Good morning ~

Three newsworthy items caught our attention this month, prompting us to consider manipulation, accountability, and how they are intertwined.

Let's start with Purdue Pharma.

Due to years of vigorous federal and state criminal and civil litigation, Reuters reported last week that a $7.4 billion Purdue Pharma opioid settlement has won broad support from 55 U.S. states and territories. This will enable Purdue Pharma to resolve a multitude of lawsuits against it and pursue a reorganization plan as part of a Chapter 11 bankruptcy filing, without shielding members of the Sackler family from further litigation. This settlement follows a June 2024 U.S. Supreme Court ruling that rejected an earlier proposal, which would have insulated the Sackler family from being held financially liable for their misdeeds.

It has been a long and torturous road to get to this point, primarily since the CDC reports that over 850,000 people have died from opioid overdoses since 1999 across the country. Of those, 292 Franklin County and North Quabbin residents have died of opioid overdoses between 2012 and 2024. These are staggering numbers, compounded by loss and trauma that will linger in our communities and others for generations.

Former Massachusetts Attorney General and now Massachusetts Governor Maura Healey had a prominent role in pursuing accountability for the thousands of Massachusetts residents who died from opioid overdoses by suing Purdue Pharma in June 2018. Massachusetts was the first state to name company leaders responsible.

According to the October 21, 2020, U.S. Department of Justice press release, "...... Purdue will admit that from May 2007 through at least March 2017, Purdue conspired to defraud the United States by impeding the lawful function of the DEA by representing to the DEA that Purdue maintained an effective anti-diversion program when, in fact, Purdue continued to market its opioid products to more than 100 health care providers whom the company had good reason to believe were diverting opioids and by reporting misleading information to the DEA to boost Purdue’s manufacturing quotas."

In layman's terms, this means that Purdue Pharma knowingly suppressed research about how addictive OxyContin could be and aggressively marketed its sales. They employed tactics such as hosting all-expense-paid conferences at resorts, attended by over 5,000 physicians, pharmacists, and nurses, which touted the non-addictive qualities of their product, when in fact the opposite was true. They created physician prescriber profiles nationwide to influence their prescribing practices. Purdue Pharma also created a "lucrative bonus system" for sales representatives, "resulting in a large number of visits to physicians with high rates of opioid prescriptions." In 2021 alone, $40 million was paid for sales incentives. (Source: Van Zee A. The promotion and marketing of oxycontin: commercial triumph, public health tragedy. Am J Public Health. 2009 Feb;99(2):221-7. doi: 10.2105/AJPH.2007.131714. Epub 2008 Sep 17. PMID: 18799767; PMCID: PMC2622774.)

As a result of these deceptive practices, nearly 145 billion prescription pain bills were prescribed across the nation. According to an investigative piece by The Washington Post, 2,286,511,654 prescription pain pills were distributed in Massachusetts between 2006 and 2019. In that same period, 23,216,510 prescription pain pills were distributed in Franklin County, an average of 23 pills per resident. This was considered average in Massachusetts but above average nationwide.

Time and time again, Purdue Pharma, the Sackler family, and its leaders were complicit in bringing about the deaths of hundreds of thousands of Americans in addition to other manufacturers, distributors, and pharmacies such as Johnson & Johnson/Janssen, Teva, Insys, Endo, Cephalon, Allergan, AmerisourceBergen, Cardinal Health, McKesson, CVS, Express Scripts, Walgreens, and Walmart. (Source: OpenAI. (2025, June 26). Response generated by ChatGPT with web search assistance. ChatGPT. https://chat.openai.com/chat.)

Elected officials, advocates, people with lived or living experience, and family members who lost their loved ones across the country have been persistent in their fight to hold these parties accountable.

As a result of their painstaking efforts, nearly $60 billion (and counting) has been awarded in opioid settlements that will go to each U.S. state and territory to mitigate the harm to communities as a result of these egregious acts. Approximately $1 billion is expected to come to Massachusetts over an 18-year period, with $3.8 million allocated to Franklin County towns. (Note: This figure does not include the towns of Athol, Petersham, Royalston, or Phillipston, located in Worcester County, but are part of the Opioid Task Force's service area.)

The Commonwealth of Massachusetts, along with its 351 cities and towns, has a role in distributing opioid settlement funding according to defined criteria. For more information on how this process works, please refer to these FAQs prepared by the Massachusetts Attorney General's Office or the resource page about opioid settlement funding for Franklin County, created by the Franklin Regional Council of Governments.

One would think 'Big Pharma" would learn from this dark chapter. Sadly, this isn't the case, which brings us to the second topic of note this month - nalmefene, perhaps better known by brand names such as OPVEE or Zurnai.

Interestingly, nalmefene was initially available in 1995 and sold as an injectable under the brand name Revex. The Baxter Corporation discontinued it in 2008 due to "business reasons," as reported by the Associated Press, citing low sales.

Manufactured by Indivior (whose representatives regularly attend many of our Opioid Task Force meetings), OPVEE received FDA approval in 2023 and is marketed to reverse overdoses caused by fentanyl and other forms of synthetic and natural opioids. Unlike the lower dose use of naloxone, also known by its brand name Narcan (sold by Emergent BioSolutions), OPVEE's half-life is 11.4 hours and is designed to remain in the body for an extended period. This effect can trigger prolonged precipitated withdrawal in individuals who have overdosed, leading to significant physical and psychological distress such as vomiting, diarrhea, stomach pain, and body aches. The intense discomfort may also drive renewed drug-seeking behavior as individuals attempt to relieve their symptoms.

Recent research, convenings, and reporting have revealed that lower-dose naloxone (2-4 mg), administered either through injection or nasal spray, improves health outcomes while safely reversing overdoses.

Why is this happening?

Money.

According to an Indivior earnings call transcript, the company is expected to generate an estimated $150 to $200 million per year from OPVEE sales. It is specifically targeting law enforcement, public safety, and other governmental entities, claiming that its product "outperforms Narcan."

Concerns about Indivior's aggressive marketing tactics in Western Massachusetts have caught the attention of local media, where reporting by New England Public Media and Shoestring revealed its efforts to pressure police chiefs and sheriffs to purchase OPVEE. Since every city and town will have access to opioid settlement funding, it is courting municipal officials to first sample its product for free, while encouraging them to use it exclusively based on its research.

However, recent reporting from FilterMag reveals Indivior's research is problematic, finding that a ...." A pre-proof was published in the journal Neuropharmacology on June 6, [2025]. Three of the four authors work for Indivior, and the fourth works for a software simulation company but was paid by Indivior for this study."

This calls into question how Indivior is manipulating the narrative about the efficacy of OPVEE, when a rigorous and peer-reviewed study found "no significant difference in the rates of survival for people who were revived from an overdose using 4 and 8 milligram naloxone spray. The study did show, however, that those who were revived with high-dose naloxone were more than 2.5 times likely to experience withdrawal signs and symptoms."

To further compound this landscape, Purdue Pharma is now in this market, despite its current legal battles. Last year, the FDA approved Zurnia, manufactured by Purdue Pharma, as the "first nalmefene hydrochloride auto-injector for the emergency treatment of known or suspected opioid overdose in adults and pediatric patients 12 years of age and older."

Purdue Pharma claims that "....it plans to sell Zurnai at cost, and that it also doesn’t turn a profit on its existing nalmefene drug, which is used in hospital settings." STAT reported last year that ...“Zurnai can be an important new tool to save lives in critical moments,” Craig Landau, the company’s president, said in a statement. “We are committed to delivering solutions to help address the opioid overdose crisis and are working to provide Zurnai at no profit to the company.” 

The irony is not lost on us that Purdue Pharma, the very entity responsible for fueling our current opioid epidemic, now wants to reverse opioid overdoses and save lives.

This brings us to our third point this month: how commercial interests are co-opting long-standing, evidence-based harm reduction efforts for commercial gain.

Case in point? Consider the reporting by The Washington Post, which revealed that Emergent BioSolutions delayed access to Narcan for over-the-counter (OTC) use for five years. What did they earn from Narcan sales over four years? $1.4 billion. While the WP article states that Emergent BioSolutions has kept OTC costs at $44.99 per dose, other forms of naloxone cost as little as $2.00.

(Illustration by Kat Brooks/The Washington Post; Matt Rourke/AP; Kim Raff for The Washington Post; Stock)

Out of the millions of doses they sold, they donated less than 1% of their production, 28,056 doses in 2021 and 2022, which happened when overdose fatalities dramatically spiked across the nation, fueled in part by the COVID-19 pandemic, which restricted access to existing programs, and increased social isolation due to the lockdowns.

As elected and appointed officials, we are not naive to the uneasy partnership between public health and pharmaceutical companies. We are grateful that nasal naloxone and other medications to treat addiction exist. The broad dissemination of naloxone has proven to save lives, and our data proves it, showing a decline of 62.5% in overdose deaths in 2024 from the previous year.

So why are we talking about this?

For nearly 12 years now, we have had a front row seat to the devastating impact of opioid misuse in our rural community. Losing almost 300 people to overdoses during that period hurts families, workplaces, and communities in countless ways. While we acknowledge the profit motive, we can also speak up and advocate for what is right to save and change lives.

Even in these uncertain times, we know that evidence-based harm reduction strategies are effective. Organizations like Tapestry, Savage Sisters, the Remedy Alliance, and others were among the first to sound the alarm and take bold, lifesaving action to make naloxone more accessible and affordable. In many cases, they acted before it was legal or widely available, helping to save lives when few others could.

We want to continue advocating for efforts to keep naloxone free, or low-cost and available to all our partners, especially law enforcement and other first responders. So, if you are ever contacted by a pharmaceutical sales representative about purchasing any form of naloxone, please do us a favor and contact us first. We have an exceptional medical director and nationally recognized addiction specialist, Dr. Ruth Potee, who can answer any of your questions, allowing us to continue serving our communities with integrity and "do no harm."

We also welcome your ongoing participation and support of our efforts. As you can see below, we will be convening several meetings and trainings this summer and fall. We hope you will join us in our ongoing quest to prevent opioid overdose deaths.

Sincerely,

Register John F. Merrigan

 Northwestern District Attorney David E. Sullivan

Sheriff Lori M. Streeter

 Co-chairs, Opioid Task Force of Franklin County and the North Quabbin Region