This November marks the 20th anniversary of the landmark Tobacco Master Settlement Agreement, in which tobacco companies agreed to pay up to $246 billion over 25 years. While the settlement produced many good outcomes, results might have been even better had states fully dedicated those funds to tobacco prevention and treatment instead of diverting too many of those dollars to non-health related expenses — such as fixing potholes.
Today, the nation faces a different but no less significant health crisis – one that could be markedly reduced with sensible allocation of new funds. As the opioid epidemic enters its second decade, it continues to wreak devastation on individuals, families and communities across the country.
Drug overdose is now the leading cause of death among people under 50 in our country. It now claims more lives annually than AIDS during the peak of that epidemic — and even more than the Vietnam, Iraq and Afghanistan wars combined. Add to these tragic human losses the extraordinary financial burden estimated at $740 billion in annual costs of addiction to healthcare, criminal justice and national productivity.
In response to this crisis, states and municipalities are following the tobacco model and suing opioid manufacturers and distributors, claiming that deceptive marketing practices fueled the epidemic, leaving states, cities and counties to pay for the harmful and costly consequences. There are many parallels in these cases, which means that we have an opportunity to avoid repeating the mistakes of the past.
If a Master Settlement is reached in the Multi-District Litigation that is currently before a federal judge in Ohio, the parties would be wise to begin mapping out priorities for its allocation now. The scope and size of the potential settlement could change the way that addiction is managed in our country — but only if the dollars are wisely leveraged.
During my forty-plus-year career as an addiction researcher and policy-maker, I have witnessed scores of missed opportunities to invest in existing, proven solutions to improve prevention of, treatment for, and recovery from addiction. In the event that a settlement or judgement is reached in the massive opioid litigation, I and my colleagues, urge policy-makers to plan now.
As such, four of the most tenured organizations in the field of addiction research and advocacy have collaborated to develop a set of consensus recommendations for addressing the opioid epidemic as part of a potential settlement agreement:
1. Enhance public and professional education; Create informed demand for effective policies and interventions. We propose several elements to achieve this goal, including implementing public awareness campaigns focused on parents that show proven effective steps they can take to help protect their children; taking steps to ensure awareness among the public about their rights to fair and equitable insurance benefits under the Parity Act of 2008; and mandating education and training in addiction in all state-funded medical, nursing and pharmacy schools.
2. Implement evidence-based prevention and early intervention strategies to reduce substance misuse and related harms. The most effective and economical way to avoid the costly consequences of opioid misuse and addiction is to invest in effective prevention and early intervention. Specific strategies include: creating and empowering a state prevention office; using legislative powers to reduce adolescent’s access and exposure to legal addictive substances; commissioning state-wide reviews of school-based prevention to assure that schools are properly trained, organized and equipped to deliver evidence-based prevention interventions; and establishing a state Screening and Brief Intervention (SBI) program and educate, train and incentivize health care professionals to understand correct methods for identifying risk factors and promoting positive behavioral change.
3. Expand access to evidence-based addiction treatment services, integrated with mainstream healthcare. Although there are many good individual treatment providers, they are operating within a fundamentally broken and under-resourced system. In response, we need to modernize addiction treatment by integrating it into mainstream healthcare. Comprehensive, quality healthcare coverage is key to achieving this goal. The campaign recommends key strategies, including: ensure that public and private health insurers are complying with federal and state parity laws and are providing equitable coverage for addiction care; increase the availability of medication-assisted treatment (MAT); maintain strong Medicaid programs; use payment models to promote quality treatment; provide funding to support internships and fellowships in addiction treatment to expand the workforce; provide resources to expand peer and family support services throughout the care continuum; and review state Medicaid and Block Grant guidelines to assure there are no undue restrictions on availability of evidence-based treatments for addiction.
The recommendations outlined above are not exhaustive. They are curated from a large number of important and effective strategies that are being used across the country. What defines our recommendations is that they all meet four core criteria: they are 1) scientifically sound; 2) rapidly scalable; 3) politically viable and 4) financially sustainable.
If implemented, they are designed to not only address health and human dimensions of the crisis, but also to ultimately reduce costs to state and localities and drive improvements in family, social and economic conditions that foster optimism, private investment, jobs and new revenue.
In other words, there is no good reason not to implement them. And although we acknowledge that there are many real and pressing budgetary concerns that must be balanced — including the need to fill potholes — we argue that there is nothing more pressing than saving the lives of citizens and averting the damage caused by addiction to every sector of the community.
Should the litigation against the opioid manufacturers result in a substantial financial settlement, the nation will have a once-in-a-lifetime opportunity to truly make a difference in the lives of millions. Let’s not squander this important opportunity.
With or without a Master Settlement, rather than continuing to rack up needless deaths and staggering costs, let’s start working now to implement proven solutions to end this crisis and improve the trajectory of how addiction is managed in this country. We cannot afford not to.
Thomas McLellan is the former deputy director of the White House Office of National Drug Control Policy and the scientific editor of the 2016 Surgeon General’s Report on Alcohol Drugs and Health. He is currently the chair of the Addiction Solutions Campaign (ASC), a collaboration among four of the longest-tenured and well-respected addiction research and policy organizations in the country.
Paul N. Samuels, president/director of the Legal Action Center,; Creighton Drury, president of Center on Addiction; Frederick Muench, president and CEO of the Partnership for Drug-Free Kids; and Richard J. Cohen, president and CEO of the Public Health Management Corporation, also contributed to this article.