States are filing lawsuits against opioid makers to try to stem the growing tide of opioid overdose deaths, but experts question if the effort will be any help.
Several states and local governments over recent months have sued opioid makers, claiming that they contributed to the nationwide epidemic through deceptive marketing and playing down the addictive power of the painkillers when pitching them to doctors.
But the move raises several major questions. Chief among them is whether the lawsuits can make a dent in an epidemic that killed 33,000 Americans in 2015.
"Even if the drug companies had to pay a lot of money either because of settlements or damage rewards, I am not sure it is gonna affect their behavior much," said Richard Ausness, associate dean at the University of Kentucky's law school and an expert in liability law.
Ausness pointed out the 2007 federal settlement with Purdue Pharma, the maker of powerful painkiller Oxycontin. The company paid the federal government more than $600 million to settle claims that it misled the public over the addictive power of Oxycontin.
"Did it stop them? No, they kept on doing it because they were making billions of dollars a year from the sale of opioids," Ausness said.
Now Purdue faces lawsuits from Ohio, Oklahoma, Missouri, Mississippi, New Hampshire and South Carolina. Several counties in California and New York as well as Chicago also have sued opioid makers. Cincinnati on Tuesday sued several opioid distributors.
Ausness said governments need to do more than just win money from the companies to change behavior or ease the opioid epidemic.
"Simply extracting money from them is probably not going to help much in dealing with opioid addiction," he said. "In theory, states and cities would spend money on addiction and treatment, but who knows what they would do."
In Oklahoma, the decision on how to spend the proceeds from a settlement or ruling would be made by the legislature with input from the attorney general, said Terri Watkins, a spokeswoman for Attorney General Mike Hunter. He has publicly said he wants the money to go toward treatment and fighting illegal drug trafficking.
Watkins added that another purpose of the lawsuit is to get opioid makers to change their marketing and to "deal with the cost to the state of opioid addictions."
But there is no guarantee that money from any settlements would go toward prevention, based on the 1990s settlement between 46 states and major tobacco makers.
The tobacco industry has paid out roughly $144 billion to the states from 1998 to 2017. Of that $144 billion, only about $500 million went to smoking prevention, according to data from the Campaign for Tobacco-Free Kids.
Some states say the lawsuits are a way to force the industry to change its ways.
"If they're not going to do it voluntarily, we're going to drag them to the table and make them," Ohio Attorney General Mike DeWine told The Washington Post.
Addiction experts say more money needs to be put into treatment options.
The 21st Century Cures Act, signed into law last year by former President Barack Obama, gives states $1 billion in grants for treatment.
"Even with that amount of money being poured into states, it is not enough," said Tom Coderre, senior adviser with the Altarum Institute and former official at the Substance Abuse and Mental Health Services Administration.
Coderre said one of every 10 people has access to treatment. Even if that number rises to three or four of every 10 people, that is "still not going to stem the tide of the epidemic," he said.
More states could join the lawsuit effort in the near future. More than half of the country's attorneys general are investigating the marketing and sales tactics of opioid makers.
But experts are raising doubts as to whether the states can win if the cases go to trial.
"There are a number of arguments that drug companies can make that may or may not be persuasive," he said. "There are a number of intervening bad actors between the drug companies and the cities and states getting stuck with the cost of addiction."
Those "bad actors" include doctors who overprescribe opioids, pharmacies that fill the product and addicts who misuse the drugs, he said.
"Drug companies can say it wasn't our fault and we are not fully responsible," he said.
Ausness said he thinks the governments likely will settle with the drug companies, as they did with the tobacco settlement.
But he cautioned that a settlement could take years. The first state lawsuit against cigarette makers was in 1994, with a master settlement being reached in November 1998.
"This is just trench warfare. Drug companies fight each and every step," Ausness said.