Legal Action Center

Ordinary unrestricted gift across legal, policy, other programs and shared support. annual recipient spending uses Form990 expenses excluding donated services; full economic resource use additionally includes pro bono services and clinical/public implementation costs. An unrestricted gift is not assumed restricted to MOUD litigation.

Count residents of the 50 states plus DC. Individual New York clients and the North Carolina case lie inside this boundary. National insurance and policy work may extend to territories; no resident-weighted marginal share was found. A 100% USA share applies only to explicitly identified in-boundary clients, not automatically to the full portfolio.

At full annual recipient cost C=8981593: Ydirect=S*o*v*u*t*b; Ypolicy=K*dp*N*up*tp*b; L=sum(y=1..T) U*((1-m)/1.03)^y; Qall=(Ydirect+Ypolicy)*d*L; QUSA=Qall*g. Direct and prospective policy recipients are disjoint. b funding responsiveness appears once. dp is net LAC contribution versus other counsel, so no extra coalition multiplier. Retained treatment exposure at most one year; post-averted-death survival finite, no extra lifetime term.

Illustrative gift G

100000 USD (judgment). Scale for a transparent hurdle calculation, not a minimum gift or a restricted opportunity.

FY2025 recipient990 spending

8981593 USD/year (observed). Year endedMarch31,2025; excludes donated services recognized in audited statements. [lac-99025]

FY2025 legal-service spending and clients

[2710399,869] USD/year; clients/year (observed). Matched fiscal-year average supports a workload denominator, not causal outcomes or marginal capacity. [lac-99025]

Fiscal-year clients with SUD legal issues

37 clients/year (observed). Not equivalent to OUD patients, MOUD cases or restored treatment; broader policy work can affect other people. [lac-99025]

Observed mortality difference during versus out of treatment

[0.0052,0.0248] deaths/person-year (observed). Arithmetic differences in Sordo's pooled crude rates:9.5−4.3 and36.1−11.3 per1000person-years; observational and heterogeneous, not causal bounds. [moud-sordo]

Conditional additional mortality reduction d

[0.005,0.02] deaths/net retained treatment-year (judgment). Tempered clinical sensitivity range informed by cohort differences. Baseline risk, fentanyl exposure, induction risk and confounding can move true effects outside it. [moud-sordo] [moud-larochelle] [moud-jones]

Discounted remaining QALYs per prevented death L

[5,15] QALYs/death (judgment). Illustrative survival/utility envelope, not full remaining life expectancy. Depends on age, comorbidities, later relapse and mortality; no patient-level LAC estimate.

Historical clinical delivery benchmark

[5980,6552] USD/treatment-year in2018 report (observed). NIDA cites preliminary Department of Defense estimates; source price base not updated. Illustrates external resource requirements, not LAC cost or a current price. [nida-treatmentcost]

S

37 reported annual SUD-issue legal clients (observed). Observed37clients retained from accepted original return; not all MOUD cases. [lac-99025]

o

0.5 see formula and rationale (judgment). Half of SUD legal clients judged to concern a treatment-relevant OUD access barrier; not measured. [lac-settlement] [moud-sordo]

v

0.5 see formula and rationale (judgment). Half those cases judged to improve access beyond other counsel or enforcement; not observed win rate. [lac-settlement] [moud-sordo]

u

0.75 see formula and rationale (judgment). Three-quarters of newly eligible direct clients judged to take up effective medication. [lac-settlement] [moud-sordo]

t

0.5 see formula and rationale (judgment). Half a year of additional retained treatment, not lifetime adherence. [lac-settlement] [moud-sordo]

b

0.5 see formula and rationale (judgment). Half of proportional legal/policy capacity judged responsive to unrestricted funding, allowing reserves and replacement. [lac-settlement] [moud-sordo]

K

4 see formula and rationale (judgment). Four prospective targeted implementation opportunities at the annual full-recipient scale: an order-of-magnitude planning prior, not four observed unfunded lawsuits. [lac-settlement] [moud-sordo]

dp

0.15 see formula and rationale (judgment). 15percentage-point implementation probability change due to LAC contribution after other counsel; not case success probability. [lac-settlement] [moud-sordo]

N

100 see formula and rationale (judgment). 100eligible people per prospective targeted policy opportunity, not nationwide statutory coverage. [lac-settlement] [moud-sordo]

up

0.4 see formula and rationale (judgment). 40percent additional medication uptake among eligible policy recipients; alternatives already incorporated. [lac-settlement] [moud-sordo]

tp

0.5 see formula and rationale (judgment). Half a year of retained additional policy-induced treatment; no future recurring cohorts. [lac-settlement] [moud-sordo]

d

0.01 see formula and rationale (judgment). One percentage point annual mortality reduction, below some observed cohort contrasts and within prior tempered clinical range; observational confounding remains. [lac-settlement] [moud-sordo]

U

0.75 see formula and rationale (judgment). Post-rescue utility .75, not full health. [lac-settlement] [moud-sordo]

m

0.05 see formula and rationale (judgment). 5percent annual competing mortality after the prevented near-term death; no indefinite survival. [lac-settlement] [moud-sordo]

T

10 see formula and rationale (judgment). Post-averted-death health stops after10years; horizon is judgment. [lac-settlement] [moud-sordo]

g

0.98 see formula and rationale (judgment). 98percent 50states+DC residence; excludes territories and foreign spillovers. [lac-settlement] [moud-sordo]

Best estimate — explicit partial-health judgment: Cost: $9.0M; USA QALYs: 0.3743129040751226; all-population QALYs: 0.3819519429337985. {"S":37,"o":0.5,"v":0.5,"u":0.75,"t":0.5,"b":0.5,"K":4,"dp":0.15,"N":100,"up":0.4,"tp":0.5,"d":0.01,"U":0.75,"m":0.05,"T":10,"g":0.98}. Finite prospective judgment, not observed throughput or confidence limits.

Weak joint judgment stress: Cost: $9.0M; USA QALYs: 0.00005582518485901846; all-population QALYs: 0.00005876335248317733. {"S":37,"o":0.2,"v":0.2,"u":0.4,"t":0.25,"b":0.1,"K":1,"dp":0.02,"N":25,"up":0.2,"tp":0.25,"d":0.002,"U":0.5,"m":0.1,"T":5,"g":0.95}. Finite prospective judgment, not observed throughput or confidence limits.

Favorable joint judgment stress: Cost: $9.0M; USA QALYs: 90.24120546594843; all-population QALYs: 90.69467886024968. {"S":37,"o":0.8,"v":0.8,"u":0.9,"t":1,"b":0.75,"K":8,"dp":0.3,"N":500,"up":0.6,"tp":1,"d":0.02,"U":0.85,"m":0.03,"T":15,"g":0.995}. Finite prospective judgment, not observed throughput or confidence limits.

No additional net health: Cost: $9.0M; USA QALYs: 0; all-population QALYs: 0. No incremental implementation or no clinical benefit; no incremental harm.

Illustrative net health loss: Cost: $9.0M; USA QALYs: -1; all-population QALYs: -1. One net USA QALY lost through disruption, displaced care or adverse substitution; stress test, not an observed estimate.

Remaining portfolio health unpriced: Cost: $9.0M; USA QALYs: unknown; all-population QALYs: unknown. Other non-overlapping pathways could add or subtract health; no invented portfolio uplift.

Rounded recognized-resource cost including pro bono: Cost: $10.6M; USA QALYs: 0.3743129040751226; all-population QALYs: 0.3819519429337985. {"S":37,"o":0.5,"v":0.5,"u":0.75,"t":0.5,"b":0.5,"K":4,"dp":0.15,"N":100,"up":0.4,"tp":0.5,"d":0.01,"U":0.75,"m":0.05,"T":10,"g":0.98}. Finite prospective judgment, not observed throughput or confidence limits. Approximate10.61million annual-report expense including donated services; not a new audited exact reconciliation.

Counterfactual: No-gift world includes existing staff, funded cases, other counsel, federal enforcement, advocacy coalitions, insurers and clinical providers. A change caused earlier counts only the additional benefit during acceleration. Successful historical cases are not repeatable units automatically purchased by a new donor. Public funding may be shifted rather than increased; measure net effective care, not budget totals.

Attribution: Use probability difference with versus without the incremental LAC work, not all beneficiaries of a coalition win. Partners and clients are necessary contributors. Keep individual-case and policy-spillover beneficiaries separate to avoid duplicate credit. Count patient residence, not LAC headquarters. Do not count legal damages, insurance savings, employment income and medical savings as QALYs. Changes in treatment mix can be harmful as well as helpful; subtract displaced effective medication treatment rather than assuming every coverage expansion has a positive sign.

Genuine best-judgment partial-health estimate. Legal-to-treatment implementation parameters are weak priors, not measured client outcomes or bounded probabilities from source data. Broad joint scenarios, zero and adverse cases remain. Other HIV, incarceration, civil-rights and economic value is not assumed worthless.

Sensitivity

• ForG=$100,000, $100,000 per10 requires10USAQALYs and $1million per10 requires1. With d×L=0.025–0.30, required netUSA treatment-years are33.3–400 and3.3–40 respectively.
• At a diagnostic midpoint d=0.01 andL=10, q=0.10. Required netUSA treatment-years are100 or10. These are clinical/model judgments only, not a central gift effect.
• If a policy produces1000gross treatment-years but only10% are causally attributable to extra LAC work after substitution, only100 count;95% USAshare reduces this to95. Neither1000,10% nor95% is an observed LAC parameter.
• As a deliberately narrow direct-case test, all37SUD-issue clients receiving one extra attributable retained MOUDyear would yield0.925–11.1QALYs. Against the fullFY2025budget this is roughly$8.1m–$97m per10. This is not a whole-organization estimate or upper bound: SUD cases may not restoreMOUD, and policy spillovers, HIVcare and other health gains are omitted.
• At fullFY2025budget, annual USAhealth hurdles are about898QALYs for$100k per10 and90QALYs for$1m per10. Full societal costing raises the numerator by additional clinical care and partner resources; medical savings are not health gains.
• Halving retention, counterfactual additionality or clinical benefit doubles the price; zero additional benefit leaves no finite positive price. Older, medically complex patients may have lower remainingQALYs and higher immediate risks, so one universal treatment-year value is inappropriate.
• Repeated treatment-years need survival weighting; do not count the same averted death multiple times or assume lifetime treatment retention. The mortality-only bridge omits morbidity and infection effects, which require separate estimates and overlap checks.
• The parity study found no statistically significant overall clinical-outcome or spending effect; its null result is not proof that all targeted access reforms fail. It argues for case-specific implementation assumptions rather than importing a generic positive policy multiplier.

Unresolved inputs

• Current unrestricted marginal budget and unfunded opportunity pipeline: staff/cases/campaigns that a gift adds, including support, pro bono constraints and alternatives.
• For direct health cases: baseline denial, treatment indication, resolution, additional initiation, retention duration and what would happen with other counsel/enforcement.
• For policy work: affected in-scope population, plausible probability difference attributable to incremental effort, actual implementation, provider capacity and uptake rather than statutory eligibility alone.
• Clinical baseline mortality, age/comorbidity distribution, quality-of-life weights and survival after averted death; measure treatment-months and avoid attributing all mortality associations causally.
• Coalition contributions, public/private spending replacement and displaced services, overlapping beneficiaries, territory share and downstream resource costs.
• Reconcile annual-report versus Form990 revenue/netassets and establish restricted versus available reserves before inferring marginal funding urgency.