The settlement money to help curb the decades-long epidemic of opioid addiction and overdose is being rolled out to small and large cities across the U.S., but advocates worry that parts of it could be used in ways that won’t make a dent in the crisis.
As state and local governments consider how to use the money, advocates say local governments may not have the bandwidth to take the right steps to identify the needs of their communities and direct their funding shares to projects that use proven methods to prevent deaths.
Opioids have been linked to approximately 800,000 deaths in the US since 1999, including more than 80,000 annually in recent years, most of which involved illicitly produced fentanyl.
Drug manufacturers, wholesalers and pharmacies have been involved in more than 100 settlements of opioid-related lawsuits with state, local and Native American tribal governments over the past decade.
The deals, some of which have not yet been completed, could be worth a total of more than $50 billion over nearly two decades and also include requirements for better control of prescriptions and disclosure of company documents.
States alone fought the tobacco industry in the 1990s and used only a small portion of the money from the resulting settlements for tobacco-related efforts.
“We don’t want to say in 10 years, ‘After we messed up tobacco, we trusted small government with opioids – and we did even worse,’” said Paul Farrell, Jr., one of the lead attorneys. representing local governments in opioid cases.
He notes that with at least another 14 years of settlement money to be rolled out, there is time for cities to use it properly, and there are resources to help.
The goal, experts say, is to help those who use opioids get treatment, to make it less likely that people who use drugs will overdose and to create an environment where people can’t use them in the first place.
For many it is personal.
Suzanne Harrison and her family launched a nonprofit organization dedicated to helping New Jerseyans access treatment and recovery programs after her brother and Navy veteran King Shaffer Jr. in 2016, died of a fentanyl and heroin overdose, days before he was scheduled to try another one. treatment program.
At the time, he was staying with a sister who lived in Moorestown, New Jersey.
That city’s board decided to transfer its portion of the settlement money to Burlington County, which has used the settlement funds to distribute an overdose antidote and run camps for children suffering from addiction.
“The county was in a much better position to address this issue,” township manager Kevin Aberant emailed, noting reporting requirements and restrictions on how the money could be used.
Top opioid settlements, including deals with Walgreen Co., CVS Health, Walmart, Johnson & Johnson and a company with OxyContin maker Purdue Pharma that is before the U.S. Supreme Court are demanding that most of the money be used to combat the crisis.
More than half of the funds will be administered by local governments, said Christine Minhee, who runs the website Opioid Settlement Tracker. In the largest agreements, states receive larger amounts by allowing eligible local governments with more than 10,000 residents to join the settlements.
Unlike most states, New Jersey required local governments to complete funding reports.
Using these submissions and additional reporting, The Associated Press examined the spending and decision-making processes for communities in Burlington County, which includes suburban and rural areas of Philadelphia. Fourteen communities are receiving allocations there and in June last year the amounts ranged from $5,000 to almost $88,000.
Last year, most communities in Burlington County had not spent the allocated money nor had they followed advice to gather public input, devise strategic plans, assess the needs of their communities and design processes for allocating funds.
In Mount Laurel, New Jersey, police took charge and organized outreach events around budget motels where first responders often administer overdose antidotes. The idea is to connect people to treatment and other services, but advocates prefer that police not be responsible for the spending.
Deputy Police Chief Tim Hudnall also said hiring peer-support navigators to help people address their addiction is being considered.
Another New Jersey town, Willingboro, spent just over $57,000 on a back-to-school wellness event, where students received backpacks full of school supplies and mental health information.
“We tried to be aggressive with it,” Gary Lawery II, the deputy township manager, said of how the money was spent. “If not, it will just sit there.”
But those approaches are not based on the kind of community needs assessments that Sara Whaley, a researcher at the Johns Hopkins Bloomberg School of Public Health who helps develop guides for counties, says are essential.
Some providers, like Shaffer’s sister Suzanne Harrison, found the process frustrating. Her organization, King’s Crusade, helps people connect with services, pays rent for sober living facilities and provides transportation to treatment. They’ve raised as much as $80,000 a year, but there’s always more demand.
Harrison said she has not had a chance to apply for allocations to subsidize this. Instead, the organization received $6,625 in opioid settlement money to host a one-time recovery community event in Evesham Township.
In Evesham, a suburb of 45,000 and Burlington County’s most populous, most of the control over settlement funds rests with the local Alcoholism and Drug Addiction Prevention Alliance, the type of agency Whaley said should be involved.
Marc Romano, director of operations for Prevention Plus of Burlington County, said he also wishes there would be a call for proposals on how to use the money. The group was given $2,000 to hold a painting night for women in recovery, which it said was “a beautiful event for recovery and recovery awareness,” but the group could do more by raising funds to support programs aimed at its prevention mission.
Councilmember Heather Cooper, whose own brother was killed by a fentanyl overdose, said there are providers in the area who can help get people into treatment, drive them there and offer other services.
“But what we’re hearing is that families still don’t know where those resources are,” she said. “So I think the marketing of that needs to increase.”
Other governments have used different approaches.
In Arkansas, all cities and counties have pooled their money to create the Arkansas Opioid Recovery Partnership.
Grants have gone to a drug task force to hire an overdose investigator and peer recovery specialist, to the American Indian Center of Arkansas to hire peer recovery specialists, and to a religious organization to expand its recovery housing center to include projects ranging from $100,000 to more than $2 million.
Kirk Lane, a former police chief and director of state drug policy who is now director of the partnership, said it is able to direct projects to underserved parts of the state and fill gaps in the state’s treatment, recovery and prevention systems to fill.
He explained, “Individual mayors and county judges didn’t have to worry about, ‘How are we going to spend that money?’”
