Will funding for initiatives against opioid addiction come from the very people who manufacture the pills? In recent months, pharmaceutical companies have found themselves in the legal hot seat. So far, over 2,000 local and tribal governments have sought action against the manufacturers in court, hoping to recoup some — if not all — of the millions spent in the national fight against addiction.
Action on the state level has been relatively successful so far; earlier this year in Oklahoma, state Attorney General Mike Hunter filed a suit against Johnson & Johnson, Teva Pharmaceuticals, and Purdue Pharma, alleging that the three major drug manufacturers not only flooded the state with an oversupply of opioids but also actively encouraged to prescribe more than they should. These companies’ actions, Hunter argued, left them with a tangible responsibility to help resolve the addiction epidemic sweeping Oklahoma.
His argument had weight; of the three, only Johnson & Johnson elected to move forward to trial, while Teva Pharmaceuticals and Purdue Pharma settled out of court for massive sums of money. Purdue’s settlement alone totaled a sum of $270 million, $200 million of which is earmarked for the creation and operation of an all-new addiction research and treatment center in Tulsa. Similarly, a portion of Teva’s $85 million settlement will be dedicated to helping resolve the opioid crisis.
These measures seem helpful at first listen, but they also beg the question — what does “helping resolve the opioid crisis” mean?
The trial in Oklahoma is gearing up to be a landmark case in the struggle between opioid manufacturers and those addressing America’s addiction crisis. Depending on its outcome, pharmaceutical companies may be forced to take greater responsibility for — and thus play a more significant role in combating — the opioid crisis. As matters stand, it seems likely that prominent companies will be compelled to pay out massive sums to address the epidemic. But will throwing funds, albeit needed ones, at the problem be enough to fix it? Will a new treatment center in Tulsa truly be the course that eradicates the opioid crisis in Oklahoma?
It might be. However, given the sheer volume of funds that may come down the rehabilitation pipeline, it may well be worth our time to create an interdisciplinary and cohesive model that links private, public, and corporate efforts into a collaborative force and maximizes the value of each dollar provided by drug manufacturers. This might sound unlikely to the point of impossibility, but it has already been successfully done before — albeit on a small-town scale.
Case Study: Little Falls, Minnesota
If small-town America had a picture in the dictionary, it might well have been of Little Falls. With a population of just over 8,000 residents, the town qualifies as “sleepy.” It’s the kind of place where everyone knows everyone else, and little happens without the entire town hearing about it in an afternoon — and in 2014, all anyone was talking about was the opioid problem.
Back then, Little Falls had seen an unprecedented number of deaths — as many as three a year, according to a Buzzfeed News profile piece on the town — as a result of the opioid epidemic. It was a problem the community’s leaders had never seen before, and one that threatened to paralyze Little Falls. Recognizing the threat, the town’s leaders, healthcare providers, and law enforcement collaborated to help residents break the cycle of addiction. They launched measures to limit unnecessary prescription refills, boosted access to addiction treatment, and chose to enroll drug users in rehabilitation programs rather than jail.
It was an approach that paid off; within six months, the instances of drug users visiting the local emergency room for painkillers fell from the top-ranked health problem to well out of the top 20. As of early 2019, over 626 residents had been successfully tapered off opioids, and an additional 100 were receiving addiction medication and treatment at the town’s hospital.
The key to Little Falls’s success? Cohesion — and lots of money. As one writer for Buzzfeed News describes the town’s approach in an article, “Little Falls didn’t do anything revolutionary. They just spent real money — at least $1.4 million in state grants since 2014 — on basic public health measures.”
Little Falls is a case study for how towns can effectively deploy massive amounts of money within an interdisciplinary framework to create lasting positive change. Similarly, successful examples exist in quiet communities across the country — Snohomish County in Western Washington, for instance, categorized the opioid crisis as an emergency on par with a natural disaster and was thus able to create a dedicated task force and apply funds in an organized and effective way. In Northern Wisconsin, Northlakes Treatment Center serves as a (well-funded) organizer that provides healthcare and coordinates local social services for victims of opioid addiction.
What links these far-flung communities’ successes? All utilized a coordinated approach that brought law enforcement, health care, and social services together into a single, well-funded, an overarching framework. One could argue that the fight against opioids needs to be conducted that way — otherwise, the crisis becomes a hydra, manifesting twice as strongly even after measures are taken against it. To quote Dr. Kurt DeVine, a leading doctor at the Gabriel Center in Little Falls, in a recent article: “[Towns] get Narcan […] or they get one little project and they think that is going to fix it. There is no easy answer. It is a lot of work. If we were doing only one thing, just Narcan, our problem would be as bad as anywhere else. You have to do it all.”
Of course, Little Falls’ — or Snohomish County’s, or Northlakes’ — approach can’t be transposed directly onto a national scale. These small towns are, well, small. It’s easier and less costly to deploy an interdisciplinary, comprehensive approach in a rural community than it might be for a state — or even a mid-size city.
But, what if?
What if states could use case studies like Little Falls and Snohomish County to create a replicable, if flexible, model that would offer a guiding framework for productive collaboration — one that could address all aspects of the opioid crisis disease and make the most of every funding dollar? What if state leaders backed these frameworks with the massive sums they receive from pharmaceutical company settlements, rather than giving the funds to a newly-built treatment center and hoping for the best?
Resolving the opioid crisis is going to be a long process. But with case studies like Little Falls and millions of dollars in settlement funds, it may be more within reach than we think.