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

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.

  • J&J: $5 billion over nine years
  • AmerisourceBergen: $6.4 billion over 18 years
  • Cardinal Health: $6.4 billion over 18 years
  • McKesson: $7.9 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.

Go deeper

Updated Sep 30, 2021 - Axios Events

Watch: A conversation on COVID-19 and America’s opioid crisis

On Thursday, September 30, Axios senior editor Sam Baker and health care editor Tina Reed explored how government, private sector and community efforts are responding to upsurges in COVID-19 cases and opioid deaths, featuring Sen. Shelley Moore Capito and Nora Volkow, director of the National Institute on Drug Abuse.

Sen. Shelley Moore Capito highlighted how the COVID-19 crisis detracted attention from the addiction crisis all across the nation, the need to return to in-person crisis intervention teams despite the affordances of telemedicine, and how governments in West Virginia are refocusing efforts and resources on children and families affected by addiction.

  • On an example of localized intervention that helps West Virginia families: “There’s a program in West Virginia that started, it’s called Handle with Care. If a child is in a home and somebody maybe gets busted for drugs in the middle of the night, then that deputy or that sheriff who intervenes is going to call the school the next morning and say ‘Johnny has had a traumatic event in his family, please handle him with care.’”
  • On why the opioid crisis needs more government attention: “The numbers are staggering. The numbers of overdoses have gone way back up in the communities that were starting to see them go down, and so the families affected are going way up. I don’t think it’s going to take much for us to refocus on this simply because not only is it close to home, it’s expanding and it’s not getting better.”

Nora Volkow explained how pandemic stress and social isolation exacerbated addiction and how research is supporting better pain treatments so doctors don’t have to prescribe opiate medications.

  • On the recent significant increase in opioid overdose deaths: “It’s not surprising that in 2020, we’ve seen a 30% increase in the number of people that have died from overdoses from various types of drugs. The main culprits are opioids, of which the main driver is the very potent synthetic drug, fentanyl.”
  • On how current research is helping medical professionals combat this problem: “There are parallel tracks that aim to actually, on the one hand for example, advance research that actually can help us lead to better treatments of pain so that we don’t have to rely on opiate medications, that’s one component to it. And the other one is very much targeted, thoughtful understanding.”

Axios Chief Business Officer Fabricio Drumond hosted a View from the Top segment with Chief External and Government Relations Officer at Partnership to End Addiction

Marcia Lee Taylor, who discussed the role that stigma surrounding addiction plays in someone’s journey to recovery.

  • “Stigma is a giant stumbling block for people being able to get help. Unlike with other health conditions, people don’t talk to their doctor, they don’t talk to their neighbors. There’s a lot of shame about it because we for a long time in our country have treated addiction as a moral failing rather than a public health problem.”

Thank you Facebook for sponsoring this event.

Biden's pick to lead major banking regulator drops out

Saule Omarova, nominee for Comptroller of the Currency, at a confirmation hearing on Nov. 18. Photo: Anna Moneymaker/Getty Images

President Biden's pick to head one of the country's most powerful banking regulators is dropping out of consideration for the post, according to a statement from Biden that accepted the withdrawal.

Why it matters: Saule Omarova, nominated to lead the Office of the Comptroller of the Currency, faced a tough path to confirmation — with opposition from Republicans and moderate Democrats.

Judge temporarily blocks Biden vaccine mandate for federal contractors

Photo: Chip Somodevilla via Getty Images

A federal judge on Tuesday temporarily blocked President Biden's vaccine mandate for federal contractors nationwide.

Why it matters: It's the latest setback in the Biden administration's rollout of COVID-19 vaccine requirements. Federal judges in two states temporarily barred the administration from enforcing mandates for millions of workers last week.