Businesses involved in the sale, distribution, and dispensation of opioids have collectively paid more than $47 billion in settlements, judgments, and penalties, the Associated Press reports. More than 500,000 Americans have died of opioid abuse over two decades. There are still many pending actions and settlement negotiations going on across the U.S. Most of the actions involve efforts by state and local governments to obtain funds for addiction treatment and overdose reversal drugs. These suits have typically proceeded on a legal theory called public nuisance, which alleges that a defendant has engaged in unreasonable conduct exposing members of the public to harm. Many claim that Purdue Pharma, the developer of Oxycontin, was the worst actor in the crisis and the company that kicked it off. The company's owners and brain trust, the members of the Sackler family, have yet to pay very much. This is due in large part to the company's legal strategy, which has involved the invocation of bankruptcy protections. The fact that the company is a private entity that the Sackler family could bleed of resources without interference from shareholders is another complication.
Now, a deal is on the table that would see members of the Sackler family pay $5.5 to $6 billion over time and require all family members to give up their ownership stakes of the company in exchange for immunity from further civil actions This divestiture would allow the company to reorganize and rebrand as Knoa Pharma, with profits from the venture going to fight the opioid crisis. The federal 2nd Circuit Court of Appeals will consider this deal after a lower court's decision to throw it out. Other drugmakers, including Johnson and Johnson, Endo International, Teva Pharmaceutical, and Mallinckrodt, have also been facing legal actions. Johnson and Johnson agreed to a $5 billion nationwide settlement alongside a separate settlement agreement from the three biggest drug wholesalers involved in the crisis. These companies—AmerisourceBergen, Cardinal Health and McKesson—agreed to pay $21 billion over 18 years in February. These funds are beginning to flow to governments at a time when state action is desperately needed to curb a wave of overdose deaths largely driven by opioids. Last year, the number of U.S. overdose deaths from all drugs topped 100,000 in a 12-month period for the first time. Settlements and judgments have also been reached against pharmacies and the consulting company McKinsey and Company.