Settlement money to help stem the decades-long opioid addiction and overdose epidemic is rolling out to small towns and big cities across the U.S., but advocates worry that chunks of it may be used in ways that don't make a dent in the crisis.
As state and local governments navigate how to use the money, advocates say local governments may not have the bandwidth to take the right steps to identify their communities’ needs and direct their funding shares to projects that use proven methods to prevent deaths.
Opioids have been linked to about 800,000 deaths in the U.S. since 1999, including more than 80,000 annually in recent years, with most of those involving illicitly produced fentanyl.
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Drugmakers, 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 not yet finalized, could be worth a total of more than $50 billion over nearly two decades and also come with requirements for better monitoring of prescriptions and making company documents public.
States alone fought the tobacco industry in the 1990s and they used only a sliver of the money from the resulting settlements on tobacco-related efforts.
"We don’t want to be 10 years down the road and say, ‘After we screwed up tobacco, we trusted small government with opioids — and we did even worse,’" said Paul Farrell, Jr., one of the lead lawyers representing local governments in the opioid suits.
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He notes that with settlement money rolling out for at least 14 more years, there’s time for towns to use it appropriately, and resources to help.
The goal, experts say, is to help those who are taking opioids to get treatment, to make it less likely people who use drugs will overdose and to create an environment for people not to take them in the first place.
For many, it’s personal.
Suzanne Harrison and her family launched a nonprofit dedicated to getting New Jersey residents access to treatment and recovery programs after her brother and Navy veteran, King Shaffer Jr., died from a fentanyl and heroin overdose in 2016, days before he was scheduled to try another treatment program.
At the time, he was staying with a sister who lived in Moorestown, New Jersey.
That town's administration decided to hand its portion of settlement money over to Burlington County, which has used settlement funds to distribute an overdose antidote and run camps for kids affected by addiction.
"The County was in a much better position to handle this subject," township manager Kevin Aberant emailed, noting reporting requirements and restrictions on how the money could be used.
The major opioid settlements, which include deals with Walgreen Co., CVS Health, Walmart, Johnson & Johnson and one with OxyContin maker Purdue Pharma that is before the U.S. Supreme Court, require that most of the funds be used to combat the crisis.
More than half of the funds will be controlled by local governments, according to Christine Minhee, who runs the Opioid Settlement Tracker website. In the biggest agreements, states receive larger amounts by getting eligible local governments with populations over 10,000 to join the settlements.
Unlike most states, New Jersey required local governments to complete reports on the funding.
Using those submissions and additional reporting, The Associated Press examined the spending and decision-making processes for communities in Burlington County, which includes Philadelphia suburbs and rural areas. Fourteen communities there receive allocations and by last June the amounts ranged from $5,000 to nearly $88,000.
By last year, most communities in Burlington County had not spent their allotted funds yet, nor had they followed advice to gather public input, devise strategic plans, conduct assessments of their communities’ needs and design processes for awarding funds.
In Mount Laurel, New Jersey, the police department was put in charge and launched outreach events around budget motels where first-responders often administer an overdose antidote. The idea is to connect people with treatment and other services, but advocates prefer police not be in charge of the spending.
Deputy Police Chief Tim Hudnall also said there is consideration of hiring peer-support navigators to try to help people address addiction.
Another New Jersey town, Willingboro, spent a little over $57,000 on a back-to-school wellness event, where students received backpacks full of school supplies and information about mental health resources.
"We’ve been trying to be aggressive about it," Gary Lawery II, the deputy township manager, said of spending the funds. "If not, it’s just going to sit there."
But those approaches have not relied on the kind of community needs assessments that Sara Whaley, a researcher at Johns Hopkins Bloomberg School of Public Health who helps develop guides for counties, says are essential.
Some service providers, such as Shaffer’s sister Suzanne Harrison, have found the process frustrating. Her organization, King's Crusade, helps connect people with services, pays rent at sober living facilities and provides transportation to treatment. They’ve raised as much as $80,000 a year, but there is always more demand.
Harrison said she hasn’t had a chance to apply for allocations to subsidize this. Instead, the organization received $6,625 in opioid settlement money to organize a one-time recovery community event in Evesham Township.
In Evesham, a suburb of 45,000 that’s the most populous in Burlington County, most of the control over the settlement funds lies with the local alliance to prevent alcoholism and drug addiction, which is the sort of body Whaley says should be involved.
Marc Romano, director of operations for Prevention Plus of Burlington County, said he also wished there was a call for proposals for using the money. The group was paid $2,000 to hold a painting night for women in recovery, which he said was "a nice event for recovery and recovery awareness," but the group could do more by getting funds to help support programs geared toward its mission of prevention.
Council member Heather Cooper, whose own brother was killed by a fentanyl overdose, said there are service providers in the area that can help get people into treatment, get them rides there and offer other services.
"But what we hear is families still don’t know where those resources are," she said. "So I think the marketing of that has to increase."
Other governments have used different approaches.
In Arkansas, all the towns and counties pooled their money by creating the Arkansas Opioid Recovery Partnership.
Grants have gone to a drug task force to hire an overdose investigator and peer recovery specialist, for the American Indian Center of Arkansas to hire peer recovery specialists, and for a religious organization to expand its recovery housing center in projects ranging from $100,000 to more than $2 million.
Kirk Lane, a former police chief and director of state drug policy who now serves as director of the partnership, said it’s able to steer projects to underserved parts of the state and to fill in gaps in the state’s treatment, recovery and prevention systems.
He explained, "Individual mayors and county judges didn’t have to worry about, ‘How are we going to spend that money?’"
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