Opioid Settlements: Last Week Tonight with John Oliver | Transcript

John Oliver discusses how state and local governments in the US are spending opioid settlements, a new deportation plan in the UK, and, of course, his favorite contestant at Eurovision.
Opioid Settlements: Last Week Tonight with John Oliver

Last Week Tonight with John Oliver
Season 11 Episode 11
Aired on May 12, 2024

Main segment: Fourth wave of the opioid epidemic in the United States (“Opioids IV”)
Other segments: Eurovision Song Contest 2024, United Kingdom and Rwanda Migration and Economic Development Partnership

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JOHN: Our main story tonight concerns the opioid crisis. If you take out one “i,” it’s actually an anagram for “rich idiot posse,” which would make a pretty good sweatshirt at the next secular family reunion. The opioid crisis is still raging, despite varying efforts to combat it over the years. This includes the brilliant plan from then-President Trump:

“The best way to prevent drug addiction and overdose is to prevent people from abusing drugs in the first place. If they don’t start, they won’t have a problem. If they do start, it’s awfully tough to get off, so we can keep them from going on, and maybe by talking to youth and telling them ‘no good, really bad for you’ in every way. But if they don’t start, it will never be a problem.”

JOHN: Yeah, it’s hard to believe that message didn’t land. From Trump talking to youth with the words “no good, really bad for you” in every way, to Melania staring icily into the distance as she burns another day waiting patiently for coronary artery disease to do its f*cking job. The point is, the opioid crisis is nowhere near over. In fact, we’re currently in what’s being referred to as the fourth wave of it. The first wave began with increased prescribing of opioids in the 90s, the second began in 2010 with heroin, followed by a third wave around 2013 involving synthetic opioids like fentanyl. This fourth wave is characterized by overdose deaths involving fentanyl plus a stimulant like cocaine or meth, which can sometimes be spiked without the user’s knowledge. In fact, most of the street drug supply is apparently now adulterated—that is how pervasive this problem is. But, to the extent that there is any good news, it is that the companies most implicated in that first wave—drug makers and other players in the supply chain that pumped pills into communities—have finally been forced to pay a price for their actions, as you probably know, if you’ve seen stories like these:

Walmart has agreed to pay $3.1 billion to settle lawsuits nationwide over the impact of prescriptions it filled for opioid painkillers.

Two of the largest pharmacy chains will pay about $10 billion in prescription opioid lawsuit settlements.

Four US corporations will pay a combined $26 billion to settle claims over their role in the opioid epidemic. Johnson & Johnson and three major drug distributors agreed to the settlement while insisting it was not an admission of guilt.

JOHN: “Oh, it wasn’t an admission of guilt, was it?” That makes sense; $26 billion is exactly how much you pay when you’re not guilty of anything. Who among us hasn’t surrendered the entire GDP of Iceland just ’cause? When you put all those settlements together, collectively, these companies have agreed to pay out more than $50 billion over 18 years to state and local governments. And getting to this point wasn’t easy. It involved consolidating thousands of lawsuits filed by various government entities and has been called the most complicated litigation in the history of complex litigation. And I think this goes without saying, but: boner alert—that is a bat signal for this show, something so boring it’s genuinely kind of hot. And people have understandable complaints about these settlements: first, that the dollar amounts are too small, which they absolutely are, putting aside the loss of hundreds of thousands of lives over the years. The opioid crisis is estimated to have caused $1.5 trillion in damage in 2020 alone. And second, almost none of the money is going to the individuals or families harmed; instead, it’s going to governments, theoretically to be used to mitigate the damage that opioids are doing. There are backstories behind both of those decisions, including that, for a bunch of complicated legal reasons, governments tend to get better outcomes in lawsuits like these than individuals. And that the most appropriate punishment for these companies—throwing them into the f*cking sun—is sadly currently unavailable to us, though I am working on a design for a catapult, and I’m tantalizingly close. And look, I could talk more about all of that, but the truth is, those decisions have now been made; they’re in the past. For this story, I’d like to do something slightly different, which is to mainly talk about the future and the decisions that haven’t been made yet. Because while $50 billion is clearly not enough to undo the damage here, it’s also not nothing—it’s double NASA’s budget and five times the revenue of an NBA season. And you should know this is also the bulk of the money governments are likely to get out of these companies because, under the terms of their settlements, they’re being released from future claims. So, when it comes to restitution, this is basically all the blood money we’re getting, making it feel especially important that we spend it well. But there have already been troubling signs that, at least in some places, the decision process on how to do so can be deeply flawed, which is particularly frustrating for those who’ve lost loved ones to this crisis, like this woman:

A dozen New York parents descended on Albany this week to complain that the governor’s budget is not being open about where the money is going. One Long Island mom, Linda Ventura, carried her son’s ashes in a Tupperware container.

“I will remain a pain in the ass in New York State because no one should join the club that these parents are here for.”

JOHN: That is a brave thing for that woman to do and a powerful message for her to send. “My name is Linda. I’m going to be a pain in the ass for you. And in case you sons of bitches forgot why we’re here, I brought along a Tupperware of my son.” I know that that sounds worrying, but the thing is, because we’re only 3 years into what will be 18 years’ worth of payments, there is still time for us to correct course. But that is why we need to talk about this right now. So tonight, let’s look at the opioid settlements. So let’s start with the fact that this isn’t the first time governments have received a huge pile of money after companies caused a public health crisis. Back in the 1990s, there was a similar wave of law against Big Tobacco that ended with a settlement of an estimated $246 billion. And at the time, everyone took a victory lap:

“Finally, we are going to begin to hold the tobacco industry accountable for decades of marketing their products and selling their products to our kids.

The states will receive the largest financial recovery in history.

We’ve arrived at our final destination, and that’s the destination of tobacco justice.”

JOHN: Ooh, tobacco justice. And look, it did sound great. Not only were tobacco companies paying a huge amount of money, but the settlement also imposed restrictions on cigarette advertising, including banning cartoon characters like Joe Camel. Although personally, I never found a sexy camel that persuasive. It seemed ridiculous to me to think that, “Oh my God, how the f*ck did you just do that?” But interestingly, that settlement is now seen as a prime example of what not to do because, at the time, the expectation was that a significant portion of the funding would be set aside to reduce tobacco use. But there were no binding requirements on how the money should be spent, so in practice, most states just used it as a slush fund to cover budget shortfalls, subsidize tax cuts, and support general government services. In fact, within just a few years, stories like this were starting to hit the news:

“Here in North Carolina, the nation’s number one tobacco producer, not a penny of the state’s $4.6 billion share has been spent on anti-smoking programs. So where’s the money going? $200,000 to improve this horse park, $115,000 for this tobacco museum to help produce a tobacco history video, and $400,000 toward the engineering of this plant that will one day process tobacco.”

JOHN: Yeah, that’s not great. And look, I realize that spending other people’s money in a dumb way could well be my exact job description, but even I know building a tobacco processing plant with tobacco settlement money is a very bad idea. And that’s not the only cautionary tale. There’s actually another example from early in this current wave of opioid settlement, specifically the one between state governments and McKinsey. In New York State, once that money started rolling in, some public health advocates were shocked at where most of it seemed to be going:

$21 million went into New York State’s general fund to build bridges and tunnels and to fill budget gaps. And that’s absolutely inexcusable.

I will be damned if I see a dollar go to fixing a pothole. Do we need potholes fixed? Absolutely. That’s not what this money is about.

JOHN: Yeah, he’s right. He’s also perhaps the most New York guy to ever exist, a man named Anthony Rosuto, ranting about potholes on behalf of an organization called F.I.S.T. A man like that isn’t born; someone in Massapequa rubbed a meatball parm, and he appeared in a puff of smoke like a genie. Now thankfully, this current $50 billion in settlement money has rules on how it can be spent. Unfortunately, they’re both very complicated and not nearly strong enough. For instance, most of the settlement agreements say that at least 85% of the money has to be used for opioid remediation, which sounds good, but that term is broadly defined. While they include a long list of what could fit into that category, they also note that the list is non-exhaustive, meaning governments could attempt to justify almost any purchase. As for the remaining 15%, that’s a free-for-all, making it basically a multi-billion-dollar slush fund. But also, as this legal expert who’s been closely tracking the settlements points out, there are worryingly few rules requiring state or local governments to report how they spend any of the money.

Public reporting of opioid settlement expenditures is not required by the settlement agreements themselves. So we’re in, um, Wild Wild West territory.

Minhee found only 16 states promised to publicly report 100% of their opioid settlement spending. Another 16 have not agreed to report any spending publicly at all, and the rest only a portion of it.

JOHN: Okay, first, shout out to the states promising to report on how they spend “some” of the money. I’m not sure that’s much better than not reporting it at all. “Oh, don’t worry, we’ll report on every dollar that doesn’t go into our mysterious money hole.” And I should say a few more states have since agreed to disclose at least some of their spending, so it’s now only these seven who are doing zero public reporting. But the point remains: There can be shockingly little transparency about where this money is going, or in some cases, not going. Because despite the fact that we are 3 years in, some states haven’t even started spending. For instance, the Iowa State Legislature recently couldn’t come to an agreement on how to spend its settlement money and then simply adjourned for the year, leaving more than $25 million unspent until 2025. But that’s fine, I guess. It’s not like this is a life-and-death situation or anything. Meanwhile, other states seem to be engaging in accounting tricks to get around restrictions. New York’s Governor Kathy Hochul proposed cutting the budget of the state’s Office of Addiction Services and Supports by more than 13%, and it’s believed that her plan was to then replace that funding with money from the opioid settlement. But that’s not increasing services, is it? It’s just moving the money around, so you can use it for whatever you like, which is infuriating. It turns out, it’s a lot less entertaining to watch someone try to launder millions in drug money when it’s not Bryan Cranston who’s doing it. And while so far I’ve mainly talked about state spending, it is worth noting that more than half of this money is actually going to local governments. It’s being divided up among cities and counties, as this local news report explains with some top-tier graphics:

Every single county in Michigan will get some money, but it really depends on how much. The smallest amount, just $173, in Union Charter Township. The biggest amount, nearly $70 million, in Wayne County. Here in West Michigan, Kent County is getting more than $18 million. So, how are they actually going to use that money? All of the experts I spoke with said it needs to be poured into four different buckets: prevention, harm reduction, treatment, and recovery.

JOHN: Okay, I know she’s telling us that the money should be going to things like harm reduction and recovery there, but it kind of feels like it’s going to local news graphics departments because that is excellent. But she is right, that experts generally agree that there are good ways to spend this money. For instance, we could hire and train more counselors and peer specialists to work with those struggling with addiction. We could also increase access to medication-assisted treatment using drugs like methadone, buprenorphine, and naltrexone. We could also better fund interventions for those continuing to use drugs—from overdose prevention centers, which we’ve discussed before on this show, to distributing naloxone, detecting fentanyl through testing strips, providing sterile syringes, and connecting people to adequate housing. All of that is a great use of settlement money, but it’s sometimes been hard for advocates to get that message across, given local leaders often simply don’t have the experience with addiction or health policy to guide them in using the money well. And that can be understandably very frustrating for those with personal experience of this crisis.

“People who use drugs are not being included at all,” says Trish Perry, a county coordinator for Ohio CAN, a nonprofit started by family members of individuals battling addiction. Every Saturday, they hand out food, clothing, and the overdose reversal drug Narcan in Newark, Ohio. But Perry says her organization has so far encountered stigma and hurdles when applying for funding from opioid settlement money that’s earmarked for local governments.

If you don’t supply people with clean use supplies and fentanyl testing strips, they die. And if they die, they never get to be a productive citizen in the community.

JOHN: That seems like a pretty good use of settlement money. Honestly, all other options tend to pale in comparison to, “If people don’t get the stuff I’m handing out right now, they’ll f*cking die.” And when you see that, the idea of using this money to fill potholes starts to sound like second-degree murder, as this magnificent New York stereotype will undoubtedly tell you. And I will say, there are places that are spending this money wisely on prevention, harm reduction, and the other things written on those CGI buckets. But places without the expertise or good guidance can become easy targets for companies looking to take this sudden surge of money off their hands.

Companies that make pill disposal products, safe pill storage, or even products for law enforcement like speed radar guns are pushing municipalities to use their settlement funds for their products, and even have tabs on their websites to track your state’s settlement money.

JOHN: That’s true, salesmen are going to small towns trying to convince them that they’re selling the cure for the opioid crisis. It’s like an insanely dark remake of “The Music Man.” “There’s trouble, folks, right here in River City, trouble with a capital ‘T’ and that rhymes with ‘P’ and that stands for painkillers.Thousands are dead.” One of those products is Deterra drug disposal pouches, which apparently contain activated carbon and cost about $4 each. The way they work is, customers place their unused medications in a Deterra pouch and add water, deactivating the drugs before tossing them, ensuring that they cannot be used even if fished out of the trash. If you’re thinking, “Wait, hold on. It’s just essentially then throwing away pills in water. Can’t you already do that with a toilet?” Yes, you can. This might be news to people, but unlike most drugs, the FDA lists opioids on its flush list for disposal, which is bad news for Deterra but another huge win for the toilet, the greatest invention in human history. “Thank you, toilet.” But despite that, Deterra’s manufacturer has promoted it heavily to local governments, even buying Google ads to get their attention, because when you search for opioid settlement-related terms, you can get served sponsored ads for Deterra with headers like, “How to use opioid settlements: Get the Deterra grant guide.” And it seems to have worked, as it’s won a bunch of contracts, including a million-dollar order from the health department in Delaware County, Pennsylvania, which seems like a huge waste of money, assuming that that county has toilets. And if they don’t have toilets, then find money to spend on that, stop shitting in buckets, shit in one of there, they are a real treat! Thank you toilet.

JOHN: But most upsettingly, in many places, the money is going somewhere that could do the exact opposite of reducing harm: the police. And that is despite explicit warnings against doing that. Last year, 130 public health advocates issued an open letter to local government saying no opioid settlement money should be spent on law enforcement personnel, overtime, or equipment, which does make sense because if we’ve learned one thing from the War on Drugs, it’s that Nancy Reagan and Mr. T produced the single stragest photo in the history of cameras, but if we’ve learned two things is that policing drug use does not make it stop. And yet, in some places, sending opioid money to police is actually mandatory. Louisiana decided to allocate 20% of its funds directly to sheriffs, with no obligation for them to report how they spend any of it. Many smaller municipalities are funneling it to law enforcement too. Sullivan County, New York, is using some of their settlement funds to pay for police overtime. Oceana, West Virginia, is using some for a new police cruiser. Bibb County, Alabama, spent over $120,000 on two new Chevy pickups for the sheriff’s office, as well as new lights, sirens, radios, and roadside cameras. And as for Brownwood, Texas, it spent $155,000 of its settlement funds to buy nine BolaWrap devices. Now, a BolaWrap is a restraint device which fires a cord around a suspect, and I could describe it to you, but instead, I’ll show you a video that the company made.

[BolaWrap training videos]

JOHN: Cool… You know, just a second ago, I thought sirens were the least helpful thing to spend opioid money on, but then I saw something that makes targets walk slightly slower away from you. Still, BolaWrap is another “useful” tool for cops to add to their belt, along with a bunch of way more lethal tools that they’ll definitely reach for instead. And it’s not just high-tech lassos. We also found multiple police departments pitching local governments on something called the TruNarc drug analyzer, arguing that it will increase officer safety. Here is a cop in Kenosha County, Wisconsin, doing exactly that at a County finance committee meeting:

So without having to open a package of a suspected narcotic, we can shine this equipment at that product, and it will tell us what the makeup is of whatever is inside it. So we’ve all seen the videos of the staff all over, the law enforcement all over the country, opening a bag, which we don’t do anymore, and, uh, breathing in that substance and passing out. This fentanyl is that — what’s the word?

Not passing out. OD-ing. Yeah, overdosing.

Going unconscious, I should say, from an OD.

JOHN: Okay, for the 10,000th time, it is all but impossible for a cop to just encounter fentanyl in the field and overdose. To quote one expert, “There has never, ever, ever, ever, ever, ever been a confirmed case of that happening.” That is two more “never-evers” than Taylor Swift uses for getting back together, so you know they’re not f*cking around. But again, that argument worked. He said, “We need the magic drug flashlight,” and that was good enough for the council to spend $30,000 on it. But honestly, I do have some sympathy for the people making these decisions. You can imagine town councils full of members who feel an enormous responsibility to spend this money well but don’t know where to start. In that situation, if a police official shows up and says, “Give it to us, we know what to do with it,” that’s almost a relief. Take Vienna, West Virginia, a city in a state absolutely hammered by the opioid crisis. Their council was approached by their police chief with a request for $13,000 from their opioid settlement fund to spend on a new police dog because their current one was getting old. The council unanimously agreed to it, even as one member made a pretty revealing comment:

This is the first time council has kind of been informed that we’ve even received those funds, um, and not entirely sure how we’re going to use the rest of it, but we should definitely, you know, have a plan in place. Not that this isn’t a good need, um, but I would hate to see that money get whittled away 13-15,000 at a time without being thoughtful about the impact this money could have for the city of Vienna.

JOHN: Right, when you don’t have a plan for your money, it can be easy to spend it in a thoughtless way. It’s a lot harder to break into your savings when it’s labeled “college funds” and not “holy shit, look at all this free jar money.” And that impulse of not wanting the settlement to be whittled away without serious thought is a good one. But here’s the thing, just 3 months later, the same guy returned to that same room to show a photo of the new police dog they bought and make a new request. Here is the mayor announcing that request to the council:

The next item on our agenda this evening is a resolution to authorize the purchase of two midsize or full-size SUVs for the Vienna Police Department using opioid settlement funds.

No, don’t do it! The police already have multiple funding sources they could use for cars. We’re constantly throwing money at them. They’re basically your rich friend who Venmo requests you 45 cents after splitting a popcorn at the movies. This would be unhinged behavior, even if your mom’s name wasn’t blue on Wikipedia. Now, to their credit, a council member spoke up again to express reservations about how little consideration seemed to be going into how they were spending this money.

I think we need to sit down and have a broader conversation about what we want to do with this money, and get more voices at the table. Obviously, yes, we’re going to take care of the police department in the ways that we can, but it’s a bigger thing; it’s about prevention, and we want to see those prevention dollars filter into our community. I think that council, we just need to put our heads together and have some time to figure out how we’re going to direct that money most effectively and efficiently.

JOHN: Exactly. And that was only slightly undermined by the fact that just 10 seconds after she was done speaking, the council voted unanimously to spend the money on the SUVs anyway, which is just maddening. Even Oprah would watch that and think, “Hey guys, you can’t just give people cars that way.” Because the sad truth is, even if every penny from the settlement did go to alleviating the opioid crisis, it’d still just be scratching the surface. But anytime you watch this money go toward policing drug users instead of helping them, it just feels like adding insult to injury, especially to communities of color who are so used to being over-policed and underserved. So what can we do? Well, again, the good news here is that we are still pretty close to the beginning of this process, so we’re at a point where we can change the arc of this story. And there are ways to do that. For instance, states can decide what counts as an allowable expense. California has said that local governments may not use money from the abatement fund to purchase many of the law enforcement toys that you’ve seen tonight. They even put out a list, explicitly stating the money can’t be spent on K9s, BolaWrap, or the TruNarc analyzer, which is good. States could also be more transparent about how they’re spending their funds. North Carolina and Colorado are currently the gold standard, with each having online portals providing up-to-date information on where their money is going. But it’s clearly not enough for the decisions to be transparent; they also have to be good. There are tools that we know work here, and they need to be funded with this money as additional spending, not just swapping out one funding stream for another. And for the final time, there are places spending it wisely on proven tools that have a real impact. But there are other places that just aren’t. And if you’re wondering, “Which place do I live in?” you may need to find out. And that unfortunately can mean having to show up in small rooms like the ones you’ve seen tonight and asking questions and advocating for real solutions. And if someone in that room suggests spending money on rope guns or new sirens, or God forbid, filling a pothole, tell them no. Because as I believe this human Statue of Liberty once said, “That is not what this money is for.”


JOHN: That’s our show, thanks so much for watching. We’ll see you next week. Good night!



JOHN: Thank you toilet!


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