McMINNVILLE, Ore. — The opioid epidemic blew into this picturesque Oregon town like a toxic wind, leaving overdoses, addiction, homelessness and wrecked families in its wake.<\/p>\n
In a humble, single-story brick building, three blocks from downtown McMinnville\u2019s wine-tasting rooms and cafes, staffers and volunteers of a recovery center called Provoking Hope help the casualties. The workers, who themselves are recovering from drug addiction, offer counseling, coffee and, for some, clean syringes.<\/p>\n
McMinnville and thousands of other towns across the United States are on the precipice of receiving billions of dollars in the second-biggest legal settlement in U.S. history. The $26 billion from three drug distributors and a pharmaceutical manufacturer would address damage wrought by opioids, which the federal government declared in 2017 was a public health emergency.<\/p>\n
States, counties and cities face a deadline in three weeks to sign onto the deal, and most states have agreed to do so. But a few holdouts remain, including Oregon, where disagreements have emerged between state and local government officials.<\/p>\n
The money is needed. In Yamhill County, where McMinnville is the county seat, it would expand counseling and treatment, including in jails, expand residential treatment and recovery facilities and fund other programs, said County Commissioner Casey Kulla.<\/p>\n
As Provoking Hope\u2019s office manager, Anne Muilenburg has seen the devastating effects of drug addiction and also experienced it first-hand. She says her addiction started as many in America did, after her physician prescribed opioids. They were for a painful spinal bone spur. Ten years later, using her prescription and buying two other people\u2019s prescriptions, she was taking 35 pills per day, far exceeding the maximum dosage.<\/p>\n
\u201cIt wasn\u2019t even enough to make me feel high. It was just enough to not make me sick,\u201d Muilenburg said. She described opiate withdrawal — experienced when she would run out of pills \u2014 as \u201cthe worst feeling ever.\u201d<\/p>\n
\u201cIt makes you feel like somebody\u2019s peeling your skin off,\u201d she recalled in her small office, decorated with posters with sayings like \u201cbe kind\u201d and \u201cstay humble.\u201d<\/p>\n
Muilenburg finally got treatment but then \u201cdrug jumped\u201d to alcohol and methamphetamine. She wound up losing her job at a car dealership and splitting with her husband, though they have since reunited. She was in and out of jail and found herself living on the street.<\/p>\n
\u201cMy being homeless was one of the things that led me to wanting to change my life,\u201d Muilenburg said.<\/p>\n
She has been free of drugs for 4 1\/2 years. Muilenburg said funds from the settlement are needed to address the community\u2019s drug dependency.<\/p>\n
\u201cWe need more treatment centers. Every place needs more treatment centers,\u201d she said. \u201cIt\u2019s ridiculous that somebody wants to go to treatment and they have to wait eight to 10 weeks for a bed.\u201d<\/p>\n
In the U.S., more than 500,000 deaths over the last two decades have been linked to opioids, both prescription drugs and illegal ones.<\/p>\n
The clock is ticking on the settlement, with a payout second only to the $200 billion-plus tobacco settlement, in 1998, with the nation\u2019s four largest tobacco companies.<\/p>\n
The three drug distributors — AmerisourceBergen, Cardinal Health and McKesson \u2014 and drugmaker Johnson & Johnson agreed in July to pay the combined $26 billion to resolve thousands of state and local government lawsuits. But if the defendants feel there\u2019s a lack of participation by states and local jurisdictions, it could cause them to back away from the landmark agreement or eventually reduce the settlement amount.<\/p>\n
\u201cThe defendants have the last bite at the apple to say, \u2018Do we have a critical mass to justify going forward?\u2019\u201d said Joe Rice, an attorney for the plaintiffs.<\/p>\n
In exchange for the payout, participating states, counties and cities would have to drop any lawsuits against the defendants and agree not to sue them in the future for the opioid epidemic.<\/p>\n
\u201cThere are complex tradeoffs at stake here,\u201d said Caleb Alexander, a drug safety expert at Johns Hopkins Bloomberg School of Public Health. \u201cOn the one hand, the settlement would offer sorely needed funding to scale up treatment and otherwise address the opioid epidemic. On the other, many parties believe the settlement is not enough.\u201d<\/p>\n
At least 45 states have signed on or signaled their intent to do so, and at least 4,012 counties and cities have also confirmed participation, plaintiffs\u2019 attorneys said Friday.<\/p>\n
Washington state has already ruled out participating, with Attorney General Bob Ferguson calling the settlement \u201cwoefully insufficient.\u201d He\u2019s suing the nation\u2019s three biggest drug distributors — the same ones in the national settlement \u2014 for $38 billion in a trial that began in November.<\/p>\n
In Pennsylvania, the district attorneys for Philadelphia and Allegheny County, which includes Pittsburgh, have sued the state attorney general to ensure their lawsuits against the drug industry could continue, saying their communities\u2019 shares from the settlement would cover only a fraction of the epidemic\u2019s financial toll.<\/p>\n
\u201cWe are not going to accept a settlement that is a sellout,\u201d Philadelphia District Attorney Larry Krasner said.<\/p>\n
Pennsylvania Attorney General Josh Shapiro says receiving payouts from the settlement is a sure thing, unlike continuing to pursue lawsuits against the companies. Local governments can opt out and keep suing, he said, but the more that do, the less the state would receive.<\/p>\n
New Mexico is still working out details, \u201cand we\u2019re anticipating that counties and local governments will be responding soon,\u201d said Jerri Mares of the state attorney general\u2019s office.<\/p>\n
In Oregon, lawyers for local governments and the state recently resolved an impasse over how the settlement would be disbursed, according to The Lund Report, a health care news site.<\/p>\n
The state of Oregon had wanted local governments to apply to it for grants. The local governments instead wanted a larger share of the funds in direct payments. There\u2019s now disagreement on how much of the settlement should go to attorneys who sued on behalf of several Oregon counties.<\/p>\n
Kulla, the Yamhill County commissioner, supports the opioid settlement but doesn\u2019t want the state taking excessive control of it.<\/p>\n
\u201cWe at the counties are the ones working with those addicted and their families, and we incur the societal costs of those addictions,\u201d he said.<\/p>\n
Under the settlement, the payments would be made over 18 years. The tobacco settlement was controlled by state governments, and most of the money has not gone to pay for the toll of tobacco. By contrast, the opioid settlements are structured so most of the money is intended to fight the crisis.<\/p>\n
Kulla recognizes there won\u2019t be a quick fix.<\/p>\n
\u201cIt\u2019s going to be long-term,\u201d Kulla said. \u201cIt\u2019s going to take generations, really, to dig ourselves out of this.\u201d<\/p>\n