Dr. Mitch Rosenthal on the Status of the Opioid Litigation Settlement

ROSENTHAL REPORT - AUGUST 2021

Proposed Opioid Settlement Puts States in a Tough Spot

The $26 billion opioid settlement announced in late July appears at first glance to be a win-win for all parties involved. The deal, yet to be approved by the states, would end a portion of the sprawling, years-long litigation that involves the country’s biggest drug distributors and Johnson & Johnson, an opioid maker. It would also establish tighter controls over the distribution of prescription painkillers, and force Johnson & Johnson out of the opioid business entirely. Most importantly, it would provide a jolt of much-needed funding to the states parceled out over the next 18 years, allowing treatment providers to scale up and possibly expand services that were curtailed due to budget cuts during the COVID-19 pandemic.

Given the scope of the nation’s severe addiction crisis, even $26 billion is woefully inadequate. Over the past decade, more than 500,000 Americans have died of drug overdose, mostly opioid-related; in 2020 alone, there were a record 93,000 fatalities—a 30 percent increase over the previous year. Families and communities across the country have been devastated, and the economic losses are enormous. Today, the opioid epidemic is tearing through the Black and Hispanic populations and threatening inmates in prisons and jails. Deaths from methamphetamines and other stimulants, in addition to synthetic opioids such as fentanyl, have also reached record levels. At the same time, the four companies that agreed to the settlement have funneled a combined $100 billion to shareholders through stock buybacks and dividends.

Thousands of other still-unresolved opioid lawsuits against manufacturers and giant pharmacy chains could eventually boost the compensation package or possibly lead to a global settlement. As it stands, when the current deal is compared with the $206 billion tobacco company settlement in 1998, the multibillion-dollar opioid industry—which egregiously underplayed the addictiveness of its products while deploying devious tactics to encourage their use—appears to be getting off easy. Under the terms of the proposed agreement, no compensation is provided for victims’ families, and companies do not have to admit responsibility for their role in the epidemic. They are also shielded from any further prosecution and liabilities.

Opposition to the deal is growing. Arguing that the settlement amount is too little, and the nearly two-decade payout period is too long, West Virginia, Washington State, and the city of Philadelphia are saying no. It’s a tough spot for states: Faced with an escalating drug crisis, they desperately need more money, but also want to hold the industry accountable. If too many states back out, the amount could be reduced or the deal scuttled altogether, which would also be unfortunate. Now is the time for the federal government to step in and top off the settlement money with an appropriate amount of funding and other resources the massive scale of the crisis demand.

Dr. Mitch Rosenthal on President Biden's Message of Promoting Treatment for Drug Users

Dr. Mitch Rosenthal on the Opioid Litigation Settlement States Made with Drug Companies

Dr. Mitch Rosenthal on the Several Grim Records Set in the New CDC Overdose Data

Overdose deaths during pandemic

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Dr. Mitch Rosenthal on President Biden Appointing Dr. Rahul Gupta as Nation's Drug Czar

Dr. Mitch Rosenthal on the Drug Decriminalization Experiment in Oregon

Dr. Mitch Rosenthal: Money from Opioid Settlements Should Be Used to Expand Treatment

ROSENTHAL REPORT - JULY 2021

More Addiction Funding Is Coming: Let’s Spend It Wisely

After a year of crippling cutbacks, drug treatment providers that were forced to curtail services during the pandemic are looking forward to a potential funding windfall that may allow them to restart programs and even expand treatment. New funding sources include settlement money from opioid litigation, opioid taxes, funds that were allocated as part of the American Rescue Plan, and President Biden’s 2022 budget proposal that includes a doubling of the Block Grant to the states. An exact figure is uncertain—opioid settlement talks and trials are ongoing, and the White House budget is, at this point, mostly a wish list—although preliminary estimates suggest that states such as New York stand to gain as much as $300 million from government sources alone through 2025. 

This is welcome news, as drug overdose fatalities last year surged to a record 90,000 nationwide. Yet, given the magnitude of the problem and the lack of funding increases over the past decades, we’re still treading water in terms of adequate resources to address the crisis. What’s more, part of the new funding stream would consist of one-time-only payouts, such as last week’s settlement of the Johnson & Johnson opioid case that will give $230 million to New York State, and an earlier deal with the consulting firm McKinsey for $573 million to 47 states.

This means that the states, and in turn, providers, cannot rely on a guaranteed flow of money to develop long-term residential programs and workforce development initiatives. With our streets flooded with deadly and dangerous drugs, and more and more addicted individuals unable to obtain treatment, what we really need is a generational shift in how we think about securing sufficient and steady funding to meet the escalating challenges of the addiction crisis.

Meanwhile, let’s make the best use of the money that’s (hopefully) in the pipeline, preferably for the following initiatives:

Upgrade the Infrastructure of Treatment

Fund expansion of facilities for long-term drug treatment for those struggling with substance use, and increase the technological capabilities that support telehealth practices that proved valuable during the pandemic lockdown.

Support Development of the Addiction Workforce

To meet the demand for more qualified, licensed professionals in addiction treatment, boost funding for education, training, recruitment and compensation, and encourage individuals to choose social work and counseling, with such incentives as paying off any remaining student debt for those who enter—and stay—in the field.

 Launch a Criminal Justice Initiative

Incarcerated individuals comprise the single largest cohort of opioid addicts, yet prisons and jails are woefully lacking in treatment services. We must engage this population with comprehensive on-site as well as post-release services, including long-term treatment, medication-assisted treatment (MAT), and training for peer-based counselors.  

Increase Metrics, Data Gathering and Media Outreach

Establish a robust system to gather, monitor, assess and disseminate data about the opioid epidemic in order to better understand the extent of the crisis, the efficacy of solutions, and to build public awareness of this “forgotten epidemic.”

 There is, of course, so much more that needs to be done. Ideally, President Biden will make good by early next year on his promise to allocate $125 billion over the next decade as part of an all-out effort to stop the opioid epidemic. But until then, making better use of the resources already available would be a promising start.

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Dr. Mitch Rosenthal on Montana's New Marijuana Regulations

ROSENTHAL REPORT - JUNE 2021

Colorado Takes a Bold Stand Against Its Marijuana Industry

 As the marijuana legalization movement—largely funded by the powerful cannabis industry—continues to score victory after victory at the state level, dissenting voices are rarely heard within the corridors of power. Yet in Colorado, a pioneering legal marijuana state, lawmakers have delivered an unusual rebuke to the pro-pot groups and lobbyists: the House of Representatives has approved a bill to place limits on the consumption of high-potency cannabis and medical marijuana and thereby help curb use by teens. For too long, physicians and researchers have warned that such products can be harmful, as they may contain up to 80 percent THC, the drug’s psychoactive component. It was only when doctors in Colorado became alarmed over a spike in psychotic episodes among young people that legislators proposed limitations. This in turn prompted an outcry from marijuana business interests, claiming their dispensaries would be devastated.

Restrictions on concentrates and medical marijuana are indeed necessary. Rather than limiting the actual level of THC in products (Vermont is the only state that does so), the proposed bill would simply restrict manufacturers from packaging individual doses larger than 0.1 grams. It would also both limit medical marijuana patients between the ages of 18 and 20 to purchasing no more than 2 grams of concentrate per day (down from 40 grams) and enact a system to track purchases by younger people. In addition, the measure asks public health officials to study the effects of concentrates on adolescents—which, of course, should have been done before Colorado legalized marijuana in 2014.

Gov. Jared Polis is expected to sign the bill once it clears the Colorado Senate, dealing a blow to the local cannabis industry and setting a new standard for regulation among states considering legalization as well as those reassessing the impact so far. Even with legalization steamrolling ahead, it’s not too late to impose reasonable safeguards and protections, particularly for the benefit of young people and other vulnerable populations.

Biden Remains Silent on Cannabis Reform, Missing an Opportunity to Define Regulatory Framework

It’s anyone’s guess what President Biden’s policy is concerning marijuana legalization. Except for the dismissing of several White House staff for using (or having used) pot a few months ago, which rankled many progressive Democrats, there’s little word on exactly where the administration stands. Biden could side with Sen. Majority Leader Chuck Schumer, who advocates ending federal-level prohibition as part of sweeping policy changes, or stick with his campaign promise to leave legalization up to each individual state without ending federal-level prohibition or setting national regulations and guidelines.

But what if the president were to propose his own way forward? A compelling argument for this was made in a recent Brookings paper, which argues that a proactive stance would put Biden in a better position to shape such reform to his liking. He could rein in the type of overly permissive system of regulation many progressives (and the industry) prefer, and legal states have already enacted. Biden’s age and family history of substance abuse are believed to be behind his reluctance to adopt a more liberal position on pot. But by taking a stand, the paper points out, he could have a powerful voice in setting the precise role of the federal government as legalization moves ahead, in a way that is more consistent with his own views. To me, this makes a lot of sense.

ROSENTHAL REPORT - MAY 2021

PRESIDENT BIDEN IS AWOL ON NATIONAL DRUG CRISIS

 Joe Biden pledged during his campaign that as president he would launch an all-out effort to combat the opioid epidemic. Yet, after nearly 100 days in office, his administration has so far done remarkably little to address a national public health crisis that killed more than 87,000 Americans over the 12-month period that ended in September—a record death toll and a 29 percent increase over the same period the year before. While grappling with the COVID-19 pandemic and pressing economic issues, the White House has unfortunately sidelined the opioid crisis, which continues to spin out of control. In San Francisco, for example, more people died last year from drug overdose than from the coronavirus. President Biden promised a $125 billion anti-opioid effort over the next decade, but has delivered only a $1.5 billion allocation through the American Rescue Plan for the prevention and treatment of substance use disorders. 

 We urge President Biden to show leadership on drug policy. For one, he must appoint a cabinet-level “drug czar” to oversee and coordinate federal initiatives. And in coordination with the CDC and other agencies, he could provide frequent briefings to the nation—similar to what was done during COVID—tracking the key metrics of the epidemic and efforts to bring it under control. 

 In addition, he could easily end the requirement that physicians obtain a special waiver in order to prescribe the addiction-withdrawal medication buprenorphine, an integral component of medication-assisted therapy (MAT). As only around 5 percent of practitioners currently have such a waiver, this poses a significant barrier to expanding treatment at a time when only 20 percent of people with opioid use disorder receive any services. Eliminating the waiver by itself won’t stop the epidemic, but it could slow the death toll by an estimated 30,000 lives a year. While an important first step, it still only tinkers around the edges of this tragedy, which requires massive federal spending and a comprehensive strategy to be brought under control.

MORE STATES IGNORE THE SCIENCE AND LEGALIZE MARIJUANA

The lesson we have learned from the COVID-19 pandemic is to “follow the science” when formulating public health policy. Yet, science is taking a back seat when it comes to state-level marijuana legalization. New York, New Mexico and Virginia are the latest to do so, choosing to disregard the growing body of scientific evidence detailing the harmful effects of the drug. In fact, legalization in New York coincided with the publication of a new study by the National Institute on Drug Addiction (NIDA) showing that, among teenagers, cannabis is nearly as addictive as prescription opioids—a finding that was ignored by the Albany lawmakers who crafted a law that lacks adequate health safeguards.

Legalization laws routinely focus on how such worthy goals as decriminalization and achieving social equity and criminal-justice reform could help communities disproportionately harmed by the failed War on Drugs. But all too often, these laws are weak on curbing underage use, limiting high levels of intoxicating THC in pot products and addressing the growing problem of drugged driving.

In some states, new legalization laws also make it more difficult for communities that don’t want retail dispensaries in their localities to opt out, for instance, by limiting the time they have to decide. Although polls show widespread support for legalization, more and more municipalities in legalized states are nevertheless saying no to having cannabis businesses in their neighborhoods, despite the loss of potential tax revenues from pot sales. They have weighed the risks and benefits of legalization, and have come down on the side of safeguarding public health.