Columbia Epidemiologists Endorse Principles to Guide Opioid Policy

January 27, 2021

A coalition of 31 organizations including epidemiologists from Columbia University Mailman School of Public Health has released a set of principles aimed at guiding state and local spending of the forthcoming opioid litigation settlement funds. The coalition of leading public health advocates is urging state and local officials to avoid the mistakes of the 1998 tobacco settlement and use the expected funds from the litigation to support efforts based in evidence that save lives. This is especially important given deaths due to opioid drug overdoses have significantly increased since the COVID-19 pandemic began, with some states reporting increases of 30 percent.

“The Tobacco Master Settlement serves as a cautionary tale for how dollars can be redirected from their intended original purpose,” said Silvia Martins, MD, PhD, associate professor of epidemiology at Columbia Mailman School, who also leads the Policy and Health Initiatives on Opioids and Other Substances interdisciplinary group. ”Our principles document focuses on the process that states and localities should go through in order to be sure that the funds are spent appropriately, equitably and have the biggest effect on the opioid overdose epidemic.”

From 1999 to 2018, almost 450,000 people died in the United States from an opioid overdose including prescription and illicit opioids. Drug manufacturers, pharmaceutical distributors, and pharmacies are expected to settle lawsuits stemming from the epidemic that could result in more than $10 billion in cash payments to states and localities.

The report, Principles for the Use of Funds From the Opioid Litigation, provides five principles to help guide spending and policies supported by the settlement funds:

1. Spend money to save lives. Given the economic downturn, many states and localities will be tempted to use the dollars to fill holes in their budgets rather than expand needed programs. Jurisdictions should use the funds to add to rather than replace existing spending.

2. Use evidence to guide spending. At this point in the overdose epidemic, researchers and clinicians have built a substantial body of evidence demonstrating what works and what does not. States and localities should use this information to make funding decisions.

3. Invest in youth prevention. States and localities should support children, youth, and families by making long-term investments in effective programs and strategies for community change.

4. Focus on racial equity. States and localities should direct significant funds to communities affected by years of discriminatory policies that now experience substantial increases in overdoses.

5. Develop a fair and transparent process for deciding where to spend the funding. This process should be guided by public health leaders with the active engagement of people and families with lived experience, clinicians, as well as other key groups.

The principles have been endorsed by organizations from across the public health, medical, harm reduction, advocacy, prevention, research, and education communities each united in their desire to see the settlement dollars used to save lives from the opioid epidemic. For more than 20 years, states have received payments from tobacco companies as a result of the multibillion dollar Tobacco Master Settlement Agreement in 1998. Yet each year, states have spent a minimal amount on tobacco use prevention and cessation programs.

Many members of the coalition who have endorsed the principles have also signed a letter to all the Attorneys General which encourages the AGs to use these principles in negotiating the settlement. For more information on the Principles for the Use of Funds From the Opioid Litigation.