As opioid settlement dollars head out the door in RI, state joins a new $450M agreement

Rhode Island joined a coalition of states in reaching a $450-million settlement this week with opioid maker Endo International Plc over accusations that the company downplayed the drugs’ risks to increase sales.

Attorney General Peter F. Neronha's office announced Thursday that the state had joined 35 others in reaching an agreement in principle with the drug maker to settle claims that Endo helped fuel the opioid crisis by illegally promoting the painkiller Opana Extended Release.

The deal, which must be approved in Bankruptcy Court, requires Endo to pay $450 million in cash over 10 years to participating states and local governments. It also must turn over its opioid-related documents for publication online in a public document archive and pay $2.75 million for archiving. Endo is permanently banned from marketing opioids.

Rhode Island’s share will be determined once the documents are finalized and court approvals are obtained, Brian Hodge, spokesman for Neronha's office, said Friday.

“This office continues to pursue opioid manufacturers, distributors and consultants all with a singular goal in mind: hold those companies accountable for deceptively peddling highly addictive narcotics to Rhode Islanders,” Neronha said in a statement. “As a result of this work, we have recovered more than $220 million in dollars and lifesaving medicine for Rhode Island … This is only the beginning, and more work remains to right the wrongs in our community, and this office is committed to the task.”

Rhode Island continuing to sue opioid manufacturers

Rhode Island is among the states hammering away through lawsuits at the drug manufacturers, drug distributors and other key players they blame for the crisis that has gripped cities and towns throughout the nation and led to countless overdose deaths.

To date, the state has recovered $90.8 million from pharmaceutical distributors McKesson, Cardinal Health and AmerisourceBergen over 18 years;  $21.1 million from manufacturer Johnson & Johnson over nine years;  $21 million from generic manufacturer Teva over 13 years, plus $78.5 million in Naloxone and Suboxone drugs over 10 years; and  $7.5 million from generic manufacturer Allergan over six years, according to Neronha’s office.

A settlement with Purdue Pharma remains in litigation, according to Hodge.

How the state is using opioid settlement money

The state has established an Opioid Settlement Advisory Committee, led by Carrie Bridges Feliz, vice president of community health and equity at Lifespan, to help determine how the money will be used to address the crisis.

Executive Office of Health & Human Services’ Acting Secretary Ana Novais recently approved a $20-million allocation for a range of uses, including $2.25 million toward developing a harm reduction center, or safe consumption site, for people to use drugs under medical oversight.

Other approved uses are $1 million for trauma support for first responders and peer recovery specialists; $700,000 to meet basic needs of high-risk clients; and  $1.75 million for housing capital and services for high risk communities.

Another $4.5 million will be dedicated to harm reduction, including a safe consumption center, $1.5 million for expanded street outreach and $750,000 for post-overdose engagement.

A total of $2.8 million will go toward treatment, with $1.5 million to be put into bricks-and-mortar investment and $500,000 to address chronic pain treatment and prevention for Black, indigenous and communities of color. Another $800,000 would head to other substance use disorder providers.

In addition, $2 million would be spent on family recovery support, intervention for substance-exposed infants and incentives for recovery housing.

The largest chunk – $6 million – will be aimed at prevention, including $4 million for school and community mental health initiatives and $1 million to enhance surveillance through the collection of race and ethnic data and multilingual communication. Another $1 million would be dedicated to strengthening nonprofit organizations focused on combating the crisis.

The smallest allotment – $1.25 million – will be spent on governance, administration and project evaluation. EOHHS will now steward the recommendations through the state procurement process, the agency said.

Governor Daniel Gov. Dan McKee emphasized the importance the settlement money will play.

“In 2022, we have already lost at least another 87 members of our community. Investing these settlement funds quickly and effectively in meaningful interventions to prevent overdoses is a top priority of my administration,” McKee said in a statement.

Committee Member Ernesto Figueroa shared a personal perspective.

“My daughter is currently struggling with substance use. Her use has affected my whole family. My grandson is unable to be in her care and I am currently his primary caretaker,” Figueroa said. “My family’s story is sadly not unique – so many Rhode Island families have had their lives disrupted by this endemic. I am so glad these funds will go to work ASAP to help Rhode Islanders – they are needed.”

Rhode Island suffered a record 435 opioid-related overdose deaths in 2021.

Why was Endo International sued?

The agreement resolves allegations that Endo boosted opioid sales through deceptive marketing that downplayed the risks of addiction while overstating the benefits. With national headquarters in Pennsylvania, Endo makes generic and brand name opioids, including Percocet and Endocet. The company also made Opana ER, an opioid medication for moderate to severe pain that was discontinued in 2017 at the direction of the Food and Drug Administration, according to Neronha’s office.

The state attorneys general allege that Endo misled the public about benefits of Opana ER’s alleged tamper resistant formulation while ignoring that it could be abused both orally through chewing or by crushing and injecting the narcotic drug. Widespread intravenous abuse led to outbreaks of Hepatitis C and HIV.

Endo is the latest pharmaceutical company to seek protection in response to lawsuits about their role in the crippling crisis. Oxycontin maker Purdue Pharma also sought court relief, as did  Mallinckrodt Plc, a manufacturer of generic opioids.

This article originally appeared on The Providence Journal: Rhode Island joins settlement against opioid maker Endo International