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Editorial: Use the opioid settlements to fight the opioid crisis
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Editorial: Use the opioid settlements to fight the opioid crisis

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Makers and sellers of prescription painkillers will soon begin paying out billions of dollars to settle lawsuits that have accused them of fueling the opioid epidemic. Most recently, more than 40 states have agreed to accept $26 billion from Johnson & Johnson and three big drug distributors, to be paid out over 18 years. It’s a considerable sum — except when measured against more than half a million lives lost this century to opioid overdose, or the tens of billions that state, local and tribal governments spend each year to address the painkiller-heroin-fentanyl scourge.

America's opioid crisis started long before 2020, but COVID-19 exacerbated the problem.  "We're in the midst of a crisis, and we're very concerned about it," said Jesse Bunch, executive director of the Turning Point Center of Chittenden County. "The pandemic had a big impact, because as you know, people were closed, institutions were closed or working remotely at, you know, 20, 50, or 30% of their capacity."CDC data shows over 93,000 people died of a drug overdose in 2020 the highest yearly total on record and a majority of those deaths involved opioids.  One of the states hit the hardest was Vermont, and that's where Bunch works. The Turning Point Center in Chittenden County is a peer recovery organization in Burlington. "People are waiting a long time for mental health counseling," Bunch said. "We're seeing an increase not only in overdoses, but in individuals going to the emergency departments in the state. And, you know, it's a situation where the problem has gotten bigger, and the resources have declined, and that's what we're struggling with."Before the pandemic, opioid deaths in Vermont actually had been trending down. But the state saw a nearly 40% increase in fatal drug overdoses in 2020, most of them involving opioids. And some of the worst months coincided with the early days of the pandemic and stay-at-home orders.  "And that's left a lot of people on the streets and struggling and not able to get into not able to get into help," Bunch said. Data from the first five months of 2021 shows opioid related deaths in Vermont have continued to rise. "We're seeing people coming in here every day, really struggling with substance use disorder, and mental health issues," Bunch said. "And we're trying to get them into the services that they need. But we're finding that often those services simply are not yet available again."State officials in Vermont recognize the need to do more. In June, they launched the KnowOD campaign aimed at helping people make safer choices and increasing awareness about opioid overdose symptoms. 

This money, and billions more from other lawsuits, should be applied to preventing and treating addiction. The task requires a dedicated fund, and a focus on opioid-use disorder. States shouldn’t divert the cash to plug holes in their budgets, as they have with many of the billions they’ve received from tobacco litigation. And it is not enough to sustain current substance use disorder programs; they must be improved and expanded.

The settlements contain guidelines — directing, for example, that the money be spent to equip schools, first responders, families and others with the overdose-reversal drug naloxone; to provide evidence-backed treatment, including for people without health insurance; to discourage drug use among youth; to expand residential treatment and counseling services for people addicted to opioids; and to support clean-syringe programs.

The trouble is that in many communities and states, politicians and law-enforcement leaders dislike some of these strategies. They balk at medication-assisted treatment, for instance, because they consider it wrong to give people buprenorphine and methadone, which are also opioids. Yet much evidence shows that these medicines weaken symptoms of withdrawal and blunt the euphoric effects of other opioids, helping people recover safely. Medication-assisted treatment can work even in cases where it isn’t possible to provide counseling.

Also beneficial are harm-reduction programs — those that distribute naloxone and also those that provide sterile syringes for users who inject opioids. These lower the risk of HIV and hepatitis B, and can help bring more people into treatment. Efforts in some states to close syringe programs are a step in the wrong direction.

Opioid lawsuit money should also be used to provide housing, childcare, employment counseling and other services to support people in treatment for opioid-use disorder. Some should also be spent on screening youth for their risk of drug use, and on education to prevent it — because the data show that people very often develop substance-use problems as adolescents. Such services would be especially valuable in minority communities, long underserved by prevention programs.

Wherever these initiatives are tried, tracking their success or failure is essential. And the data should be made public, so lessons can be learned. During the past year and a half, as COVID-19 has kept people at home, under stress and away from medical and mental health care, deaths due to opioid use disorder have spiked — especially among Black, Hispanic and Native American people. And it has been difficult for cities, counties and states to adequately respond. Windfalls from opioid lawsuits will arrive at a time of unprecedented need. States mustn’t waste the opportunity.

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