Andrew S. Pollis, JD

The latest announcement suggests that there is something more in writing than at the time of the last announcement and that there is more specificity about how the money would get divided up if the settlement goes through.

Several states have already agreed to sign on, but it is not clear how many states in total will agree to be part of the deal. The total size of the deal could be lower if there are not enough states to trigger payment of the whole $26 billion. Indeed, the deal may fall apart entirely if there is not enough buy-in to satisfy the distributors; we don’t know how many the companies would require (or, put the other way, how many dissenters the companies will tolerate, because each dissenter equates to increased litigation and liability risks).

I find it noteworthy that Washington state is already a holdout, and that could be a problem, because the other states do not want to get themselves into a position where they look like they negotiated a worse deal for their citizens than Washington state (or any other dissenter) eventually recovers. Further complicating all this is the fact that the states must in some fashion coordinate with their respective political subdivisions, where dissent could potentially prevent a state from signing on to the deal.

Stefan Kertesz, MD, MSc

The $26 billion settlement between a coalition of states, three pharmaceutical distributors and Johnson & Johnson delivers funds that, we hope, will advance treatment, prevention and safety programs related to addiction to opioids and other substances. If they do, it offers a measure of hope amidst a cataclysm of deaths.

However, this high-profile win against four companies risks obscuring a higher level of responsibility for our crisis, which falls jointly at the feet of our medical profession, and U.S. culture at large. Crucially, no private company forced medical schools to give both pain and addiction care short shrift. No company forced our culture to stigmatize addiction, pain and disability. Private companies simply profited by our negligence, even if they did so recklessly.

Because of our negligence, the U.S. health care system rewarded doctors for quick “encounters” rather than healing relationships. That misguided priority explains why we ran opioid prescriptions ever-upward until 2012.

That same negligent attitude explains why we reversed course so recklessly, with the elderly and disabled being cut off and denied pain medication in ways the FDA itself condemns. In both instances, we focused on minimizing some easy numbers, whether it was pain scores, or later, morphine milligrams. It is crucial to understand this: the simple numeric solutions were always the wrong ones. If some of this enormous money could be used to help American medicine correct its gravest flaws, it would be money well spent.

Anita Gupta, DO, PharmD, MPP, GMP, FASA

According to provisional data from CDC, more than 93,000 people died from drug overdoses in 2020, a number that is rapidly increasing. The CDC also said the opioid crisis peaked for the last 12 months ending in May 2020, and according to the CDC, drug overdose deaths rose by close to 30% in the United States in 2020, the highest ever in the country. Combined, the COVID-19 pandemic, opioid crisis and financial despair are the most significant health and economic displacements in United States history.

This legal precedent, in coordination with multi stakeholder organizations, will hopefully make meaningful changes to help guide the future of U.S. policy, focusing on creating best practices and medication safety to create appropriate access, equity and accountability for opioids and pain medications.

Jeanne Lackamp, MD

Settlement dollars are only as good as the systems and programs that are put into place for their distribution and utilization. Monies risk being squandered if comprehensive, practical plans are not put into place.

Through University Hospitals, we have created myriad opportunities for multidisciplinary providers to collaborate, to provide our patients with the best care possible. This is exemplified through our work on opioid safety. Initiatives include martialing available resources to provide education to providers and patients; creating, and expanding, multi-tiered services for our patients; and implementing outreach to our community members, as their trusted health care provider.

Opioid use disorder (indeed, any addiction) must be treated like a chronic, complex disease process — and therefore we must recognize the need for comprehensive services for patients and their loved ones. Opioid settlement dollars must be distributed in an intentional, mindful and collaborative fashion — and must be based upon actionable proposals — in order to do the most good for our patients.

David Noll, JD

The most immediate impact of this agreement on health care will be the availability of a massive amount of new money for opioid abatement. The money could not come at a better time, as opioid deaths are spiking and public health systems are under stress from COVID-19.

The ways that the money can be used are strictly regulated by the settlement agreement, so I do not think the settlement will have much effect on the day-to-day work of health care providers who are not working in public health agencies. However, I think all health care providers should expect to see new well-funded public health programs for dealing with opioids that, hopefully, take some of the burden of the opioid crisis off of them.