U.S. states had until August 21 to decide whether or not to sign on to a proposed $26 billion settlement with the nation’s three largest distributors of opioid drugs and Johnson & Johnson, all of which are accused of fueling the opioid epidemic. Five states have rejected this deal.

Four states—New Mexico, Oklahoma, Washington and West Virginia—have outright rejected the deal with McKesson Corp, AmerisourceBergen Corp and Cardinal Health Inc, and a separate $5 billion agreement with J&J, Reuters reported

New Hampshire rejected the settlement proposal with Johnson & Johnson but did agree to the terms with the three drug distributing giants. 

Additionally, Georgia has not rejected the deal. An email statement issued by Georgia Attorney General Christopher Carr read, "We have not rejected the deal, but we have not joined because at the present time joining the national settlements does not guarantee the best outcome for Georgia and its counties, cities and citizens.” 

The statement continued, "We remain active in representing Georgia throughout negotiations, and we’re going to continue to get input from Georgia stakeholders."

The final settlement amount will ultimately depend upon how many states join, but the proposal, announced on July 21, and its complex compensation formula is based on the expected participation of 44 states. 

According to Reuters, however, the participation of Alabama and Nevada “appeared to be in doubt.” Should these two states not join the settlement, only 42 or 43 would be joined, depending on the participation of Georgia.

Under the settlement, much of the fund would be allocated towards treatment and other services that are needed because of opioid addiction and would resolve more than 3,000 lawsuits filed by counties, municipalities, states, tribal nations and other entities. 

The lawsuits have accused the distributors of ignoring “red flags that pain pills were being diverted into communities for illicit uses and that J&J played down the risks of opioid addiction,” Reuters reported. 

The majority of the lawsuits against opioid distributors and manufacturers have been filed by local governments. An additional master settlement between local governments and defendants is unlikely because settlement money directed to individual states would be allocated towards municipalities within those states. 

Municipalities in participating states have until Jan. 2 of next year to sign on, and more than $10.5 billion of the settlement is “tied to the extent to which localities participate.”