National

Change in drug overdose deaths per 100k people, by race/ethnicity

Data: Kariisa, et al., 2022, "Vital Signs: Drug Overdose Deaths, by Selected Sociodemographic and Social Determinants of Health Characteristics — 25 States and the District of Columbia, 2019–2020";  Chart: Simran Parwani/Axios

Drug overdose deaths surged by 30% during the first year of the pandemic, with Black and Native American communities bearing a disproportionately higher burden, the CDC reported on Tuesday.

Why it matters: The pandemic highlighted long-overlooked disparities in health care and how social determinants like poverty, housing and transportation can hinder access to care, including substance use treatment.

Fentanyl has accelerated the opioid crisis and is often being laced into other drugs, sometimes unbeknownst to the user.

Takeaways: Overdose rates were highest in areas with the most treatment options available, in 25 states and the District of Columbia, where data was available, the report found.

"Just because there's availability of services doesn't meant they're necessarily accessible," Mbabazi Kariisa, a CDC health scientist, told reporters.

Systemic racism, income inequality, and lack of reliable housing, transportation and health insurance all play a role in why drug overdoses are disproportionately affecting Black and Native American people, CDC officials said.

By the numbers: In 2020, there were 91,799 Americans who died of a drug overdose, according to HHS, and from 2019 to 2020 overdose rates increased the most among teens and young adults.

Black youths and young adults ages 15 to 24 years old experienced the largest overdose death rate increase at 86%.

Native American people ages 25 to 44 years old saw an increase of 49% in the rate of overdose deaths.

White people ages 15 to 24 years old had a 34% increase in overdose death rate.

The bottom line: The landscape is evolving, CDC officials said, and illicit drug use as well as poly-substance use is a major cause for concern in communities, especially when fentanyl can kill a person who uses it once.

Overdose deaths soared in 2020, highlighting racial disparities

New data from the CDC show that Black and Native American people were disproportionately impacted by unintentional drug overdoses in 2020.

Opioid overdose deaths

Opioids

The U.S. faces a range of health care flashpoints — unaffordable drugs, opioids, vaping — as we debate whether to adopt universal care. For now, the Affordable Care Act is the law of the land, but Republicans want to issue it a final death blow.

Health

McKinsey & Company found opportunities to boost opioid manufacturers' sales amid the addiction crisis from 2004 to 2019, new documents published by the University of California at San Francisco and Johns Hopkins University show.

Why it matters: When one opioid fell out of favor with federal regulators, drugmakers created and marketed another, further stoking the crisis. 

The more than 114,000 pages of documents show how McKinsey had a much broader role advising the companies than was previously documented, providing growth and turnaround plans to combat the loss of revenue from opioid lawsuits, advice on how to deal with regulators and strategies to boost sales while concern about the addictive properties of the painkillers grew. 

Flashback: Nearly half a million people died from an opioid-related overdose from 1999 to 2019, according to the CDC, and the proliferation of prescription opioid addiction gave way to heroin then synthetic opioid use, which continued the upward trajectory of opioid deaths through 2019.

Despite lawsuits, regulation and backlash during the height of the opioid epidemic, McKinsey continued to consult with leading opioid drugmakers Purdue Pharma, Endo Pharmaceuticals, Johnson & Johnson and Mallinckrodt, the new documents show.

The new documents reveal "a sweeping and detailed depiction of a firm that became a trusted adviser to companies at the core of an epidemic that has claimed half a million American lives," the New York Times reported.

The other side: In 2019, McKinsey cut ties with opioid manufacturers, and in early 2021, the company reached a $573 million settlement agreement with 47 states, five territories and the District of Columbia, which called for the release of the internal documents.

"As we have said before, we recognize the terrible consequences of the opioid epidemic and have acknowledged our role in serving opioid manufacturers," a McKinsey spokesperson said in a statement in response to the documents being published on Thursday. 

Documents reveal McKinsey's role increasing opioid sales until 2019

More than 114,000 documents reveal the role McKinsey played in consulting with drug companies at the height of the opioid epidemic.

Illustration of the score line on a pill in the shape of an upward arrow instead of straight across.

Opioid epidemic

Estimated number of U.S. drug overdose deaths

Data: CDC; Chart: Erin Davis/Axios Visuals 

Drugs for treating opioid abuse aren’t reaching most high-risk patients, potentially widening gaps in care as overdose deaths hit record highs.

The big picture: New provisional data show a 15% surge in overdose deaths during the pandemic, rekindling a debate over whether enough Americans in the throes of the addiction crisis have access to potentially life-saving treatments.

Driving the news: Nearly 53% of patients with opioid use disorder were not prescribed buprenorphine, which reduces the risk of future overdoses, according to a new analysis of insurance claims from about 180,000 people.

More than 70% of opioid users who also misuse other substances, such as alcohol or methamphetamine, weren’t prescribed the drug, per the analysis in JAMA Network Open, which was based on data that predated the pandemic.

The analysis also found buprenorphine was better at helping prevent future overdoses than another commonly used addiction treatment, naltrexone.

What they’re saying: “This is equivalent to giving those with advanced cancer a less aggressive treatment,” said co-author Laura Bierut, a professor of psychiatry at Washington University. 

“It seems obvious to many of us that we should be giving the most aggressive and effective treatments to those who are most seriously ill.”

Many doctors remain reluctant to prescribe buprenorphine for use at home without supervision. Some experts say there’s also a lack of data about the drug’s effectiveness in those who misuse multiple substances.

A 2020 VA study of veterans found a lower likelihood of buprenorphine treatment for patients with multiple substance use disorders.

The American Medical Association recommends other strategies, such as making the easy-to-use opioid overdose antidote naloxone available over-the-counter and legalizing the use of strips that test drugs for the synthetic opioid fentanyl, which remain illegal in about half the states.

Where it stands: The National Center for Health Statistics said at least 107,622 people died from overdoses in 2021 -- more than in any other year on record and a major increase from the estimated 93,655 deaths in 2020.

A growing number of deaths involve fentanyl, which is often mixed with other drugs, and the stimulant methamphetamine.

The Biden administration last month sent Congress its first national drug control strategy, which emphasizes addressing untreated addiction through harm reduction strategies and evidence-based treatments and clamping down on drug trafficking.

Harm reduction, which includes steps like expanded access to needle exchanges, has drawn controversy, as well as skepticism from health experts who say it won't make a major dent in overdose deaths. 

The big question: It remains to be seen if the worsening addiction crisis leads to more prescribing of buprenorphine -- or a broader reevaluation of treatment strategies. 

Opioid abuse treatments don't reach those most at risk

Opioid addiction

The Solomon R. Guggenheim Museum has removed the Sackler name from an education center following years-long controversies over the family's role in the opioid crisis.

Why it matters: The Sacklers made billions from the sale of highly addictive opioid painkillers and were embroiled in several litigation battles until March, when they reached a $6 billion settlement with U.S. states.

The Guggenheim's removal of the Sackler name took place quietly last week and was not publicly announced, the New York Times reports.

What they're saying: "The Guggenheim and the Mortimer D. Sackler family have agreed to rename the arts education center," museum spokesperson Sara Fox said Tuesday in a statement.

"We believe this decision is in the best interest of the Museum and the vital work it does."

The big picture: The Guggenheim, based in New York City, is the latest institution to cut ties with the disgraced family.

The National Gallery in London said Monday that it would remove the Sackler name from its walls, according to Forbes.

The Metropolitan Museum of Art dropped the name from one of its most popular galleries as well as six other exhibition spaces in December, per the Times.

Several museums have outright rejected donations from the family.

Guggenheim becomes latest museum to drop Sackler name

More museums are cutting ties with the Sacklers after they were embroiled in litigation over their role in the opioid crisis.

Photo of people milling about several floors of art galleries

Museum-goers look at paintings on Dec. 12, 2021, at the Guggenheim Museum in New York City. Photo: Robert Nickelsberg via Getty Images

After a record economic expansion, the coronavirus pandemic sent the U.S. economy into a recession as unemployment soared to staggering heights. The country now faces urgent questions about how much stimulus is needed for reeling consumers and businesses, and what a recovery might look like.

Economy & Business

Members of the Sackler family who own Purdue Pharma have reached a deal with U.S. states to pay as much as $6 billion in cash to end widespread litigation against the OxyContin maker over its role in the nation's opioid epidemic.

Why it matters: The deal, which was announced on Thursday but still must be approved by a judge, would give states and local governments billions of dollars for treatment programs.

Catch up quick: An earlier settlement, which would have required the Sacklers to pay $4.5 billion, was rejected by a federal judge in December after eight states and Washington, D.C., fought against the deal.

Details: The eight states and D.C. agreed to the new settlement after more cash was given and other terms, including an apology, were accepted, per AP.

In exchange, the Sacklers would be protected from further civil lawsuits.

What they're saying: "The Sackler families are pleased to have reached a settlement with additional states that will allow very substantial additional resources to reach people and communities in need," according to a statement in the court filing.

"While the families have acted lawfully in all respects, they sincerely regret that OxyContin, a prescription medicine that continues to help people suffering from chronic pain, unexpectedly became part of an opioid crisis that has brought grief and loss to far too many families and communities," they added.

Sackler family and states agree to $6B Purdue Pharma settlement

An earlier settlement, which would have required the Sacklers to pay $4.5 billion, was rejected by a judge in December.

Purdue Pharma headquarters in downtown Stamford, April 2, 2019, in Stamford, Conn. Photo: Drew Angerer/Getty Images

Purdue Pharma

President Biden has made the COVID-19 crisis and a post-Trump return to national unity and traditional democratic ideals his top priorities. From vaccinations to stimulus to schools, Biden is seeking bipartisan compromise while showing a willingness to use executive authority and bare Democratic majorities in the U.S. House and Senate to implement his policies. Republican leaders are navigating deep party divisions over if and how to move beyond former President Trump.

Politics & Policy

Johnson & Johnson and the country's three major drug distributors agreed Tuesday to pay $590 million to Native American tribes affected by the opioid crisis, according to a proposed settlement.

Why it matters: It's the largest opioid settlement for Native Americans, the Washington Post notes. 

"American Indians have suffered the highest per capita rate of opioid overdose and are more likely than other group in the United States to die from drug-induced deaths," said Douglas Yankton, chair of the Spirit Lake Nation in North Dakota, in a statement, per AP.

"The dollars that will flow to Tribes under this initial settlement will help fund crucial, on-reservation, culturally appropriate opioid treatment services," Yankton added.

The big picture: More than 400 tribes sued the companies, alleging that they helped fuel abuse of the addictive painkillers, Bloomberg reports.

By the numbers: In Tuesday's settlement, distributors McKesson, Cardinal Health and AmerisourceBergen have agreed to pay $440 million over seven years to tribes that have been disproportionately impacted by the opioid crisis.

Johnson & Johnson will pay $150 million over two years, according to the settlement.

The agreement is in addition to the $75 million settlement AmerisourceBergen, Cardinal Health and McKesson reached with the Cherokee Nation last year to resolve a lawsuit alleging the companies contributed to an opioid crisis in the tribe's territory.

What they're saying: Johnson & Johnson said in a statement that the proposed agreement "is not an admission of any liability or wrongdoing and the Company will continue to defend against any litigation that the final agreement does not resolve," but added that the settlement was "appropriate and responsible."

J&J noted it no longer sold prescription opioids in the U.S.

AmerisourceBergen said the settlement "will both expedite the flow of resources to communities impacted by the crisis while enabling AmerisourceBergen to focus on ensuring the pharmaceutical supply chain is meeting the needs of health care providers and patients," according to AP.

The other distributors could not immediately be reached for comment.

Drug distributors reach major opioid settlement with Native American tribes

It's the largest opioid settlement for Native Americans.

An entry sign to the Johnson & Johnson campus shows their logo in Irvine, California on August 28, 2019

U.S. Customs and Border Protection reported a 1,066% increase in fentanyl seized in south Texas during fiscal year 2021, the agency said this week.

Driving the news: Border patrol officers at eight ports of entry from Brownsville to Del Rio seized 87,652 pounds of narcotics, including marijuana, cocaine and fentanyl with an estimated estimated street value of $786 million.

The agency seized 41,713 pounds of marijuana, 8,592 pounds of cocaine, 33,777 pounds of methamphetamine, 1,215 pounds of heroin and 588 pounds of fentanyl from Oct. 1, 2020 through Sept. 30, 2021.

"Because of its potency and low cost, drug dealers have been mixing fentanyl with other drugs including heroin, methamphetamine, and cocaine, increasing the likelihood of a fatal interaction," according to the Drug Enforcement Administration. 

The big picture: The new figures comes as America's substance use crisis has spiraled over the course of the pandemic, Axios' Caitlin Owens reports. 

An estimated 100,306 people in the United States died from a drug overdose in a 12-month period ending last April, according to provisional data released by the Centers for Disease Control and Prevention in November.

That's the first time drug overdose fatalities reached six figures in a 12-month period and it's roughly a 28% increase over the same period one year earlier, Axios' Jacob Knutson reports. 

What they're saying: "Our significant gains in fentanyl and cocaine seizures underscore the deadly nature of the contraband we encounter, the need to utilize Personal Protective Equipment (PPE) to protect our officers and our continued resolve to carry out our vital border security mission," said Randy J. Howe, director of field operations in the Laredo Field Office. 

Go deeper: America's substance use crisis has spiraled

Border patrol reports 1,066% increase in fentanyl seized in south Texas

Border patrol officers at eight ports of entry from Brownsville to Del Rio seized 87,652 pounds of narcotics.

A man shows his proof of vaccination to a Customs and Border Protection agent atop the Paso Del Norte Port of Entry in downtown El Paso, Texas, on Nov. 8. Photo: Paul Ratje/AFP via Getty Images

Fentanyl

A jury has ruled against opioid manufacturer Teva Pharmaceuticals, finding them liable for public nuisance charges in connection with their distribution of opioids in New York, State Attorney General Letitia James announced Thursday.

Why it matters: The verdict, which followed a six-month trial that came after a lawsuit by the state, found the opioid manufacturer had played a role in fueling the opioid crisis. A subsequent trial will determine how much Teva will be required to pay. 

Teva was the sole defendant left in the lawsuit after the state settled with other drugmakers, including Johnson & Johnson and Allergan, earlier this year. 

James filed the lawsuit in 2019 and was the first of its kind to target the entirety of the opioid supply chain, the New York Times notes. 

What they're saying: "This is a significant day for New York state," James said in a statement. "But, more importantly, this is a significant day for every family and community torn apart by opioids."

"Teva Pharmaceuticals USA and others misled the American people about the true dangers of opioids," she added. 

"While no amount of money will ever compensate for the human suffering, the addiction, or the lives lost due to opioid abuse, we will immediately push to move forward with a trial to determine how much Teva and others will pay."

New York jury finds drugmaker Teva liable in opioid epidemic

Teva was the sole defendant left in the lawsuit after the state settled with other drugmakers.

Photo: Lionel Bonaventure/AFP via Getty Images

Teva

A federal judge’s decision to reject Purdue Pharma’s multibillion-dollar opioid settlement shines a light on a controversial part of bankruptcies that quietly helps grease the wheels for complicated reorganizations.

Catch up fast: At issue are “non-debtor releases” provided to Purdue's owners, the Sackler family.

U.S. District Judge Colleen McMahon said the releases — agreements that shield the family from future litigation — can’t legally be granted by a bankruptcy court. 

Why it matters: If the Supreme Court (where the case may ultimately be headed) decides these releases aren’t allowed, a key part of bankruptcy sausage-making disappears. That means that complex deals involving multitudes of brawling creditors may be even harder to hammer out.

State of play: The Sacklers are contributing $4.5 billion as part of a deal for Purdue to reorganize and emerge from bankruptcy with new owners and a different name. Those billions will go toward resolving existing litigation and to communities fighting opioid abuse — in exchange for the releases.

Releases like these also drew ire in the bankruptcies of Boy Scouts of America and USA Gymnastics — two cases that similarly stemmed from massive legal liabilities the organizations couldn’t afford.

In the bankruptcy world, releases are not uncommon as a way to encourage investors to contribute funds toward the reorganization — but critics say it’s a way for those investors to stamp out their legal liability without filing for bankruptcy themselves, as Reuters reports.

"This, if it stands, will completely upend Chapter 11 practice. It effectively takes non-debtor releases off the table,” Lindsey Simon, an assistant law professor at the University of Georgia's law school, tells Reuters, of McMahon’s ruling.

A group of Democratic Senators also want to all but do away with non-debtor releases: it’s in a bill they proposed earlier this year.

The bottom line: Releases can feel ethically murky, but they're part of the machinery that allows companies to emerge from bankruptcy faster, and prevents the value destruction that years of litigation can cause.

Purdue Pharma's ripple effect on bankruptcies

Critics say releases are way for investors to stamp out their legal liability without filing for bankruptcy.

Bottles of Purdue Pharma OxyContin medication.

Bottles of Purdue Pharma OxyContin medication. Photo: George Frey/Getty Images

Drug company Allergan reached a $200 million settlement with the state of New York for its role in the opioid crisis, State Attorney General Letitia James announced Wednesday.

Why it matters: The settlement comes more than two years after James filed the lawsuit. It bars the company from selling opioids in New York.

Earlier this year, Johnson & Johnson reached a $230 million settlement with the state, agreeing to halt the manufacturing and sale of such drugs in New York. 

As part of the agreement, the company will also have to make information about opioids and opioid products "more accessible to the public," per the release. 

What they're saying: "For more than two decades, opioids have wreaked havoc on New Yorkers and Americans across the nation — causing pain, addiction, and death," James said in a statement.

"Our ongoing trial has been about the role companies like Allergan and its predecessors played in helping grow this epidemic, profiting while Americans suffered," she added.

"While no amount of money will ever make up for the thousands who lost their lives or became addicted to opioids across our state, these funds will be used to prevent future devastation.”

Allergan to pay New York $200 million in opioid settlement

The settlement comes more than two years after Attorney General Letitia James filed the lawsuit.

New York

The three dominant prescription drug distributors — AmerisourceBergen, Cardinal Health and McKesson — and Johnson & Johnson have agreed to pay a combined amount of $26 billion to settle allegations that they fueled the country's opioid crisis.

Why it matters: The companies, which have admitted no wrongdoing, are paying a sum of money that equates to 4% of their combined annual revenue. Meanwhile, a record 70,000 Americans died from opioid overdoses during the pandemic in 2020.

By the numbers: The $26 billion settlement, announced by a group of state attorneys general, varies by company and will be paid out over time.

AmerisourceBergen: $6.4 billion over 18 years

Cardinal Health: $6.4 billion over 18 years

Each of the three drug distributors have already set aside funds in anticipation of a settlement.

The big picture: All states, except for West Virginia, and local governments will now have a chance to sign on to the settlement.

"The substantial majority of the money is to be spent on opioid treatment and prevention," the state AGs said.

What they're saying: "Distributors can easily bear this burden," analysts at stock market firm Baird wrote this week. "We think [Wall] Street is more than ready for substantial resolution, even if not all-encompassing ... We haven't popped the champagne yet, but the bottle is definitely chilling."

Flashback: In 2018, executives at AmerisourceBergen, Cardinal Health and McKesson told Congress they did not think their companies contributed to the opioid crisis.

What to watch: Settlements have still not been finalized with Purdue Pharma, other opioids manufacturers like Teva and pharmacies, although Purdue is working on a settlement through bankruptcy. Native American tribes also are pursuing legal action.

Drug distributors, J&J reach $26 billion opioids settlement

The amount equates to 4% of the companies' combined annual revenue.

An amber drug vial with white painkiller pills falling out.

Four key opioid companies have reached a near-global settlement. Photo: John Moore/Getty Images

Data: Mental Health Treatment and Research Institute; Chart: Axios Visuals

As suicide and overdose rates have increased, mental health and substance abuse insurance coverage has gotten worse, according to a new Milliman report commissioned by the Mental Health Treatment and Research Institute.

Why it matters: Behavioral health treatment often isn't covered by insurance, and it's often unaffordable — including for patients for whom treatment is a matter of life and death.

By the numbers: Coverage of substance abuse treatment was especially bad compared to physical health treatment.

The numbers for residential treatment facilities are particularly rough; in 2017, more than 50% of care in these facilities was out of network.

Behavioral health providers are also paid less than physical health providers. 

Behavioral health providers are paid, on average, less than the Medicare rate, while primary care doctors and physical health specialists make more than the Medicare rate.

These low rates can discourage providers from joining insurance networks.

My thought bubble: If we're going to make a serious attempt to tackle suicide and overdose rates, enforcing the requirement that mental health care be covered the same way physical health care is would be a good place to start.

 Go deeper: Why we're failing to stop teen suicide

Mental health coverage is getting worse

That's happening as opioid overdoses and suicide rates rise.

Health Care

Mental health

Data: National Health and Nutrition Examination Survey; Chart: Andrew Witherspoon/Axios

The health troubles we're seeing now — especially among young people — will continue to strain the system for years and even decades to come.

The big picture: Rising obesity rates now will translate into rising rates of type 2 diabetes and heart disease. The costs of the opioid crisis will continue to mount even after the acute crisis ends. And all of this will strain what’s already the most expensive health care system in the world. 

By the numbers: 18% of American kids are now obese, according to new CDC data. So are roughly 40% of adults. And it's projected to get worse.

That helps explain why diabetes rates are also rising, and why roughly 30% of adults have high blood pressure.

Why it matters: More obese children means there will be more adults down the road with chronic conditions like diabetes — which can’t be cured, only managed — and these diseases in turn increase the risk of further complications, such as kidney disease and stroke.

Diabetes roughly doubles your lifetime health care bills, according to the CDC, and costs the U.S. a total of $245 billion per year.

As the price of insulin continues to skyrocket, the disease only gets harder for patients to manage, if they can afford treatment at all.

We’re only beginning to see the full costs of the opioid crisis, even though it has raged for years.

A White House report earlier this week pegged the cost of the epidemic at a staggering $696 billion last year alone, including the cost of productivity lost to addiction.

The tide has only barely begun to turn on overall overdose deaths — they still numbered around 68,000 last year.

And many survivors of the epidemic will face long-term health costs. Addiction recovery can be a lifelong process requiring sustained investments. It has also led to skyrocketing rates of Hepatitis C — some states have seen their infection rates rise by more than 200% over the past decade.

Groundbreaking new treatments offer the first-ever cure for Hepatitis C, but at price tags so high that states are experimenting with entirely new ways of paying for the drugs, fearing the status quo simply can’t bear these costs all at once.

The bottom line: The flaws in the U.S. health care system compound one another. 

They reward doctors and hospitals for performing more treatment on sick people, and those treatments are expensive. That leaves big gaps in prevention, which drives the need for more expensive treatment.

That's how we ended up with the world's most expensive health care system, but without a particularly healthy population to show for it. And that trajectory isn't changing.

Today's health problems are tomorrow's health crises

Rising obesity rates will strain the most expensive health care system in the world.

Health care costs

Rural America is stuck in a cycle of increasingly vulnerable patients with declining access to health care.

Why it matters: Rural patients often can't afford care, are being hounded by hospitals and collection agencies over their unpaid bills, and are facing the reality of life in communities where the last hospital has closed.

Rural Americans tend to be older, sicker and lower-income than urban Americans. They suffer from higher rates of obesity, mental health issues, diabetes, cancer and opioid addiction, as my colleagues Stef Kight and Juliet Bartz reported.

They're also more likely to be uninsured or covered by Medicare or Medicaid, which pay doctors and hospitals less than private insurance does.

A small and shrinking population, mostly covered by insurance plans that don't pay very much, many of whom need a lot of care, puts more financial pressure on providers, especially hospitals. Physician shortages are common.

What they're saying: “Rural hospitals have long been right there on the edge on average, and we’re seeing more and more of them flip over to red," said Mark Holmes, a professor at UNC-Chapel Hill and director of the Cecil G. Sheps Center for Health Services Research.

And hospital closures often exacerbate the problems communities were already facing. 

Hospitals are often the largest or second-largest employer in a rural community. 

113 rural hospitals have closed since 2010, according to the Sheps Center.

These are disproportionately located in the South — the region with the nation's worst health outcomes, and where most states haven't expanded Medicaid — leaving hospitals with more uninsured patients.

The plight of America's rural health care

That makes rural Americans even more vulnerable.

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