From the War on Drugs to harm reduction: Imagining a just overdose crisis response

The overdose crisis is a health equity crisis. Over the past two decades, overdose-related fatalities have reached devastating numbers across the country. From urban epicenters to rural counties, the hardest hit communities are a stark reminder that the current ‘drug crisis’—like the ones preceding it—was not an accident.
Long before the overdose crisis entered the national spotlight, structural inequalities across race, ethnicity, and class created the societal conditions that lead to opioid use and have amplified the health disparities that increase the risks of overdose-related mortalities and morbidities.
In 2014, local, state, and tribal jurisdictions began pursuing legal action against pharmaceutical manufacturers and distributors in hopes of recovering a range of costs associated with opioid-related overdose. While there is growing consensus within the opioid litigation community that funds should be used solely for overdose-related issues, settlement negotiations have been complicated by differing priorities among plaintiffs. These tensions will likely continue even after settlements are reached, as government officials begin distributing settlement funds amid economic strain and historic depletion of government revenue due to the COVID-19 pandemic.
This position paper offers recommendations for policymakers, community organizations, funders, and other stakeholders on effective and evidence-based ways to use opioid settlement funds to promote public health and health equity. In addition, it reflects on broader policy reforms that would create an enabling environment for the best use of settlement funds. (author introduction)