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Hundreds of Native American tribes that have suffered disproportionately high addiction and death rates during the opioid epidemic agreed on Tuesday to a tentative settlement of $590 million with Johnson & Johnson and the country’s three largest drug distributors.
Together with a deal struck last fall between the distributors and the Cherokee Nation for $75 million, the tribes will be paid a total of $665 million.
Additional money has also been committed to them by Purdue Pharma in a settlement currently in mediation.
“We are not solving the opioid crisis with this settlement, but we are getting critical resources to tribal communities to help address the crisis,” said Steven Skikos, the top lawyer for the tribes.
Tuesday’s settlement, announced in the U.S. District Court in Cleveland, seat of the national opioid litigation, is similar to one struck with the states and local governments last summer.
If, as expected, most tribes sign on, the deal would be notable for its size as well as its acknowledgment of the 574 federally recognized tribes as a distinct litigating entity. Their voices have traditionally been excluded or downplayed in earlier national settlements involving the states, such as Big Tobacco.
Roughly 15 percent of the total will go toward legal fees and costs but the bulk will be directed to addiction treatment and prevention programs, to be overseen by tribal health care experts.
“My tribe has already committed to use any proceeds to confront the opioid crisis,” said Chairman Aaron Payment of the Sault Ste. Marie tribe of Chippewa in Michigan, which has 45,000 members. “The impact of the opioid epidemic is pervasive, such that tribes need all the resources we can secure to make our tribal communities whole once again.”
A signature achievement of this deal is the timetable, which is far more compressed than the one struck last summer with states and local governments. Johnson & Johnson will pay the tribes its $150 million portion over two years; the distributors will pay $440 million over six and a half years.
By contrast, the drug manufacturer will pay thousands of local governments and states $5 billion over nine years, with the distributors — AmerisourceBergen, Cardinal Health and McKesson — paying $21 billion over 18 years.
The distributors did not respond to requests for comment. Johnson & Johnson said that the settlement did not represent an admission of wrongdoing. The company said that it would continue to defend itself in other cases.
Although about 175 tribes filed cases against these and other pharmaceutical industry companies, the rest of the 574 tribes will benefit as well. Tribes range in population size from roughly 400,000 to a mere handful of people. According to 2018 census data, 6.8 million people identify as American Indian or Alaska Native, or 2.1 percent of the American population, of which slightly less than half live on or near tribal lands and are likely eligible to receive tribal services such as health care.
But American Indians and Alaska Natives have endured disproportionately high opioid-related overdose deaths, by many metrics. In 2016, for example, Oglala Lakota County in South Dakota, home to the Oglala Lakota tribe, had an opioid-related death rate of 21 people per 100,000, more than twice the state average. According to one study, pregnant American Indian women were up to 8.7 times more likely than pregnant women from other groups to be diagnosed with opioid dependency or abuse.
Lloyd B. Miller, a lead lawyer for the tribes, said that the settlement “provides outsized funding as compared to the states on a per-capita basis because the opioid disaster caused outsized and disproportionate devastation across tribal communities.”
The agreement will go forward when 95 percent of the litigating tribes by population have formally agreed to it.