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The COVID-19 pandemic is causing an increase in relapses. Here are signs to look for.
Being aware of this issue is a big first step in helping vulnerable communities (such as those struggling with addiction) combat relapse during this pandemic.
07 May, 2020
Photo by Sasha Freemind on Unsplash
- Many mental health and addiction professionals are worried that the lockdown, quarantine and isolation caused by the COVID-19 pandemic will cause a surge in relapses of individuals who are struggling with sobriety at this time.
- Stress, loneliness, isolation, boredom and a lack of support for the addiction community are the biggest triggers for relapse right now.
- However, being aware of these triggers and supporting those in your life struggling with addiction through the help of online platforms can be a way to combat relapses during the COVID-19 pandemic.
<p>According to the <a href="https://www.samhsa.gov/data/report/2017-nsduh-annual-national-report" target="_blank">National Survey on Drug Use and Health</a>, 19.7 million Americans (aged 12+) struggled with a substance use disorder in 2017 alone. That same year, statistics show 1 in 8 adults struggled with both alcohol and drug-use disorders at the same time.</p><p>Now, in 2020, we're dealing with a <a href="https://bigthink.com/coronavirus/" target="_self">global pandemic</a>, and many health care professionals worry these numbers will rise, as the stress and negative mental health impact of the pandemic could potentially trigger relapses in people who have reached sobriety.</p><ul class="ee-ul"></ul>
COVID-19 and addiction: why are relapses more common during a pandemic?
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzI1NDQ5OS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxOTY2NjE5N30.O8-wjlJ6A0gvC6YmmsR_V-vnL62DrgstTMudYLonNZU/img.jpg?width=980" id="2f3ea" class="rm-shortcode" data-rm-shortcode-id="466760f8bdb0b8bf1ce93ec8c88bddc3" data-rm-shortcode-name="rebelmouse-image" alt="sad woman thinking COVID-19 addiction relapse potential" />Stress, declining mental health, lack of community support and boredom can all trigger relapse - being aware of this can help prevent it.
Photo by Monster e on Shutterstock
<p><strong>Stress and declining mental health can contribute to relapse potential</strong></p><p><a href="https://abcnews.go.com/Health/lot-struggles-recovering-addicts-coronavirus-creates-challenge-stay/story?id=69914643" target="_blank">Dayry Hulkow</a>, the primary therapist at Arete Recovery Center in Pembroke Pines, Florida explains,<em> "We have already seen relapses happening, moments of crisis, obviously a lot of mental health issues associated with the addiction and all the stresses that are going on in the world right now." </em></p> <p>Hulkow, like many other addiction specialists, fears the pandemic will grow the rate of relapse of those struggling with addictions all around the world. </p> <p><strong>Community supports sobriety, isolation triggers relapse</strong></p><p>The idea that community is a large part (maybe the most important part) of maintaining a sober lifestyle <a href="https://bigthink.com/personal-growth/addiction-recovery-community" target="_self">has been proven</a> - and with many areas of the world on lockdown with orders not to attend gatherings or support groups, the fear of relapse is a well-placed one. </p> <p>Licensed mental health counselor <a href="https://www.theguardian.com/world/2020/mar/28/americans-addiction-rrelapse-coronavirus" target="_blank">Denny Kolsch</a> explains the issue with lockdown orders and addiction recovery, <em>"The message we are receiving is to stay away from people. Isolate. Don't be around people - and for people that are in recovery, that's a recipe for disaster."</em></p> <p><strong>Boredom and limited access to the outside world can cause negative feelings that often lead to relapse</strong></p><p><em>"Also, there is boredom," </em>explains Hulkow, <em>"having to stay at home with very limited access to the outside world, hobbies, meetings, and employment can be triggering as well." </em></p> <p>Adding to that being quarantined in close-quarters with family members or friends, there could be family disputes or arguments that are also triggering for people who are recovering from addiction. </p><p>Relapses are common throughout the journey to sobriety from drugs and/or alcohol - in fact, Addiction Center states that up to 60% of individuals struggling with addiction will have at least one relapse before reaching sobriety.<br></p> <p>This is especially more likely during a time where people may be isolated at home, feeling anxious by the news or fearful for their health or the health of their loved ones. </p> <p>Family members and friends of loved ones who struggle with addiction should be particularly mindful during stressful times such as a pandemic, as there may be signs that your loved one is struggling and nearing a relapse. </p> <p><strong>Some signs of relapse during a pandemic can include: </strong></p><ul><li>Change in eating or sleeping habits </li><li>Declining hygiene</li><li>Lying or manipulative behavior</li><li>Glamorizing past drug/alcohol use</li><li>Bottling up emotion and/or mood swings that are unpredictable</li><li>Feelings or messages of hopelessness ("I just don't see a point in…") </li></ul>How to cope with the relapse potential during a pandemic
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMzI1NDY4Ni9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYwMDkyNTc3Mn0.1hN-bJSYnetzNBEDcI54_rHyLmjfg1TOpAOG82FKBz0/img.jpg?width=980" id="00571" class="rm-shortcode" data-rm-shortcode-id="c4c15e764ae974720700900b7f2eee24" data-rm-shortcode-name="rebelmouse-image" alt="concept of online support group AA/NA meeting during COVID-19 pandemic" />Online support groups, AA/NA meetings and virtual coffee dates can be a great way to stay in touch with members of the community and support each other during this stressful time.
Photo by Nadia Snopek on Shutterstock
<p>The COVID-19 pandemic has raised a lot of problems for the general population, and these problems can be amplified and magnified by at-risk populations such as people struggling with addiction.</p><p>The shock of going through a pandemic can cause confusion, loneliness, panic, stress, and fear - all of which can be triggers for relapse. Adding to that being isolated or quarantined in your home (either by yourself or with others) can bring on boredom, irritation, and feelings of inadequacy, again - all of which can be contributing factors to a relapse. </p> <p><strong>How to cope with addiction during quarantine: </strong></p><ul><li>Alternative self-care methods (meditation, reflection, journaling) can help you find a new perspective and stay in tune with your feelings, which makes it much easier to spot (and prevent) a relapse.</li></ul> <ul><li>Maintain contact with your outside supports for sobriety - attend virtual AA/NA meetings, phone hotlines, or keep in regular contact with your sober friends to support each other. An entrepreneur based in New York City has launched an app called <a href="https://loosidapp.com/" target="_blank">Loosid</a>, which is dedicated to providing hotlines and online services to assist those struggling with addiction during this time. As of April 2020, the app has seen over 60,000 users - the app creator, M.J Gottlieb, tells ABC News that there has been a 93.8% increase in active users during the pandemic. </li></ul> <ul><li>Create a routine for yourself to occupy your mind and body, preventing boredom which can cause overthinking and stressful thoughts. </li></ul> <ul><li>Staying active or creating an exercise schedule in your home can provide you with a rush of feel-good hormones (endorphins, dopamine, adrenaline) that can help your body stay healthy during the quarantine. </li></ul> <p><strong>Awareness is key in preventing a relapse and maintaining positive mental health</strong></p><p>While<a href="https://bigthink.com/politics-current-affairs/social-distancing-math" target="_self"> social distancing</a> and lockdown measures have been put into place for very valid reasons, we simply cannot ignore the massive impact this has on our more vulnerable populations (people struggling with homelessness, addictions, and mental health conditions). The best way to support each other during this difficult time is to use online platforms to stay in contact and reconnect, keeping in mind that this is a very difficult time for some people. </p> <p>Being aware that the loved one in your life who has struggled with addiction in the past may relapse could be key to helping them stay sober. </p>
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#6: How psychedelics work: Fire the conductor, let the orchestra play | Top 10 2019
Next up on the top 10 countdown, Big Think's sixth most popular video illustrates the mental fireworks of a psychedelic experience.
27 December, 2019
- Big Think's #6 most popular video of 2019 explains the ego's "location" in the brain: It would be the default mode network, where much of your self-critical mind chatter happens. Taking psychedelics down-regulates this brain network.
- Researchers describe the effect of psychedelics as "letting the brain off its leash", or firing the conductor to let the orchestra play. Without the default mode network acting as a dictator, areas of the brain that don't normally interact meet, producing phenomena like hallucinations and synesthesia.
- An overactive ego may be what punishes those of us plagued with anxiety, addiction and mental health disorders. Psychedelics can have a beneficial effect by temporarily killing the ego, jogging the brain out of negative thinking patterns.
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<strong>How to Change Your Mind: What the New Science of Psychedelics Teaches Us About Consciousness, Dying, Addiction, Depression, and Transcendence</strong></p>
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Sexually transmitted disease rates are booming
A harrowing new report by the CDC should serve as a wake-up call.
18 October, 2019
Image source: MinDof/Shutterstock
- STD rates have risen every year since 2013, with 2017 showing the largest increase.
- Syphilis passed from mothers to babies is causing easily preventable infant deaths.
- STDs are easy to cure so far — the key is getting regularly tested.
<p>Every year from 2013 through 2017 the number of STD (sexually transmitted diseases) has gone up. 2017 was the worst of all, with 200,000 more cases than the previous year, according to new information <a href="https://www.cdc.gov/nchhstp/newsroom/2019/2018-std-surveillance-report-press-release.html" target="_blank">published by the CDC</a>. (2018 data has not yet been analyzed.) All three of the major STDs — gonorrhea, chlamydia, and syphilis — have experienced significant increases in the number of case reported.</p><p>While STDs and the more broadly defined STIs (sexually transmitted infections may not produce symptoms) are often considered little more than a distasteful inconvenience, untreated they can lead to serious health consequences. Perhaps the most tragic increase in recent years is a 22% increase in infant deaths from congenital syphilis that can be unknowingly passed to newborns from mothers unaware of their own infections.</p><p><a href="https://www.cdc.gov/nchhstp/newsroom/2018/press-release-2018-std-prevention-conference.html" target="_blank">According</a> to Jonathan Mermin of the CDC, "We are sliding backward. It is evident the systems that identify, treat, and ultimately prevent STDs are strained to near-breaking point." What is going on?</p>
Gonorrhea, chlamydia, and syphilis
<p>The statistics are sobering in the period from 2017 to 2018 alone. The CDC reports:</p> <ul> <li>Gonorrhea cases have increased 5%, to more than 580,000 cases. This is the highest number of infections reported since 1991.</li> <li>Chlamydia has set a new record, more than 1.7 million cases, an increase of 3% throughout 2017.</li> <li>There were 115,000 cases of syphilis. The STD is most infectious during its primary and secondary stages, and these increased by 14% to 35,000 cases. During 2017, syphilis in newborns rose to 1,300 cases, an increase of 40%. Underscoring its source is that syphilis among women of child-bearing age went up by almost an identical amount, 36%.</li> </ul> <p>Gonorrhea, chlamydia, and syphilis, the most common sexually transmitted infections, can be cured with antibiotics (for now). Left untreated, the STDs can lead to transmission to other people, as well as "adverse health outcomes such as infertility, ectopic pregnancy, and increased HIV risk," says the CDC.</p><p>And of course, there's the congenital syphilis killing babies. Most states in the U.S. have reported cases, though 70% of them are concentrated in just five states: Texas, California, Florida, Arizona, and Louisiana.</p><p>The heartbreaking loss of newborn life is easily avoidable. Gail Bolan of the CDC says, "There are tools available to prevent every case of congenital syphilis. Testing is simple and can help women to protect their babies from syphilis — a preventable disease that can have irreversible consequences."</p><p>It's for this reason the CDC recommends that all women get tested the first time they visit their healthcare provider upon becoming pregnant, and — if they live in high-risk areas — they should get tested a second time at the start of their third trimester and again before delivery. This advice applies even to expectant mothers who aren't currently sexually active. In addition to being transmissible through genital, oral, and anal sex, there are <a href="https://www.hivplusmag.com/wellness/2016/8/24/yes-you-can-get-sexually-transmitted-infection-without-having-sex" target="_blank">plenty of other ways</a> to quietly pick up an STD infection.</p><p>There's good reason not to put off getting an STD and STI checkup. Gonorrhea is one of the worrying bacteria becoming <a href="https://www.cdc.gov/nchhstp/newsroom/2018/press-release-2018-std-prevention-conference.html" target="_blank">increasingly resistant</a> to antibiotics, according to both the <a href="https://www.cdc.gov/std/stats18/figures/31.htm" target="_blank">CDC</a> and the <a href="https://www.popsci.com/antibiotic-resistant-gonorrhea-getting-worse/" target="_blank">World Health Organization</a>, who report that it currently afflicts about 78 million people worldwide each year. According to the WHO's Teodora Wi, "The bacteria that cause gonorrhea are particularly smart. Every time we use a new class of antibiotics to treat the infection, the bacteria evolve to resist them."</p><a href="https://www.cdc.gov/nchhstp/newsroom/images/2018/std/std-infographic-complete.jpg" ><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjAxMzk3OC9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYxMzEzNDg5MH0.e5FKQAsj1dQ4ePvc5IovpMG9ve4-Nf21WlhhIOwcNsI/img.jpg?width=980" id="0d4d9" class="rm-shortcode" data-rm-shortcode-id="99b196c36f8ccca00d3eab59e589eed6" data-rm-shortcode-name="rebelmouse-image" /></a>Image source: CDC
Why are STD rates on the rise
<p>The CDC cites three likely reasons:</p> <ul> <li><em>Drug use, poverty, stigma, and unstable housing, which can reduce access to STD prevention and care</em></li> <li><em>Decreased condom use among vulnerable groups, including young people and gay and bisexual men</em></li> <li><em>Cuts to STD programs at the state and local level — in recent years, more than half of local programs have experienced budget cuts, resulting in clinic closures, reduced screening, staff loss, and reduced patient follow-up and linkage to care services</em></li> </ul> <p>The subtext of the CDC's third bullet point about local programs being cut is that there's a compelling statistical <a href="https://www.cdc.gov/mmwr/volumes/68/wr/mm6806a4.htm?s_cid=mm6806a4_w" target="_blank">intersection</a> between the increase in drug use — particularly meth — and heterosexual syphilis. The CDC proposes new collaborations between STD control programs and substance-use disorder services providers — not cutting back such programs as seen recently.</p><p>Finally, the stigma attached to having an STD or STI is real, and many would simply prefer to assume they don't have one. This is despite the <a href="http://www.ashasexualhealth.org/stdsstis/statistics/" target="_blank">estimate</a> that among sexually active people, some 80% will have an STI (with STDs being a subset of these) at some point in their lives. Since many of these infections, especially STIs, present no symptoms, it's easy to opt out of testing.</p><p>This is obviously a bad idea. It's much smarter to get tested regularly and, if necessary, treated. Encourage your partners and friends to get tested — without making fun — and be forthcoming and honest if you have an infection. Use condoms religiously, and when your healthcare provider inquires about your activities, be honest.</p><img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMjAxMzk4MS9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTY0NjE1Nzk2Nn0.aNO_juWC7eiHw9FeIbDm9FzpbeZFuGlFCoZfMXQSD4s/img.jpg?width=980" id="0e1c1" class="rm-shortcode" data-rm-shortcode-id="040584d269d8e02c06c28877e222311d" data-rm-shortcode-name="rebelmouse-image" />Image source: celiafoto/Shutterstock
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Imprisonment: Doctor who illegally prescribed 500,000 doses of opioids to serve 40 years
Dr. Joel Smithers was recently sentenced to decades in prison for the numerous illegal prescriptions he gave out.
07 October, 2019
Image source: Southwest Virginia Regional Jail Authority/photofunny.net
- According to law enforcement officials, every individual who visited Smithers' practice in Martinsville, Virginia, was given an opioid prescription.
- Patients traveled hundreds of miles to visit his practice, where Smithers only accepted cash or credit cards and not insurance.
- Smithers and similar doctors represent one part of the chain of responsible parties who contributed to the opioid epidemic.
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<p>Dr. Joel Smithers was recently sentenced to 40 years in prison for illegally prescribing more than <a href="https://www.nytimes.com/2019/10/02/us/opioids-doctor-sentenced-joel-smithers.html" target="_blank">500,000 doses</a> of opioids over the course of two years. According to law enforcement officials, every patient who visited Smithers' practice in Martinsville, Virginia, left with an opioid prescription.</p><p>Martinsville stands out amidst the opioid epidemic. This town, whose population is only a little more than 13,000, has issued opioid prescriptions at a rate <a href="https://www.statnews.com/2017/07/07/opioids-per-person-national-leader/" target="_blank">six times</a> the national average, placing it among the highest in the nation.</p><p>Some patients would travel hundreds of miles to visit Smithers in order to acquire opioids from his practice. According to court documents, Smithers said that there were "a few patients from Virginia, but most of them, through word of mouth, would come from Kentucky and West Virginia. Those were the main two places."</p><p>One man who testified during Smithers' trial said he would drive between eight and 10 hours from Kentucky to Martinsville to get oxycodone and hydrocodone after a local doctor refused to prescribe him. "There wasn't — there wasn't no doctors in my area like that to see," <a href="https://www.npr.org/2019/10/02/766403612/doctor-gets-40-years-for-illegally-prescribing-more-than-half-a-million-opioid-d" target="_blank">said</a> the man. </p><p>Notably, Smithers did not accept insurance, and instead collected, in all, more than $700,000 in cash and credit card payments.</p><p>"This defendant not only violated his Hippocratic Oath to his patients, but he perpetuated, on a massive scale, the vicious cycle of addiction, despair, and destruction," said attorney Thomas Cullen in a <a href="https://www.justice.gov/usao-wdva/pr/virginia-doctor-convicted-861-federal-counts-drug-distribution-including-distribution" target="_blank">statement</a>. "We have no higher priority than investigating drug-dealing physicians and other corrupt health-care practitioners and putting them in federal prison." </p><p>Some estimates have put the number of Americans addicted to opioids at between <a href="https://www.nytimes.com/2019/10/02/us/opioids-doctor-sentenced-joel-smithers.html" target="_blank">five and 10 million</a>, though the official government estimate is 2.5 million. As a result of this epidemic, more than 300,000 Americans have died. Researchers at the CDC have discovered that the lethality of the opioid epidemic has even reversed Americans' typically upward-trending <a href="https://bigthink.com/politics-current-affairs/opioid-epidemic-life-expectancy" target="_self">life expectancy</a>. The last time that life expectancy dipped this significantly? World War I. </p>
<img type="lazy-image" data-runner-src="https://assets.rebelmouse.io/eyJhbGciOiJIUzI1NiIsInR5cCI6IkpXVCJ9.eyJpbWFnZSI6Imh0dHBzOi8vYXNzZXRzLnJibC5tcy8yMTM5ODM1Ny9vcmlnaW4uanBnIiwiZXhwaXJlc19hdCI6MTYzMjA3ODA0NH0.bLprYUwIFLisyf6kmem-CioYUnHWdJ0ZlDGqAnvLgFE/img.jpg?width=1245&coordinates=209%2C394%2C29%2C502&height=700" id="65c8b" class="rm-shortcode" data-rm-shortcode-id="fdf2c519cb34d163ab46ffd89b7f89a8" data-rm-shortcode-name="rebelmouse-image" />
<div><br></div>Naloxone, a drug that reverses opioid overdoses.
Photo credit: Bernard Weil / Toronto Star via Getty Images
<p>We typically conceive of opioid addicts as buying illegal drugs such as heroin from a dealer in an alley, but the reality is that most addicts are getting their vice through legal channels, such as was the case with Smithers. According to a <a href="https://www.psychiatrictimes.com/substance-use-disorder/opioid-epidemic-who-blame" target="_blank">report</a> by the Substance Abuse and Mental Health Services Administration, less than 5 percent of users get their opioids from a drug dealer, while nearly a quarter got their opioids from a single doctor.</p><p>While the opioid epidemic would not be possible without the contribution of unethical doctors, the role of pharmaceutical companies cannot be ignored either. Purdue Pharma, for instance, spent years misleading doctors on the dangers of their flagship product, OxyContin. Richard Sackler, then-president of the company, <a href="https://www.nytimes.com/2019/01/15/health/sacklers-purdue-oxycontin-opioids.html" target="_blank">wrote</a> in a 2001 email that, "We have to hammer on abusers in every way possible." Doing so would shift the blame from pharmaceutical companies' unethical behavior to drug user's moral failings. "They are the culprits of the problem," wrote Sackler. "They are reckless criminals." </p><p>After being sued for more than $10 billion in damages, Purdue Pharma recently filed for <a href="https://www.reuters.com/article/us-purduepharma-bankruptcy/purdue-pharma-seeks-to-halt-opioid-suits-against-company-sacklers-idUSKBN1W334C" target="_blank">bankruptcy</a>.</p><p>Purdue Pharma is far from the only pharmaceutical company that played a role in the opioid epidemic. <a href="https://www.nytimes.com/2019/10/01/health/opioids-settlement-johnson.html?module=inline" target="_blank">Johnson & Johnson</a> recently became the fifth pharmaceutical company to settle in order to avoid going to trial over their part in the opioid crisis, agreeing to pay $20.4 million.</p><p>Pharma representatives' jobs are to convince doctors to prescribe their products, and while this can take the form of disinformation, often pharmaceutical companies convince doctors through speaking opportunities, conferences, trips, and free meals. One often-cited study found a significant correlation between pharmaceutical spending of this kind and how frequently doctors prescribed opioids. Specifically, taking doctors out for meals was the <a href="https://www.wired.com/story/pharma-spending-on-doctors-is-correlated-with-opioid-deaths/" target="_blank">biggest predictor</a> of whether that doctor would write more opioid prescriptions. </p><p>Regulating such behavior and revising drug policy has become a focus in the 2020 election as well. The <a href="https://bigthink.com/politics-current-affairs/presidential-candidates-opioid-plans" target="_self">candidates' strategies</a> for handling the opioid epidemic vary significantly, but for the most part, they target much-needed changes to drug treatment policy, such as increasing the availability of naloxone, which reverses opioid overdoses; prioritizing treatment over incarceration for addicts; regulating when doctors can prescribe painkillers; and other policy changes.</p><p>There are a lot of parties that bear responsibility in developing the opioid crisis, including doctors like Smithers. Fortunately, there is reason to be optimistic. Provisional data from the CDC shows that the reported number of opioid deaths from 2018 to 2019 have decreased by <a href="https://www.cdc.gov/nchs/nvss/vsrr/drug-overdose-data.htm" target="_blank">3.9 percent</a>. While it's a small figure, hopefully it's the beginning of a long-term reversal in the opioid epidemic.</p>
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Purdue Pharma, maker of OxyContin, files for bankruptcy
Some critics say the move is designed to shield those who profited from the dangerous drug.
17 September, 2019
Erik McGregor/Getty
- Purdue Pharma is facing thousands of lawsuits that allege the decades-old drug company misleadingly marketed the opioid OxyContin.
- On Sunday, Purdue filed for bankruptcy after reaching a tentative settlement deal with some of the parties suing the company.
- The deal, which some plaintiffs have already rejected, calls for a potential payout of up to $12 billion and for the company to restructure itself.
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<p>Purdue Pharma LP — the company that makes the controversial painkiller OxyContin — has f<a href="https://www.wsj.com/articles/oxycontin-maker-purdue-pharma-files-for-bankruptcy-protection-11568604141" target="_blank" rel="noopener noreferrer">iled for bankruptcy protection</a>, a move that temporarily halts thousands of lawsuits against the drug company from more than 2,600 cities, counties, and other parties. Those plaintiffs have accused Purdue of misleadingly marketing OxyContin as it fueled the American opioid crisis, which has killed more than <a href="https://bigthink.com/politics-current-affairs/opioid-company-criminal" target="_blank" rel="noopener noreferrer">400,000 people over the past two decades</a>. </p><p>Days before the bankruptcy filing, Purdue reached a tentative settlement deal with some of the parties suing the company. That deal could pay out up to $10 to $12 billion over the following years, and it also calls for Purdue to restructure itself into something called a public benefit trust, in which profits earned from OxyContin and other drugs would go toward plaintiffs' claims and the development of medicines to fight drug addiction. </p><p>"This unique framework for a comprehensive resolution will dedicate all of the assets and resources of Purdue for the benefit of the American public," Steve Miller, chairman of Purdue's board of directors, said in a statement. "This settlement framework avoids wasting hundreds of millions of dollars and years on protracted litigation, and instead will provide billions of dollars and critical resources to communities across the country trying to cope with the opioid crisis."</p><p>The deal also requires the Sackler family, Purdue's owners and one of the wealthiest families in the U.S., to pay plaintiffs $3 billion over seven years and to give up control of the company. Twenty-four states and some 2,000 local governments have agreed to the deal so far.</p><p>But other states, including New York, Massachusetts, and Washington, D.C., have rejected the deal, arguing that Purdue is unjustly avoiding liability and that the settlement won't actually pay out $12 billion over time. </p><p>In an op-ed for <a href="https://beta.washingtonpost.com/opinions/why-im-rejecting-the-purdue-pharma-settlement/2019/09/16/1f86e94c-d8b5-11e9-ac63-3016711543fe_story.html" target="_blank">The Washington Post</a>, Maura Healey, attorney general of Massachusetts, echoed these reasons for rejecting the deal, which she characterized as a "ploy that's offensive to families who have lost loved ones to this epidemic."</p><p>"I rejected the settlement because it doesn't tell the truth about what happened," she wrote. "Families deserve to know what Purdue and its executives and directors knew, and what they did. The evidence — their emails, business plans, board minutes, all of it — should be put on the Internet for all to see. Purdue and the Sacklers have fought for years to keep the facts secret. Under their proposal, the story could stay hidden forever.</p><p>I also turned down their proposal because neither the company nor its leadership admit they did anything wrong. That's not accountability."</p><p>Miller suggested <a href="https://www.apnews.com/c2780653e7934908856bfbf00eafddf1" target="_blank">there's no alternative</a>, and said the company doesn't plan to admit wrongdoing.<br></p><p>"The alternative is to not settle but instead to resume the litigation," he <a href="https://www.apnews.com/c2780653e7934908856bfbf00eafddf1" target="_blank">said</a> on a call with reporters. "The resumption of litigation would rapidly diminish all the resources of the company and would be lose-lose-lose all the way around. Whatever people might wish for is not on the table now."</p><p>But Healey and others suggest there is something on the table: the Sackler family's personal wealth.</p><p>"Purdue's bankruptcy filing is the company's latest tactic to protect the Sackler fortune," she wrote in her op-ed. "It won't work. Our case against the company and the Sacklers will end, but not this week and not on their terms. We started this fight, and we will end it with accountability and justice."</p>
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