A fledgling, small-scale approach to dealing with the state’s opioid crisis paid off big last week for Oklahoma State University (OSU) when it became the surprise beneficiary of a $270 million legal settlement with Purdue Pharma. It’s the first agreement in some 1700 pending cases around the United States against Purdue, which makes the painkiller OxyContin, and other manufacturers of prescription opioids.
On 26 March, the state of Oklahoma agreed to drop its suit alleging deceptive marketing practices by Purdue in exchange for a National Center for Addiction Studies and Treatment at OSU’s medical complex in Tulsa. Purdue and the Sackler family, which owns the Stamford, Connecticut–based company, will provide a $177 million endowment for the national center, along with $20 million over 5 years for naloxone and other drugs to treat opioid addiction. The state is continuing its suit against several other companies, with opening arguments set for 28 May.
The windfall for the new entity, which aspires “to become the premier addiction research center in the nation,” rewards OSU’s ambition. In October 2017, it opened a modest Center for Wellness and Recovery within its medical school to train future addiction medicine physicians, study the underlying causes of addiction and pain, provide treatment to those suffering from opioid use disorder, and educate the public about the burgeoning epidemic, which claims 130 lives a day in the United States and in 2017 killed nearly 800 Oklahomans. The center now has a staff of eight and a $2.4 million budget.
Jason Beaman, who heads the psychiatry department at the medical school and directs training efforts for the wellness center, acknowledges that OSU has a lot of ground to make up to become a preeminent medical research organization. “The [psychiatry] department has zero history of NIH [National Institutes of Health] grants,” he says. “But we’ve got four in review right now.” In addition, the center’s first two addiction medicine fellows start this summer, and he hopes to have six in the next cohort.
Beaman says he left the University of Arkansas in 2015 and returned to his alma mater because the medical school had made addressing the state’s mounting opioid crisis a priority. “Our mission is to train primary care physicians to work in rural and underserved areas,” says OSU’s Kayse Shrum, who became the youngest and first female president of an Oklahoma medical school when she was promoted into the job in 2013. “And that’s where the [addiction] crisis is most acute. So we began hiring psychiatrists with expertise in addiction medicine.”
Shrum and Beaman also benefited from serendipity. The medical school at their archrival, the University of Oklahoma (OU) in Norman, is known nationally for its efforts to combat cancer and cardiovascular disease, and last year its faculty members could boast of 105 NIH grants. (OSU has one, a capacity-building grant to study adverse childhood experiences.) But in 2016, OU officials decided addiction medicine was no longer a priority and ended the training program.
“We lost our funding, and I retired after 25 years there,” says emeritus professor William Yarborough, who ran the program. “Meanwhile, OSU was ramping up its program. So once [the state and Purdue] reached a deal, there really wasn’t anybody else at the table,” says Yarborough, who is president of the Oklahoma Society of Addiction Medicine.
Beaman’s department has swelled from three to 20 faculty members in the past 3 years, and he expects the settlement and the endowment to accelerate that growth. “There are three or four people who I anticipate being able to hire almost immediately,” he says. “And I’ll also go on the road. Maybe I’m being a Pollyanna, but who wouldn’t want to be part of what I hope will be the first sign of the end of the country’s opioid epidemic?”
The settlement creates an endowment that is likely to generate less than $10 million a year in new spending. That new pot is dwarfed by the $500 million that NIH will spend this year on its new Helping to End Addiction Long-term Initiative, launched in April 2018. And even that amount, public health advocates say, is minuscule compared with the magnitude of the opioid epidemic and the pressing need for treatment facilities, medical providers, and prevention.
Cheryl Healton, dean of public health at New York University in New York City, praises Oklahoma Attorney General Mike Hunter for negotiating a deal that funnels most of the money to those needs. “That’s a far cry from the tobacco settlement,” she says, referring to the $126 billion tobacco companies have paid out to date to 46 states under a 1998 agreement.
For many years Healton led a national public antismoking campaign financed by the massive settlement. State officials were given the power to allocate the money as they saw fit, however, and less than 1% of it has gone to tobacco prevention programs, even as tobacco companies continue to spend billions each year on marketing their products.
Healton says there’s an urgent need for a similar, sustained national public education campaign to combat the opioid epidemic. The best chance for that, she says, is a well-focused, master settlement of the pending opioid cases, something that a federal judge in Ohio has tried to pull off, so far unsuccessfully. Absent that, Healton worries that any deals struck by individual states and localities could wind up being too little, too late, to save many lives.
“Compared with tobacco, the use of opioids is likely to grow,” she warns. “And it’s up to all of us to be a countervailing force.”