Long-awaited resolution to the lawsuits against Purdue Pharma

By Josh Rising and Abigail Winiker 

Payments made to states, cities and counties as a result of the opioid litigation settlements have not yet included money from one of the entities most closely associated with the opioid overdose epidemic: Purdue Pharma. However, a bankruptcy judge overseeing the proceedings with Purdue recently announced approval of a plan that could add as much as $7 billion to the $50 billion already secured via other settlements. 

Purdue manufactured and heavily promoted opioids including Oxycontin and profited from the dramatic rise in the prescribing of opioids. The company made false claims that minimized the addictive potential of prescription opioids, while aggressively targeting and incentivizing providers to prescribe large quantities of Oxycontin. State attorneys general, the federal government, affected families, and other entities have all brought litigation against Purdue and members of the Sackler family, the company’s owners. This litigation has been overseen by a bankruptcy judge since the company’s declaration of bankruptcy in 2019. 

Key questions that have hampered the resolution of these lawsuits have been: 1) how much money the Sackler family would personally be required to pay, and 2) whether the Sacklers would be shielded from future litigation as part of the settlement. The Supreme Court ruled in 2024 that the Sacklers could not be given immunity as part of the bankruptcy proceedings, leading to the agreement that was just announced.

Key elements of this settlement include:

• Direct payments to families. Unlike other opioid litigation settlements, the Purdue Pharma settlement includes payments to families directly affected by opioids. These payments, which will total around $850 million, are expected to range from $7,000 to $16,000. To date, individual victims have faced significant challenges accessing payouts from this and other opioid settlement agreements.
• Transformation of Purdue into a public benefit company. The Sackler family will relinquish their ownership of the company. Purdue will become Knoa Pharma, a public benefit company that will manufacture some opioids and opioid reversal medications. The board of Knoa will be appointed by states, and profits will be used to address the ongoing overdose epidemic.
• Public document release. Internal Purdue documents related to the opioid epidemic will be made available to the public. 

The settlement includes language which stipulates that 95% of annual remediation payments must be spent on Opioid Remediation efforts. It also states that any spending on non-remediation must be reported publicly. Yet whether these goals will be met effectively is a critical question. It has become clear that few enforcement mechanisms are in place to ensure transparency, leaving large proportions of allocated settlement funds not publicly trackable. Further, some expenditures are being used to support programs or interventions not backed by evidence or expert opinion. 

States and counties receiving payouts from this agreement should use the Principles for Use of Funds from the Opioid Litigation to guide their spending decisions, prioritizing evidence-based spending, fair processes for decision-making, and transparency in funding allocations. 

One unanswered question is whether and how many entities and individuals will elect not to participate in the settlement in order to preserve their ability to independently sue the Sackler family. Baltimore City, for example, chose not to participate in the multi-district litigation, choosing to independently file their own lawsuits, and has indicated they may pursue this approach with Purdue once again. 

The settlement agreement has been met with mixed emotions: some who were personally impacted by the crisis feel disappointed with the minimal payouts for individual victims and the lack of criminal liability for the Sackler family; others are relieved to see this case come to a close, with billions of dollars set to support opioid abatement efforts across the country. 

Josh Rising, MD, MPH, is a pediatrician with extensive experience, both inside and outside of government, working on strategies to address the opioid epidemic. He operates at the intersection of medicine, health policy, and public health, using his skills and expertise to advocate for evidence-based policies at the federal and state level that improve the health and well-being of communities.

Abigail Winiker, PhD, MSPH, is an Assistant Scientist in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health and the Program Director for the Bloomberg Overdose Prevention Initiative. Her work and training in harm reduction and health education inform her public health practice, and she strives to conduct research with direct translational implications to improve outcomes for at-risk populations.