Spending prescription painkiller settlement cash

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.

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 young people; 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, child care, employment counseling and other services to support people in treatment for opioid-use disorder. Some should also be spent on screening young people 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.

FROM AN EDITORIAL IN BLOOMBERG OPINION