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Can the Opioid Crisis Avoid the Pitfalls of the Tobacco Wars?

If American and tribal governments take drug companies to court and settle, the money should actually be used to combat addiction.

Lawyers leave the courthouse in Cleveland (Megan Jelinger/AFP/Getty Images)

This week, hours before a deadline that would have sent both cases to a single jury trial, Cuyahoga County and Summit County in Ohio reached a $260 million settlement agreement with opioid distribution companies McKesson, Cardinal Health, and AmerisourceBergen, and manufacturer Teva Pharmaceuticals.

For the two counties, the settlement appeared to be a win—they will soon be flush with cash to be used to fund efforts to curb the crisis and provide services for those still in the grip of opioid addiction. For many smaller governments, especially those of tribal nations or rural American counties, the opioid crisis has represented a major financial burden on social services, including law enforcement, welfare, rehabilitation, and healthcare. The settlements will also allow the governments to avoid the costs of a lengthy lawsuit, including potentially years more of inevitable appeals by the distribution and drug companies.

But the agreement also signals a win for the pharmaceutical companies. A trial would have meant depositions. It would have required documents and internal practices long kept secret by the private companies to be made public. It would have forced company executives, or at least their lackeys, to stand in court and answer for a crisis that over the last two decades has claimed the lives of over 400,000 Americans—roughly the number of American lives lost in World War II.

Around 2,400 similar lawsuits against these companies and others have been filed by federal, tribal, state, county, and city agencies and governments across the nation. The settlement in Ohio will almost certainly prompt many of these other jurisdictions to at least weigh the possibility of following suit, likely in a series of multi-billion dollar deals that provide payouts for decades to come.

If that does end up happening, then several questions quickly arise, chief among them: Can any sum of money really replace citizens and their political representatives being able to hold private companies publicly and legally responsible for negligence and outright disdain for public health? And, if settlements are the chosen route, how, exactly, will these governments spend that money?


The opioid crisis does not have a Jeffrey Wigand yet. Wigand, the former vice president of scientific research at the massive tobacco company Brown & Williamson, occupies a space in American whistleblower history shared by Daniel Ellsberg, Mark Felt, and Edward Snowden. Wigand’s 60 Minutes interview in 1996, stating that Brown & Williamson had knowingly added addictive and carcinogenic ingredients to cigarettes, prompted a flurry of state-based Medicaid lawsuits which would lead to the 1998 Master Settlement Agreement. His coming forward also provided what for so long had been denied to the American public: the truth about what Big Tobacco knew about the harmful effects of its product.

There are some truth-tellers in the opioid crisis. Carol Panara, hired by Purdue as a sales representative in 2008, told CBS how Purdue encouraged their sales team to tell doctors that patients exhibiting addiction-like tendencies were in fact just experiencing “psuedoaddiction.” The cure, according to Purdue: more opioids. Ann Marie Williams, a state government manager for Reckitt Benckiser Group, a British opioid producer, recorded company conversations, sounding the alarm on kickback schemes and the practice of encouraging off-label high dosages, leading to a $1.4 billion settlement between RB Group and the U.S. government bodies they did business with. And most notably, Joe Rannazzisi, a former DEA agent, explained to 60 Minutes and the Washington Post how drug companies used their resources to duck major federal repercussions during the height of the crisis.

But while lawsuits and settlements are finally underway, American citizens haven’t had the catharsis of the 1996 cigarette moment. In Wigand, they got an executive at the third-largest tobacco company in the nation finally admitting what Big Tobacco had long denied. It was enraging for many, but it also offered a sense of closure that has yet to emerge from the opioid crisis.

In settling the opioid lawsuits with the two Ohio counties, the four companies that agreed to fork over funds all issued statements denying any wrongdoing. Walgreens, the sole plaintiff that refused to settle the case, did not. “We never prescribed any opioid medication, and never sold opioid medications to pain clinics, internet pharmacies or the ‘pill mills’ that fueled the national opioid crisis,” a Walgreens representative said in a statement to The New York Times. “Our pharmacists have always been committed to serving patients in the communities where they live and work.”

If more lawsuits are set aside for payouts, then only cash and similar statements of denial will define the response to the crisis in the history books. And just like in the tobacco wars, the matter of what happens with that cash suddenly becomes all the more crucial in establishing a nationwide state of recovery.


Setting aside the usefulness of getting private industry leaders to admit their mistakes for the record—the decision to settle is now wholly up to the governments behind the thousands of lawsuits—conversations need to happen now, not after the settlements are reached, about what will happen with the opioid payouts after they are obtained by tribes, states, and counties.

Of the $27 billion that tobacco companies will pay out to state governments in 2019, just 2.4 percent will be earmarked for tobacco use prevention and addiction treatment. Instead, states have opted for the past two decades to spread the money elsewhere to pay for other general government services that have nothing to do with nicotine—it has become a supplement to taxes when it was actually obtained for specific purposes.

The opioid settlements should not repeat this trend, and yet it seems almost inevitable that they will. Over the past 11 years, following the red wave of 2010 in conservative states with rural communities particularly susceptible to the opioid crisis, taxes on the wealthy and private industries have been slashed to the point of serious strain on basic public services. If a deal is reached that pays out tens of billions of dollars for a generation, the decision of what to do with these funds would rest with the same state legislatures that slashed these public services.

For the 77 tribal governments who have filed suits against the opioid companies, the issue is not so much rooted in their own government denying their citizens basic services, but of Congress continually refusing to adequately fund the programs as set out by the legally binding treaties signed by both parties. This refusal of adequate funding has only compounded the reality that Native communities were some of those hit the hardest by the opioid crisis. The Mashpee Wampanoag Tribe currently maintains a population around roughly 2,600. In 2016, the tribal government declared a public health state of emergency after eleven citizens passed away from opioid-related causes. To put this into perspective: Had the same percentage of the Massachusetts population passed away that year, the state would have lost 29,000 people.

Across the board—as seen in recent guest columns in USA Today and CNN Opinion, among others—experts seem to basically agree on how the funds should be spent: The money must be focused on programs that distribute clean syringes and Naloxone, counseling and youth outreach for those at-risk or suffering from addiction, and long-term recovery services to prevent relapses. Cuyahoga County councilors seem to understand the need for such services: On Tuesday, the council introduced legislation to create a Opioid Mitigation Fund, where all the money from the settled lawsuit would be directed.

If settlements are the direction chosen by these jurisdictions, which the Cuyahoga and Summit case seems to portend, then it will be crucial that in five, ten, twenty years from now, when the crisis is no longer leading the nightly news, those responsible for directing this money to the appropriate coffers remember what opioids did to thousands of communities. If the memories wane and America forgets the pain that this crisis wrought on the affected nations, then we’ll all be standing around as the next private-industry-induced public health crisis takes it toll, having the same discussion and trying to figure out whether to take the flashy payday, or actually hold out for justice.