People with substance use disorders across the country have no formal say in how most of the nearly $50 billion in opioid lawsuit settlements is being used to stem the crisis, a new analysis finds.
Some advocates say this is one reason some of the funds are being used for efforts that are not considered proven methods for saving lives from overdose, including equipment to screen prison inmates for contraband, drug-detecting police dogs and incapacitation systems. Unnecessary prescription medications.
Officials in Jackson County, West Virginia, voted earlier this year to use more than $500,000 in settlement funds to build a first responder training center and shooting range. They also allocated $35,000 to a rapid response team working with overdose survivors.
Josh George, who has been in recovery for three years after 23 years of drug use, primarily heroin, now runs a recovery group with his wife and other family members.
Some of that money may have gone to the county’s only recovery center, he said.
“All these people were doing it with their own money.” George said. “I tried to help these people.”
Over the past eight years, drugmakers, wholesalers, pharmacy chains and other companies have agreed to settlements to resolve thousands of lawsuits filed by state, local and Native American tribal governments alleging the companies’ practices contributed to the crisis.
Opioids have been a major problem in the United States since the late 1990s, with the most fatal cases reaching more than 80,000 per year as of early this year. The primary culprit has shifted from prescription drugs to heroin, fentanyl and other lab-produced substances that are often added to other illicit drugs.
Funding the multibillion-dollar national settlement would begin in 2022 and continue until at least 2038. The agreement calls for most funds to be used to respond to the crisis, but provides great flexibility in how to do this.
Christine Minhee of the Opioid Settlement Tracker and public health organization Vital Strategies planned to release a state-by-state guide on Monday explaining how government funding decisions are made. This guide aims to help supporters know where they can make their voices heard.
Minhee, who used that information and other data to calculate settlements totaling less than $50 billion, excluding the settlement with OxyContin maker Purdue Pharma that was rejected by the Supreme Court, helped the advisory group decide how to spend about half of them. I found it helpful. But they have decision-making authority over less than a fifth of them.
Less than one in seven is overseen by a committee that reserves at least one seat for someone who uses or has used drugs, but some places that don’t need them may have such members anyway.
Brandon Marshall, a professor of epidemiology at Brown University’s School of Public Health and a former member of the Rhode Island Opioid Settlement Advisory Committee, said he observed the process involving experts and people with experience using drugs quickly being assigned to work groups. Because we know harm reduction and other areas.
“This is not a simple way to ensure that funds are used effectively,” he said. “This kind of system ensures that money gets out more quickly.”
Public health advocates said the money should be used in ways proven to save lives, prevent drug use and focus on racial equity, and decisions should be transparent.
However, many communities are following regular government spending practices rather than assessing local needs or consulting with experts or people affected by the pandemic.
Renville County, Minnesota, used a $100,000 settlement to pay about two-thirds of the cost of body scanners for the county jail to detect drugs in incoming inmates, even if the inmates have swallowed baggies.
“I can’t say that the person who made that decision thought it was the best use of the money,” said Alicia House, executive director of the Steve Rummler Hope Network, which provides overdose prevention and education throughout Minnesota.
Renville County Sheriff Scott Hable said in an interview that keeping people from being strip searched and keeping drugs out of the jail is consistent with the facility’s policy of emphasizing treatment for inmates with substance abuse disorders.
The scanners have been used nearly 1,400 times since last year, identifying six cases of contraband. He said twice bundles of drugs were found that inmates had swallowed before entering.
The county’s governing body made spending decisions. Sara Benson, the county’s public health director, said the government was forming an advisory group for future settlements and wanted to include people with real-world experience.
Dick Waybright, chairman of the Jackson County Board of Commissioners in West Virginia, said the training center will help law enforcement, EMS and 911 personnel respond to the opioid crisis.
“You’re not just investing money in a program that’s not going to last,” he said in an interview. Additionally, he said no one other than the rapid response team had requested funds for the first round of opioid payments.
Kelly DeWees, George’s mother, said there are many needs in an area hit hard by addiction, including transportation for people in recovery and prevention education and counseling for children with substance use disorders. Breath of Life, an organization run by her son and daughter-in-law, can help start a recovery home.
The group is currently requesting the $15,000 remaining in county funds, which Waybright said he expects will be paid to them soon.
For others, spending decisions are much more personal.
Tonia Ahern, a community coordinator at the National Center for Advocacy and Recovery, lost her son to an overdose at age 29. She co-founded a group that plans to produce a handbook of suggestions for New Jersey communities on how to use the funds.
“If you’ve never experienced it, you have no idea what they need,” Ahern said.
