The U.S. Supreme Court’s recent decision to strip the Sacklers of immunity from opioid-related lawsuits marks a pivotal moment in the fight for corporate responsibility in the public health crisis. As legal battles rage, new report reveals alarming disparities in access to lifesaving opioid treatment for vulnerable populations, while addressing today’s urgent public health needs. , highlighting the dual challenge of seeking justice for the past.
A pivotal 2024 Supreme Court decision overturned a bankruptcy court ruling that granted the Sackler family, owners of Purdue Pharma, immunity from lawsuits related to the opioid crisis. According to an article published in JAMA, this decision stems from Harrington v. Purdue Pharma and could signal a shift in this dynamic.
The U.S. Supreme Court’s recent decision to strip the Sacklers of immunity from opioid-related lawsuits marks a pivotal moment in the fight for corporate responsibility in the public health crisis.
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Meanwhile, a new report from the Office of Inspector General (OIG) highlights significant barriers to obtaining medications to treat opioid use disorder (MOUD) for Medicare and Medicaid enrollees. 2 This continues to affect many people outside of Medicare and Medicaid. The Supreme Court’s actions in response to this crisis, combined with the latest data on public impact, demonstrate legal possibilities in addressing the ongoing public health challenges of the opioid crisis and treatment access. Masu.
“As the United States continues to combat the opioid crisis, access to medications to treat opioid use disorder (MOUD) is essential to address high rates of opioid use disorder and overdose deaths.” said Lewis A. Day, team leader and social science professor. Research analysts at the Assessment and Inspection Bureau said in a statement: For example, HHS-OIG has found that hundreds of counties with a high need for MOUD services have few or no MOUD providers treating Medicare or Medicaid enrollees, and many enrollees with opioid use disorder receive treatment through their respective programs. I discovered that I have not received MOUD. ”
Purdue Pharma and the Sackler Family’s Role in the Opioid Crisis
In 1996, Purdue Pharmaceuticals began a strategy to promote OxyContin, an extended-release version of oxycodone. 1 By aggressively marketing the drug and downplaying the risks of addiction, Purdue fostered an environment that encouraged overprescription of opioids, the JAMA authors write. The company more than doubled its sales force and funded more than 20,000 educational programs for doctors while disguising the risk of addiction as less than 1%. Sales of OxyContin soared 2300% between 1996 and 2000, by which time OxyContin had become the leading substance of abuse in the United States, fueling the opioid crisis and propelling the Sacklers into the ranks of America’s richest people.
According to the article, Purdue and the Sacklers faced thousands of lawsuits as the opioid crisis worsened. To avoid liability, the Sacklers used two major strategies. First, it siphoned billions of dollars from Purdue into offshore accounts after settling criminal charges with the federal government in 2007. Then, in 2019, Purdue declared bankruptcy, but the Sacklers themselves kept much of the wealth they had extracted from the company.
Supreme Court overturns Sackler immunity
In 2021, a bankruptcy court approved a settlement granting the Sacklers immunity from further litigation in exchange for a $6 billion payment, a portion of which was earmarked for public health programs. But critics argued that the deal allowed the Sacklers to escape full liability while retaining billions of dollars, setting a dangerous precedent for corporate wrongdoing.
On June 27, 2024, the Supreme Court reversed this discharge in a 5-4 decision and sent the case back to bankruptcy court for renegotiation. The ruling stated that bankruptcy protection was intended for honest debtors who fully disclosed their assets, and that individuals seeking to protect billions of dollars in offshore accounts while avoiding liability for their actions It was emphasized that it was not intended for
The Sacklers now face new lawsuits from individuals and state and local governments affected by opioid misuse. They must either strike a consensual deal with the plaintiffs or file for bankruptcy themselves. The authors emphasized that this decision significantly increases the risk for the Sacklers and could set an important legal precedent for corporate liability during public health crises.
Implications for public health and corporate responsibility
The opioid crisis costs the United States between $50 billion and $600 billion annually. While the original $6 billion settlement was intended to provide some economic relief, the article cited prominent arguments that the compensation was inadequate compared to the scale of the damage caused by the crisis. There is.
“This case reveals how those in power who harm public health have used legal tactics, including bankruptcy, to avoid accountability from the U.S. judicial system,” the article said. said. “Even if Mr. Harrington shuts down one mechanism for avoiding accountability, others are working hard to establish legal safeguards against corporate wrongdoing that contribute to the brunt of U.S. morbidity and mortality.” Many mechanisms need to be addressed.”
Are local efforts enough to combat the opioid crisis?
Despite the increasing prevalence of substance use disorders, particularly opioid use disorder, access to medication and treatment remains a persistent barrier. While medical centers and networks are working to reduce these barriers in different regions of the country, many on the front lines emphasize that further progress is urgently needed. .
In an interview with The American Journal of Managed Care® (AJMC®), Michael Lynch, M.D., associate professor of emergency medicine at the University of Pittsburgh and attending physician, emergency physician and pharmacotoxicologist at the University of Pittsburgh Medical Center, explains how his center I explained how I responded. We have had success with telemedicine.
“In general, we know that about three-quarters of people with substance use disorders receive no treatment at all. Only five people with opioid use disorder actually receive drug treatment. “Many of the barriers are deliberate,” he said. “People don’t know where to go. They have to wait. There are a lot of hurdles to overcome to get evidence-based care.”
While center-specific efforts can reduce harm reduction, there are social and institutional barriers that play a major role in preventing access to care for many Americans living with substance use disorders.
“There are a lot of concerns around stigma, like transportation, child care, jobs. There’s just a lot of barriers. They’ve always existed and always will exist,” Lynch said. “What we’ve found is that telehealth bridge clinics can really help address these barriers and at least help people transition to a longer-term, perhaps more traditional, in-person or hybrid model. It’s about helping people get started on treatment and stabilize.”
These barriers still exist for people who regularly see their doctors and have insurance. Unfortunately, when we look at marginalized communities, such as those with low or no income, the unhoused, and the recently incarcerated, disparities in access to care widen and stigmatization from health care providers. The same is true for the possibility of encountering.
Allegheny Health Network’s Inclusion Health Center’s Urban Health Outreach works to bridge the gap for these populations by providing health care and education directly to the community. Lack of access to treatment extends beyond the scope of community-based care programs such as these, which are designed to fill these gaps.
“We are committed to advancing healthcare without bias, whether it’s for substance use disorders or just providing care for people experiencing homelessness or those who have been historically excluded from healthcare. “We are working hard to achieve that,” Sly said in an interview with AJMC. “We really try to set an example for our colleagues, but we also try to teach and train them directly, because the only people in the health care system who can take care of homeless people are They should not be the only ones who can do this job.”
OIG report reveals gaps in access to opioid treatment
While the legal landscape surrounding the opioid crisis is evolving and voluntary health initiatives aim to address it, public health challenges remain, as does the urgency to ensure access to treatment. It continues. The OIG report highlighted significant gaps in access to MOUD, particularly among Medicare and Medicaid enrollees. 2
The findings revealed that 19% of counties do not have a MOUD provider and nearly one-third of counties do not have a provider that accepts Medicare or Medicaid. This disparity is particularly pronounced among office-based buprenorphine providers, many of whom do not serve these populations, even though most opioid treatment programs do. Furthermore, administrative and financial challenges make it difficult for MOUD providers to operate in high-need areas, further exacerbating treatment shortages.
The OIG report provides several recommendations to improve access to MOUD services.
Geographically targeted efforts to increase the number of MOUD providers in high-need counties. Evaluation of reimbursement rates to ensure that Medicare and Medicaid payments for MOUD services are sufficient to attract and retain providers. Establishment of a national directory of MOUD providers to assist individuals in their search. Health care providers who actively treat patients with Medicare and Medicaid.
As the United States continues to grapple with the opioid crisis, the Harrington v. Purdue Pharma decision marks an important step toward holding corporate executives like the Sacklers accountable for their role in the public health disaster. At the same time, addressing gaps in access to MOUD remains a key public health priority, as highlighted in the OIG report.
References
1. Aaron DG, Levitin AJ, Sinha MS. Legal responsibility for the health crisis: ‘Unprotecting’ the Sacklers. jam. Published online on September 25, 2024. doi:10.1001/jama.2024.16200
2. Medicare and Medicaid enrollees in many high-need areas may not have access to medications to treat opioid use disorder. Office of the Inspector General; September 2024. Accessed October 1, 2024. https://oig.hhs.gov/documents/evaluation/9999/OEI-BL-23-00160.pdf
3.HHS OIG. HHS-OIG Efforts to Address the Opioid Epidemic. September 27, 2024. Accessed October 1, 2024. https://oig.hhs.gov/newsroom/news-releases-articles/hhs-oigs-efforts-to-address-the-opioid-epidemic/
4. Shaw M. Combating the Opioid Epidemic: Insights from the Front Lines. AJMC. September 2, 2024. Accessed September 30, 2024. https://www.ajmc.com/view/combatting-the-opioid-epidemic-insights-from-the-front-lines
5. Grossi G. A framework for promoting health equity: urban health support. AJMC. May 9, 2024. Accessed September 30, 2024. https://www.ajmc.com/view/frameworks-for-advancing-health-equity-urban-health-outreach
