The tragedy of the $457 million opioid settlement headed to Missouri is how small it really seems in the context of the massive number of deaths wrought by the ongoing crisis that involves pain pills, heroin addiction, and the new deadly strain of synthetic fentanyl coming from Mexico and China.
In 2017 alone, for instance, which was five years after opioid pill distribution reached its peak in Missouri, a Missouri Hospital Association analysis to the state of $14 billion, just under 5% of the state’s gross domestic product that year. That cost comes from lost lives and wages, spikes in health care costs, and increases in law enforcement, corrections and mental health expenses.
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Missouri’s share of the first of several national settlements with the providers and distributors of opioid medications will cover barely a fraction of what was lost in just one year of an epidemic that is going on two decades old.
“This is just the start,†says ºüÀêÊÓƵ lawyer Jack Garvey, one of several attorneys representing the cities and counties across the state that filed lawsuits against Johnson & Johnson, Purdue Pharma, Mallinckrodt Pharmaceuticals and others seeking recompense for the damage the drugmakers and their partners had done by creating a generation of people addicted to opioids. Many of those people would graduate to heroin and other drugs.
“My clients have been living this practically for the past 20 years. They have started seeing the effects of this opioid epidemic since the early 2000s and they have been at a loss for how to pay for it. They are very appreciative of the money and they are very serious about taking this responsibility on,†Garvey said. “The defendants have created a generation of addicts and the counties and cities are left to deal with this.â€
The latest memorandum of agreement on the opioid settlement was announced by Attorney General Eric Schmitt on Friday. It would have been worth millions of dollars less if Schmitt hadn’t reversed his position from last fall and agreed to negotiate with the cities and the counties over how much money for future health care services the local governments would control; and how much would be controlled by state government. But Schmitt eventually sat down with the cities and counties and their attorneys, and, Garvey says, his office negotiated “in good faith.â€
In the end, with the help of a federal mediator, the various parties landed on about 60% of the settlement ($274 million) going to the state, and 40% ($183 million) going to the cities and counties that filed the original lawsuits. The cities and counties in Missouri that were not part of such lawsuits will split a smaller amount that comes out of the state’s portion of the settlement. The cities and counties that were part of the lawsuits that forced the settlement will pay attorneys’ fees, capped at 9%, out of their proceeds.
Schmitt’s office has not responded to a Sunshine Law request seeking a copy of the actual memorandum of agreement.
Despite last fall’s impasse, which was broken in part when Schmitt heard from Republican commissioners such as Franklin County’s Tim Brinker, who didn’t appreciate being shut out of negotiations, the final agreement is one that the cities and counties believe is fair.
“The deal worked out between the Missouri attorney general and the litigating subdivisions should bring maximum settlement funds … that will benefit everyone in the state,†said Brian Madden, a Kansas City lawyer who has been involved in the litigation.
What that means going forward is that local governments and public health departments will be working with the nonprofits who battle the opioid epidemic on city streets and in rural areas, to decide how this money gets to those who need it most.
“This settlement ensures funds will go directly to the community programs with proven track records of supporting recovery efforts,†said ºüÀêÊÓƵ County Executive Sam Page, in an emailed statement.
Particularly with the spike of deaths related to fentanyl, the needs are massive. Opioid-related deaths are still rising, toping 100,000 nationally last year, according to the Centers for Disease Control and Prevention.
Money from the national settlement could start flowing later this year. The agreement requires 85% of the money to go directly to treatment — from harm-reduction programs, to evidence-based rehab, peer-recovery coaches, and funding for behavioral and mental health providers.
There is hope in $457 million being made available to battle Missouri’s ongoing fight against opioid abuse. But winning the fight will take more than political posturing, and the real challenge is just beginning.