How should the opioid settlements be spent? Those hit hardest often don’t have a say

People with substance use disorders across the country are denied a formal say in how the bulk of the roughly $50 billion comes in Money to settle opioid lawsuits is being used to curb the crisis, a new analysis shows.

Some advocates say this is one reason why some of the money goes to efforts they don’t consider proven ways to save lives from overdose, including equipment to scan inmates for contraband, drug-sniffing police dogs and systems to to neutralize unnecessary prescription medications.

In Jackson County, West Virginia, officials voted earlier this year to use more than $500,000 in settlement funds for a first responder training center and a shooting range. They also allocated $35,000 to a rapid response team that works with overdose survivors.

Josh George, who has been in recovery for three years after 23 years of drug use, mainly heroin, now runs a recovery group with his wife and other family members.

Some of the money could have gone to the province’s only recovery center, he said.

“All these people did it for their own money,” George said, “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 that the companies’ practices contributed to the crisis .

Opioids have been a major problem in the US since the late 1990s deadliest trajectory earlier this decade reaches more than 80,000 annually. The main causes have shifted from prescription pills to heroin fentanyl and other laboratory-produced substances often added to other illegal drugs.

The multi-billion dollar rural settlement funds began rolling out in 2022 and will continue until at least 2038. The agreements call for the majority of the money to be used to combat the crisis but offer great flexibility in how to do this.

Christine Minhee of Opioid Settlement Tracker and Vital Strategies, a public health organization, planned to release a state-by-state guide Monday outlining how public funding decisions are made. The guide is intended to help advocates know where they can make their voices heard.

Using that information and other data, Minhee, which has reached just under $50 billion in settlements, including one with OxyContin maker Purdue Pharma, which The Supreme Court rejectedfound advisory groups help determine expenditures of about half of that. But they have decision-making power over less than a fifth of it.

Less than $1 out of $7 is overseen by boards that reserve at least one seat for someone who uses or has used drugs, although some places where this is not required may still have such members.

Brandon Marshall, professor of epidemiology at Brown University School of Public Health and former member of the Rhode Island Opioid Settlement Advisory Committee, said he has noticed that processes involving experts and people with experience with drug use have quickly made allocations to groups that working on harm reduction and other areas because they know the groups.

“It’s not just a way to ensure that the funds are used effectively,” he said. “Systems like that also ensure that money goes out the door faster.”

Public health advocates saying the money should be used in ways proven to save lives, prevent drug use and focus on racial equity, and that the decisions should be transparent.

But many communities follow regular government spending practices instead assessing local needs or consultation with experts or people affected by the epidemic.

Renville County, Minnesota, used $100,000 in settlement money to pay about two-thirds of the cost of a body scanner for the county jail to detect drugs in incoming inmates, even if they have swallowed bags of them.

“You can’t possibly tell me that whoever made these decisions thinks this is the best use of the funding,” said Alicia House, executive director of the Steve Rummler Hope Network, which provides overdose prevention and education across Minnesota.

Renville County Sheriff Scott Hable said in an interview that keeping drugs out of the jail — without subjecting people to strip searches — fits with the agency’s emphasis on treating inmates with substance abuse problems.

The scanner has been used almost 1,400 times since last year, with contraband identified in six cases. Twice, packets of drugs were found that prisoners had swallowed before entering, he said.

The administrative body of the province made the decision on the expenditure. Sara Benson, the province’s public health director, said the government is putting together an advisory group on future settlement use and wants to involve people with experience.

In West Virginia, Jackson County Commission Chairman Dick Waybright said the training center will help law enforcement, EMS and 911 workers respond to the opioid crisis.

“It wouldn’t just throw money at a program that wouldn’t last,” he said in an interview. Furthermore, he said, no one other than the rapid response team has asked for money for the first payment of the opioid settlement.

George’s mother, Kelly DeWees, said there are many needs in an area hit hard by addiction, including transportation for people in recovery, prevention education and guidance for children of people with substance use disorders. Breath of Life, the group her son and daughter-in-law run, could use help setting up a recovery home.

The group is asking for the $15,000 currently in the county’s fund and Waybright said he expects it to be awarded to them soon.

For others, spending decisions are even more personal.

Tonia Ahern, community coordinator for the National Center for Advocacy and Recovery, lost her son to an overdose when he was 29. She co-founded a group that wanted to create a handbook with suggestions for New Jersey communities on how to use the funding.

“If you’ve never experienced it, you have no idea what they need,” Ahern said.