Enlarge / Grace Bisch holds a picture of stepson Eddie Bisch who died as a result of an overdose on outside of the U.S. Supreme Court on December 4, 2023 in Washington, DC. The Supreme Court heard arguments regarding a nationwide settlement with Purdue Pharma, the manufacturer of OxyContin. (credit: Getty | Michael A. McCoy)

In a 5-4 ruling, the US Supreme Court on Thursday rejected an opioid settlement plan worth billions over the deal's stipulation that the billionaire Sackler family would get lifetime immunity from further opioid-related litigation.

While the ruling may offer long-sought schadenfreude over the deeply despised Sackler family, it is a heavy blow to the over 100,000 people affected by opioid epidemic who could have seen compensation from the deal. With the high court's ruling, the settlement talks will have to begin again and the outcome and possible payouts to plaintiffs are uncertain.

Between 1999 and 2019, as nearly 250,000 Americans died from prescription opioid overdoses, members of the Sackler family siphoned approximately $11 billion from the pharmaceutical company they ran, Purdue Pharma, maker of OxyContin, according to the high court's ruling. In 2007, amid the nationwide epidemic of opioid addiction and overdoses, Purdue affiliates pleaded guilty in federal court to falsely branding the highly-addictive OxyContin as less addictive and less abusive than other pain medications. Out of fear of future litigation, the Sacklers began a "milking program," the high court noted, draining Purdue of roughly 75 percent of its assets.

Enlarge / Mifepristone (Mifeprex) and misoprostol, the two drugs used in a medication abortion, are seen at the Women's Reproductive Clinic, which provides legal medication abortion services, in Santa Teresa, New Mexico, on June 17, 2022. (credit: Getty | Robyn Beck)

The US Supreme Court on Thursday struck down a case that threatened to remove or at least restrict access to mifepristone, a pill approved by the Food and Drug Administration for medication abortions and used in miscarriage care. The drug has been used for decades, racking up a remarkably good safety record in that time. It is currently used in the majority of abortions in the US.

The high court found that the anti-abortion medical groups that legally challenged the FDA's decision to approve the drug in 2000 and then ease usage restrictions in 2016 and 2021 simply lacked standing to challenge any of those decisions. That is, the groups failed to demonstrate that they were harmed by the FDA's decision and therefore had no grounds to legally challenge the government agency's actions. The ruling tracks closely with comments and questions the justices raised during oral arguments in March.

"Plaintiffs are pro-life, oppose elective abortion, and have sincere legal, moral, ideological, and policy objections to mifepristone being prescribed and used by others," the Supreme Court noted in its opinion, which included the emphasis on "by others." The court summarized that the groups offered "complicated causation theories to connect FDA’s actions to the plaintiffs’ alleged injuries in fact," and the court found that "none of these theories suffices" to prove harm.