What to do with billions in opioid settlements? Hopkins coalition has suggestions

Johanna Alonso, BridgeTower Media Newswires

Hoping to avoid the mistakes of the massive 1990s tobacco industry settlement, a coalition led by John Hopkins Bloomberg School of Public Health is offering guidance to state and local governments expected to reap billions from opioid litigation.

The 31 organizations, brought together by faculty members at the Bloomberg school, said their guidance is rooted in a list of five principles that encourage governments to allocate money into evidence-based opioid treatment and prevention programs. The coalition warns that programs without a scientific foundation may be ineffectual or even counterproductive.

These principles also encourage governments to place emphasis on both youth-focused programs, in an effort to address an increasing number of opioid-related deaths in the 15-19 age group, and programs that combat racial inequity by addressing root causes of health disparities in minority communities.

The coalition, which is composed of research and advocacy groups, wanted to publish this guidance due to what its members view as the failures of governments to appropriately use the $206 billion from the massive 1998 tobacco settlement. Some estimates state that as little as 3% of those funds have been spent on programs to reduce the use of tobacco, according to Hopkins.

Sara Whaley, a research associate at the School of Public Health and one of the lead collaborators on the report, said the team at Hopkins wanted to do its part to prevent history from repeating itself.

However, other organizations were already working to compile lists of effective, research-based interventions that municipalities could consider implementing, so instead, the coalition sought to offer guidance not on what programs to fund, but on how to fund them equitably, transparently and fairly.

Alongside its central principles, the coalition’s report also includes advice on how state and local governments can practically apply these principles. In explaining how to develop a fair process for deciding where to spend the settlement money, for example, the report notes that perspectives of public health experts, minority communities and those with experiences related to opioid addiction must be considered.

It then cites a method utilized by the Ryan White HIV/AIDS Program, which distributes funds for HIV health care and support services. To assure that funds are being distributed appropriately, “at least one-third of the members of the community Planning Councils that allocate funds to treatment providers must receive program services themselves,” the report says.

“New dollars from the opioid litigation will help communities implement evidence-based programs, such as naloxone distribution and syringe service programs, that will reduce the number of people dying from drug overdoses,” said Monique Tula, executive director of the National Harm Reduction Coalition. “As they implement these principles, states, cities and counties must include the voices of people who use drugs to make certain the programs and policies are designed to meet their needs.”

Increased opioid-related deaths amidst the coronavirus pandemic further demonstrate the urgency of following these principles, even as the economic downturn caused by COVID-19 might persuade governments to use the funds to balance their budgets, the coalition says. Preliminary data shows that overdose deaths rose across most states in 2020 as compared to 2019, with some reporting an increase of over 30%.

It is not yet clear when payments will begin to be distributed and how they will be dispersed among the many jurisdictions involved in the settlements, which is why the group wanted to release this guidance as early as possible — so that states and municipalities have as much time as possible to prepare.

“Before states even got the money, we wanted them to be thinking of where it should go,” Whaley said, adding that some have already created a fund to hold the money, which is one of the coalition’s recommendations.

Among those involved in the settlement are opioid manufacturer Johnson & Johnson and distributors McKesson, Cardinal Health and AmerisourceBergen, who reached a tentative settlement of $26 billion last November.
Teva Pharmaceuticals and Purdue Pharma each reached separate agreements, with Teva agreeing to donate $23 billion worth of buprenorphine naloxone, a drug used to treat narcotics dependence, and $250 million in cash; Purdue will pay $8.3 billion.