison to the $26 billion that will go to states and local jurisdictions as a result of the master settlement agreement in the National Prescription Opiate Litigation. These proceeds will be distributed to plaintiffs over 18 years, with jurisdictions beginning to receive funds as early as this month.

By any measure, this is a significant cache. But given the breathtaking number of drug overdose deaths in our country — more than 100,000 in the year ending in April 2021, with about three-quarters of them from opioids — and historic underfunding of the nation’s addiction-care system, even this amount doesn’t come close to meeting the needs of local communities. A report issued by United Hospital Fund of New York City estimated, for example, that the opioid epidemic will cost the nation $400 billion by 2030 due to the “ripple effect” on children whose parents are addicted. Stack these costs up against the proceeds of the opioid litigation, and the unmet needs of local communities are huge.

Workforce shortages, overly burdensome regulations that inhibit access to medications for opioid use disorder, and barriers to coverage for necessary addiction services are just a few of the hurdles faced by people with opioid use disorder. But while expanding the nation’s addiction treatment system is necessary, we must also focus on preventing substance use disorder. A holistic response to addiction necessitates addressing root causes such as untreated trauma and adverse childhood experiences brought about by poverty and parental incarceration.

Given the gap between the needs and the funds available, it is imperative that available money be spent on evidence-based programs and that accountability measures be in place to monitor expenditures and adjust to changing circumstances. At a gathering at Georgetown University Law Center last fall, litigators, policy experts and academics came together to identify guiding principles for opioid litigation expenditures. One lesson stood out: We must apply what was learned from the 1998 tobacco settlement and develop a system of oversight to guide opioid litigation expenditures. This oversight system must involve the community in a meaningful way and include ongoing accountability for expenditures.

An opioid litigation governing body would include representatives of affected communities, public health experts and government officials to guide the dissemination of funds. Representatives of affected communities might include people in recovery from an opioid use disorder, along with individuals who have lost loved ones to an overdose. Truly meaningful involvement in decision-making requires that participants receive the necessary information to gauge the effectiveness of their expenditures, along with the ability to adapt to changing trends in substance use and overdose in a community. This governing body would ensure that funds are spent effectively and prevent funds from being diverted from addiction-related purposes.

It has taken many years of legal proceedings to arrive at a point when local communities will finally receive money from the opioid litigation. Certainly, the actions of the opioid manufacturers, distributors and other related companies are not solely responsible for the current state of the nation’s addiction response. But these funds, along with other government resources, will help diminish the ripple effect that seems inevitable. The three waves of the opioid epidemic, the first of which began with prescribed opioids, can’t be turned back. But building a system of accountability that reflects our communities can begin to turn back the tide of overdoses in this country.

Governing's opinion columns reflect the views of their authors and not necessarily those of Governing's editors or management.
Regina LaBelle is the director of the Addiction and Public Policy Initiative at the O’Neill Institute at Georgetown University Law Center.
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