The money could be used for prevention and treatment services, health care practitioner training, or other ways to stem the epidemic.
Over the past 3 decades, the opioid crisis in the US has claimed millions of lives. It started in the 1990s with an increase in prescription opioids. Fast forward to 2010 when the country endured its second wave of opioid-related deaths associated with the growing consumption of heroin. In 2013, the US entered its third wave of opioid-related deaths from the use of synthetic opioids such as fentanyl, fentanyl analogs, and tramadol.1,2 This trend continues to rise with more than 106,000 drug overdose–related deaths in 2021. Of those fatalities, opioids contributed to 75.4%.1
Image credit: Svyatoslav Lypynskyy | stock.adobe.com
Reps Marcy Kaptur (D, Ohio) and Ashley Hinson (R, Iowa) introduced the Opioid Settlement Accountability Act in January 2024. This bill requires states to use settlement funds from pharmaceutical companies to address issues relating to opioids such as opioid use disorder (OUD) prevention and treatment services, or providing health care practitioner training, first responder equipment, and social support services.3 Additionally, the bill bans the federal government from using Medicaid to take part of the states’ settlement funds and guarantees that the funds stay under local control.4
More than $50 billion in settlement money is expected to make its way to state and local governments.5 Most of the settlements mention that 85% of the funds must be dedicated to mitigating the opioid epidemic, but there is no enforcement in place to guarantee that states are meeting that 85% threshold. Therefore, the allotment is up to the states’ discretion of what they think opioid abatement means and how they decide to use the money. Another drawback to the settlement bill is that it does not mention how Congress would monitor each state’s use of the settlement money, nor will it require states to provide transparency on where that money is going.4 This creates hesitancy about the bill from both legislators and the public.
Lynsey D. Steffen is a PharmD candidate at the University of Kentucky College of Pharmacy in Lexington.
Joseph L. Fink III, JD, DSc (Hon), BSPharm, FAPhA, is a professor emeritus of pharmacy law and policy and former Kentucky Pharmacists Association Professor of Leadership at the University of Kentucky mCollege of Pharmacy in Lexington.
The bill focuses on allocating settlement funds to prevention and treatment services, which may include opioid treatment programs (OTPs) and rehabilitation centers. OTPs provide medication-assisted treatment, including buprenorphine, methadone, and naltrexone for those with OUD.6 The use of these medications has been proven to significantly decrease opioid cravings, risk of overdose, and spread of infectious diseases such as HIV and hepatitis C.6 Despite the high demand for OTPs, in 2021 it was estimated that only 1 in 5 Americans received related medications to combat OUD, due to regulatory, institutional, and financial barriers, among other reasons.7
Patients are often unable to obtain medications for OUD (MOUD) due to lack of coverage by private and/or public payers. The Affordable Care Act, which was signed into law in 2010, granted states that have adopted Medicaid expansion the ability to provide substance use treatments as a benefit within Medicaid.8 This allows the use of MOUD to become more accessible for patients unable to afford care out of pocket. As of July 2024, 10 states have yet to make this expansion. Patients also experience physical challenges accessing MOUD due to lack of transportation and child care, inability to travel long distances, and lack of information about where to seek treatment programs.8,9
The Substance Abuse and Mental Health Services Administration has made strides to advance access to MOUD from federal initiatives, such as eliminating the requirement for practitioners to obtain a waiver to prescribe buprenorphine.10 The Opioid Settlement Accountability Act aims to increase the number of changes from these 2 into hundreds if advancements are appropriately funded and prioritized.
