We need a Master Settlement Agreement for the opioid crisis

We need a Master Settlement Agreement for the opioid crisis
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The opioid crisis in America — a human-manufactured epidemic — is unprecedented, with nearly 48,000 people losing their lives annually from an opioid overdose. The closest analogy to the magnitude of deaths occurring and the direct line to corporate marketing efforts are the extraordinary death and disease caused by the tobacco industry.

There is one key difference: opioids are a necessity in a number of circumstances to control pain. However, the marketing practices willfully employed by the opioid industry and its partners in the supply chain — sadly including doctors themselves — may well constitute negligence on the order of the tobacco industry. This became increasingly clear in recent weeks when, thanks to a Massachusetts lawsuit, new information came to light on Purdue Pharma’s aggressive and lucrative marketing of OxyContin.


Since the surgeon general’s 1964 report on the hazards of smoking, smoking rates have steadily declined with the help of policy and legal initiatives. Many of these strategies need to be adopted now if we are to arrest the opioid epidemic.

The problem must be systematically attacked using the full continuum of interventions, including preventing unnecessary access to opioid prescriptions in the first place, through the transition from pill addiction to street heroin caused by the high street price of opioid pills (50 dollars versus 5 dollars for an equivalent dose of heroin).

One strategy will be crucial: the collective effort of state attorneys general in pursuing civil and potentially criminal charges and ultimately crafting a settlement similar to, but vastly better than, the famous tobacco settlement they finalized in 1998 to provide substantial funds to states.

This settlement impacted tobacco marketing practices; closed fake research and policy institutes designed to deceive the public; funded a highly acclaimed public education effort from 2000 to the present known as “truth”, which successfully reduced youth initiation; and made billions of dollars available to states to recompense them for the extremely high costs to their state budgets for caring for those afflicted with tobacco-related illness.

The Master Settlement Agreement protected the tobacco industry from further litigation by states and localities related to issues settled, which was of value to the industry.

A federal judge is now working to fashion a settlement among more than 1,500 litigants seeking redress from the harms of opioids. The risk of the wrong type of settlement emerging is substantial. The U.S. opioid industry is extremely large and profitable estimated by one report to reach nearly $35 billion annually by 2025. States in particular bear the brunt of public health costs for addiction treatment and medical care, law enforcement, and social services expenditures.

I recently described in the "New England Journal of Medicine" what the minimum provisions might be in an opioid settlement at least as robust as the tobacco settlement. I put forth that states must, principally through their state attorneys general, seek an extremely substantial settlement to both recover past losses arising from the willful effort of these bad actors as well as to insure an adequate funding stream going forward to reverse the current epidemic through a range of evidence-based efforts to prevent and treat opioid addiction.

A settlement must reimburse states for costs of addiction treatment, social services, and legal-aid costs for criminalized drug use, as well as require consumer and provider warnings about addiction. A settlement should also fund a mass-media public education campaign to reverse false assumptions about opioid use, as well as educate health providers to improve support for policy-related changes. Nothing less will likely mean this epidemic is sustained and may grow for many years to come, costing untold pain and suffering.

The U.S. is experiencing a reduction in life expectancy in large part due to the epidemic of opioid addiction. It is urgent that our judicial system steps in to hold the executives responsible for this unfolding tragedy accountable, not only to stop this epidemic but to send a message that consumer protection in America means something and has teeth.

Cheryl Healton, DrPH, MPA, is the dean of the NYU College of Global Public Health and the founding the CEO and president of Legacy (now the Truth Initiative) from 1999-2013.