Conceptualizing and Measuring Abatement from the Opioid Epidemic: A Case Study from Pennsylvania

Perspective Opioids

Policy Points:

  • In 2021, four major pharmaceutical manufacturers and distributors reached a proposed settlement agreement with 46 state Attorneys General of $26 billion to address their liabilities in fueling the US opioid epidemic. It raises important questions about abatement conceptualization and measurement for allocating settlement funds among substate entities.
  • We outline the political economy tensions undergirding the settlement and allocation, introduce an abatement conceptual framework, describe how an abatement formula was developed for Pennsylvania to allocate settlement funds, and summarize considerations for future settlement allocation efforts.
  • Documenting the challenges and experiences of this task is essential to inform future efforts.

The impacts and costs of the opioid epidemic in  the United States have been well documented in the popular press, in public health circles, and from local, state, and federal policy perspectives.1-6 A common response from states and municipal governments bearing the burden of addressing the opioid epidemic was to file lawsuits as plaintiffs alleging misrepresentations, fraud, and negligence by prescription opioid manufacturers and distributors, retail pharmacies, and individual providers and clinics. Plaintiffs claimed that the harms associated with prescription opioids were downplayed and even intentionally mischaracterized.7,8 They also argued that these same parties did not meet Drug Enforcement Agency (DEA) requirements to monitor suspicious orders and investigate situations where opioids were diverted from appropriate clinical use to illegal distribution, sale, and use.7 These claims sought remuneration for the cost of past damages, as well as the cost to remedy or abate the lasting impact of the epidemic moving forward. More than 3,000 US cities, counties, and sovereign tribal nations sued a similar set of manufacturers, distributors, providers, and pharmacies, and were subsequently “bound together” as part of Federal Multidistrict Litigation (MDL), through which parties can coordinate pretrial activities including settlements.7,9

While from a strictly legal perspective, the civil claims brought by states’ Attorneys General (AG) and those brought by counties, cities, and sovereign tribal nations are separate and distinct by different entities, in practice they have become inextricably linked for purposes of moving meaningful settlements forward. Specifically, the industry defendants have offered financial payments and conduct reforms in exchange for the withdrawal of legal claims by almost all states and their political subdivisions. If full participation is not achieved, the total settlement would be reduced accordingly.9 As a result, robust conversations have taken place between state AGs and their public health consultants with the various counties, cities, and other political subdivisions, about how to fairly allocate proposed settlement dollars across all entities. The goal of this allocation was to incentivize as many political subdivisions as possible to participate in the joint settlement. As this paper describes, the conversation between the state level constituents and the substate level entities has centered around the equitable distribution of settlement dollars across political subdivisions to address abatement needs and reduce the effects of the opioid crisis moving forward.

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References

  1. Kuehn Massive costs of the US opioid epidemic in lives and dollars. JAMA. 2021;325(20):2040-2040.
  2. Crowley DM, Connell CM, Jones D, Donovan MW. Considering the child welfare system burden from opioid misuse: research priorities for estimating public costs. The Amer J Managed Care. 2019;25(13 Suppl):S256-S263. https://www.ajmc.com/view/considering-child-welfare-system-burden-opioid-misuse-research-priorities-estimating-public-costs
  3. Leslie DL, Ba DM, Agbese E, Xing X, Liu G. The economic burden of the opioid epidemic on states: the case of The Amer J Managed Care. 2019;25(13 Suppl):S243-S249.
  4. Morgan PL, Wang The opioid epidemic, neonatal abstinence syndrome, and estimated costs for special education services. The Amer J Managed Care. 2019;25(13 Suppl):S264-S269.
  5. Segel JE, Shi Y, Moran JR, Scanlon Opioid misuse, labor market outcomes, and means-tested public expenditures: a conceptual framework. The Amer J Managed Care, 2019;25(13 Suppl):S270- S276.
  6. Zajac G, Nur SA, Kreager DA, Sterner G. Estimated costs to the Pennsylvania criminal justice system resulting from the opioid crisis. The Amer J Managed Care. 2019;25(13 Suppl):S250-S255.
  7. United States District Court, Northern District of Ohio. MDL 2804 National Prescription Opiate [cited 2022 Feb16]. https://www.ohnd.uscourts.gov/mdl-2804. Accessed September 19, 2022.
  8. Ausness RC. A progress report on opioid litigation. Journal of Legal Med. 2020;40(3-4):429-446.
  9. Gluck AR. MDL nationalism, federalism, and the opioid epidemic. DePaul Rev. 2020;70:321.

Citation:
Rhubart D, Chen Q, Sterner G, Newton R, Shaw B, Scanlon D. Conceptualizing and Measuring Abatement from the Opioid Epidemic: A Case Study from Pennsylvania. Mibank Q. 2022;100(4):1128.