Paul Farrell Jr. was enjoying his extended family’s Sunday ritual of an after-Mass meal at his parents’ house in Huntington, West Virginia, when the challenge that would transform his life and reverberate across the country landed on the breakfast table.
His father was wearing an apron and cooking bacon. His mother dropped onto the table a newspaper story—which would later win a 2017 Pulitzer Prize for Eric Eyre of the Charleston Gazette-Mail—that first made the country aware of an opioid crisis in which nearly 800 million pills were dumped into a state of 1.8 million people.
“We saw it here first—we call it ground zero for a reason,” Farrell said. “It’s claimed the lives of my friends and my friends’ children, my neighbors. You will not find anybody in this community that has not been impacted. We have an epidemic of grandparents raising grandchildren because of a lost generation.”
“This wasn’t a wave, this was a tidal wave of pills into communities.” –Paul Farrell, Jr.
Farrell’s mother wanted to know what he was going to do about it. He pleaded that he was a personal injury lawyer, but she knew he would fight for his hometown. So Farrell, a political science major who graduated from Notre Dame in 1994, combed through his law books until he found a statute—chapter 7-1-3kk—that jumped off the page, giving the county commission the power to eliminate and abate a public nuisance.
“The opioid litigation didn’t start with a lawsuit; it started with an idea,” Farrell said. “If the Exxon Valdez crashed into our shores and spilled oil all over, we would have the power to force Exxon to clean up the oil spill. Well, somebody crashed into our shore and dumped 80 million pills into Huntington, West Virginia. They broke it. Now they need to fix it.”
That idea spread across West Virginia and eventually included all 50 states in settlements with the pharmaceutical companies, distributors, and pharmacies responsible, in all worth more than $50 billion. About 2,000 lawsuits were consolidated into the largest mass tort in the history of the country. Now, more than a million deaths later, the question is how to best use the settlement money to address a crisis that decimated the nation.
Farrell went back to his Notre Dame roots for guidance. He asked economist Bill Evans, a co-founder of the Wilson Sheehan Lab for Economic Opportunities (LEO), to curate the data that tracks every pill from manufacturer to distributor to pharmacy for future academic research to study how opioids overwhelmed the health care system—and how to stop it from happening again.
LEO is also leading the charge to determine which service programs have solid research evidence that they are working to alleviate the crisis. On August 5–6, Notre Dame will host “A Pathway to Hope: Summit on the National Opioids Settlement,” bringing together elected officials, academic researchers, and other federal, state, and nonprofit organization leaders from across the country to discuss and develop evidence-based strategies to most effectively distribute the opioid lawsuit settlement funds.
“What we’re trying to get out of the conference is just a framework, a notion of how you would go about evaluating these programs,” Evans said. “What are the key things that you need to focus on and why you need to evaluate? We need to provide information to other jurisdictions, other organizations, about what works and what doesn’t work because up until now, it’s not working. There’s a hundred thousand people dying a year. It’s just a staggering number.”
Farrell said Notre Dame’s role brings the story full circle because that’s where he first studied the role of the government as a social construct to improve people’s lives.
“Notre Dame attracts those people that want to fight for something,” Farrell said. “It’s in our core, it’s in our structure. Notre Dame gives us the education, the confidence, the networking. It gives us a platform to fight. And so it’s just who I am and it’s who we’ll always be.
“I don’t like bullies. And what Notre Dame taught me was how to stand up to a bully.”
Ground zero
Sara Lindsay, chief program officer for Catholic Charities West Virginia, grew up in Appalachia just across the border in southwest Pennsylvania. Now a Huntington resident, she said West Virginia was a vulnerable target for the pill peddlers because it was already disadvantaged with high rates of poverty and chronic illness, as well as limited access to services and a mountainous geography.
“In West Virginia, it’s really clear and easy to see the link between poverty and opioids and substance use disorder,” she said. “When you have a family who is already so many steps behind because of the impact of poverty, there’s just such a big disadvantage already. So, stress increases and barriers and challenges start to add up. And that chronic stress really lays the groundwork for people searching for some relief from that.”
A few drives around the city center were enough to reveal a woman injecting her arm with a needle near an outpatient clinic and a man passed out with his legs on the train tracks and a gun on his lap. Lindsay described how a domino effect can lead the vulnerable into trouble.
“If a person is injured on a job or has a chronic illness, they’re prescribed painkillers to manage that temporarily, and for good reason,” she said. “But those painkillers are an addictive opioid, and when substance abuse becomes an issue, people are forced to find other ways to survive. Many will switch over to heroin and other drugs that are more accessible.”
Catholic Charities West Virginia is the state’s largest provider of social services. One example is a hospital transition program that evaluates a family’s needs when someone enters the hospital and provides wraparound services to prevent a spiraling family disaster or hospital readmission.
Despite the challenges of the opioid crisis, Lindsay said the region’s culture of resilience makes it an inspiring place to work. “There’s a very community-minded spirit about the people, and it’s really exciting to be a part of that kind of work,” she said.
Fighting back
Farrell said that same community spirit helped him persuade the Cabell County Commission to file the first lawsuit to force the distributors of OxyContin to clean up the public health disaster their pills caused. He said the lawsuit grew as more communities along the lines of the maps showing overdose deaths decided to file similar suits.
“There’s an intersection that happened between prescription opioids and heroin,” he said. “Where that intersection happens is different in different places in different times. Here in this Ohio River Valley, it hit first.”
“They sold 80 million pills of pharmaceutical-grade opium in my hometown of a hundred thousand people and claimed no responsibility for it.” –Paul Farrell, Jr.
Though the community was already feeling the effects, Farrell hadn’t realized the extent of the problem before the Charleston newspaper article. He served a subpoena on the Drug Enforcement Administration to obtain the proof—a massive database called ARCOS, which tracks every single pain pill sold in the United States between 2006 and 2019, tracing the path from manufacturers to distributors to pharmacies in every city and town.
“That was the tipping point of this whole litigation,” Farrell said. “We could see the absolute insanity of the number of opium pills dumped into the communities. There’s a town here in West Virginia of 1,500 people. They were getting 3 million pills a year.
“This wasn’t a wave. This was a tidal wave of pills into communities.”
The ARCOS database is what Farrell asked Evans and Notre Dame to curate for academic purposes going forward “so that we don’t make the same mistakes again,” Farrell said. Notre Dame in February developed the data into a more user-friendly interface that offers customizable queries that help each county and state understand the origins of the opioid crisis.
Federal law requires pharmaceutical distributors to track the data for any patterns that raise red flags, such as a doctor writing more prescriptions than usual or a pharmacy ordering more pills than its population warrants. Either that wasn’t happening before, or the people with authority were making too much money to stop the profit train. Farrell said unmarked delivery trucks were sometimes sent at night to avoid getting hijacked.
“I want someone to take responsibility for it,” he said. “I want the sons of bitches on the record for what they did. Look, they sold 80 million pills of pharmaceutical-grade opium in my hometown of a hundred thousand people and claimed no responsibility for it.”
Abating the crisis
Bill Evans, the Notre Dame economist and LEO co-founder, has done considerable research on substance abuse, from smoking and alcohol use to the violence of the crack epidemic. He considers economics to be about more than just money issues, and the drug crisis is at its core a classic study of supply and demand.
“We have the tools to identify what is really changing here,” Evans said. “The vast majority of evidence seems to suggest that this is really a supply-driven phenomena, that we have doctors that are being more aggressive at prescribing medications. We have pharmaceutical companies that are encouraging doctors to do this. We have people that are gravitating from prescription drugs to illegal drugs because of changes in the formulation of the pills.”
In 2019, the National Bureau of Economic Research issued a paper from Evans that showed efforts to reformulate OxyContin to make it less prone to abuse instead fueled a heroin epidemic that increased the rate of lives lost. Another study that year blamed Purdue Pharma for marketing practices that targeted states with less regulation. A 2023 study concluded that the opioid crisis was responsible for millions of children living apart from their parents.
LEO’s core function is researching whether social service providers are delivering the best solutions for their clients and whether the most effective programs can be replicated elsewhere. Lindsay said Catholic Charities West Virginia has been working with LEO for several years to evaluate the impact of its hospital transition program.
“We’re accustomed to not really having a concrete way of evaluating the work that we do,” Lindsay said. “Most of what we get in terms of feedback is anecdotal, and we do our best to piece that together and make sense of it. But with LEO, we’re generating hard data to demonstrate that what we’re doing is effective.
“Working with LEO has really helped us to evaluate our impact, first of all. But then secondly for disseminating that information, telling that story to other folks in rural areas across the country.”
Lindsay said LEO can play a crucial role in helping social service providers make the most effective use of the billions in settlement money just starting to flow from the opioid cases.
“We feel a real sense of responsibility to the people that we serve, to be ready with some concrete plans for how we would like to see the settlement money be spent, how we can play a role in creating effective change and making good use of those dollars,” she said.
Evans believes the August summit at Notre Dame can help participants find a similar appreciation for evidence-based solutions.
“I hope that the people that are distributing the resources, the people that are receiving the money, are going to have a better appreciation for the importance of evaluation,” he said. “I think the settlement is actually not the solution, but the start of the solution.
“The most staggering statistic about the drug crisis is that between 1999 and today, 1.1 million people have died from drug poisoning. If you look at the history of the United States, 1.1 million US soldiers have died in all armed conflicts starting with the American Revolution.”
“There’s a very community-minded spirit about the people, and it’s really exciting to be a part of that kind of work.” –Sara Lindsay, chief program officer of Catholic Charities West Virginia
Farrell said the deaths are only the beginning of the fallout he’s seen firsthand. His father, a local judge, has struggled to find enough foster families to give homes to the children who lost their parents to incarceration or death. His brother is running for mayor to try to find ways to improve the town’s economy and health care.
“What we are finding is that there is a tail to this dragon,” he said. “How are we going to deal with these children who are struggling with no family support and who have significant educational and developmental delays?”
Evans said these children and their caregivers will be a priority for LEO.
Still fighting
The public nuisance cases filed by Farrell kept growing as the opioid pills and heroin addiction turned into fentanyl overdoses and deaths across the nation. States got on board and threatened to take over the litigation and reach their own settlement through their attorneys general.
Farrell traveled the country fanatically, devoting all his time and resources to the case. He even had to pull out of his law firm and take a second mortgage on his house to keep going. Some of the most successful attorneys in the country joined his legal team.
When class action litigation against the tobacco companies led to a settlement in 1998, the $250 billion awarded to the states was appropriated to a rash of budget needs other than its intended purpose of tobacco cessation and education programs. Farrell did not want to see that mistake happen again. He also wanted the facts on the record.
So Cabell County pulled out of the settlement talks and went to a bench trial. Despite having the same evidence that led to settlements across the country, the judge in 2022 ruled against Cabell County and Huntington.
“There are always obstacles,” Farrell said. “There’s always humbling moments. So for all the success that we’ve had in the opioid litigation, we have one big loss. We won all over the country, and I lost the case from my hometown. And that was a soul-crushing moment for me.”
The devastation of that setback was somewhat consoled by settlements recovering nearly a billion dollars for the state soon thereafter. He also appealed the case and won the right to argue a legal question before the West Virginia Supreme Court in the fall.
“For anybody that knows me, the fight’s not done,” Farrell said. “I’ll never stop fighting for my hometown. We have 55 counties in West Virginia, so I told them they have to beat me 55 times.”
One clear victory was creating guardrails to ensure that—unlike the tobacco settlement—the bulk of the money must go to fixing the ongoing health crisis. Looking back, he described the years-long struggle as belonging to a real social movement.
“When we were able to galvanize the country and change the way medicine is practiced, we changed the way people view opioid addicts,” he said. “We began changing the health care system and then Congress began holding hearings, and we were able to give a voice to all of the people that had been lost.”
He said the two objectives of the opioid litigation were transparency and accountability.
“We’ve brought transparency—we’ve revealed to the country where every pill of opium went,” Farrell said. “We’ve put companies into bankruptcy for selling opium. We’ve brought more responsibility to the industry to better understand the power of opium.
“As for accountability, we’ve brought more than $50 billion worth of abatement proceeds to our communities. So on a macro level, we’ve done some amazing things. Now what’s important is on a micro level, we do the right thing. And that’s why this summit at the University of Notre Dame is so important. We can use the power of LEO to study what’s working, what’s not working, and really make a difference to bring an end to the opioid epidemic.”
