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By Geoff Mulvihill, Associated Press

Drugmaker Teva announced Tuesday that it has agreed to contribute more than $4.3 billion in cash and medications to settle lawsuits in the state and local governments and Native American tribes that claimed the company contributed to the U.S. opioid epidemic.

The deal in principle would rank among the larger ones so far in a yearslong trend of companies settling the complicated lawsuits over the toll from an addiction and overdose epidemic, which has been linked to more than 500,000 deaths in the U.S. over the last two decades.

In their lawsuits, state governments and others claimed the Israel-based company promoted Actiq and Fentora, prescription opioids approved to treat cancer pain, plus generic opioids including oxycodone for use for non-cancer purposes. The states also said the company downplayed the addiction risks and encouraged doctors to continue to increase the doses they prescribed. The states claimed the company and its distributor, Anda, failed to comply with requirements on monitoring and reporting suspicious orders.

The multibillion-dollar settlement is to be paid over 13 years, with most of the money going to fight the opioid epidemic. The settlement includes providing up to $1.2 billion worth of naloxone, a drug that reverses overdoses, at no charge — although states could take a smaller amount of cash instead, if they choose. It also includes the payouts from several settlements the company has recently reached with individual states.

New York is not included in the settlement, although the parties say negotiations with that state are continuing. A jury there last year found the company liable in a trial involving claims from the state government and two counties. The trial will go to a damages phase if a settlement isn’t reached with Teva before then.

Teva said it does not expect to stand trial on any other opioid claims this year, even as cases involving claims against other companies continue to go to court.

“While the agreement will include no admission of wrongdoing, it remains in our best interest to put these cases behind us and continue to focus on the patients we serve every day,” Teva said in a statement.

North Carolina Attorney General Josh Stein, one of the chief negotiators, said the settlement would help address the crisis, which has become more deadly in recent years. “Every week I meet people whose lives have been torn apart by the opioid epidemic,” Stein said in a statement. “Far too many families and friends have experienced painful loss to overdose. But I also meet inspiring people who are living happy lives in recovery — and this agreement will help thousands more North Carolinians get the treatment and support they need to free themselves of addiction.”

For the deal to be finalized, it needs approval from state and local governments and tribes.

“While this agreement is a vital step, we also recognize that this alone will not put an end to the opioid epidemic,” lead lawyers representing local governments said in a statement. “We will continue to work to hold companies up and down the opioid supply chain accountable.”

There have been more than $40 billion worth of proposed and completed settlements over opioid claims in recent years, according to an Associated Press tally.

Earlier this year, drugmaker Johnson & Johnson finalized a $5 billion settlement, and the three national drug distribution firms — AmerisourceBergen, Cardinal Health and McKesson — finalized one worth a total of $21 billion. OxyContin maker Purdue Pharma is trying to persuade a court to let it move ahead with a deal that could include up to $6 billion in cash from members of the Sackler family who own the company. That potential deal would also transform the company into a new entity with profits used to combat the crisis.

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