Hundreds of Native American tribes that have suffered disproportionately high addiction and death rates during the opioid epidemic agreed on Tuesday to a tentative settlement of $590 million with Johnson & Johnson and the country’s three largest drug distributors.

Together with a deal struck last fall between the distributors and the Cherokee Nation for $75 million, the tribes will be paid a total of $665 million. Purdue Pharma has already committed at least tens of millions more to the tribes in a settlement that is in mediation.

“We are not solving the opioid crisis with this settlement, but we are getting critical resources to tribal communities to help address the crisis,” said Steven Skikos, a top lawyer for the tribes.

Native Americans have endured disproportionately high opioid-related overdose deaths, by many metrics. In 2016, for example, Oglala Lakota County in South Dakota, home to the Oglala Lakota tribe, had an opioid-related death rate of 21 people per 100,000, more than twice the state average. According to one study, pregnant American Indian women were as much as 8.7 times more likely than pregnant women from other demographic groups to be diagnosed with opioid dependency or abuse.

Maine is getting tens of millions of dollars from a nationwide settlement with several pharmaceutical companies over their role in the opioid crisis.

The settlement, announced by Attorney General Aaron Frey, will resolve dozens of individual lawsuits filed by Maine cities and towns against opioid manufacturer Johnson & Johnson and drug distributors Cardinal, McKesson, and AmerisourceBergen. The state will get more than $130 million over the next 18 years as part of the nationwide settlement. 

Frey said the agreement “paves the way for Maine to receive significant resources” to address the opioid epidemic that is “ravaging” the state.

“At a time when Mainers continue to suffer from the pain and loss inflicted by the opioid epidemic, this agreement and the settlement it secures represents a significant opportunity to confront the crisis head on,” he said in a statement. “These resources will be deployed to address this crisis, provide necessary treatment for addiction, and save lives.” 

Under the plan, at least 20% of the proceeds will go to the state to address the epidemic; 30% of the funds will be diverted to the 39 Maine counties and municipalities that either filed litigation against the settling companies or that have more than 10,000 residents, according to the attorney general’s office. 

McKinsey & Company, the consultant to blue-chip corporations and governments around the world, has agreed to pay nearly $600 million to settle investigations into its role in helping “turbocharge” opioid sales, a rare instance of it being held publicly accountable for its work with clients.

The firm has reached a $573 million agreement with attorneys general in 47 states, the District of Columbia and five territories, according to a court filing in Massachusetts on Thursday. Separate deals were announced in Washington State, for $13 million, and in West Virginia, for $10 million. Nevada, not party to the agreements, will continue to pursue its opioid investigation, according to the attorney general’s office.

The settlements come after lawsuits unearthed a trove of documents showing how McKinsey worked to drive sales of Purdue Pharma’s OxyContin painkiller amid an opioid crisis in the United States that has contributed to the deaths of more than 450,000 people over the past two decades.