Two dozen states remain opposed or uncommitted to the proposed settlement, setting the stage for contentious legal battles over who bears responsibility for a public health crisis that has claimed the lives of nearly 400,000 people between 1999 and 2017, according to the latest US data.

Thousands of cities and counties, along with nearly every state, have sued Purdue and, in some cases, its controlling Sackler family.

The lawsuits, seeking billions of dollars in damages, claim the company and family aggressively marketed prescription painkillers while misleading doctors and patients about their addiction and overdose risks.

Purdue and the Sacklers have denied the allegations.

Opposing states, including Massachusetts, New York and Connecticut, want the Sacklers to guarantee more of their own money will go toward a settlement, and have questioned Purdue’s calculations valuing the overall deal at more than US$10 billion.

The Sacklers, who would cede control of Purdue in the proposed settlement, have offered US$3 billion in cash and an additional US$1.5 billion or more through the eventual sale of another company they own, called Mundipharma, according to the company and people familiar with the terms.

Sunrise Lee, ex-stripper who worked as pharmaceutical company ‘closer’, gave lap dance to doctor at nightclub to boost sales of addictive fentanyl spray

The Sacklers have declined to revise their offer.

“This is the fork in the road. There are only two ways to go from here,” said Purdue Chairman Steve Miller.

Miller said Purdue plans to argue to opposing states that fighting the proposed settlement will likely result in protracted litigation, increasing legal fees and depleting value that could be steered to US communities reeling from opioid abuse.

He described bankruptcy proceedings as the “best hope for finalising and implementing a global resolution to this litigation”.

In a statement, members of the Sackler family controlling Purdue said they hoped those opposing the current settlement offer would eventually change their minds.

“It is our hope the bankruptcy reorganisation process that is now underway will end our ownership of Purdue and ensure its assets are dedicated for the public benefit,” the family said.

China hits back at Donald Trump’s fentanyl claim, saying US ‘only has itself to blame’ for opioid crisis

The outcome of Purdue’s attempted bankruptcy reorganisation and settlement negotiations will help determine how much money US communities receive from the company and the Sacklers to address harm from opioids.

A reorganisation and settlement would ultimately need to be approved by a US bankruptcy judge.

States suing the Sacklers, including several over the past week, allege the family improperly reaped billions of dollars from opioid sales despite knowledge of their harmful effects.

The Sacklers, some of whom previously served on the Purdue’s board and are well-known wealthy philanthropists, have denied the allegations.

A host of other opioid makers, such as Johnson & Johnson, and drug distributors like McKesson Corp, will face claims they created a public nuisance across the US with their mishandling of the medicines.

States and municipalities contend drug makers, distributors and pharmacy chains conducted illegal marketing campaigns pushing the painkillers, failed to adequately oversee orders and ignored red flags about unusually frequent retail sales.

Additional reporting by Bloomberg