Opioid Settlement Money Could Go Up in Smoke
Over 50 billion dollars in opioid settlement money has been awarded to States so far. Why states? In 2019, when 34,000 cities tried to break the logjam that had kept opioid settlement cases in limbo for the previous 18 months, 39 state attorneys general worked to get all the state and local cases consolidated under state control. This attempt was no minor thing; municipalities had been burned before in the big tobacco settlement, and they were not eager to see history repeat itself. According to The Campaign for Tobacco-Free Kids and Harvard’s Allan M. Brant, as little as 2.7% of the more than $200 billion went to tobacco prevention and cessation efforts. The rest found its way into the hands of state legislatures eager for a new source of revenue they did not need to tax the voting public for.
While the tobacco settlement was agreed to in 1998, cigarette smoking still kills over 400,000 Americans each year, four times the current number of overdose deaths. This is despite an industry-funded advertising campaign to discourage new smokers and free nicotine replacement products for anyone without a prescription or a medical exam. The lesson for our time is that every penny of that settlement needs to go to the people who were harmed and the communities that have been hollowed out by death, despair, and decay. Anything else is not only a failure of public health policy but a failure of moral leadership.
We know a lot more about the disease of addiction today. We know it is not a moral failing but a lifelong struggle. We know that addiction affects not only the addict but the family, and most importantly, we know that sobriety is possible with proper treatment.
With $50 billion, we could build 50 of the world’s best treatment centers, not institutions or poorly funded city programs, but palaces. We could staff them with the best therapists, doctors, and psychiatric nurse practitioners and create a teaching pipeline to educate and train the next generation of leaders in addiction medicine. We could offer medications to prevent withdrawal, reduce cravings, and treat common co-occurring depression, anxiety, and other mental health issues. We could provide family therapy, couples counseling, and grief counseling to heal the families, the partners, and the friends who live with or have lost people with substance misuse issues. We could be in every school in this country with a campaign to discourage early drug and alcohol use. Most importantly, we could do it all free of charge.
What we cannot do is waste this opportunity again.
It has been seven years since my last drink. I was fortunate enough to go to a place like the one I just described. It was a place of hard work and healing, apart from the “Florida shuffle,” where some bide their 28 days in unattended misery until the inevitable relapse and return. A place outside of traditional insurance-based programs that, to survive, must tie their treatment plans and programs to what will be reimbursed.
I once spoke to a treatment center CEO who grew tired of the inevitable question from families: “Where is the best treatment center in the United States?” because he knew the answer was “What is the best place you can afford?” Vivitrol, a common monthly injection shown to reduce cravings in opioid and alcohol-dependent patients, costs $1,500 a month without insurance. The new weight loss drug Wegovy at $1,300 a month, but while Wegovy can be administered at home, Vivitrol patients need to find a provider and may need to pay additional co-pays and fees for an appointment to have the drug injected monthly. Even the old standby methadone can cost hundreds of dollars a month if you can find someone specially certified to prescribe it and a clinic that has run the NIMBY gauntlet to open near you.
Lawmakers continuously refer to the addiction epidemic in the country as a “crisis”; it is time to put their money where their mouth is.
Chris McGuinn worked on opioid policy at the U.S. Department of Labor, works in the addiction treatment industry in Northern Virginia, and founded More Than 28, which seeks to increase insurance coverage for addiction treatment.