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The High Cost Of The Opioid Epidemic For Communities


The state of Oklahoma claimed another settlement with a drug company. Teva Pharmaceuticals agreed to pay the state $85 million. That's compensation for the company's role in the opioid crisis. Another company, Johnson & Johnson, has not settled, and a trial begins this week. This is all part of a sweeping trend. Hundreds of local and state governments across this country are suing pharmaceutical firms. North Country Public Radio's Brian Mann covers opioid litigation for NPR News.

Hi there, Brian.


INSKEEP: What are the costs that state and local governments are facing across this country that give them any standing to demand these big settlements?

MANN: Yeah. So what's really interesting here, Steve, is we've already seen more than 200,000 people die so far from prescription pain medication overdoses. That's according to the Centers for Disease Control. But there's still this big, expensive fight underway to keep opioid-dependent people alive. And I traveled to Summit County, Ohio, to learn more about how one community is responding. And I want to start with a guy named Richard Milhof. When the epidemic started, he saw it up close.

RICHARD MILHOF: A lot of my friends are passed way. They've overdosed and died.

MANN: I meet Milhof in the town jail and Barberton, a working-class town just outside Akron, Ohio. We actually talk through the bars of his cell. Police say they found him carrying a small amount of heroin, and they're holding him until he can see his caseworker. Milhof tells me a lot of people close to him got hooked on pain pills.

MILHOF: Almost every single friend that I had that I grew up with is dead because of it.

INSKEEP: Heroin used to be a painful but fairly manageable problem in Summit County. Then the number of prescriptions for opioid medications surged. Jerry Craig, who heads the county's main addiction treatment program, says drug companies created a vast, new hunger for opioids, snaring people who didn't know the risk.

JERRY CRAIG: I think they are as complicit in this as the dealers that are dealing it on the streets. And for that, I think that they should pay a price.

MANN: When the supply of prescription pain pills started drying up in 2016, Craig says desperate people turned to the black market. They bought heroin often laced with deadly fentanyl and carfentanil.

CRAIG: Three hundred and forty overdose deaths that year in Summit County alone - and our overdoses went from three a day to over 12 a day.

MANN: In this way, Summit County looks a lot like the rest of the country. The human cost has been enormous. But local officials around the U.S. say the epidemic also carries an actual dollar cost.

DONNA SKODA: We had no cash on hand. We had to start looking for grants.

MANN: Donna Skoda heads Summit County's public health department. She says everything had to change once the opioid crisis hit - more law enforcement, more rehab beds, needle exchange programs. She points to one aspect of the county's operations where the budget exploded - foster care.

SKODA: It's been the increase in the number of children they've had to take for safety reasons. I mean, it's just doubled. And then not to mention the children that have been orphaned - so it just complicates everything. But it has been devastating.

MANN: In this one Ohio county, taxpayers have spent nearly $70 million the last few years responding to the crisis. The cost of law enforcement alone rose more than 40%. But it's not just the county on the hook for this epidemic. In my three days on the ground in Summit County, I found city governments, schools, nonprofits, hospitals all scrambling to cope. Mike Hughes is a doctor at Barberton's hospital.

MIKE HUGHES: We knew that we needed to do something different.

MANN: They launched a pilot program last year, inviting anyone suffering from addiction to come to the emergency room. They started running ads on local television.


UNIDENTIFIED PERSON: They're open 24/7, 365. And when you need help, you can walk right in.

MANN: Hiring more nurses cost half a million dollars a year - money the hospital didn't have. Hughes says they didn't have any choice. People were dying, so they launched the program using donated money. A lot of the work in Summit County is still happening on a shoestring, through donations, volunteers and property-tax dollars.

INSKEEP: OK, so wow. Brian Mann, is this the kind of expense for which state and local governments want to be compensated?

MANN: That's exactly right, Steve. So Summit County alone - they told me that the price tag for this opioid epidemic there could run into the hundreds of millions of dollars. Multiply that times all the counties and cities around the U.S. struggling with this, and you'll get a sense for just how big the pressure is on drug companies as these lawsuits move forward.

INSKEEP: Now, we started with news that Teva Pharmaceuticals has settled with one state - the state of Oklahoma. What's Oklahoma do with that money?

MANN: Right. So $85 million - some of that will go to local governments, who need that cash to help pay for things like law enforcement and rehab programs. Experts say that could save lives. And I will say, Steve, this is beginning to look like a trend. More and more of these small and mid-sized drug companies are scrambling to get clear of these lawsuits through settlements. Again, the claims are that their marketing really got millions of Americans hooked. I do want to say it's important Teva denies any wrongdoing, despite this settlement. But Teva is still being sued by other local and state governments around the country.

INSKEEP: Wow - might face more pressure to settle elsewhere. But not everybody is settling everywhere. We should note that trial that is supposed to begin tomorrow, if I'm not mistaken, in Oklahoma also, against Johnson & Johnson - what's at stake?

MANN: Yeah, so Oklahoma's attorney general, Mike Hunter, is now focused on this one, big company. And this is where these lawsuits could get really interesting. If these huge companies with deep pockets, like Johnson & Johnson, are held liable for a sizable part of cleaning up the opioid epidemic, these payouts could jump very quickly. We've been talking about millions of dollars here, Steve. But this could jump into the billions, so people are watching Oklahoma closely this week. And they're going to be watching again when an even bigger test trial gets under way later in the year out in Ohio.

INSKEEP: This has got to be a challenge if you're a pharmaceutical company CEO because you can't just cut one check and settle one lawsuit. If you settle one, you have to anticipate more lawsuits all across the country.

MANN: That's right. And in some jurisdictions, people have been pushing for what's called a global settlement, similar to the tobacco settlements back in the 1990s, where it would sort of resolve all of this at once, get the industry out from under this and sort of, you know, mark a fresh beginning and also route billions of dollars to these communities that need this help desperately. But so far, that kind of big settlement just hasn't been reached.

INSKEEP: Brian, thanks.

MANN: Thank you, Steve.

(SOUNDBITE OF AKASHA SYSTEM'S "TERTIARY") Transcript provided by NPR, Copyright NPR.

Brian Mann is NPR's first national addiction correspondent. He also covers breaking news in the U.S. and around the world.