After years of litigation to hold the pharmaceutical industry accountable for the deadly abuse of prescription painkillers, payouts from what could reach more than $50 billion in court settlements has begun flowing into states and communities to address the nation’s ongoing opioid crisis.
But even the payments are included stacks of outlining guidance key strategies for drug prevention and addiction treatment, the first wave of awards sparks heated debates about the best use of the money, including the role that law enforcement should play in tackling in a public health disaster.
State and local governments are allocating millions of dollars for overdose reversal drugs, addiction treatment drugs, and wound care vans for people with injection-site infections. of medicines. But law enforcement departments receive opioid settlement money for political resources such as new cruisers, overtime pay for narcotics investigators, phone hacking tool, body scanners to detect drugs in prisoners and restraint devices.
“I have great ambivalence about using opioid money for that purpose,” said Chester Cedars, chairman of the advisory opioid task force in Louisiana. president of St. Martin Parish. The state directives say only “law enforcement expenditures related to the opioid epidemic,” added Mr. Cedars, a retired prosecutor. “That’s wide open as to exactly what that means.”
On Monday, 133 addiction medicine specialists, legal aid groups, street outreach groups and other organizations issued a list of proposed priorities for funds. Their recommendations include housing for people in recovery and expanding access to syringe exchange programs, personal use test strips for fentanyl and xylazine, and drug addiction treatment.
They clearly state that no funds “shall be spent on law enforcement personnel, overtime or equipment.”
“Law enforcement already gets a lot of funding, and I’m sure they’re going to say it’s not enough,” said Tricia Christensen, an author of the proposed priorities, who is the policy director at Community Education Group, which tracks opioid settlement money across Appalachia. But opioid money, he says, “is really weird.”
Groups that track opioid settlements use different criteria to estimate the total payout. But even using the most conservative tabulation, the final cost could be north of $50 billion once pending lawsuits are resolved, notably Purdue’s multibillion-dollar bankruptcy plan, which was temporarily halted by the Supreme Court last week.
At first glance, that looks like an amazing trove of money. In fact, it will has been divided for 18 years and is already dwarfed by the massive scale of the opioid crisis, now dominated by illicit fentanyl and other drugs.
The spectacle of states as well as thousands of cities, counties and towns all struggling to determine the most effective use of these much-needed funds raises many questions.
Underlying the wrangling is a push for more transparency in awarding money and a determination not to repeat the mistakes of the Big Tobacco settlement 25 years ago. State governments used most of the $246 billion from tobacco companies to plug budget holes and pay for other projects, and allocated relatively little to solve nicotine-related problems.
Today, states and local governments have committees to determine the appropriate allocation of opioid money. Sheriffs and police officers make up less than a fifth of the members on those task forces, according to a recent review of KFF Health News, Johns Hopkins University and Shatterproof, a national nonprofit dedicated to addiction.
But public sentiment in many communities is favorable taking drug dealers off the streets as a way to alleviate the crisis.
When Samuel Sanguedolce, the district attorney of Luzerne County in Pennsylvania, presented his budget to the County Council in November, he made a pitch for some of the county settlement moneyabout $3.4 million so far.
“With 10 more detectives, I could arrest those cases around the clock,” he said, referring to drug dealers. “I think this is a good way to use money that resulted from this opioid crisis to help those detectives without putting it on the taxpayers.”
“And I asked not only for detectives,” he continued. “But hiring people, of course, costs money, the way they need guns and vests and computers and cars.”
In many areas of the country, the lines between law enforcement and health care can be somewhat blurred: Police and sheriff’s departments are also emergency responders, trained to provide overdose reversal drugs. Louisiana allocates 20 percent of this opioid money to parish sheriffs.
Sheriff KP Gibson of Acadia Parish, who represents sheriffs on Louisiana’s opioid task force, said he intends to use the $100,000 his department is set to receive for the “medical needs” of people in jail, including others’ t other opioid treatment and counseling. The goal, he said, is to help inmates become “productive citizens within our community,” once they are released.
Public health officials and addiction treatment specialists are also concerned about another use of the money: grants for faith-based rehab programs which bans federally approved drugs like Suboxone and methadone, which cut cravings for opioids.
“I would be open to a faith-based cancer program, but not one that doesn’t allow you to take effective drugs to treat cancer,” said Dr. Joshua Sharfstein, a professor at the Johns Hopkins Bloomberg School of Public Health, has released it own guiding principles for settlement funds.
Throughout the years of negotiating opioid settlements, attorneys for states, tribes and local governments and those defending distributors, manufacturers and pharmacy chains fought to avoid the pitfalls that arose from Big Tobacco litigation.
This time, local governments reached an agreement with state attorneys general on the allocation of the money. Legislatures are largely excluded from most funds.
Johns Hopkins praised Rock County, Wis., as a jurisdiction working to get a full picture of local needs for money: It assembled a working group to review the evidence-based literature and conducted surveys and meetings to get community suggestions.
In North Carolina, county governments receive 85 percent of the funds, which have totaled nearly $161 million so far. Having signed on to the basic principles worked with the attorney general, counties have great discretion over spending their allocations.
“When you look at who is responding to the issues of the opioid epidemic, it is addressed locally by EMS, social services and jails. Those are all county functions in North Carolina, so it makes sense for them to get most of the resources,” said Josh Stein, the North Carolina attorney general, who helped negotiate the national opioid settlements. .
Each county establishes its own priorities. Stanly County, he said, is setting up teams to reach people who have just survived overdoses, hoping to connect them with services. Mecklenburg County has earmarked some of its funding for post-recovery education and job-training programs.
Such uses can help uplift a community stricken by addiction, Ms. Christensen, whose group tracks opioid settlements for 13 states. “I really subscribe to the idea that an overdose is often a ‘death of despair’ – that the reason many people spiral into disordered drug use has a lot to do with what happened to them and their lack of opportunities,” he said. “So how do we invest in the community to prevent that from happening generation after generation? That’s why I think community input is so important in this process.”
The groups that released the new set of priorities cited examples of promising uses of the funds. MichiganPlans include adding rooms to hospitals so new mothers can stay with babies born with neonatal abstinence syndrome. Kentucky provides $1 million to four legal aid groups to represent people with opioid-related cases.
“I was blown away by that,” said Shameka Parrish-Wright, executive director of the VOCAL-KYa community group that worked on the priority documents. Mrs. Parrish-Wright, a drug-addicted, homeless and incarcerated former Louisville mayoral candidate, added: “Those legal entities are really helpful in making sure we deal with paraphernalia and eviction charges. People who come out of treatment are sometimes discriminated against because of those charges and can’t get housing or work.”
VOCAL-KY did not apply for settlement money but works closely with groups that do. Its members attend meetings held by Kentucky’s opioid task force. “Knowing that Black and brown and poor white communities are dealing with it the worst, we pushed them to have another town hall in those communities,” said Ms. Parrish-Wright.
With Big Tobacco keeping an eye on these debates, the issue of accountability comes up. Who makes sure grantees spend their money appropriately? What penalties will happen to those who color outside the lines of their grants?
For now, the answers remain to be seen. Christine Minhee, a lawyer on the run the Opioid Settlement Tracker, which examines the state’s strategies for spending funds, noted that on that question, large legal agreements can be ambiguous.
“But between the lines, the settlement agreements themselves indicate that the political process, rather than the courts, will bear the actual burden of enforcement,” he said. “This means that the task of implementing the spirit of the agreement – ensuring that the settlements are spent in ways that maximize the lives saved – is left to the rest of us.”
