Today we interview Aneri Pattani about the Sackler family and its involvement with the opioid crisis. We read about this in September’s book, Empire of Pain by Patrick Radden Keefe. Aneri Pattani is KFF Health News senior correspondent. She reports on a range of public health topics, focusing on mental health and substance use disorders. Her work has received national recognition, including a 2021 award from the Institute for Nonprofit News for reporting on the flawed oversight of addiction treatment facilities in Pennsylvania. She was also part of a team that received the News Leaders Association’s 2021 Batten Medal for Coverage of the Coronavirus Pandemic. Before joining KFF Health News, Aneri wrote for Spotlight PA, a collaborative newsroom investigating Pennsylvania state government. She was a 2019 recipient of the Rosalynn Carter Fellowship for Mental Health Journalism. This interview brings us up to date on the latest developments of what has happened with the Sackler family, Purdue Pharma, and settlement deals. Aneri tells us she became interested in health journalism because, as a young person, she found she enjoyed talking with people and writing about it. The health beat became interesting with her during her internship working with a woman’s health reporter in Texas. She likes how her reporting addresses things that effect people every day. Aneri took a master’s degree in public health in May in order to better understand the systems that impact health Linny and Nancy were both born in Philadelphia. Linny still lives in Pennsylvania. They wanted to hear about Aneri’s reporting through Spotlight PA. Aneri tells us while she was working at the Philadelphia Inquirer, they developed a statewide investigative journalism effort located in Harrisburg, tracking elected and appointed officials. Aneri was there during the start of the COVID-19 pandemic. She’s no longer with Spotlight PA but recently co-wrote an article with on of her former colleagues. Linda notes that PA governor Josh Shapiro is named in our September book as one of the AGs involved in suing Purdue Pharma industry. Aneri said it took AGs a while to understand the impact of opioids after families contacted them. Aneri mostly reported on the legislative, not executive side of policymaking so was not involved in interviewing AGs like Shapiro. Empire of Pain by Patrick Radden Keefe concludes as 2020 is coming to a close. The Committee on Oversight and Reform of the U.S. House of Representatives has held a hearing on “THe Role of Purdue Pharma and the Sackler Family in the Opioid Epidemic.” The book was published in 2021. At that point, the Sacklers have continued to live as fabulously wealthy people who milked the profits of OxyContin through their business Purdue Pharma. And, in fact, they managed to shield themselves from lawsuits via Purdue Pharma's bankruptcy plan that provided the Sackler family, which owned Purdue Pharma, immunity in exchange for paying up to $6 billion for claims related to the company's misleading marketing of OxyContin. Since then the legality of this settlement has been working its way through the courts, culminating with a US Supreme Court decision this summer. Nancy asks Aneri the status of Purdue Pharma, the business. Aneri tells us Purdue Pharma has essentially filed for bankruptcy. The proposal is that it would restructure into a public benefit corporation. The laws have not changed in the marketing or prescribing of opioids, but regulators are become more aggressive in monitoring. Some of the opioid companies have come to settlements that limit their marketing and manufacturing of these drugs, too. Settlement funds from over a dozen companies are going to states for remediation of the impact of the drug, but the actual use of the funds has varied widely with some states directing funds to law enforcement equipment and other items that may have previously be paid for out of government funds. States’ settlement advisory groups vary widely in how they allow the public to comment on or even attend meetings. Of 39 states and DC, 4 councils meet in secret, 10 don’t allow the public to comment. This frustrating for people who have been directly impacted and want to be sure the funds are being used in ways they think will be effective. Purdue Pharma restructured in March 2021 along with a mandate that the Sackler family pay an US$4.2 billion over the next nine years to resolve various civil claims in exchange for immunity from criminal prosecutions. This "legal firewall" was opposed by 24 state attorneys general as well as the attorney general for Washington, D.C. "If the Sacklers are allowed to use bankruptcy to escape the consequences of their actions," said the state AGs who called the proposal legally unprecedented, "it would be a roadmap for other powerful bad actors. Linda asks Aneri what is happening with the Sackler’s bearing any responsibility for the opioid crisis. Aneri tells us that the Sacklers still are not facing much responsibility. As part of the bankruptcy filing, members of the family were mandated to attend a hearing where victims and family members of victims testified on the impact of opioids on their lives. The Sackler name is being removed from institutions. Their profits, however, are intact. They have faced no jail time. In June 2024, the U.S. Supreme Court ruled that the family could not shield themselves from responsibility by claiming immunity with the bankruptcy filing. Now, everyone is back to the negotiating table since their immunity has been removed. Aneri tells us the 5-4 ruling did not fall along party lines or any other expected divides. The justices seemed to be very thoughtful about weighing the justice of financial remuneration for victims against the justice of the family facing responsibility. The ruling also means that there may again be a lot of civil lawsuits filed against the Sacklers since their immunity has been stripped away. Linda notes that OxyContin has created three waves of overdose deaths: In the 1990s it was primarily prescription opioid deaths; in 2010s when Oxy was reformulated, many persons with addictions transitioned to heroin; and beginning in 2013 synthetic opioids such as fentanyl came to dominate. Opioid deaths and addiction continue. In 2021 Aneri investigated the flaws in Pennsylvania’s oversight of addiction treatment facilities and found that the state has allowed providers to continue operating despite repeated violations of state regulations and harm to clients. Aneri and her colleague started hearing stories from families that their loved ones were not getting the care they expected. They found the department responsible for oversight rarely took very strong action against violations. They also found that employees reported falsifying patient records to reflect care that was not delivered. Aneri tells us that this piece was completed in the early 2020s, so she can’t speak to the current situation as to whether PA has improved its oversight. Aneri’s work at KFF Healthnews is the news arm of the foundation. She focuses on mental health and substance use. She has, in the past two years, on the opioid settlement and how governments are using the funds. So far, at least, it has been a mixed bag. Nancy asked Aneri what primary things we should be doing as a country to reduce overdose deaths. Aneri says she will tell us what experts have told her: We need to make our healthcare system easier to access and navigate for patients. There are a lot of arbitrary institutional policies that prevent people from accessing care. Also, people with lived experience should be included in ensuring care is accessible and that funds are being directed effectively.