The drug policy world has been left torn by the Supreme Court’s ruling on Thursday that Purdue Pharma’s bankruptcy deal could not move forward if it included legal protections for the company’s billionaire owners.
In one camp are those who were eager to see the agreed-upon $6 billion settlement put to work preventing and treating opioid addiction. In the other are those who found the prospect of shielding the Sackler family from civil lawsuits to be indefensible.
But there is a third camp, too: One that argues Purdue, its infamous pain drug OxyContin, and the overall scandal are of little relevance to today’s overdose epidemic, in which fentanyl, methamphetamine, and other illicit drugs combine to kill over 110,000 Americans each year.
“I won’t argue against the emotional stance of a bereaved parent who lost a child to OxyContin,” said Stefan Kertesz, an addiction doctor and professor of medicine at the University of Alabama-Birmingham. “But what got us into this crisis and what will get us out of it is a whole lot bigger than the execution of a revenge plan against owners of a company.”
With Thursday’s ruling, Purdue and many of the state attorneys general who sued the company pledged to restart negotiations on a new settlement agreement. But the clean slate is leading advocates to ponder whether pursuing justice for the dead, accountability for the Sacklers, and prevention of future deaths are fully compatible goals.
Since the opioid crisis captured the nation’s attention, the Sacklers have been the focus of countless books, television shows, and protests advocating that the family name be removed from numerous art museums and university buildings.
Even as the Sacklers rose to infamy, however, the drug crisis was morphing from OxyContin to heroin and, later, from heroin to fentanyl. Meanwhile, the U.S. has sharply cut its opioid prescribing rates — which Kertesz and many pain patients now argue has caused a secondary crisis by driving Americans from regulated, predictable pain drugs to unregulated, volatile opioids like fentanyl.
“Where we are today is that the vast majority of people are not dying from prescription opioids,” said Sara Whaley, a researcher focused on substance use policy at the Johns Hopkins School of Public Health. “Our crisis is very much the illicitly manufactured synthetic opioids, like fentanyl.”
The funding landscape has also changed as other pharmaceutical companies, drug wholesalers, and pharmacies have also agreed to settle claims relating to their roles in the opioid crisis. Those settlements total roughly $50 billion, some of which is now flowing to governments and community organizations.
While pursuing justice for the Sacklers may be cathartic, Kertesz argued, it is unclear whether the Sacklers’ status as a national pariah is motivating the type of systemic change needed — or whether, in his view, it simply constitutes another “quick fix.”
Instead, Kertesz said, the country requires a sweeping overhaul of its health system, including an emphasis on listening to patients and using long-proven tools like the addiction medication buprenorphine to help prevent future overdose deaths.
The U.S. health system “helped create health care payment schemes that punish time spent listening to patients and learning their problems while rewarding quick visits and high tech,” he said. “Those were policy decisions organized medicine negotiated, long before Purdue Pharma came along to exploit them. And reality is, no one is trying to fix them.”
Still, the Supreme Court’s 5-4 decision to derail Purdue’s settlement process leaves in flux a sum of $6 billion that can’t yet be used for treatment, prevention, or naloxone distribution. It also delays sizable payments to thousands of individual plaintiffs who sued Purdue on the part of lost loved ones.
And while today’s drug crisis bears little resemblance to the one Purdue helped fuel long ago, it’s easy to draw a line from one to the next, Whaley said.
“Where we are today is a product of what happened two decades ago with Purdue,” she said. “They’re two separate things, but the impact that these settlements have today is that they result in additional resources that state and local governments can invest back into communities to address the crisis.”
To the loved ones of many recent overdose victims, Purdue and OxyContin don’t represent a previous phase of the drug crisis, but rather an inescapable trauma.
“It’s very raw for me and for a lot of families,” said Dita Bhargava, a parent advocate with the nonprofit advocacy group Shatterproof. Her oldest son, Alec, died in 2018 at 26. His addiction, she said, began with OxyContin.
The pain of recent loss, coupled with the continued devastation of today’s drug crisis, has left many members of the addiction and drug policy communities in an impossible bind.
“It’s not clear-cut: There are many advocates who felt like we needed that money right away,” Bhargava said. “We do. There are so many people out there who are suffering helplessly. But on the flip side of that, there are a lot of advocates — and I felt this way to a certain extent, and still do — who feel the Sacklers need to be held accountable to the fullest extent of the law.”
It’s a choice that no one should have to make, Bhargava said. The $6 billion is a “drop in the bucket” by federal spending standards, she added, and adequately responding to the overdose crisis should not come at the expense of holding the Sacklers accountable, or vice versa.
Perhaps as important as the funds, Bhargava and others said, is what message the eventual end of the Purdue case will send: Namely, whether it serves as a durable warning to potential corporate wrongdoers, or instead suggests that a high enough dollar amount can erase their misdeeds.
“From a public health perspective, will it really make a difference? Perhaps not,” said Regina LaBelle, a former high-ranking drug policy official in the Obama and Biden administrations and the director of the Addiction and Public Policy Initiative at Georgetown’s O’Neill Institute. “But the justice system is about accountability and enforcing the rule of law.”
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