John Greene and his counselor Emily Georgia at Household & Youngsters’s Counseling Providers in Cortland, N.Y. Greene is 4 months into restoration for the primary time since he began commonly utilizing medication at age 14. He credit a brand new program that the counseling middle began with opioid settlement cash.
Celia Talbot Tobin for KFF Well being Information
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Celia Talbot Tobin for KFF Well being Information
Prior to now few years, state and native governments throughout the U.S. have begun spending billions in opioid settlements paid by corporations accused of fueling the overdose disaster. However the place is that cash going, who’s getting it and is it doing any good?
KFF Well being Information, partnering with the Johns Hopkins Bloomberg Faculty of Public Well being and Shatterproof, a nationwide nonprofit centered on dependancy, undertook a yearlong investigation to seek out out.
Dozens of interviews, hundreds of pages of paperwork, an array of public data requests and outreach to all 50 states resulted in a first-of-its form database that catalogs greater than 7,000 methods opioid settlement money was utilized in 2022 and 2023. It is essentially the most complete useful resource to this point monitoring a few of the largest public well being settlements in American historical past. (You may discover the database on the finish of this story.)
Among the many findings:
- States and localities acquired greater than $6 billion in opioid settlement funds in 2022 and 2023. Based on public data, they spent or dedicated a couple of third of that quantity and put aside about one other third for future use. The ultimate third was untrackable, as many jurisdictions didn’t produce public reviews on the funds.
- Reviews of spending tracked the minuscule to the monumental, from $11.74 to purchase postage in Yavapai County, Arizona, to greater than $51 million to extend the dependancy remedy workforce in California.
- States allotted, on common, about 18% of their funds for dependancy and psychological well being remedy; 14% for restoration companies resembling housing, transportation, and authorized assist; 11% for hurt discount efforts resembling overdose reversal medicines; and 9% for prevention packages that goal to cease folks from growing substance use problems. States dedicated, on common, about 2% for syringe service packages, by way of which individuals can get sterile needles. (A wide range of entities acquired this cash, from regulation enforcement to nonprofit organizations to authorities companies.)
- Governments reported spending greater than $240 million on functions that didn’t qualify as opioid remediation. (Most settlements permit states to spend as much as 15% of their funds this manner.) Most of this tranche went to authorized charges, however a number of jurisdictions funneled cash to their normal fund. One county even despatched funds to its highway and bridge division.
- A number of cities and counties reported expenditures they stated addressed the overdose disaster however that would go away a median individual scratching their head — resembling $33.07 to an anti-abortion being pregnant middle in Sandborn, Indiana, and $30,362 to display first responders for coronary heart illness in Oregon Metropolis, Oregon.
“When folks know that individuals aren’t watching and there isn’t any accountability, then they will type of do what they need,” stated Tonja Myles, a group activist in Baton Rouge, Louisiana, who’s in restoration. “That is why we’ve to have some type of database and accountability.”
Regardless of the current decline in total overdose deaths within the U.S., greater than 90,000 folks nonetheless died within the 12 months ending July 2024 and charges are rising in lots of Black and Native American communities.
“We won’t mess up or miss this second,” Myles stated.
Opioid settlement payouts are anticipated to whole about $50 billion over almost twenty years, paid by greater than a dozen corporations that made or distributed prescription painkillers, together with Johnson & Johnson, Walgreens, and Walmart. Though it is a big sum, it is dwarfed by the scale of the disaster, making every greenback that is spent important.
KFF Well being Information and its companions reviewed a whole bunch of settlement spending reviews, extracting expenditures line by line, and developed a methodology to type the expenditures into classes like remedy or prevention. States got a possibility to evaluate the information and touch upon their spending.
To make certain, the database doesn’t seize the total image of opioid settlement spending nationwide. Some locations don’t publish spending reviews, whereas others declined to interact with this undertaking. The info introduced here’s a snapshot as of the top of 2023 and doesn’t account for additional spending in 2024. The variations in how states management, course of and report on the cash make apples-to-apples comparisons almost unattainable. Nonetheless, the database helps to fill a spot left by a scarcity of nationwide reporting necessities and federal authorities inaction.
It’s “a software for many who need to objectively measure whether or not every thing that may be executed is being executed,” stated Matthew Myers, a former president of the Marketing campaign for Tobacco-Free Youngsters, which compiles related annual reviews on tobacco settlement cash.
Funding for remedy is a transparent winner
The highest precedence to emerge from early opioid settlement spending was remedy, with greater than $416 million spent or dedicated to residential rehabs, outpatient counseling, medicines for opioid use dysfunction, and extra.
The state of New York — which spent essentially the most on remedy — allotted about $22 million of that for packages that make the gold commonplace for care as straightforward as attainable for sufferers: offering same-day prescriptions for buprenorphine, a drugs that decreases cravings for opioids.
The outcome was a program that John Greene stated modified his life.
John Greene at Household & Youngsters’s Counseling Providers in Cortland, New York. Greene is 4 months into restoration for the primary time since he began commonly utilizing medication at age 14. He credit a brand new program that the counseling middle began with opioid settlement cash.
Celia Talbot Tobin for KFF Well being Information
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Celia Talbot Tobin for KFF Well being Information
Greene, 57, used to reside within the woods down the road from Household & Youngsters’s Counseling Providers in Cortland, N.Y. He cycled by way of jails and hospitals, overdosing half a dozen occasions and attempting rehab simply as many.
However now he has 4 months of restoration below his belt — the longest stint since he began commonly utilizing medication at 14.
He stated it is as a result of the counseling middle’s new program — funded by a mixture of state and native opioid settlement {dollars} — has a distinct method. Counselors aren’t didactic and judgmental. They do not power him to give up smoking marijuana. A number of workers members have skilled dependancy themselves. They drive Greene, who would not have a automotive, to physician appointments and the pharmacy for his buprenorphine prescription.
Now Greene lives and works along with his brother, seems ahead to weekly counseling periods and is notching small victories — resembling shopping for his nephew toy automobiles as a stocking stuffer.
“It made me really feel good to do one thing for any person and never anticipate nothing again,” Greene stated.
Emily Georgia, one in every of Greene’s counselors, stated the middle has labored with almost 200 folks like him prior to now 12 months. With out the settlements, “this system most likely would not exist,” she stated.
Throughout the nation, the cash helps different revolutionary remedy approaches:
- $21 million for a brand new program in Kentucky that diverts folks with psychological sickness or dependancy who face low-level expenses away from incarceration and into remedy, schooling, and workforce coaching
- Greater than $3 million for, partly, three new cellular methadone packages in Massachusetts, to deliver the medicine to rural and underserved areas
- Tens of hundreds of {dollars} every in Iowa and Pennsylvania to cowl out-of-pocket remedy prices for folks with out insurance coverage or these with excessive deductibles
Philip Rutherford, an knowledgeable on substance use dysfunction on the Nationwide Council for Psychological Wellbeing, stated these efforts “are actually constructive” and lots of have been “traditionally troublesome or unattainable to realize with federal or state funding.”
However some funds are additionally flowing to remedy approaches that defy finest practices, resembling denying folks medicines for opioid use dysfunction.
Some within the restoration group contemplate methadone and buprenorphine a crutch. However examine after examine exhibits that the medicines assist folks keep in remedy and scale back the threat of overdose and loss of life. Analysis even suggests that remedy with out these medicines might be extra dangerous than no remedy in any respect.
Though not everybody will need medicine, settlement funds should not “prop up a system that does not permit folks to have that selection,” stated Regina LaBelle, a professor of dependancy coverage at Georgetown College.
Infants, forgotten victims of the epidemic
Whereas remedy acquired a windfall in early opioid settlement spending, one other facet of the disaster was uncared for: neonatal abstinence syndrome, a situation through which infants uncovered to medication within the womb expertise withdrawal.
A licensed nursing assistant comforts an toddler who lately arrived at Jacob’s Hope, a specialty nursery in Mesa, Arizona, that helps look after substance-exposed newborns and their mother and father.
Ash Ponders for KFF Well being Information
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Ash Ponders for KFF Well being Information
Nationwide, greater than 59 newborns a day are recognized with it. But solely about $8.4 million in settlement cash was dedicated to the problem — lower than 0.5% of all funds publicly reported as spent or dedicated in 2022 and 2023.
Specialists in public well being and dependancy, in addition to affected households, say it is as a result of stigma.
“A mother utilizing medication and being a dad or mum is a really uncomfortable actuality to face,” stated Ashley Grant, a 38-year-old mom of three in Mesa, Ariz. “It is simpler to simply push it below the rug or allow them to fall by way of the cracks, as unhappy as that’s.”
It nearly occurred to her.
Grant realized she was pregnant together with her third youngster final 12 months. On the time, her companion was in jail and he or she was utilizing medication after an eight-year interval of restoration, was estranged from her household and did not know the way she’d survive the following 9 months.
Throughout a go to to a methadone clinic, she noticed a sales space about Jacob’s Hope, a specialty nursery that cares for substance-exposed newborns and their mothers. Nursery workers related her with a therapist, helped her enroll in parenting lessons and dropped off diapers and a playpen at her residence.
After delivering on the hospital, Grant and her child boy stayed at Jacob’s Hope for a couple of week. Nurses confirmed her how skin-to-skin contact calmed his withdrawal signs and extra frequent feedings and burpings decreased gastrointestinal discomfort, which is frequent amongst substance-exposed newborns.
Right now, Grant has roughly 5 months of restoration. She bought licensed as a peer restoration specialist and hopes to hitch Jacob’s Hope someday to assist mothers like her.
However the nursery’s future is unsure.
After opening in 2019, Jacob’s Hope almost shut down this summer season as a result of low reimbursements and delayed funds from insurers, stated Lyndsey Steele, its affiliate director. Group donations saved the nursery afloat, however “it is nonetheless hanging on by a thread,” she stated.
She’s hoping opioid settlement cash may also help.
In 2022, Jacob’s Hope acquired about $250,000 from Arizona’s opioid settlements. However this 12 months, the legislature captured the state’s share of remaining funds and, in a controversial transfer, gave it to the Division of Corrections.
Jacob’s Hope has now turned to native governments, which management their very own settlement {dollars}. Its residence metropolis of Mesa stated a primary spherical of grant purposes ought to open within the spring.
Steele prays it will not be too late for infants in want — the epidemic’s “forgotten victims,” she known as them.
Jo Jones (left) is the founding father of Jacob’s Hope, a specialty nursery in Mesa, Ariz., that cares for substance-exposed newborns. Lyndsey Steele (proper) is the nursery’s affiliate director. Steele is hoping to safe opioid settlement cash to assist preserve the nursery afloat.
Ash Ponders for KFF Well being Information
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Ash Ponders for KFF Well being Information
Coronary heart illness screening, robotic ambulances, and extra
Some opioid settlement expenditures have sparked fierce disagreement. They typically fall into three buckets: cash for regulation enforcement, funding for youth prevention packages and purchases unrelated to the opioid disaster.
Settlement {dollars} nationwide have purchased physique scanners, Okay-9 items, bulletproof vests, patrol vehicles and laptops and printers for police and sheriffs.
Some spending strayed even farther from the spirit of the settlement. In Oregon Metropolis, Oregon, greater than $30,000 was spent on screening first responders for coronary heart illness. Police Chief Shaun Davis stated his workers reply to opioid-related emergencies and expertise trauma that will increase their threat of coronary heart assault.
However some folks query if settlement funds ought to be footing the invoice.
“This seems to me such as you’re attempting to defray different prices” from the police price range, stated Stephen Loyd, chair of Tennessee’s Opioid Abatement Council. “I do not suppose that there is any means that this opioid cash was earmarked for stuff like that.”
A second space of rivalry is youth prevention.
Though most individuals agree that stopping youngsters from growing addictions is vital, the execution is difficult.
Almost half one million settlement {dollars} have gone to the Drug Abuse Resistance Training program, generally generally known as D.A.R.E. Many years of analysis recommend its unique curriculum is ineffective.
Robeson County, N.C., spent about $10,000 in settlement cash to purchase “Andy the Ambulance,” a robotic ambulance with huge eyes and an audio system by way of which a human operator can talk about the risks of medicine. EMS Director Patrick Cummings stated his staff has taken the robotic to church buildings and elementary faculties.
We “haven’t any research that present it is working,” he stated, however educating children looks like a superb funding as a result of “in the event that they by no means attempt it, they do not get addicted.”
Then there’s the chunk of cash — as much as 15% of every state’s funds — that is a free-for-all.
Flint, Mich., spent almost $10,000 on an indication for a group service middle. The town reported that the expense didn’t qualify as “opioid remediation.” In different phrases, it is unrelated to addressing the disaster.
However Caitie O’Neill, a metropolis spokesperson, stated that “the constructing signal makes it attainable for residents to seek out” the middle, which homes metropolis companies, “together with Narcan kits, fentanyl testing strips, and substance abuse referrals.”
Jurisdictions throughout 29 states reported non-remediation spending in 2022 and 2023. Most opioid settlements require such reviews however function on an honor system. Nobody is checking if the opposite 21 states and Washington, D.C., had been truthful.
Jackie Lewis misplaced her 34-year-old son, Shaun, in October 2022 to an opioid overdose. She is elevating Shaun’s daughter, now 9 years previous, on her Social Safety funds. Lewis needs officers accountable for settlement funds to assist households like hers. “We nonetheless exist and we’re nonetheless struggling,” she says.
Maddie McGarvey for KFF Well being Information/30272172A
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Maddie McGarvey for KFF Well being Information/30272172A
Jackie Lewis, an Ohio mom whose 34-year-old son, Shaun, died of an overdose in October 2022, finds that tough to abdomen.
“That is blood cash,” she stated. Some folks have “overpassed that.”
Lewis is elevating Shaun’s daughter, making certain the 9-year-old receives counseling in school and may attend the hip-hop music lessons she enjoys — all on Lewis’ Social Safety funds. This 12 months they moved to a smaller city with decrease prices.
As settlement funds proceed flowing, she needs officers accountable for the cash to assist households like hers.
“We nonetheless exist and we’re nonetheless struggling,” she stated.
KFF Well being Information’ Henry Larweh and Megan Kalata, Johns Hopkins Bloomberg Faculty of Public Well being’s Sara Whaley and Vivian Flanagan, and Shatterproof’s Kristen Pendergrass and Sahvanah Prescott contributed to this text.
KFF Well being Information is a nationwide newsroom that produces in-depth journalism about well being points and is likely one of the core working packages at KFF .
The Johns Hopkins Bloomberg Faculty of Public Well being has taken a number one function in offering steering to state and native governments on using opioid settlement funds. College from the college collaborated with different specialists within the discipline to create rules for utilizing the cash, which have been endorsed by over 60 organizations.
Shatterproof is a nationwide nonprofit that addresses substance use dysfunction by way of distinct initiatives, together with advocating for state and federal insurance policies, ending dependancy stigma, and educating communities concerning the remedy system.
Shatterproof is partnering with some states on tasks funded by opioid settlements. KFF Well being Information, the Johns Hopkins Bloomberg Faculty of Public Well being, and the Shatterproof staff who labored on this report should not concerned in these efforts.
Lydia Zuraw of KFF Well being Information created the graphics on this story and Daniel Wooden tailored them for NPR.
