Quote card by Opinion.

The opioid crisis was a calculated and cunning scheme to generate substantial profits at the expense of many Americans’ well-being. Beginning in the 1990s, opioids were prescribed at higher levels than ever before. Pharmaceutical companies pushed for more opioid prescriptions, downplayed addiction risks and framed America’s medical system for the deaths associated with these drugs.  

In 2021 alone, 80,411 people died from an opioid overdose. Three of the largest opioid distributors — McKesson, Cardinal Health and AmerisourceBergen — reached a major settlement in 2021 with thousands of local governments as a result of their improper manufacturing and distribution of opioids and the horrific consequences these actions have had. The terms of the settlement largely required the distributors to pay billions of dollars to state and local governments.

It is expected that 85% of funds from the settlement will flow into addiction treatment and prevention, with state counties receiving the bulk of the money. Montgomery County, N.C., for example, has already spent $70,000 of the settlement on Narcan. It is important to recognize that the terms of the settlement are non-specific, as “prevention and treatment” is an umbrella term for many strategies and approaches. And, with no guidelines as to how the money is supposed to be distributed, the risk of inequity arises.

Black Americans are dying at a higher rate from opioid addiction than ever before. From 2015 to 2017, Black Americans showed the largest opioid overdose death increase in comparison to all other races: 103% for opiates and 361% for synthetic opioids in large central metropolitan areas, and 100% and 332%, respectively, in large fringe metros. Currently, no data is indicating a decrease in OOD rates among Black Americans.

With a devastating rate of 18.8% in comparison to the national poverty rate of 10.5%, a disproportionate amount of Black Americans experience poverty in comparison to other racial groups. Eighteen and a half percent of the non-elderly U.S. population lacks access to health insurance, and within this group, 70% are low-income individuals. Without health insurance, low-income Americans cannot be prescribed overdose-reversing drugs, enter a detox or rehabilitation program or even attend a yearly checkup that can help detect early signs of bladder, oral, larynx, stomach, esophageal and lung cancers that are all associated with excess opiate usage. This lack of access to care significantly contributes to the rising OOD rates within this specific racial demographic.

But how can America help eliminate this disparity? The answer is simple: Enact new guidelines that include tangible ways funds can be funneled into high-risk groups, such as the Black community. 

First, a portion of settlement dollars should be given back to the Black community directly.

Currently, Black Americans have suffered the highest number of lives lost to opioid overdoses, so reparations should be provided to their families. Direct reparations are important because they are a way of acknowledging the human rights violations committed against families involved with the crisis. This is a great way of maintaining integrity and justice between America’s citizens and its institutions.

The opioid settlement money can also effectively promote addiction treatment for high-risk community members with definitive allocation under strict guidelines. Instead of maintaining the current standard of vaguely funneling money into “prevention and treatment,” new guidelines should reference specific treatment facilities and programs that are known to help opioid misuse. This way, organizations that are making an actual impact can expand their services and continue to help mitigate the crisis.

Next, a significant portion of the opioid settlement funds should be dedicated to advancing equitable access to health insurance. While this remains a contentious matter, boosting government health care spending could expand medical services for individuals with lower-cost insurance plans and ease the financial burden on families allocating a substantial portion of their income to health care expenses. Consequently, individuals grappling with opioid addiction could access the medical care necessary to fight their condition.

Guidelines that emphasize providing funding to social justice organizations that have direct relationships with marginalized individuals affected by the opioid crisis are vital. These organizations have experience in working with communities impacted by the crisis, which means they can help effectively utilize the funding. Working with grassroots organizations allows for change to happen at micro as well as macro levels. 

Finally, new guidelines concerning the opioid settlement must prioritize transparent fund allocation. One significant obstacle hindering the effective utilization of funds lies in the absence of public oversight regarding their allocation. Because Americans do not know exactly where funding is going, specific improvements are difficult to suggest. Transparency is necessary to help impact Americans as positively as possible. 

The opioid crisis should not be absolved by simply forcing corporations to pay the very profits they earned from inflicting suffering on Americans to the government. Lives were lost, and families were ruined. Strategic guidelines must be crafted and put into action to effectively utilize the opioid settlement funds to repair the communities that have suffered the most.

Rachelle Evans is an Opinion Columnist. She writes about the influence of healthcare and wellness in politics and American culture. She can be reached at evansra@umich.edu.