Paying for the opioid epidemic

PAUL BUTLER, HOST: Coming up next on The World and Everything in It: Opioid settlements.

Last week, the Supreme Court ruled against the owners of drug company Purdue Pharma. It held they cannot be shielded from lawsuits related to overprescribing opioids.

NICK EICHER, HOST: Here’s a bit of background on the case: Purdue Pharma made and marketed the prescription painkiller OxyContin. But in 2007, it started facing lawsuits alleging the company knowingly downplayed the likelihood of addiction. After that, company owners, the Sackler family, began removing assets from the company.

BUTLER: The company declared bankruptcy in 2019 and agreed to give billions of dollars to those harmed by the opioid crisis. That was in exchange for shielding the Sacklers from any future lawsuits. But in the 5-4 decision, the Supreme Court said that because the Sacklers had not filed for bankruptcy themselves, they cannot be shielded under bankruptcy law without permission from those who might sue.

EICHER: The justices say that the bankruptcy system is supposed to allow debtors to settle their debts… And since the Sacklers didn’t participate, they cannot use it to settle a potential debt. That sends the parties back to the negotiating table.

BUTLER: But that isn’t the only case major companies have settled over the opioid crisis. Over the past few years, Walmart, CVS, and Johnson & Johnson have settled for billions of dollars. And in recent weeks, states have started receiving those funds. What are the regulations on the opioid funds and how are states using them?

WORLD Radio’s Mary Muncy reports.

MARY MUNCY: LIFEHouse Sober Living is a house and program in Indiana for women in recovery. It applied for a share of the state’s opioid settlement funds. Casey Johnson is a resident who just got out of prison in March. She was there for dealing drugs.

CASEY JOHNSON: I had a job within a week of getting out and coming here.

She works at Goodwill and it’s her first job ever, but without a license or car, she relies on LIFEHouse Founder Amy Chaudion to help with a lot of her daily needs.

AMY CHAUDION: We can't feed them spiritually until they're physically taken care of, and so that's usually our high priority is getting their physical needs met, getting them to the dentist, getting them food stamps and insurance.

The opioid settlement funds could help with some of those things, especially transportation costs.

CHAUDION: They get out of jail and they're like, left to their own devices, and they don’t have a car to get to work or recovery meetings or any of the things, so they end up going back to the same old things.

Indiana is set to receive nearly a billion dollars in opioid settlement funds over the next few years, a fraction of the around $50 billion dollars companies are dolling out to people harmed by the opioid crisis. And that doesn’t include potential settlement money from the Purdue Pharma case.

So as the first installments start coming in, officials across the country are trying to figure out what they can and can’t do with it.

DANNY SCALISE: What we've looked at is we want to prevent future overdoses, prevent future addiction issues.

Danny Scalise is the Director of Public Health for Burke County, North Carolina. The county is in the Appalachian Mountains and has seen high rates of opioid-related deaths compared to other North Carolina counties.

SCALISE: At the same time, we realize we have a lot of people here who are already suffering. So how do we balance taking care of people who are currently suffering with preventing people who might get to that suffering? And it's a tough balance.

Most states have applied to be part of a long list of settlements. The states will receive different amounts of money based on which settlements they’re a part of and a formula involving opioid overdose death rates, prescription rates, and population.

So, for example, out of one $26 billion dollar settlement, North Carolina will receive $750 million over the next 18 years. The settlement requires states to use the vast majority of the money to fight the opioid crisis, but they have a lot of freedom in how those dollars are spent.

North Carolina is distributing nearly all of it to counties and municipalities based on how opioids affected them.

SCALISE: We're trying to build things that aren't going to need settlement funds for their entirety.

But not all states are alike.

West Virginia has the highest drug overdose death rates in the country. A quarter of its nearly a billion dollars in settlement money will go to local governments. The rest will go to a state-run foundation that will distribute the money through grants.

Tennessee has the second-highest overdose death rate. It has appointed a council to distribute 65 percent of its funds with the remaining funds going to counties.

So with billions of dollars on the line, what kinds of programs will be most effective in helping those hurt by opioids?

TIMOTHY ALLEN: About 50 percent of people abuse substances on a monthly basis.

Timothy Allen is board-certified in addiction medicine and is doing a fellowship in pediatric and adult psychiatry.

ALLEN: The 50 percent who don't use, don't understand the 50 percent who do use, and vice versa.

Allen says spending money on things like a billboard with a syringe under a red circle with a slash through it won’t work.

ALLEN: If you had people were trying to struggle with obesity, would you put pictures of donuts up on billboards and then put a big red circle and a slash? Well, no, that'd be advertising.

Allen says you can’t scare an addict, but there are things that work.

He says any funding going towards preventing drug use will require caring for people on an individual basis—helping them find something better.

ALLEN: That requires a lot of dedication, and it's not as simple as slapping up a billboard and saying, ‘knock it off.’ And so it takes a lot more societal will to see those things change, if you want to change drug use.

Back in Indiana, Chaudion started LIFEHouse in 2016 after recovering from her own addiction to heroin. She wanted to give other women the safe space and support they would need to succeed. For Johnson, that meant helping with transportation and life skills.

CHAUDION: She's spent most of her adult life in prison, so having that funding to be able to give her the space and then have the resources to get her to a job. It is huge. But we could never do it without those funds.

Reporting for WORLD, I’m Mary Muncy in Hamilton County, Indiana and Burke County, North Carolina.

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