The global consulting firm McKinsey agreed last month to pay $573 million to 47 states, the District of Columbia and five U.S. territories to settle allegations that the firm helped opioid manufacturers overmarket their addictive drugs.
Expected soon are multi-billion-dollar settlements with opioid manufacturers and distributors.
It is time to ask: Will the money be used to save lives during an ongoing overdose epidemic that kills more than 6,000 people every month?
Twenty years ago, states began to receive payments from tobacco companies as a result of the Tobacco Master Settlement Agreement. Ultimately, however, states spent less than 3% of the money from the settlement and tobacco taxes on smoking prevention or cessation programs, using the rest for other purposes. Some states even used the funds to support the tobacco industry.
5 principles for leveraging the funds
To avoid squandering today’s opportunity, more than 30 major organizations that work to address addiction have endorsed five principles for states, cities and counties to use when deciding how to spend the dollars. These groups are united in their desire to ensure that the mistakes from the tobacco settlement are not repeated.
►Spend it all to save lives. Establishing a dedicated fund for dollars that come from the lawsuits can prevent diversion to address budget gaps and other unrelated priorities. Using the money for unrelated purposes was the primary mistake made with the tobacco settlement dollars. Advocates will still need to watch that the money in the fund isn’t redirected elsewhere during difficult budgetary times.
►Use evidence to guide spending. A deep base of research shows, for example, that methadone and buprenorphine are highly effective treatments for opioid use disorder. Settlement funds should be used for interventions — ranging from prevention to treatment to recovery supports to harm reduction — that work. Funds should not be wasted on unproven approaches or methods associated with greater overdose risk.
Focus on helping young people
►Invest in youth prevention. Many programs focused on children have been shown to reduce both the risks of substance misuse and other negative outcomes such as school failure and unemployment. These types of initiatives yield a high financial return on investment — as much as $18 returned for every dollar spent, according to some studies. Spending today helps young people, their families and their communities stay out of harm’s way tomorrow.
►Use new funds equitably. The opioid epidemic has affected communities regardless of race or class. However, in recent years, the rate of deaths due to overdose has been rising more rapidly in communities of color. The epidemic has also played out differently in other areas. People of color are much more likely to face criminal justice involvement for their drug use. By paying attention to racial equity, policymakers can start to undo these harms.
►Implement a fair process for deciding where to spend the funds. The process should involve public health leaders, clinicians, families, law enforcement and people affected by substance use disorders themselves; all affected communities should be represented. Meetings should be public, with decisions widely shared. Transparency and accountability will not only build trust but also generate momentum for other necessary policies.
It is no easy task to spend large amounts of settlement funds effectively, and, if the tobacco settlement is any indication, the risk of failing is high. Applying these principles will help state and local governments navigate the process in a thoughtful way, make smart decisions, and see substantial and tangible results.
We cannot let this lifesaving opportunity go to waste.
Michael Botticelli served as director of the White House Office of National Drug Control Policy from 2014 to 2016. Joshua Sharfstein is professor of the practice at the Johns Hopkins Bloomberg School of Public Health.