In this week’s $260 million settlement between drug companies and two Ohio counties hit hard by the opioid crisis, $25 million worth of the addiction medication known as Suboxone is a big part of the deal.
Suboxone would make up a much larger share of a proposed national settlement announced shortly afterward by a bipartisan group of state attorneys general: an estimated $26 billion over 10 years out of a $48 billion overall settlement.
But addiction experts question whether donated Suboxone — one of three evidenced-based medications used to treat opioid addiction — should be such a huge part of the settlements, because states could make a greater impact by spending the money on other measures.
“The primary barrier to getting more people into treatment is not the cost of the drug,” said Andrew Kolodny, senior scientist at the Institute for Behavioral Health at Brandeis University and co-director of the Opioid Policy Research Collaborative.
Suboxone costs roughly $500 a month for patients who pay out of pocket. Even so, Kolodny said, the real barrier to people with opioid addictions getting help is the lack of willing prescribers and the shortage of treatment programs.
The settlement calls on Teva to provide as much Suboxone as needed over the next decade, an estimated value of $26 billion. “Focusing on just one medication as a one-size-fits-all solution across the country,” said Yngvild Olsen, an addiction specialist in Baltimore who serves on the board of the American Society of Addiction Medicine, “misses the mark.” “Different states may have different needs and obtaining the medication may not be top-most among them,” she said. “Without a robust trained workforce and funding for comprehensive services, a simplistic settlement may not get us very far.”
Matt Salo, director of the National Association of Medicaid Directors, agreed that instead of medicine, the equivalent value in cash would allow states more flexibility in addressing states’ unique addiction problems. “There’s no question that the value of a cash settlement outweighs the value of an in-kind contribution,” he said. In the 1998 Tobacco Master Settlement Agreement valued at $246 billion over 25 years, there was an attempt to earmark up to 25% of the total amount for smoking cessation, Salo recalled. “A worthy goal, but one that would have had very different impacts across states. Utah, for example, ran the numbers and concluded that, in order to spend that amount on smoking cessation programs, they would first have to start paying people to smoke.”