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DPA Podcast Episode 40: Christine Minhee on the Promises and Perils of Opioid Litigation

Today, news broke that the Department of Justice has reached an $8 billion-plus settlement with Purdue Pharma for its role in the opioid crisis. This money should be used to combat the public health emergency of overdose deaths, but another public health emergency -- the COVID-19 pandemic -- has taken hold of media coverage and government spending. As overdose deaths continue to increase, where will this money actually go? We sat down with Christine Minhee, an expert on opioid litigation and creator of the opioid settlement tracker: a project that asks, "Will opioid settlements actually be spent in ways that bolster the public health response to drug addiction?" She spoke with Mary Sylla, a senior staff attorney with DPA, about what opioid litigation is, why it’s so complex, how it ties into our current moment, and what her pie in the sky dream for a settlement would look like.

To see more of Christine’s work, visit opioidsettlementtracker.com. For more information on DPA’s work to prevent fatal overdose, visit drugpolicy.org/overdose.

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Transcript

Intro  (0:02)  
Welcome to Drugs and Stuff, a podcast from the Drug Policy Alliance.

Gabriella Miyares  (0:10)  
Hello and welcome to another episode of Drugs and Stuff. I'm your host, Gabriella Miyares. With everything currently going on in 2020 -- the COVID-19 pandemic, movements against continuing racial injustice and militarized police, a struggling economy, and the upcoming presidential election, just to name a few -- the ongoing issue of opioid overdose isn't receiving as much news coverage. But overdose rates have actually been increasing as public health crises layer atop one another. While we've discussed overdose before on the podcast, we've never deeply explored the legal side of the issue, particularly the litigation and settlements related to the opioid crisis. Today, we are thrilled to welcome Christine Minhee, an expert on the subject and the creator of the opioid settlement tracker, a project that asks, "Will opioid settlements actually be spent in ways that bolster the public health response to drug addiction?" Christine spoke with Mary Sylla, a senior staff attorney with DPA, about what the opioid settlements are, why they're so complex, how they tie into our current moment, and what her pie in the sky dream for a settlement would look like. Let's listen in.

Mary Sylla  (1:35)  
Hi, everyone. My name is Mary Sylla, and I'm a senior staff attorney at the Drug Policy Alliance. I have the great privilege today to interview Christine Minhee: a lawyer, a 2019 Soros Justice Fellow, and a visiting scholar at the University of Washington School of Law. You can see her active work at opioidsettlementtracker.com, her brainchild, where she explains and documents the result of the opioid litigation, and examines how and whether a massive lawsuit in the US has meaningfully addressed the harm pharmaceutical companies did by marketing opioids as non addictive. It includes an amazing infographic. I've never seen four years of complex class litigation portrayed as clearly. So welcome, Christine, and thanks for being on our podcast.

Christine Minhee  (2:20)  
Thank you so much, Mary. It's 100% my pleasure.

Mary Sylla  (2:24)  
So today, we're going to cover the basics of the opioid litigation and settlement, what makes it problematic, and how it fits into the 2020 moment. It has relevance for both governmental health polity and responses to epidemics, as well as racial and social justice issues. We're coming up on the first anniversary of the bellwether opioid case's settlement, on October 21. So it's a good time to take stock of the impact of the settlement and see whether we can extract any lessons learned for policy advocates at this point. So Christina, I'd like to start out by having you give us a layperson's overview of the opioid litigation, how it came to be, what it entails, all the nitty gritty.

Christine Minhee (3:03)  
Love it. Love it. Yes, the opioid litigation is ridiculously complex. So a layperson's overview is even sometimes challenging to do. I should say that there's this man Joe Rice. He's one of the lead attorneys for local government plaintiffs in the federal line of litigation. He says that the opioid litigation is the most complex civil litigation case that our judicial system has dealt with maybe ever, end quote, and I've been studying this exclusively for a year and I find that it boggles my mind even still. So if there are listeners out there who find its complexity intimidating, it's not because you're missing anything. You're right on point if you feel a little overwhelmed just thinking about it. But just to level set a little here, in order to help folks wade through the news, when folks talk about the opioid litigation, they're typically referring to civil suits, filed by plaintiffs, states, cities, counties and tribal sovereign nations, against big pharma opioid manufacturers -- companies like Purdue and Johnson Johnson -- opioid distributors, lesser known to the typical household but companies like McKesson, AmerisourceBergen, and Cardinal Health -- and retailers, which are just basically pharmacies, like CVS and Walgreens. But when people say opioid litigation, they're also referring to some of the big pharma federal bankruptcy proceedings, the most famous of which is obviously Purdue's. What they typically aren't referring to is those federal prosecutions of big pharma companies by the DOJ, where the federal government is a plaintiff filing civil and criminal charges. Personally, I think the federal executive branch's involvement is superficial police theater at this stage of the crisis, since both Congress and federal agencies like the FDA DA failed miserably to do their jobs at the outset to mitigate the grand scale and the, how terrifying the opioid crisis has become. And also, whatever money is won from Big Pharma and Federal prosecutions will likely line the pockets of the DOJ and not be used by local communities or abatement. So the really juicy issues involved in the litigation, like who get to spend the settlement money and what it will be spent upon, don't really involve them. And I should also mention here that if it seems like opioid cases have been in the news forever, that's because they have. Your guys's new executive director Kassandra Frederique makes the point that we in the drug policy space have never had the luxury of slow stepping work. But the irony with the opioid litigation is that despite how urgent the work of harm reduction is, especially when drug overdoses are surging, in our new COVID world of things, the opioid litigation itself is moving like friggin molasses, and it's changed over time too. People say that the opioid crisis is made up of three waves: overdose deaths attributed to prescription opioids, those attributed to heroin, and those attributed to synthetics like fentanyl. But the opioid litigation came in three waves as well, first, in cases brought by individuals, usually family members of someone who's passed away from an overdose involving prescription opioids, second, in classes of individuals. And third, in cases brought by government plaintiffs at all levels, the cities, counties, states and sovereign tribal nations. And they're seeking monetary relief for having expended so much of their own funds combating the effects of opioid manufacturers, distributors and retailers, consistently pursuing what I would say short term profits over long term human health. And they've been doing this for decades. As you can guess, we're in this third wave now, which means that the opioid cases that we hear about in the news are those where government is a plaintiff and not an individual person. And here with these government cases, there are two minds of litigation. The ones in state courts, which are brought by States Attorneys General where the plaintiffs are the states themselves, and the cases in federal court, where the plaintiff is not the federal government, but cities, counties, and the tribal sovereign nations. This part can be kind of confusing, because you'd think that the local cases belong in local court, and many of them have began in local court. But the majority of them, 2900-ish are in the federal court system, because they've been lassoed together into a federal multidistrict litigation, which is kind of like a class action, but not really. This federal MDL multidistrict litigation, the MDL as we call it, is based out of Cleveland, and it's overseen by a federal trial judge named Dan Polster. Governments have been more successful than individuals when suing Big Pharma for a million different reasons. But one of them is that governments can come to court with like macro population level data about the rates of death and diversion. And that more persuasively paints the picture of a pattern of Big Pharma's bad behavior. And it frees up a broader set of claims, like wreaking public nuisance. But you know, even with the government's involvement, we still don't have a global settlement, or at least like right as of this moment. And it'll be interesting to learn whether this changes from now, until when the podcast airs, because it could happen. Global settlement, I should say, is kind of a misnomer. It doesn't really involve any international cases, just those in the US. But it in theory would resolve all the cases in this third wave of government plaintiffs litigation that was brought, brought by, states, localities and the tribes. And it bears some similarity to the big tobacco master settlement agreement in 1998, where states banded together to reach a 246 billion dollar settlement with cigarette companies like Philip Morris. A global deal was supposed to reach, be reached by March 20 of this year, which was the original start date of a highly anticipated opioid trial in New York. Big state trials tend to light the fire under the asses of parties involved in litigation. But COVID has obviously halted those proceedings, the trial's postponed, and now we're in the situation where we're celebrating, quote, unquote, celebrating the anniversary of the first federal opioid trial back in October of last year, but we still don't have a global settlement deal. Well, as of taping. And I don't know what possessed me, but one day in April, I decided to call Judge Polster's chambers, see if I could get him to talk to me. And through the grace of his clerks who I completely hounded, but who nevertheless passed on my message, he actually gave me a call back. And during our super surreal conversation, I somehow had the nerve to ask him if he ever had nightmares of herding cats, because getting a global settlement in the opioid litigation has been just that. It's been really chaotic. The Big Tobacco master settlement agreement, for instance, that was a little bit more monolithic. It was 46 state attorneys general, reaching a deal with four big tobacco firms. But whatever big opioid settlement comes out of this is more tower of Babel, since it involves multiple levels of government, the states, city, county, tribal nations, settling with dozens of big pharma companies, and not all of them play the same role in the opioid industry. Some of them have already settled with certain jurisdictions and not others, and often for disproportionate amounts. So it's kind of messy, and there's a ton of legal nerdy analysis about why localities and tribes are suing alongside states. Judge Polster, though, thinks it's because they don't want to get shafted again, like they did with the big tobacco settlement, which states have misspent like crazy. Depending on who you ask, states have spend about a third of that $246 billion Big Tobacco settlement filling budget deficits. Zero states, as of now, fund prevention programs at levels recommended by the CDC. And North Carolina, for instance, is super famous for spending some of their big tobacco settlement dollars on subsidies for tobacco farmers, which is just about as opposite as you can get to the spirit in which those funds were won in litigation. And with the, like, epic dumpster fire that has been 2020, where governments at all levels are bleeding chips, and where state officials are seeing 15 to 25% of their general funds tied up in managing pandemia, the risk of states breaking their settlement spending promises with the opioid settlement becomes an even huger issue. Even John Kasich, former Republican governor of Ohio, came out recently to say that the likelihood of states misspending opioid settlement funds to fill COVID related budget gaps is "as certain as gravity." Apparently one state even wants to use COVID bailout money to refurbish their state's capital, which is beyond me. But Big Pharma investor news tells me that COVID has shifted the balance of power between plaintiffs and defendants in the opioid litigation, since governments in the red are now more willing to take cash sooner. And if you're worried about whether opioid settlements will actually be spent promoting access to evidence based treatments, and be spent building up the structural determinants of health, I feel you. Like, I'm there, too. We're all in the same boat worried about that.

Mary Sylla  (12:25)  
Christine, I want to jump in. I, uh, you've gotten to this somewhat, the way that this settlement is problematic and complicated design. But one point you just got to was how the judicial branch might not be the best branch to deal with this problem, to deal with something that probably came out of lack of federal regulation of the opioid medications in the first place and the pharmaceutical companies in general. Was -- is there a way that this could have been dealt with better by the executive? Or the legislative branch?

Christine Minhee  (12:55)  
Yeah, yeah, I do think so. Judge Polster has this really great quote out there he says something along the lines of you know, the federal courts are the least likely branch of government to take this on. But frankly, the state and federal governments, the, the other branches, the executive and the legislative branches have failed. They've, they've punted. So now this issue is in the federal courts. The point you're making is a really astute one. It seems in opposite to see something that could have been taken care of legislatively or with better enforcement, here in the federal court system. And I think that that's what contributes to the complexity of the opioid litigation and why it's so confusing to think about, like first, like the scale of the litigation is super intimidating. I kind of like to see the opioid litigation as a scene from one of those Transformers movies. Because there's this epic, almost unrealistic quality to the size of parties involved, like governments are banding together to take on giant billion dollar pharma companies. And for those of us who are watching this on the ground, there exists this sense that they're going to duke it out in the sky, however they want to, with or without our say, and the best that we can hope for is some manna to float down to us from the wreckage, which is super sad. And secondly, and more to your point. I'm just going to keep it real here. Like we may not even be holding the right parties responsible. People like to blame Big Pharma for all of this. And I think that makes sense, especially from a symbolic justice point of view. Just like Marie Antoinette said, Let them eat cake. Purdue Pharma and the Sacklers, the family that privately owns Purdue, kind of said let them eat Oxy. And in this intensely capitalistic America, bankruptcy has become the new beheading, so to speak. So despite the fact that there are some who think that it'd make more sense to see specific officials at the FDA, DEA on trial instead, government plaintiffs are going after Big Pharma corporations in part because they're richer and they can finance more. I've made the joke with you, Mary, that harm is Big Pharma's middle name, you literally can't spell Big Pharma without it. But I often wonder whether we're supposed to dream of lucrative settlements with big pharma companies in order to stay asleep -- in order to stay narcoleptic against what's a more terrifying reality, this reality that we're suing them in part because the federal regulators have failed. Those who are tasked to protect us, and not corporate shareholders. And our federal agencies prioritized pursuit of corporate profit over public health at really pivotal moments. And they chose to look away until it's folks who look like they could possibly be the sons or daughters of stereotypical Congresspeople who are dying. And additionally, like we aren't seeing all of these opioid cases go to trial, which means that the data about the breadth of harm inflicted, won't get into the public record in a lot of cases, our big pharma defendants, they get tax writeoffs for settling versus admitting criminal harm. And despite my privilege of having gone to law school and understanding the litigation better for it, I cannot see how settlement without admission of guilt isn't anything but hush money. So, like the scale of the litigation, it's as massive as it is inexact. And for those listening, like, you aren't wrong to find litigation complicated or to feel that itotherwise rubs you the wrong way. You're right on point. You know, I mentioned Judge Polster's quote earlier, the, the man at the helm of the Federal multi district litigation, the federal court is probably the least likely branch of government to try and tackle this, he says, but candidly the other branches of government, federal and state, have punted, so it's here. And I think that's a really powerful indictment. And it's accurate to what I see, after having studied the litigation nonstop for what feels like forever. Because I think in an ideal world, our executive and legislative branches could have done a lot more to mitigate what was, before COVID, our greatest public health threat. But in this world, the best we can hope for at this stage is for settlement dollars to be spent combating this preventable overdose crisis as we in the harm reduction community would prefer to call the opioid crisis. And especially after 450,000 people have already died from opioid related overdoses. And that's sad, but that's the best that we can hope for. If I might just add, like, it's sad that it's not an overly dramatic or that it's not an overly partisan statement anymore to say that health care in America just sucks. And the opioid crisis and now COVID, they're just revealing its weaknesses. Those of us on the left, we hate the role of capitalism and the effect it's had on healthcare because it's produced inequitable outcomes, especially in health access. But those on the right have reason to disagree with it to at least, like ideologically speaking. Since the crazy levels of political power big pharma companies have, undermines a truly free market, one where cronyism isn't as ugly, where antitrust laws actually mean something, and where regulatory agencies do their job and don't respond to requests for protection from special interest lobbyists. And to be clear, like, all of this grossness I feel isn't because of free market capitalism, per se, but the fake one that we see driving the American healthcare industry. There's this Princeton husband-wife, economist team, Anne Case and Angus Deaton. And they've pointed out that the American healthcare system is a perfect example of political protections, redistributing income upward to the pharma, industry and hospitals, all while producing the worst health outcomes seen in any rich country, despite us spending far more than every other country in the world on health care. And in the truly free market, big pharma companies wouldn't be able to have as much legislative help protecting their profits, and they wouldn't be able to so regularly prioritize short term gains over long term health the way that they do. So while many big pharma companies are bad actors, is this crony capitalism we have in America that keeps me up at night. Deaton and Case, they explicitly attribute opioid related overdoses and other deaths of despair, as they call it, to this crony capitalism culture we have. One that hasn't benefited the average American in the American heartland, but has left them behind, which in their point of view, is why so many of our opioid overdose deaths are white. 

Mary Sylla  (19:55)  
So you've started to make the bigger connection to current events that I wanted you to make -- how this ties into the 2020 moment, how it's connected both to the pandemic and issues of racial and social injustice that are being brought to light by both the pandemic and by the result of murder and brutality by police officers around the country. So we're in a time when we're reimagining systems -- systems of policing, systems of response to pandemics, hopefully. Can we reimagine the response to the opioid overdose death epidemic? And you know, how we could deal with all the issues that the opioid litigation has sought to address, but as you pointed out, so inadequately?

Christine Minhee  (20:37)  
Oh, for sure. I mean, even though my job involves a lot of documenting things that are really sad, documenting the harms, documenting the litigation and how, you know, whether or not it's actually doing justice for those on the ground, I will say that I have a lot of hope. I have a lot of hope, because this is a moment where we can confront ugly truths if we choose to confront them. This is a moment of, a reawakening for a lot of folks. And I should say that, you know, I mentioned that Angus Deaton and Anne Case's research tied the opioid crisis into the death of American manifest destiny, so to speak, like they they talk a lot about how economic failures in our country have contributed a lot to the reason why the demographics of the opiate crisis, in particular, are so Caucasian. I think that there's a lot to unpack there. And I think that part of this confrontation of ugly truths that we have to do in this country will involve, it will necessarily involve racial justice and social justice issues. I should say that, like in my circles, it's a pretty contentious thing to point out constantly that opioid overdose deaths have mostly been white. It is true that historically, and at a population level, folks who misuse heroin and other non prescription opiates tended to be minorities in urban areas, while those misusing Oxy tended to be older, wider and more suburban. But what a lot of people don't realize is that calling the opiate crisis, a crisis at all expresses the type of privilege the same kind of privilege that shows through when white babies born to addicted mothers aren't called crack babies, but they have neonatal abstinence syndrome, right. The media treatment is remarkably different. Even Michael Botticelli, he's the former director of the White House's Office of National Drug Control Policy, he makes the point that those who die from overdoses involving prescription opioids tend to be more middle class and empowered. They know how to call legislators and get angry with insurance companies, for instance. And the fact that people of color don't necessarily represent, like, the typical face of the opioid crisis, that arguably expresses their general underprivilege. They were prescribed opioids less because they had less access to health care to begin with. If one study found that 72% of pharmacies and predominant predominantly white neighborhoods had adequate prescription opioid supply, and that only 25% of pharmacies in predominantly non white neighborhoods did. And I know I'm preaching to the choir here by saying this on a Drug Policy Alliance podcast, but the war on drugs has produced a ton of de facto resegregationist shifts in American society. And for folks of color, watching all of the messiness about the opioid crisis adds insult to decades of injury. Like academically speaking, critical race theorists say that the mostly white fatalities of the opiate crisis is what provides the political enthusiasm necessary for this country to fully embrace public health based rather than criminal justice faced responses to drug related harms. And that's generally described as progress. But I think that a fuller and more complete sense of progress would involve conscientiously realizing that calling drug overdoses a crisis only now, flattens the impact the war on drugs has had on people of color and other marginalized communities generally. And it steals the spotlight and focus, and the focus of the public, away from groups who deserved it all along to begin with. But I will say that in a really twisted way, I think it's helpful for our national consciousness in this meta sense, I guess, to disassociate drug harms with certain groups of human beings, since it opens us up to this idea that there's something uglier happening here in America, and that it's happening, and it's been happening for quite some time. And the marginalized communities were just the canaries in the coal mine, as we're seeing now with COVID. When Case and Deaton, the husband-wife economist team at Princeton, when they started looking at why it was almost exclusively white people who were dying of deaths of despair from the 90s through 2013. And deaths of despair for them means death by drug overdoses, suicide or alcoholism. So when they started looking at it, they concluded that minority underprivilege alone can't be responsible for a person's likelihood of dying by drug overdose, and that the notably white opioid deaths had a lot more to do with something a lot bigger and more invisible. I mentioned earlier that they make the argument that it's this death of American manifest destiny, or in other words like this death of free market capitalism doing what it should in America, and instead going really, really wrong. Like globalization, big health care costs, and industry shifts from manufacturing to services, they're affecting other countries in the world. But not all of them have a working class that's been as destroyed or industries with such crazy high levels of political protection. So here in the US, both opioid supply and demand, make it unique. And we know from science that the pain that we feel from being socially excluded is neurologically the same or very similar to the pain we experience when we suffer a quote unquote, real injury. And yet, we wonder why so many Americans are dependent on pain medications, even though the American government has been betraying folks in the heartland for decades. And even though we all feel the pain of working class folks being left behind, in an economy that is large, largely chosen to grow without us, there's data out there that shows that pain reporting is actually lower in areas of a country where folks tended to be more highly educated, and that the fraction of people in the area who voted for Trump in the 2016 election, that that's also strongly correlated with the fraction and pain reporting. And I think that that ties it all together in this endless circle that just keeps spinning around and around and around for me. And I think about this, this endless cycle of things that are connected, because we've just passed a major threshold of coronavirus deaths, there have been 200,000 folks who have died from the virus. And according to, so I'm here in Seattle, and I'm with the University of Washington's Law School as a visiting scholar. At U-Dub, there's also what's called the Institute for Health Metrics and Evaluation. And they projected that we're slated to see the number of folks who have died from coronavirus expand to 410,000 by the end of the year. This is huge for something that just began this March. But that figure still pales in comparison to the 760,000 folks who have died from drug overdoses since 1999. Two thirds of which involved opioids. So we know that with every opioid related death, there are about 30 ER visits associated with that death, and then with every one death, there are 100 people living with opioid use disorder specifically, which is to say nothing of the grand quantity of folks who suffer from substance use disorder overall. And we know that overdose deaths have skyrocketed since COVID became our number one public health emergency. And Mary, you and I know from that issue of molecular psychiatry sent me and when we were public health nerding out, I guess, that having substance use disorder at all puts you at a much higher risk of COVID-19. And at risk for much, much worse outcomes, which, and that has, you know, it's to say nothing for the reported elevated risk for folks of color, and how access to health care is harder for marginalized groups overall. So in this moment, I really, really, really do hope that this is a time where the political majority in this country is able to truly acknowledge that weaknesses and public health affect us all. This moment is huge. It's a huge opportunity. And I think that the way we strike while the iron is hot, has to involve necessarily thinking super critically about how opioid settlement dollars will be spent, like will they be spent in ways that are ineffective? Will they be siphoned off in states, into states' general funds? Or are they going to be spent strengthening the programs and organizations that secure the structural determinants of health for all? And are they going to be spent building those programs where they don't exist? Those are the questions that I think about.

Mary Sylla  (29:52)  
I think about them too, and I worry that that this settlement in this litigation is not actually going to bring the change that we could hope for. But to try to end on a more optimistic note, our listeners are, you know, folks who are paying attention to the drug war, who want to end the criminalization of substance use and the incarceration of people with substance use disorder. What would you say to them? What would be, you know, a takeaway and action steps they could take from the work you've done and the information you've collected?

Christine Minhee  (30:25)  
Yeah, I think that's really a huge question. So I think the future, one where we can take action, and we feel like it's leading to a bigger and grander conclusion that's healthier for everybody, I think that it's going to necessarily involve arguing what we've been arguing for in different ways. Those who work in the public health space and those who work in the drug policy space. You know, we see the harms that drug stigma, that stigma surrounding drug use the harms that that produces. And we often argue, for the eradication, too, we argue to take down stigma in ways that are morally based. But I think that there's a huge opportunity at this stage of things to argue that stigma is just straight up cost ineffective. In this moment, I'm thinking of this man, his name's Chris Steele. And he's a former member of the Oklahoma House of Reps. And he used to vote for measures that were pro prison system expansion. But then he later had a change of heart and even said that it'd actually be impossible to identify as a fiscal conservative, if you're going to be okay with wasting money on inefficient systems that don't produce the results of what they're intended to produce. He was talking about mass incarceration specifically, but I really think he could have been talking about any other thing, the war on drugs, and drug stigma included. So you know, drug stigma, we talk about it a lot in our communities. Stigma attached to drug use is, it isn't new -- tale as old as human time, and is often dealt and felt at the individual level. But it's also codified by local and state policy. By you know, we know, abstinence-based or other types of higher barrier employment, higher barrier healthcare, and housing programs, codified through nonviolent arrests that disrupt super valuable investments made in treatment continuums. And it's codified through you know, the deeper deprioritized funding for local community orgs and user health centers. So there are those of us who really feel these costs, and we work with them every day. And it's very persuasive for us to make the argument that it's morally wrong. But I think that the way to move the needle on it at the state and federal funding level is to sell it -- it's also really, really expensive. Because, like, objective cost benefit analyses show that stigma around drug use is ultimately cost inefficient, and that expanding access to treatment saves money. These are numbers and figures, I'm about to say that paint the picture of things that we feel instinctively but just to put numbers on it. Researchers -- researchers in one study, they estimated that the New England states would save about $1.3 billion if they were to expand their opioid treatment programs by 25%. The National Institute on Drug Abuse, they state that every dollar invested in treatment and programming returns $4-7 in criminal justice cost savings. And then when you throw healthcare savings into the mix, total savings to local and state governments outmuscle the costs of expanding treatment, the cost of expanding treatment, it outmuscles it by 12 to 1. And of course combating stigma, drug stigma, means funding things like syringe exchange programs as well, which are described by some as the most cost effective public health intervention ever created. But harm reduction programs notoriously lack funding, despite the World Health Organization endorsing so many of their initiatives, which means that even the smallest of planning and budgeting decisions made by government officials at all levels are super important in the fight to combat it. Like stigma isn't new, as I said, you know, but the irony of the war on drugs, one of the many ironies, is that by excluding from society, those normatively considered to contribute to our economy less or who are otherwise less valuable to existing power structures, it actually ends up costing society far, far more. And local and state governments are the ones footing the bill. Given that the costs of continuing to exclude drug users from societal resources, even though those costs are handily outweighed by the savings involved, reincorporating them into our homes, into our communities and into our economy, decision makers at all levels are acting against their own economic interests when they don't proactively work to combat stigma surrounding drug use and treatment. So what I'd say is that, you know, the information is out there, the data is out there, these numbers are here. Assuming that conservative interests, or assuming that interest that would be opposed to the harm reduction movement and treating drug use with compassion and care, assuming that those interests have money as the number one priority, use that weight against them, you can make cost savings arguments, and you can refer to cost benefit analyses to make the argument that stigma, it's not doing any good. And in fact, it's crazy expensive. And I think that the expensiveness node is quite persuasive. For reasons I mentioned earlier, everything COVID related and the fact that governments at all levels are bleeding chips. 

Mary Sylla  (36:11)  
Well, I just want to thank you, Christine, for explaining the opioid litigation and settlement to us and putting it in the 2020 context, in the context of broader movements, including harm reduction and the war on drugs. I want to refer listeners again to your website, opioidsettlementtracker.com. Are there any final closing comments you want to make?

Christine Minhee  (36:32)  
It's important to speak truth to power at moments like these. And I think just for the record, now, I've talked a lot about the litigation, I've talked a lot about cost savings and macro socio economic changes in this country. But I just want to put a voice to those who think that the litigation is still kind of BS, right, that it's not reflective of the harms that are felt on the ground. So I think to put a voice to the things that we all know, I kind of wanted to talk about my pie in the sky, ideal opioid settlement, because we're going to be utterly lost if the settlements aren't spent in ways that address the structural determinants of health. And we cannot spend them on Band Aid measures. So in the spirit of those high goals, there are a few idealistic terms that show up on my wish list. And I want to caveat all of this, to say that, you know, my knowledge of how this crisis came to, came to be, makes everything I'm about to say feel unrealistic, and kind of fantastical, but a girl can hope. And I find that it's important to put words to the things that we really need when especially when the climate now is one of financial rejection, funding rejection, right. So I think in an ideal world, I think the magical opioid settlement would magically get rid of every DEA regulation that makes it easier to get black market heroin than it is to get opioid use disorder medication prescribed by normal doctors and dispensed daily at community pharmacies. I think I'd also require Big Pharma to pair every one of their offers of quote free or life saving drugs, for them to pair those offers with the offer to pilot and fund pharmacy based models of treatment, with fair reimbursement for pharmacist clinical services. In my ideal, I think I'd also have the farmer required to actually follow existing legislation that mandates reporting and marketing limitations. And I'd create, I'd have the settlement create new marketing lobbying limits on pharmaceutical companies that are more reflective of the stuff we see abroad for instance. I'd obviously include conflicts of interest restrictions against folks who bounced between the DEA, the DOJ and pharma companies, and who also bounced from those groups and into the law firms that actually represent Big Pharma. Those folks are called the revolvers, because you participate in this revolving door. And, of course, you know, I, I would provide as much funding that these programs actually need, the programs that are targeted at attacking the structural determinants of disease, like housing and employment services for those in recovery. And I would also, you know, hold opioid suppliers responsible for making sure that these initiatives went through, which is to say nothing of like my super fantasy settlement provisions. You know, I think public education programs that are devoted not to warning kids just about the dangers of drugs, but programs that teach everybody about the history of the drug war. Now in this dark 2020 reality, I think it keeps me going at least to hope for these things. And even though the arc of humanity might not bend towards justice within our lifetimes that we can see it bending before we go, right, which is a really morbid, but also a really long tail justice perspective to take, like how to make good trouble in the long term, and also the short term. So those are the things I think about. And I really appreciate the opportunity to kind of go out there and talk about the pie in the sky stuff.

Mary Sylla  (40:36)  
I think that's wonderful. I think that's a wonderful place to end. Good trouble and the arc of justice. 

Christine Minhee  (40:42)  
Oh, yeah. 

Mary Sylla  (40:43)  
Thank you so much. Thank you so much, Christine, for spending some time with us and explaining this litigation. I really appreciate it.

Christine Minhee  (40:51)  
Oh, thank you. It's wonderful to get the opportunity to talk about something so technical at to connect it to all the things that I care about when I close my laptop, the things that I continue thinking about. And I would imagine these are the issues that you know, our listeners, that, that they think about when they close their laptops, and when they shut off their phones at night, too. We're all thinking about it. And I think that there is room for hope.

Mary Sylla  (41:16)  
We at DPA are lucky to have you as a colleague and I appreciate your time.

Christine Minhee  (41:21)  
Same feelings back atcha.

Gabriella Miyares  (41:28)  
Thanks again to Mary and Christine for that incredibly informative and interesting exploration. To learn more about Christine Minhee's work, visit opioidsettlementtracker.com. And if you're curious about the work DPA is doing to combat deaths from overdose, visit drugpolicy.org/overdose. We want to thank you again for listening. If you haven't already, follow our Twitter account @drugsnstuffDPA to get the latest updates on new episodes. Feel free to reach out with new ideas. We would love to hear from you. We hope everyone is as well as they can be in this challenging time. Until next time, stay safe and stay well.

Outro  (42:14)
Drugs and Stuff is brought to you by the Drug Policy Alliance. If you like what you hear in the podcast, do us a favor and rate the show on iTunes. Give it five stars and a nice review. Also, we'd love to hear from you. Tweet at us @drugsnstuffDPA, use the hashtag #drugsandstuff. And check out our website drugpolicy.org to see the other work we do, sign up for our emails, and donate. Special thanks to our producer Katharine Heller, and to the hard working staff of the Drug Policy Alliance for all of their work. Thanks for listening.

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