Hundreds of Native American tribes who have suffered disproportionate addiction and death rates during the opioid epidemic agreed to a $590 million interim settlement on Tuesday with Johnson & Johnson and the nation’s three largest drug distributors .

With a deal reached last fall between distributors and the Cherokee Nation for $75 million, the tribes will receive a total of $665 million. Purdue Pharma has already committed at least tens of millions more to the tribes as part of a mediated settlement.

“We are not solving the opioid crisis with this settlement, but we are getting essential resources for tribal communities to help solve the crisis,” said Steven Skikos, one of the tribes top lawyers.

Native Americans have suffered a disproportionate number of opioid-related overdose deaths, by many metrics. In 2016, for example, Oglala Lakota County in South Dakota, home to the Oglala Lakota tribe, had an opioid-related death rate of 21 people per 100,000, more than double the United States average. State. According to one study, pregnant Native American women were up to 8.7 times more likely than pregnant women from other demographic groups to be diagnosed with opioid addiction or abuse.

The outlines of the new settlement, announced in U.S. District Court in Cleveland, seat of the national opioid litigation, are similar to a deal the companies reached with state and local governments last summer.

If, as expected, most tribes sign on, the agreement would be notable for its size as well as its recognition of the 574 federally recognized tribes as a separate litigating entity. Their voices have traditionally been excluded or minimized in previous national agreements involving states, such as the landmark agreement with the big tobacco companies in the 1990s.

About 15% of the total will go to legal and other court costs, but the bulk will be directed to drug treatment and prevention programs, which will be overseen by tribal health care experts.

“My tribe has already pledged to use any product to address the opioid crisis,” said President Aaron Payment of the Sault Ste. Marie Tribe of Chippewa in Michigan, which has 45,000 members. “The impact of the opioid epidemic is pervasive, so the tribes need all the resources we can get to get our tribal communities together again.”

A signature development in this agreement is the timeline, which is much faster than the one tentatively agreed to last summer with states and local governments. Johnson & Johnson will pay the tribes its share of $150 million over two years, once the deal is finalized; the distributors – AmerisourceBergen, Cardinal Health and McKesson – will pay $440 million over six and a half years.

In contrast, the drugmaker will pay thousands of local and state governments $5 billion over nine years, with distributors paying $21 billion over 18 years.

The distributors did not respond to requests for comment or declined to discuss the settlement. Johnson & Johnson said the settlement did not represent an admission of wrongdoing. The company said it would continue to defend itself in other cases.

Although approximately 175 tribes have filed lawsuits against these and other pharmaceutical companies, the rest of the 574 tribes will also benefit. Tribes range in population size from around 400,000 to a handful of people. According to 2018 census data, 6.8 million people identify as American Indian or Alaska Native, or 2.1% of the U.S. population, with just under half living on or near proximity to tribal lands and are likely eligible to receive tribal services such as health care.

The agreement will go forward after an overwhelming majority of the suing tribes have signed it. Then the money will be allocated to all the tribes, whether or not they have filed a complaint.

Lloyd B. Millera senior tribal attorney, said the settlement “provides disproportionate funding relative to states on a per capita basis because the opioid catastrophe has caused disproportionate and disproportionate devastation in tribal communities.”

Geoffrey Strommer, a tribal lawyersaid the tribes were determined that the bitter outcome of the Big Tobacco litigation more than two decades earlier would not be repeated in the opioid litigation.

In the Big Tobacco litigation, a court barred the tribes from suing. And although states have used tribal population and the impact of cigarettes on tribal health in negotiations with tobacco companies, Strommer said states have never set aside money from Big Funds. Tobacco for the tribes themselves.

So whether the tribes would get their own seat at the negotiating table against the drug companies or be left out altogether has been hotly debated, according to several lawyers familiar with the talks.

Judge Dan Aaron Polster, who presides over thousands of merged opioid cases in federal district court in Cleveland, insisted that tribes have an equal right to bring their own cases, regardless of states.