Tight controls will be needed to guarantee that all funds support evidence-based methods of prevention and treatment.
The opioid lawsuits and multi-billion dollar settlements that are being negotiated may seem like one-of-a-kind, but the U.S. has dealt with settlements of this magnitude before—in the 1990s, when Big Tobacco companies agreed to pay about $246 billion in damages over 25 years.
That money was intended to prevent people from smoking, and to help people stop if they were already addicted. And yet, just 2.4% of the settlement funds have gone toward cessation and prevention efforts.
Leana S. Wen, former Baltimore health commissioner and current visiting professor at George Washington University Milken Institute School of Public Health, says that we need to proceed carefully to ensure that the opioid settlements aren’t squandered in the same way.
Supporting Evidence-Based Methods of Prevention and Treatment
Writing for The Washington Post, Wen says, “To prevent a similarly egregious diversion, today’s policymakers should commit—at the outset—to a strong public health framing for the opioid settlement. This starts with tight controls to guarantee that all funds support evidence-based methods of prevention and treatment.”
Wen outlines a series of steps to ensure that the opioid funding is distributed fairly and used effectively. First, she says, the government needs to stop supporting out-of-date detox programs that do not result in long-term sobriety. Instead, she says, the funds should be used to fund medication-assisted treatment, the gold standard for treating opioid use disorder.
“Rapid ‘detox’ programs do not work, and, in fact, lead to higher rates of overdose deaths,” Wen writes. “Yet, these detox programs still get government funding, and many states force people to comply with these methods. That needs to change.”
Racial Disparities in Fund Distribution
Next, Wen suggests that the funds be distributed to areas most affected by opioid addiction. This could be done using a model similar to the one that the Ryan White HIV/AIDS Program uses to distribute money to areas hardest hit by HIV/AIDS outbreaks.
It’s important, Wen notes, that the funds be sent not just to areas with the highest prescription rates, but also to places where heroin and street drugs have been devastating. This is crucial in order to ensure that there are no racial gaps in who benefits from the settlement funds.
“A funding distribution that focuses only on one face of the disease would violate public health best practices,” she writes. “It would also worsen racial disparities. Already, many in my city and around the country are angry that opioid addiction was not deemed an epidemic until decades after it claimed the lives of countless people in minority communities.”
Wen continues, “When the face of addiction was black and brown—and associated with heroin—addiction was seen as a crime and a moral failing; when it became white and associated with pills, addiction became understood as a disease. To be sure, it is an important development that much-needed resources are finally coming to address this crisis. But unless street drugs are given equal weight to prescription opioids, the response will not only be ineffective, it will perpetuate systemic injustice and structural racism that have long undergirded opioid addiction.”
