For the first time in 30 years, drug overdose deaths in America are on the decline—a drop that some have attributed to the wider distribution of naloxone and new restrictions on prescription opioid painkillers. But this news is tempered by concerns about a rising number of methamphetamine-linked deaths and the continuing presence of synthetic opioids like fentanyl in the drug supply.Although total drug overdose deaths in the United States dropped by about 5 percent in 2018 (the most recent figures available)—the number of overdose deaths still exceeded 68,000 people.And Black people are making up an increasing share of these deaths: in 2017, the most recent year for which data is available, opioid overdose deaths among Black people rose more than 25 percent.The crisis not only impacts public health: too often, opioid use disorder leads to criminal justice involvement.It’s a deadly cycle: a recent study from North Carolina looking at people released from state prison found that they were 40 times as likely to have a fatal opioid overdose within the first two weeks after release as the general population.
In 2019, jurisdictions across the nation continued to use a variety of tactics in their battles against the opioid epidemic, with varying success. Some enacted controversial laws to charge people who supply the drugs involved in fatal overdoses with murder.Others increased access to syringe exchanges and naloxone, a drug that can reverse opioid overdoses.Some even considered establishing supervised injection sites.And the federal government, all 50 states, and Washington, DC—as well as a number of cities, counties, and Native American tribes—pursued some combination of criminal investigations and civil lawsuits against pharmaceutical companies.
Some progressive methods of addressing the crisis gained ground in unexpected places. Big cities like Chicago, New York, and San Francisco have been offering resources like syringe exchanges and naloxone distribution for decades, but in recent years, these efforts have expanded to traditionally conservative jurisdictions.In 2014, no southern state provided access to syringe exchanges or naloxone; today, all states in the South let people obtain naloxone without a prescription, and an increasing number are setting up syringe exchanges.(Currently, 29 states and the District of Columbia allow syringe exchanges; 12 states—the majority of which are in the South and Midwest—have laws that make them illegal, and nine states permit exchanges based on local ordinances.)Georgia and Florida were among the states that approved bills legalizing syringe exchanges in 2019.And North Carolina, which legalized syringe exchanges three years ago, approved state funding for clean syringes in July; it also decriminalized the use of testing strips that alert people to dangerous contaminants in their drugs.
Another strategy in the fight against fatal overdoses—opening safe injection facilities that allow people to use drugs under the supervision of medical staff—got a significant boost in October when a federal judge ruled that establishing such a site in Philadelphia would not violate the federal Controlled Substances Act.The U.S. District Court judge held that while the Controlled Substances Act prohibits operating a facility for the purpose of using illegal drugs, the purpose of the proposed site was not to facilitate the use of drugs but to save lives and help people get into treatment.The U.S. Department of Justice (DOJ) had sued for a declaratory judgment against the nonprofit Safehouse in February that would have definitively established that supervised injection sites are illegal under federal law, after the city of Philadelphia said it would not prosecute those who ran the facility or used drugs there.The DOJ has vowed to fight the court’s ruling.
Despite these advances, states are also increasingly returning to “war on drugs”-era criminal justice responses to the crisis, doubling down on stricter sentencing for those who supply drugs that are involved in fatal overdoses. North Carolina, for example, passed the Death by Distribution Act, which gives prosecutors the option to pursue murder charges against people who supply heroin, fentanyl, and other opioids that lead to deaths—without having to prove the person acted with malice.In response to criticism by advocates like the North Carolina Harm Reduction Coalition that a possible murder charge might make someone afraid to call 911 in the event of an overdose, North Carolina’s new law includes language saying that it does not restrict or interfere with the state’s Good Samaritan laws.But the same advocates have expressed concern that those laws are silent on whether a person who calls 911 and also provided the drugs at issue is protected from prosecution.
Twenty-three states, Washington, DC, and the federal government have enacted similar drug-induced homicide laws, and more than a dozen other states use existing manslaughter, felony murder, or other homicide laws for the same purpose.Opponents, however, say such laws don’t deter people who supply drugs, disproportionately affect people of color, discourage people from calling 911, and too often result in incarceration for the friends and families of overdose victims—people who are often also dealing with substance use issues.This last reason was why Virginia Governor Ralph Northam vetoed a bill in May that would have made it a felony murder to make, give, or sell drugs that cause a fatal overdose.
Perhaps the most significant development in the fight against opioids in 2019 was the action taken against major players in the drug industry, including the launch of a criminal investigation by federal prosecutors into whether opioid makers and distributors intentionally allowed the drugs to flood the market.In late November, it was reported that at least six drug companies had received federal subpoenas: Mallinckrodt Pharmaceuticals plc, Teva Pharmaceutical Industries Ltd., Johnson & Johnson, Amneal Pharmaceuticals Inc., and wholesale drug distributors McKesson Corp. and AmerisourceBergen Corp.Separately, Purdue Pharma, maker of the opioid painkiller OxyContin, acknowledged that it is working with the DOJ to resolve a criminal matter.
But criminal charges weren’t the only way pharmaceutical companies ended up in court in 2019: civil lawsuits also proliferated. In August, a judge in the Cleveland County District Court in Oklahoma ordered Johnson & Johnson to pay the state $572 million in the first trial to hold a drug manufacturer liable for contributing to the crisis.And thousands of consolidated lawsuits brought by cities, counties, tribes, and individuals are still pending, folded into one massive federal case known as the National Prescription Opiate Litigation.This case, overseen by the Northern District of Ohio, compiles cases brought by individual jurisdictions and groups of jurisdictions against one or more manufacturers and distributors of prescription opioids and is likely to take years to litigate as groups of defendants negotiate settlements with individual plaintiffs and some defendants attempt to settle all claims.Companies that reached multimillion-dollar civil settlements with local governments in 2019 include Johnson & Johnson; generic manufacturers Mallinckrodt Pharmaceuticals and Teva Pharmaceuticals; and drug distributors McKesson, Cardinal Health, and AmerisourceBergen.In the meantime, some claims are still proceeding to trial under a carefully managed schedule: two Ohio counties agreed to settle claims on the eve of an October 2019 trial, and a trial against major pharmacy chains including CVS, Rite Aid, and Walgreens has been set for October 2020.
In September, facing claims from all 50 states and hundreds of local and tribal governments, Purdue Pharma filed for bankruptcy.Purdue—as well as its owners, the Sackler family—is attempting to settle the lawsuits for an estimated $10 billion, which includes the donation of drugs for substance use treatment and overdose reversal as well as new ownership for the company, but the settlement is opposed by 25 states.In October, a federal bankruptcy judge ordered a monthlong halt in legal action by the states in opposition so the company could proceed with the settlement, saying that the costs of litigation were siphoning funds from the company that should be dedicated to the settlement.