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Here’s How to Use $50 Billion in Opioid Settlement Money to Help People

A new set of opioid abatement recommendations, developed by an interdisciplinary team led by Harvard health economist Dr. Richard Frank, helps states and cities understand how to use settlement funds to address opioid-related harms.

An addiction recovery sign

When the news broke that the Justice Department reached a historic $8.3 billion settlement with Purdue Pharma in light of their efforts to stoke addiction to painkillers, including OxyContin, leaders in the response to the opioid crisis saw it as the first of many such settlements. Over the next several years, an estimated $50 billion or more in damages is expected to be paid out to states, counties, cities, Native American tribes, hospitals, and other groups nationwide. The billions in expected damages are the results of lawsuits brought by these entities against opioid manufacturers, distributors, and retail pharmacy chains for their role in worsening the opioid epidemic — one of the worst public health crises America has faced in recent decades.

The magnitude of this payout is significant, and recipients will, in many cases, have considerable discretion over how these lawsuit dollars will be spent. How should policymakers and community leaders allocate the payout to best serve communities affected by the opioid crisis? Many are understandably keen to avoid the outcomes of the tobacco litigation, in which only 2.6% of litigation payouts actually went to smoking prevention and cessation programs.

Dr. Richard Frank, professor of health care policy at Harvard University, led a cohort of experts in substance use disorder (SUD) treatment, health care payment, criminal justice reform, harm reduction, prevention, and related issues, to develop a spending guide that highlights interventions with demonstrated efficacy to reduce the various harms of the opioid crisis. Frank has held positions as Special Advisor to the Office of the Secretary at the Department of Health and Human Services and Assistant Secretary for Planning and Evaluation in the Department of Health and Human Services, often testifying on the economic and health costs of the opioid epidemic.

“We’re trying to provide states and localities with information that will be useful to them about what will work and what will not work to prevent and combat opioid use disorder,” said Dr. Frank. “There’s a lot of misunderstanding about what works, so we will try to separate what is clearly evidence-supported and what is more unclear.”

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Dr. Richard Frank

Dr. Richard Frank, professor of health care policy at Harvard University, led a cohort of experts in substance use disorder (SUD) treatment, health care payment, criminal justice reform, harm reduction, prevention, and related issues, to develop a spending guide that highlights interventions with demonstrated efficacy to reduce the various harms of the opioid crisis.

The guide provides actionable strategies and organizes what is known about public health-related services, programs, and strategies that are considered “best bets” for helping people who use opioids. It highlights a variety of evidence-based prevention, treatment, and harm reduction measures, including medications for opioid use disorder (MOUD), naloxone, and syringe exchanges. These interventions are what leading researchers consider some of the most effective ways that states and counties can utilize money from the opioid litigation lawsuits.

The opioid settlements will be litigated amid the COVID pandemic. The pandemic’s impact has caused increasing rates of overdose deaths and put states and local governments in an even tighter financial position. With dueling pressures of falling revenues and rising costs for things like unemployment benefits, states and cities may look to cut where they can—and it’s often social service programs like opioid prevention programs that find themselves on the cutting block.

That’s not the only worry. While the vast majority of new money to fight the opioid epidemic has come from the federal government, Frank worries that the treatment centers, traditionally funded by states, will see a decrease in reimbursable patients as many lose their health insurance due to job loss, leading to loss of access to care.

Dr. Frank is hopeful that the abatement report, combined with the general public’s broader understanding of the opioid epidemic, will help inform how cities and states use funds — from the litigation and from other sources — to save lives and mitigate the harms from opioid use disorder. The report gives policymakers insight into the infrastructure needed to successfully implement abatement programs; provides cost estimates for scaling them; and offers examples of how states might be able to develop abatement programs that will work within various political, financial, and infrastructure landscapes.

“You’ve seen New York City and a number of other localities get very creative recently on how to implement evidence-based services,” said Dr. Frank. “If you had asked me two years ago whether in my lifetime I would see methadone [an FDA-approved medication frequently cited as the gold standard for OUD] be a home-delivered service, I would have told you there’s no way that’s going to happen, and now you see it.”

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Dr. Richard Frank - COVID Impact

Arnold Ventures also discussed with Dr. Frank the impact of the COVID-19 virus on efforts to address the opioid epidemic.