Bill requires states to use opioid comparators to combat the opioid epidemic

Over the past three decades, the opioid crisis in the United States has claimed millions of lives. It began in the 1990s with a surge in prescription opioids. In 2010, the country experienced its second wave of opioid-related deaths, coinciding with rising heroin use. In 2013, the United States experienced its third wave of opioid-related deaths due to the use of synthetic opioids such as fentanyl, fentanyl analogues, and tramadol.^1.2 This trend continues: In 2021, there were more than 106,000 deaths from drug overdoses. 75.4% of these deaths were due to opioids.¹

Photo credit: Svyatoslav Lypynskyy | stock.adobe.com

Representatives Marcy Kaptur (Democrat, Ohio) and Ashley Hinson (Republican, Iowa) have introduced the Opioid Settlement Accountability Act in January 2024. This bill would require states to use settlement funds from pharmaceutical companies to address opioid-related issues, such as prevention and treatment services for opioid use disorder (OUD) or providing training for healthcare professionals, equipment for first responders, and social support services.³ In addition, the bill prohibits the federal government from seizing any portion of states’ Medicaid settlement funds and guarantees that the funds remain under local control.⁴

More than $50 billion in settlement payments are expected to go to state and local governments.⁵ Most settlements mention that 85% of the funds must be used to curb the opioid epidemic. However, there is no guarantee that states will meet that 85% limit, so the allocation is up to states’ discretion as to what they mean by opioid curbing and how they want to use the money. Another drawback of the settlement proposal is that it does not mention how Congress would oversee each state’s use of the settlement money. Nor does it require states to be transparent about where the money is going.⁴ This leads to skepticism about the bill among both lawmakers and the public.

The bill focuses on allocating comparison funds to prevention and treatment services, which may include opioid treatment programs (OTPs) and rehabilitation centers. OTPs provide medication-assisted treatments, including buprenorphine, methadone, and naltrexone for people with OUD.⁶ Taking these medications has been shown to significantly reduce opioid cravings, the risk of overdose, and the spread of infectious diseases such as HIV and hepatitis C.⁶ Despite high demand for OTPs, it was estimated that only one in five Americans received appropriate medications to combat OUD in 2021, due to regulatory, institutional, and financial barriers, among others.⁷

Patients often cannot afford medications for OUD (MOUD) because private and/or public payers do not cover them. The Affordable Care Act, which took effect in 2010, allowed states that have elected to expand Medicaid to offer substance abuse treatment as a benefit within Medicaid.⁸ This makes MOUD use more accessible to patients who cannot afford treatment out of pocket. As of July 2024, 10 states have not yet made this expansion. Patients also face physical difficulties in accessing MOUD due to a lack of transportation and child care, the inability to travel long distances, and a lack of information about where to find treatment programs.^8.9

The Substance Abuse and Mental Health Services Administration has made great strides in improving access to MOUD through federal initiatives, such as eliminating the requirement that physicians obtain a special authorization to prescribe buprenorphine.¹⁰ The Opioid Settlement Accountability Act aims to increase the number of changes from those two to hundreds if progress is appropriately funded and prioritized.