The Wall Street Journal reported on communities hard hit by the opioid epidemic, hoping settlement funds would mitigate the damage done by drug addiction. The Opioid Master Settlement Agreement was patterned after the tobacco settlements, except federal officials tried to structure the funds in such a way to avoid the money from being siphoned off for purposes unrelated to drug treatment. The WSJ conveyed some examples of how communities would like to use the funds, but the money is a drop in the bucket compared to the need:
“This community has been so damaged over the years, the money is not going to come close to completely healing all the problems that were created,” said Pat White Jr., the county’s judge-executive, a position akin to mayor.
Officials around Appalachia are reaching similarly underwhelmed assessments of the potential for settlement funds to help their constituents. Meanwhile, the opioid crisis—which started with pain pills and is now fueled by fentanyl—continues killing at a record pace.
The settlements total $50 billion dollars. That’s $1 billion per state, although some states have been hit worse than others.
In Kentucky, the estimated cost from deaths and lives undermined by addiction that year exceeded $24 billion. Per-capita costs there were among the nation’s highest.
Kentucky is expected to receive about $900 million in settlement funds, with half administered by the state and half going to local governments. State law specifies a long list of permissible expenditures, many aimed at treatment and recovery. Some areas are more restricted—such as law enforcement, which is eligible for funding aimed at education and emergency response, but not, say, narcotics investigations.
How the money should be spent is the subject of much debate. The need for drug rehab centers in hard-hit communities is great. Drug treatment is complex and unlike other forms of medical treatment. Moreover, drug treatment facilities are expensive, and few people get off drugs until the negative aspects outweigh the perceived benefits of drug use.
Some organizations want funding for mental-health services, but Williams worries giving to one group will raise expectations from others. He wants to devote funds to drug courts and inmate training programs at the jail, yet isn’t sure such projects qualify for settlement money.
Some counties are trying to extend the reach of their settlement funds by pooling them with neighbors for bigger regional projects. Others are supplementing settlement money with other funding sources.
White, the judge-executive, said he and colleagues have discussed using a chunk of the $867,000 in settlement funds the county has gotten so far to help establish the area’s first residential treatment center. But at a recent training on the funds, White said, he heard the money couldn’t be used for a facility that receives Medicaid money. County officials paused the plan, he said.
Purdue Pharma, the manufacturer of OxyContin, is often blamed for kick-starting the opioid crisis. The drug maker marketed OxyContin aggressively, claiming it was less addictive than other opioids. At this time (early 2000s) untreated pain was a widespread medical problem and the potential for addiction was underappreciated. Within a few years the potential for addiction became clear. A physician, writing in Missouri Medicine, recently said some of the blame lay with well-meaning physicians:
First, in all fairness, I will start with physicians. We overprescribe opioids, just as we overprescribe antibiotics. But it is generally well meaning; we don’t want our patients to experience pain. But then we prescribe 30 or 60 pills when 5 or 20 would have been adequate. We do that because we are used to prescribing in multiples of 30; 30 days for a month supply of a once a day medication, 90 days for a mail-order prescription. Prescribing 6 or 10 pills will undoubtedly result in a phone call from a pharmacist asking for a round number of pills, taking up time better spent entering meaningless information into our electronic health record systems. It is the leftover pills that sit forgotten in the medicine cabinet which often lead to trouble, stolen by a relative or visitor and abused. But sometimes it is that prescription that was provided for true pain that leads rapidly to tolerance and addiction.
The role of these physicians can best be described as innocent bystander. We were truly trying to help the patient.
Finally, as a comment to the WSJ article wondered, did addiction come before Oxycontin or did Oxycontin create a demand for opioids? Many public health advocates blame the fentanyl epidemic on overprescribing of Oxycontin, but that view is too simplistic.
The opioid crisis, characterized by overdose deaths due to fentanyl, is easy to blame on companies with deep pockets. That seems to be the American way. However, $50 billion (of $500 billion) is unlikely to put a dent in drug abuse or mitigate the effects of synthetic opioids like fentanyl that are so strong 2mg can cause death.