Leaders urged to use opioid settlement funds to tackle substance use, overdoses

Workers from the Rhode Island Executive Office of Health and Human Services host a community outreach event. The state is using settlement monies for harm reduction programs, recovery housing, opioid treatment centers and more.

Photo courtesy Rhode Island Executive Office of Health and Human Services

With billions of dollars in opioid settlement funds going to U.S. state and local governments, public health advocates are hopeful the money can help reduce deaths and addiction.

Although the payout will not end the epidemic, which claims more than 200 lives a day, many government health leaders view the allocations as a game-changer.

“We didn’t really change strategy,” Ana Novais, assistant secretary for the Rhode Island Executive Office of Health and Human Services, said of the state’s approach to drug-use prevention and harm reduction. “What changed was finally having the means to make an impact.”

Last year, more than 107,000 drug overdose deaths were recorded in the U.S., according to provisional data released in May by the National Center for Health Statistics — the first decline in five years. Deaths from synthetic opioids such as fentanyl accounted for nearly 70% of the total.

While the decline in deaths was widely celebrated, numbers are still extremely high, showing the urgent need for prevention, treatment and other interventions.

Over nearly two decades, about $50 billion of settlement money from pharmaceutical companies will go to states, counties and municipalities. The settlements came after years of litigation that held opioid manufacturers, distributors and national pharmacies responsible for fueling the U.S. opioid epidemic, which ended nearly 645,000 lives from 1999-2021 alone.

Rhode Island’s share of the settlement money will be $150 million, with payments spread over five to 17 years. As of May, Rhode Island has received $50.8 million of that total, Novais told The Nation’s Health.

With so much money arriving in government coffers, health advocates want to avoid what happened with the 1998 Tobacco Master Settlement Agreement, when billions in funds that could have gone toward tobacco cessation and prevention were used for other purposes.

Under the opioid settlements, states must spend at least 85% of funds on programs focused on preventing and treating drug use, and there is emphasis on creating a fund or trust separate from general budgets to hold the monies. However, governments are not required to publicly post how funds are spent. And what counts as opioid remediation is open to interpretation.

Some governments are spending settlement funds to bolster law enforcement and incarceration. Louisiana is allocating 20% of its money to sheriff’s departments. Greene County, Tennessee, earmarked a portion of the $2.7 million it has received over two years to upgrade its county jail and a workhouse.

“Funding the criminal justice system and penalizing people for drug use might not be in line with the motivation of the settlement,” said Sara Whaley, MPH, MSW, MA, a researcher at Johns Hopkins Bloomberg School of Public Health, which tracks use of the settlement funds.

Whaley is co-author of a white paper from the school that recommends best practices for using the opioid settlement fund spending. The principles have been endorsed by over 50 public health groups, including APHA.

The recommendations call for states and municipalities to use the money to save lives, rely on evidence to guide spending, invest in youth prevention, focus on racial equity and develop a fair and transparent process for deciding where to spend the funds.

Another state that has begun using its funds to address overdoses is Kentucky. In April 2023, the state awarded millions to a handful of local groups involved in substance use reduction. The Kentucky Harm Reduction Coalition received $500,000, the largest grant in its 10-year history. The statewide organization performs naloxone distribution and training, oversees syringe services and conducts mobile outreach, which includes education, psychiatric care and treatment for substance use disorder.

Shreeta Waldon, MA, executive director of the coalition, said the funds are broadening the coalition’s reach and capacity and strengthening connections with partners, who include the Louisville Recovery Community Connection and the University of Louisville School of Medicine Department of Psychiatry.

“So many partners are collaborating that it has become a real family, a village of people coming together,” Waldon told The Nation’s Health.

Another local funding recipient that is using settlement monies for public health is Pennsylvania’s Cambria County, which has one of the state’s highest overdose death rates. Over the last two years, the Cambria County Drug and Alcohol Program has received over $1 million for youth prevention.

The monies helped fund the RISE — Referral, Intervention, Support and Engagement — Project, a counseling service for at-risk students 14 years and older at 15 schools in the county.

“They’re using opioid settlement funds for a program to increase school-based mental health providers,” Whaley said. “I think it’s exciting to see that creativity and people thinking about the whole person in their (funding) responses.”

• Copyright The Nation’s Health, American Public Health Association