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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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The Milbank Quarterly’s multidisciplinary approach and commitment to applying the best empirical research to practical policymaking offers in-depth assessments of the social, economic, political, historical, legal, and ethical dimensions of health and health care policy.