In was the dawn of the 21st Century when untreated pain became a public health priority. In 1990 Dr. Mitchel Max, then president of the American Pain Society, authored an editorial in the Annals of Internal Medicine lamenting the lack of progress treating pain over the previous two decades. Within a few years Joint Commission jumped on the bandwagon and published Pain: The Fifth Vital Sign. Thus began America’s experiment in aggressive pain treatment and its descent into opioid addiction and overdose deaths.
Purdue Pharma was the purveyor of the opioid pain drug OxyContin. Purdue stood accused of aggressively marketing OxyContin far beyond therapeutic need. The following is a press release from Wisconsin senator Baldwin:
As owners and operators of Purdue Pharma, the Sackler family exacerbated the opioid epidemic’s staggering human and economic toll on hundreds of thousands of Americans.
When faced with declining sales in the 2000s, the Sacklers employed aggressive marketing tactics to “turbocharge” OxyContin sales, eventually resulting in Purdue pleading guilty to federal criminal charges in 2007 for misleading doctors and regulators. Nevertheless, Purdue continued these aggressive tactics in the years that followed, leading to the company’s 2020 guilty plea. During this same time, the Attorney General of the State of New York has alleged members of the Sackler family tried to shield their fortunes from investigation by transferring billions of dollars from Purdue to themselves.
In the ensuing years some states were worse than others about allowing unmitigated access to opioids with few concerns about therapeutic need. Florida became the go-to state for pain clinics, so-called pill mills, where anyone could get a prescription for opioid pain pills that were filled on the spot. Addicts would drive from adjacent states or even father to get pills in Florida, according to a recent documentary:
American Pain is a one-stop shop, supplying both prescriptions and painkillers. At the door, a hulking bouncer warns people not to snort their pills in the parking lot. That would attract the kind of attention that the clinic’s owners, twin brothers Chris and Jeff George, are trying to avoid.
The George brothers made it easy to get drugs at their clinics, where no appointments were necessary. Patients flocked to Florida from Tennessee, Kentucky, Ohio, West Virginia and other Appalachian states ravaged by opioid abuse.
Some drug dealers drove to the clinics from Kentucky in rented buses marked “Tree of Life Baptist Church” to mask their criminal intentions, the film shows.
State Attorneys General sued opioid manufacturers using the tobacco settlement lawsuits as a model to recover funds from companies who profited from loose pain pill manufacturer and distribution. States ultimately secured $50 billion in settlements. The vast majority of the funds (85%) are supposed to be used to fight addiction.
Spending the money effectively and equitably is a tall order, given the persistence and complexity of addiction, which affects individuals and communities, and is the topic of heated debates in scientific research, social services, politics, criminal justice, and even at kitchen tables.
If opioids are a drug elixir that intoxicates and afflicts users with addiction, money has a similar affect on governmental entities, federal, state and local.
What’s more, many states are not being transparent about where the funds are going and who will benefit. An investigation by KHN and Christine Minhee, founder of OpioidSettlementTracker.com, concluded only 12 states have committed to detailed public reporting of all their spending.
Not to mention concerns that money will flow to activities that have little to nothing to do with opioid treatment: building new stadiums or public schools. Back in the ’90s, these day-to-day budget priorities consumed most of what states won from cigarette companies in the national tobacco settlement, leaving little for anti-smoking programs.
Case in point: Greene County Tennessee. Over the past couple years Greene County has received more than $2.7 million in settlement funds from manufacturers and distributors of opioid drugs. The county’s rate of drug overdose deaths tops the nation. So far most of the settlement money received, and money not yet received, has been put towards paying off county debts.
They have put $2.4 million toward paying off the county’s debt and have directed another $1 million arriving over more than a decade into a capital projects fund. In March, they appropriated $50,000 from that fund to buy a “litter crew vehicle” — a pickup truck to drive inmates to collect trash along county roads.
Public officials defend the spending, claiming the county has borne the cost of the opioid epidemic for years.
“We’ve been dealing with this crisis for quite some time, but nobody wants to pay the bill as it comes,” Morrison said. “So when these funds are made available, then we are paying bills that have been due for quite some time.”
Opioid pills are no longer the scourge they once were because states tightened laws governing their distribution. Just try getting a prescription for effective pain medication when you need it. People I’ve talked to say getting pain relief is like pulling teeth. Nowadays those who became addicted from easy-to-access pain pills have turned first to heroin and later to the synthetic opioid, Fentanyl. Now that money is flowing in from opioid settlements state and local government are in no mood to spend it on addiction treatment.
This article has a table of the street price of opioid drugs.