SAFE GC Coalition: AMA’s Principles to Spend Opioid Settlement

The American Medical Association (AMA) has joined a coalition of more than 30 medical, academic, public health and advocacy organizations in support of principles to help guide state and local spending of potential opioid litigation settlement funds. The coalition, coordinated by the Johns Hopkins Bloomberg School of Public Health, is urging state and local officials to avoid the mistakes of the 1998 tobacco settlement and use the expected funds from the litigation to support evidence-based efforts that save lives. The American College of Emergency Physicians, American Society of Addiction Medicine, American Public Health Association, and the National Harm Reduction Coalition are among the other organizations backing the principles.

Addiction is an ongoing public health crisis in the United States; an estimated 20 million people have a substance use disorder (SUD) related to alcohol or illicit drugs. Recent attention has focused on the role of opioids which have killed more than 500,000 people over the past two decades. Driven in large part by increases in overdose deaths and suicides (which are often associated with substance misuse), life expectancy in the United States dropped from 2014 to 2017, the first three-year decline in nearly a century. Already dire, the situation has worsened with the COVID-19 pandemic. The economic downturn and social distancing mandates have increased the chance of overdose among people who use drugs. Preliminary data indicate that overdose deaths have increased in most states compared to a year ago, with some states reporting an estimated 30% increase in opioid-related deaths so far in 2020. Early evidence also indicates a significant increase in alcohol consumption, anxiety, and depression during the pandemic.

Accordingly, addressing mental health and addiction should be part of any COVID-19 response. Confronting this new crisis, many localities are already adopting interventions that save lives. Fortunately, new financial resources from opioid litigations can help states and communities fund additional programs. States, cities, and counties will soon be receiving funds from opioid manufacturers, pharmaceutical distributors, and pharmacies as a result of litigation brought against these companies for their role in the opioid epidemic that has claimed more than half a million lives over the past two decades. Governors, attorneys general, and legislators will face difficult decisions in determining the best use of these funds.

The AMA sees this is an unprecedented opportunity to invest in solutions to address the needs of people with substance use disorders. For this to happen, jurisdictions must avoid what happened with the dollars that states received as part of the litigation against tobacco companies. Those landmark lawsuits were hailed as an opportunity to help current smokers quit and prevent children from starting to smoke. Unfortunately, most states have not used the dollars to fund tobacco prevention and cessation programs. Overall, less than 3% of revenue from the settlement and tobacco taxes went to tobacco control efforts. Failure to invest these dollars in tobacco prevention and cessation programs has been a significant missed opportunity to address the greatest cause of preventable death in the United States.

To guide jurisdictions in the use of these funds, the AMA encourages the adoption of five guiding principles through specific actions outlined here. The principles are as follows:

1. Spend money to save lives. Given the economic downturn, many states and localities will be tempted to use the dollars to fill holes in their budgets rather than expand needed programs. Jurisdictions should use the funds to supplement rather than replace existing spending.

2. Use evidence to guide spending. At this point in the overdose epidemic, researchers and clinicians have built a substantial body of evidence demonstrating what works and what does not. States and localities should use this information to make funding decisions.

3. Invest in youth prevention. States and localities should support children, youth, and families by making long-term investments in effective programs and strategies for community change.

4. Focus on racial equity. States and localities should direct significant funds to communities affected by years of discriminatory policies and now experiencing substantial increases in overdoses.

5. Develop a fair and transparent process for deciding where to spend the funding. This process should be guided by public health leaders with the active engagement of people and families with lived experience, clinicians, as well as other key groups.

The SAFE Glen Cove Coalition is conducting an opioid prevention awareness campaign entitled. “Keeping Glen Cove SAFE,” in order to educate and update the community regarding opioid use and its consequences. To learn more about the SAFE Glen Cove Coalition please follow us on www.facebook.com/safeglencovecoalition or visit SAFE’s website to learn more about the Opioid Epidemic at www.safeglencove.org.