John Greene and his counselor Emily Georgia at Household & Kids’s Counseling Providers in Cortland, N.Y. Greene is 4 months into restoration for the primary time since he began commonly utilizing medicine 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 firms 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 College of Public Well being and Shatterproof, a nationwide nonprofit targeted on habit, undertook a yearlong investigation to seek out out.
Dozens of interviews, 1000’s of pages of paperwork, an array of public information requests and outreach to all 50 states resulted in a first-of-its type database that catalogs greater than 7,000 methods opioid settlement money was utilized in 2022 and 2023. It is probably the most complete useful resource so far 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 obtained greater than $6 billion in opioid settlement funds in 2022 and 2023. In accordance with public information, 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 experiences on the funds.
- Studies 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 habit therapy workforce in California.
- States allotted, on common, about 18% of their funds for habit and psychological well being therapy; 14% for restoration companies equivalent to housing, transportation, and authorized support; 11% for hurt discount efforts equivalent to overdose reversal medicines; and 9% for prevention packages that goal to cease folks from creating substance use problems. States dedicated, on common, about 2% for syringe service packages, via which individuals can get sterile needles. (A wide range of entities obtained this cash, from regulation enforcement to nonprofit organizations to authorities businesses.)
- 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 basic fund. One county even despatched funds to its highway and bridge division.
- A number of cities and counties reported expenditures they mentioned addressed the overdose disaster however that would depart a mean particular person scratching their head — equivalent to $33.07 to an anti-abortion being pregnant middle in Sandborn, Indiana, and $30,362 to display screen first responders for coronary heart illness in Oregon Metropolis, Oregon.
“When folks know that folks aren’t watching and there isn’t any accountability, then they will type of do what they need,” mentioned 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 will not mess up or miss this second,” Myles mentioned.
Opioid settlement payouts are anticipated to whole about $50 billion over practically twenty years, paid by greater than a dozen firms that made or distributed prescription painkillers, together with Johnson & Johnson, Walgreens, and Walmart. Though it is a big sum, it is dwarfed by the dimensions of the disaster, making every greenback that is spent vital.
KFF Well being Information and its companions reviewed lots of of settlement spending experiences, extracting expenditures line by line, and developed a methodology to kind the expenditures into classes like therapy or prevention. States got a chance to assessment the info and touch upon their spending.
To make sure, the database doesn’t seize the total image of opioid settlement spending nationwide. Some locations don’t publish spending experiences, whereas others declined to interact with this venture. The information 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 practically not possible. Nonetheless, the database helps to fill a niche left by an absence of nationwide reporting necessities and federal authorities inaction.
It’s “a device for individuals who wish to objectively measure whether or not every little thing that may be performed is being performed,” mentioned Matthew Myers, a former president of the Marketing campaign for Tobacco-Free Children, which compiles comparable annual experiences on tobacco settlement cash.
Funding for therapy is a transparent winner
The highest precedence to emerge from early opioid settlement spending was therapy, 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 probably the most on therapy — allotted about $22 million of that for packages that make the gold commonplace for care as straightforward as doable for sufferers: offering same-day prescriptions for buprenorphine, a medicine that decreases cravings for opioids.
The outcome was a program that John Greene mentioned modified his life.
John Greene at Household & Kids’s Counseling Providers in Cortland, New York. Greene is 4 months into restoration for the primary time since he began commonly utilizing medicine 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 stay within the woods down the road from Household & Kids’s Counseling Providers in Cortland, N.Y. He cycled via jails and hospitals, overdosing half a dozen instances 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 medicine at 14.
He mentioned 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 unique strategy. Counselors aren’t didactic and judgmental. They do not power him to quit smoking marijuana. A number of employees members have skilled habit 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 — equivalent to shopping for his nephew toy vehicles as a stocking stuffer.
“It made me really feel good to do one thing for any individual and never anticipate nothing again,” Greene mentioned.
Emily Georgia, certainly one of Greene’s counselors, mentioned the middle has labored with practically 200 folks like him up to now yr. With out the settlements, “this system in all probability would not exist,” she mentioned.
Throughout the nation, the cash helps different revolutionary therapy approaches:
- $21 million for a brand new program in Kentucky that diverts folks with psychological sickness or habit who face low-level costs away from incarceration and into therapy, training, and workforce coaching
- Greater than $3 million for, partially, three new cellular methadone packages in Massachusetts, to deliver the remedy to rural and underserved areas
- Tens of 1000’s of {dollars} every in Iowa and Pennsylvania to cowl out-of-pocket therapy prices for folks with out insurance coverage or these with excessive deductibles
Philip Rutherford, an skilled on substance use dysfunction on the Nationwide Council for Psychological Wellbeing, mentioned these efforts “are actually constructive” and lots of have been “traditionally troublesome or not possible to attain with federal or state funding.”
However some funds are additionally flowing to therapy approaches that defy finest practices, equivalent to denying folks medicines for opioid use dysfunction.
Some within the restoration group take into account methadone and buprenorphine a crutch. However research after research reveals that the medicines assist folks keep in therapy and cut back the danger of overdose and loss of life. Analysis even suggests that therapy with out these medicines could be extra dangerous than no therapy in any respect.
Though not everybody will need remedy, settlement funds should not “prop up a system that does not permit folks to have that alternative,” mentioned Regina LaBelle, a professor of habit coverage at Georgetown College.
Infants, forgotten victims of the epidemic
Whereas therapy obtained a windfall in early opioid settlement spending, one other facet of the disaster was uncared for: neonatal abstinence syndrome, a situation by which infants uncovered to medicine within the womb expertise withdrawal.
An authorized nursing assistant comforts an toddler who lately arrived at Jacob’s Hope, a specialty nursery in Mesa, Arizona, that helps take care of 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 identified with it. But solely about $8.4 million in settlement cash was dedicated to the difficulty — lower than 0.5% of all funds publicly reported as spent or dedicated in 2022 and 2023.
Consultants in public well being and habit, in addition to affected households, say it is as a result of stigma.
“A mother utilizing medicine and being a father or mother is a really uncomfortable actuality to face,” mentioned Ashley Grant, a 38-year-old mom of three in Mesa, Ariz. “It is simpler to only push it below the rug or allow them to fall via the cracks, as unhappy as that’s.”
It virtually occurred to her.
Grant discovered she was pregnant along with her third youngster final yr. On the time, her companion was in jail and she or he was utilizing medicine 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 employees 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 widespread amongst substance-exposed newborns.
In the present day, Grant has roughly 5 months of restoration. She acquired 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 practically shut down this summer time as a result of low reimbursements and delayed funds from insurers, mentioned Lyndsey Steele, its affiliate director. Group donations stored the nursery afloat, however “it is nonetheless hanging on by a thread,” she mentioned.
She’s hoping opioid settlement cash may help.
In 2022, Jacob’s Hope obtained about $250,000 from Arizona’s opioid settlements. However this yr, 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 mentioned a primary spherical of grant functions ought to open within the spring.
Steele prays it will not be too late for infants in want — the epidemic’s “forgotten victims,” she referred to 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, Ok-9 models, bulletproof vests, patrol vans 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 mentioned his employees reply to opioid-related emergencies and expertise trauma that will increase their danger of coronary heart assault.
However some folks query if settlement funds must be footing the invoice.
“This seems to me such as you’re attempting to defray different prices” from the police finances, mentioned Stephen Loyd, chair of Tennessee’s Opioid Abatement Council. “I do not assume that there is any approach 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 creating addictions is necessary, the execution is hard.
Almost half 1,000,000 settlement {dollars} have gone to the Drug Abuse Resistance Training program, generally often called D.A.R.E. Many years of analysis recommend its authentic curriculum is ineffective.
Robeson County, N.C., spent about $10,000 in settlement cash to purchase “Andy the Ambulance,” a robotic ambulance with massive eyes and an audio system via which a human operator can focus on the risks of medication. EMS Director Patrick Cummings mentioned his staff has taken the robotic to church buildings and elementary colleges.
We “have no research that present it is working,” he mentioned, however educating children looks like 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 practically $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, mentioned that “the constructing signal makes it doable 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 experiences 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 desires officers in command of 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 mentioned. Some folks have “overlooked 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 yr they moved to a smaller city with decrease prices.
As settlement funds proceed flowing, she desires officers in command of the cash to assist households like hers.
“We nonetheless exist and we’re nonetheless struggling,” she mentioned.
KFF Well being Information’ Henry Larweh and Megan Kalata, Johns Hopkins Bloomberg College 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 among the core working packages at KFF .
The Johns Hopkins Bloomberg College of Public Well being has taken a number one position in offering steerage to state and native governments on using opioid settlement funds. School from the college collaborated with different consultants within the area to create ideas for utilizing the cash, which have been endorsed by over 60 organizations.
Shatterproof is a nationwide nonprofit that addresses substance use dysfunction via distinct initiatives, together with advocating for state and federal insurance policies, ending habit stigma, and educating communities in regards to the therapy system.
Shatterproof is partnering with some states on tasks funded by opioid settlements. KFF Well being Information, the Johns Hopkins Bloomberg College of Public Well being, and the Shatterproof staff who labored on this report will not be concerned in these efforts.
Lydia Zuraw of KFF Well being Information created the graphics on this story and Daniel Wooden tailored them for NPR.
