A federal bankruptcy judge gave conditional approval Wednesday to a sweeping settlement that will remove the Sackler family from ownership of OxyContin maker Purdue Pharma and devote potentially $10 billion to fighting the opioid crisis that has killed a half-million Americans over the past two decades.

If it withstands appeals, the deal will resolve a mountain of 3,000 lawsuits from state and local governments, Native American tribes, unions and others that accuse the company of helping to spark the overdose epidemic by aggressively marketing the prescription painkiller.

Under the settlement, the Sacklers will have to get out of the opioid business altogether and contribute $4.5 billion. But they will be shielded from any future lawsuits over opioids.

The drugmaker itself will be reorganized into a new charity-oriented company with a board appointed by public officials and will funnel its profits into government-led efforts to prevent and treat addiction.

Also, the settlement sets up a compensation fund that will pay some victims of drugs an expected $3,500 to $48,000 each.

After an all-day hearing in which he analyzed the plan’s pros and cons for a nonstop 6 1/2 hours, U.S. Bankruptcy Judge Robert Drain said he would approve it as long as two relatively small changes were made. If so, he said, he will formally enter the decision on Thursday.

He said that while he does not have “fondness for the Sacklers or sympathy for them,” collecting money from them through lawsuits instead of a settlement would be complicated.

The deal comes nearly two years after the Stamford, Connecticut-based company filed for bankruptcy under the weight of the lawsuits.

Under the settlement, the Sacklers were not given immunity from criminal charges, though there have been no indications they will face any.

State and local governments came to support the plan overwhelmingly, if grudgingly in many cases. But nine states and others had opposed it, largely because of the protections granted to the family.

The attorneys general of Connecticut, the District of Columbia and Washington state immediately announced they will either appeal the ruling or explore the possibility of doing so.

The Sacklers “should not be allowed to manipulate bankruptcy laws to evade justice and protect their blood money,” Connecticut’s William Tong said.

Some families who lost loved ones to drugs also came out against the settlement, including Ed Bisch, of Westampton, New Jersey, whose 18-year-old son died of an overdose nearly 20 years ago. “The Sacklers are buying their immunity,” he said.

But other families said they did not want to risk losing the money that will go toward treatment and prevention.

“If they gave me a million dollars, would it help bring back my son?” said Lynn Wencus, of Wrentham, Massachusetts. “Let’s help the people who are really struggling with this disease.”

In a statement, members of the Sackler family said: “While we dispute the allegations that have been made about our family, we have embraced this path in order to help combat a serious and complex public health crisis.”

Purdue chairman Steve Miller said the settlement averts “years of value-destructive litigation” and “ensures that billions of dollars will be devoted to helping people and communities who have been hurt by the opioid crisis.”

The bankruptcy judge, based in White Plains, New York, had urged the holdouts to work out an agreement for the same reason.

“Bitterness over the outcome of this case is completely understandable,” Drain said. “But one also has to look at the process and the issues and risks and rewards and alternatives of continued litigation versus the settlement laid out in the plan.”

Some of the opioid deaths over the past two decades have been attributed to OxyContin and other prescription painkillers, but most are from illicit forms of opioids such as heroin and illegally produced fentanyl. Opioid-linked deaths in the U.S. continued at a record pace last year, hitting 70,000.

The crisis devastated the reputation of the Sackler family, major philanthropists whose name was once emblazoned on the walls of museums and universities around the world. With the settlement, family members who have owned the company will still be worth billions.

Whether the deal holds the Sacklers sufficiently accountable was the most contentious question through the proceedings. Those suing succeeded in boosting the amount the Sacklers would pay from a likely $3 billion.

David Sackler, a former Purdue board member, had testified that family members would not accept the agreement unless it protected them from lawsuits. Otherwise, he said, the family would defend itself in litigation that could drag on for years and eat up the company’s and the family’s assets in lawyers’ fees.

His father, Richard Sackler, a former Purdue president and board chairman, said under questioning that he, his family and the company did not bear responsibility for the opioid crisis.

Drain noted that none of the four Sacklers who testified offered an explicit apology. “A forced apology is not really an apology, so we will have to live without one,” he said.

The judge requested two somewhat technical changes to the plan: one clarifying that Sackler family members would be protected only from lawsuits involving opioids, and one on the procedure for bringing non-opioid claims against them.

One projection commissioned by a group of attorneys general found that the family’s wealth could rise from the current estimate of $10.7 billion to more than $14 billion by 2030 despite the required payments. That’s because the family could continue to benefit from investment returns and interest as they make their gradual contributions over a decade under the deal.

Lawyers for Purdue and branches of the Sackler family disputed the assumptions used in the projection.

The settlement also requires members of the Sackler family, who are scattered across the U.S., Britain and elsewhere in Europe, to get out of the opioid business worldwide.

Several attorneys general won another provision that will create a massive public repository of company documents, including ones that normally would be protected by attorney-client privilege.

Purdue has said the settlement overall will be worth about $10 billion, which includes the value of addiction treatment and overdose antidote drugs it is developing.

The bankruptcy case is not the first time Purdue had faced legal trouble over the marketing of its painkillers.

The company pleaded guilty in 2007 to federal charges it misled regulators and others about the addiction dangers of OxyContin and agreed to pay more than $600 million in penalties.

Last November, as part of a settlement with the U.S. Justice Department, Purdue pleaded guilty to conspiring to defraud the United States and violating anti-kickback laws.

Purdue’s bankruptcy has been the highest-profile case in a complicated universe of opioid litigation.

Drugmaker Johnson & Johnson and the three largest U.S. drug distribution companies recently announced a settlement that could be worth up to $26 billion if state and local governments agree.

Individual trials also remain, including one scheduled to start in October in Cleveland over the role pharmacies played in the crisis. Other trials have been held this year in California, New York and West Virginia, though verdicts have yet to be reached.

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LAS VEGAS (AP) — Nevada has struck a $45 million settlement deal with McKinsey & Company for the global consulting firm’s role in advising opioid makers how to sell more prescription painkillers amid a national overdose crisis.

The western state reached the deal after sitting out a multi-state settlement with McKinsey announced in February. The hard bargaining has allowed Nevada to win a settlement that’s three and a half times larger than the average settlement with other states.

“Nevada needed and deserved more than what was being made available to us in the multi-state settlement,” state Attorney General Aaron Ford said Monday. Ford, a Democrat, said that had Nevada stayed in the multi-state deal, it would have received $7 million, which he called “woefully insufficient.”

The $45 million will be paid in two installments of $23 million in 45 days and $22 million in 120 days.

McKinsey said the deal reached with Nevada is “consistent with the commitment we made in February to be part of the solution to the opioid epidemic,” and it “believes its past work was lawful.” The company said the settlement agreement does not contain any admission of wrongdoing or liability.

The New York-based company in February settled for $573 million with 47 states, the District of Columbia and five U.S. territories. It also at the time announced separate settlements with Washington state for $13.5 million and West Virginia for $10 million.

“We deeply regret that we did not adequately acknowledge the tragic consequences of the epidemic unfolding in our communities,” McKinsey Global Managing Partner Kevin Sneader said at the time.

Opioids, which include prescription drugs like OxyContin and illegal substances such as heroin and illicit fentanyl, have been tied to more than 470,000 deaths in the U.S. over the past two decades.

McKinsey’s role came into the spotlight in recent months when OxyContin maker Purdue Pharma LP sought to settle claims against it in bankruptcy court. The Nevada Attorney General’s Office said in legal documents that McKinsey worked with Purdue from 2004 to 2019 to boost sales even as the resulting opioid epidemic emerged.

The consulting firm helped create a plan for Purdue to “turbocharge” sales of OxyContin and other opioids, according to the office, and focused on doctors prescribing high numbers of the drug and encouraged them to prescribe patients more potent doses.

Nevada, with a population of more than 3 million, has been among the hardest-hit states by the crisis. By 2016, it had enough opioid prescriptions for 87 out of 100 residents while overdoses exceeded the national average, according to Ford’s office.

Money from the settlement will be used to address the impacts of the opioid epidemic, Ford said, but the specifics would be hammered out by the governor, state lawmakers and other officials.

The state separately is pursing a wide-ranging lawsuit against Purdue along with the company’s former president, his family, other drugmakers, distributors and pharmacies.

The civil lawsuit accuses more than 40 defendants of violating state laws about deceptive trade practices, false claims, racketeering, negligence and public nuisance. Ford said a trial date has been tentatively scheduled for 2022.

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A bipartisan congressional investigation released Wednesday found that key players in the nation’s opioid industry have spent $65 million since 1997 funding nonprofits that advocate treating pain with medications, a strategy intended to boost the sale of prescription painkillers.

The report from Sens. Chuck Grassley of Iowa and Ron Wyden of Oregon found the contributions continued in recent years, even as the industry’s practices and the toll of opioid addiction came under greater scrutiny.

The senators, the top Republican and Democrat on the Senate Finance Committee, are considering legislation to expand an existing federal system that tracks payments from companies to doctors so it will include payments to nonprofit organizations.

They also want guidelines to require more transparency on the federal task forces and panels that help the U.S. Department of Health and Human Services develop policies.

“We’ve found that the possibility of donor influence could and has undermined the efforts to develop and advocate good policy,” Grassley said in a statement. “When it comes to opioids, we need to make sure there is transparency and accountability to prevent what, in this case, led to serious public misunderstanding of the risks of these highly addictive drugs.”

Opioids include prescription drugs such as OxyContin and Vicodin as well as illegal ones like heroin and illicitly-made fentanyl. They have been linked to 470,000 deaths in the U.S. since 2000. In a 2016 investigation, The Associated Press and Center for Public Integrity found that opioid makers were backing advocacy groups that supported access to the drugs.

For the report released Wednesday, the senators’ staffs examined financial records for 10 advocacy groups that endorsed access to powerful prescription painkillers from 2012 through 2019. The investigation added the new findings to previous Senate investigations that tracked similar information back to 1997.

Wednesday’s report identified a series of connections between the contributions and the work done by the groups.

In 2017, one of the groups, the Alliance for Patient Access, took over the Alliance for Balanced Pain Management, a project previously run by Mallinckrodt. The company, one of the nation’s biggest makers of generic prescription opioids, paid the group $200,000 that year to help support its efforts.

The nonprofit has said that it alone determines the group’s advocacy efforts, which include using physical therapy, chiropractic care and yoga as alternatives to opioids for pain treatment after surgery. It said it would have a response to the Senate report later Wednesday. Mallinckrodt did not immediately respond to questions.

Mallinckrodt this year announced a $1.6 billion settlement of thousands of lawsuits over its opioids and later declared bankruptcy, in part to allow it to pay the settlement over time.

The report also found that the drugmaker Daiichi Sankyo paid the American Chronic Pain Association $75,000 in 2018 as part of the group’s efforts to promote formulations of opioids that were supposed to deter abuse. That type of drug has not been found to be less addictive than other types of opioids, though it is harder to crush or dissolve to get a faster or more powerful high. The American Chronic Pain Association did not immediately respond to a message seeking comment.

A month after the payment, the advocacy group posted a video on its website in which a doctor seems to downplay the addiction risk of that type of drug, saying it’s an “unusual” occurrence. In a statement, company spokeswoman Kimberly Wix described the payment as an unsolicited grant intended to support the nonprofit’s online survey on abuse-deterrent formulations.

“Daiichi Sankyo has no influence over content, communications, activities, etc., developed by third-party organizations to which we provide financial support through grants or charitable contributions,” she said.

Daiichi Sankyo was the fifth-largest contributor to the groups from 2012 to 2019. The top four, all of which gave at least $2 million over that span, were Teva, Pfizer, Insys and Purdue Pharma. Daiichi Sankyo did not immediately respond to messages from the AP.

“The potential dangers presented by opioids makes this Trojan horse-style of marketing particularly troubling,” Wyden said in a statement. “But make no mistake that such practices are widespread across the pharmaceutical industry, and consumers are often left in the dark.”

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