How do you measure an epoch of despair that gripped an American city? In 50 years of ER visits for drug overdoses? In deaths listed as premature? In the cost of drug treatment and prison time? Is that enough? What of parents left bereft and children left without parents? What of the emotional toll on cops and firefighters, doctors and nurses? What scale do we use to weigh all the pain inflicted on generations of Baltimoreans by heroin, cocaine, crack and, in more recent years, fentanyl?
Even as lawyers for the city negotiate large settlements from the drug producers and distributors that caused the opioid epidemic, there are costs impossible to measure, going back decades: The loss of so much human potential, the debilitating effect of drug addiction on families, the abandonment of neighborhoods, the harm to a city’s psyche – the oppressive sense that thousands of our fellow citizens, panhandling for dollars or sleeping in vacant houses, might never reach the community’s mainstream.
And even more incalculable – the cause of all that dysfunction and despair, the enormity of personal problems manifest in a period of drug addiction like we’ve never seen before, in a city that has seen way too much.
The good news this week in Our City of Perpetual Recovery is that Allergan, a pharmaceutical company, will pay a $45 million settlement within 30 days for its role in the most recent horror, the opioid epidemic.
And that’s just the beginning of settlements with other defendants named in a 105-page lawsuit the city had the wisdom to bring six years ago, when Catherine Pugh was mayor. By going its own way and filing suit in state court, the city reaped a much larger settlement than it would have along another path. Had it joined other Maryland jurisdictions in negotiating a so-called global settlement with the manufacturers, the payoff would have been $7 million spread over seven years.
“We had a lot of pressure to basically sell out our residents for the global settlement, and this shows that would have been wrong,” said City Solicitor Ebony Thompson.
Baltimore’s law department, led in 2018 by City Solicitor (and former federal judge) Andre Davis, alleged that Allergan and other manufacturers spent billions to market their products “not for what they really were – dangerous, addictive and potentially deadly narcotic painkillers meant for short-term use — but rather as safe, effective pain relievers that could be taken in perpetuity with little to no risk of addiction.”
In fact, thousands of people suffering various forms of pain took the pills and became addicted to them. Then, if they could no longer get or afford the prescription stuff, they looked for illegal opioids – heroin or pills sold on the street. That spawned thousands of new heroin users, and soon heroin was almost completely replaced by fentanyl.
Thousands of Baltimoreans died from overdoses, part of an epidemic that touched every corner of the nation. And the dying has continued since, despite all efforts to get more naloxone, the opioid overdose reversal medication, in the hands of more citizens.
It must be noted that, before OxyContin and other painkillers reached local pharmacies and streets, Baltimore had been making progress in saving the lives of people addicted to heroin, the illegal drug of choice for as long as I’ve been here, since the mid-1970s.
Consider this point, from a couple of decades ago: While Baltimore frequently led the nation in drug-related emergency room visits, a significant increase in funding for drug treatment contributed to a significant decline in overdoses by the summer of 2001, when Martin O’Malley was mayor. Faced with one of the toughest public health challenges in existence – moving people addicted to drugs into sustainable recovery – a 20% drop in ER visits for overdoses was no small achievement.
But, a month after that positive report, OxyContin started to appear in the city and Baltimore County. It was also showing up in Allegany County and other rural areas of Maryland. Police reported that the potent pain med was being used as a substitute for heroin.
Meanwhile, Purdue Pharma, maker of OxyContin, was well on the way to making billions from it.
While corporate profits grew, so did the number of overdose deaths across the country. The count last year was 107,543, according to the Centers for Disease Control and Prevention. The vast majority of the deaths were from opioids, according to the National Institutes of Health.
Baltimore was particularly hard hit over the years, with millions of doses of the addictive painkillers prescribed in a city with a history of addictions and numerous vulnerabilities.
Davis says data from the Baltimore City Health Department, under former commissioner Leana Wen, and the Baltimore Fire Department, under former Chief Niles Ford, was essential in adding up the cost of the crisis and making the case against Allergan and the other defendants.
The Allergan settlement is impressive, but that company’s sales here represented less than 1% of the market. The sales of other defendants in the city’s lawsuit represent about 80% of the market. The potential settlements could be huge, reaching the hundreds of millions, if not $1 billion or more.
That kind of money could go deep: For more and better treatment for those in recovery, but also for healing those who’ve been traumatized – parents left bereft, children left without parents – through Baltimore’s epoch of despair.
