These pitches land daily in the inboxes of state and local officials in charge of distributing more than $50 billion from settlements in opioid lawsuits.

The money is coming from an array of companies that made, sold, or distributed prescription painkillers, including Johnson & Johnson, AmerisourceBergen, and Walgreens. Thousands of state and local governments sued the companies for aggressively promoting and distributing opioid medications, fueling an epidemic that progressed to heroin and fentanyl and has killed more than half a million Americans. The settlement money, arriving over nearly two decades, is meant to remediate the effects of that corporate behavior.

But as the dollars land in government coffers — more than $4.3 billion as of early November — a swarm of private, public, nonprofit, and for-profit entities are eyeing the gold rush. Some people fear that corporations, in particular — with their flashy products, robust marketing budgets, and hunger for profits — will now gobble up the windfall meant to rectify it.

“They see a cash cow,” said JK Costello, director of behavioral health consulting for the Steadman Group, a firm that is being paid to help local governments administer the settlements in Colorado, Kansas, Oregon, and Virginia. “Everyone is interested.”

Costello receives multiple emails a week from businesses and nonprofits seeking guidance on how to apply for the funds. To keep up with the influx, he has developed a standard response: Thanks, but we can’t respond to individual requests, so here’s a link to your locality’s website, public meeting schedule, or application portal.

California Healthline obtained email records in eight states that show health departments, sheriffs’ offices, and councils overseeing settlement funds are receiving a similar deluge of messages. In the emails, marketing specialists offer phone calls, informational presentations, and meetings with their companies.

Alabama Attorney General Steve Marshall recently sent a letter reminding local officials to vet organizations that reach out. “I am sure that many of you have already been approached by a variety of vendors seeking funding for opioid initiatives,” he wrote. “Please proceed with caution.”

Of course, not all marketing efforts should prompt concern. Emails and calls are one way people in power learn about innovative products and services. The country’s addiction crisis is too large for the public sector to tame alone, and many stakeholders agree that partnering with industry is crucial. After all, pharmaceutical companies manufacture medications to treat opioid addiction. Corporations run treatment facilities and telehealth services.

“It’s unrealistic and even harmful to say we don’t want any money going to any private companies,” said Kristen Pendergrass, vice president of state policy at Shatterproof, a national nonprofit focused on addiction.

The key, agree public health and policy experts, is to critically evaluate products or services to see if they are necessary, evidence-based, and sustainable — instead of flocking to companies with the best marketing.

Otherwise, “you end up with lots of shiny objects,” Costello said.

And, ultimately, failure to do due diligence could leave some jurisdictions holding an empty bag.

Take North Carolina. In 2022, state lawmakers allotted $1.85 million of settlement funds for a pilot project using the first FDA-approved app for opioid use disorder, developed by Pear Therapeutics. There were high hopes the app would help people stay in treatment longer.

But less than a year later, Pear Therapeutics filed for bankruptcy.

The state hadn’t paid the company yet, so the money isn’t lost, according to the North Carolina Department of Health and Human Services. But the department and lawmakers have not decided what to do with those dollars next.

$1 Million for Drug Disposal Pouches

Jason Sundby, CEO of Verde Environmental Technologies, said the Deterra pouches his company sells are a low-cost way to prevent expensive addictions.

Customers place their unused medications in a Deterra pouch and add water, deactivating the drugs before tossing them, ensuring they cannot be used even if fished out of the trash. A medium Deterra pouch costs $3.89 and holds 45 pills.

The goal is to “get these drugs out of people’s homes before they can be misused, diverted, and people start down the path of needing treatment or naloxone or emergency room visits,” Sundby said.

Sundby’s company ran an ad about spending settlement dollars on its product in a National Association of Counties newsletter and featured similar information online.

It may be paying off, as Deterra is set to receive $1 million in settlement funds from the health department in Delaware County, Pennsylvania, and $12,000 from the sheriff’s office in Henry County, Iowa. The company also has partnerships with St. Croix and Milwaukee counties in Wisconsin, and is working on a deal in Connecticut.

Several other companies with similar products have also used their product sites to urge jurisdictions to consider the settlements as a funding stream — and they’re seeing early success.

DisposeRx makes a drug deactivation product — its version costs about a dollar each — and received $144,000 in South Carolina for mailing 134,000 disposal packets to a program that educated high school football players, coaches, and parents about addiction.

SafeRx makes $3 pill bottles with a locking code to store medications and was awarded $189,000 by South Carolina’s opioid settlement council to work with the Greenville County Sheriff’s Office and local prevention groups. It also won smaller awards from Weld and Custer counties in Colorado.

None of the companies said they are dependent on opioid settlements to sustain their business long-term. But the funds provide a temporary boost. In a 2022 presentation to prospective investors, SafeRx called the opioid settlements a “growth catalyst.”

Critics of such investments say the products are not worthwhile. Today’s crisis of fatal overdoses is largely driven by illicit fentanyl. Even if studies suggest the companies’ products make people more likely to safely store and dispose of medications, that’s unlikely to stem the record levels of deaths seen in recent years.

“The plausible mechanism by which they would even be able to reduce overdose is a mystery because prescription medications are not driving overdose,” said Tricia Christensen, policy director with the nonprofit Community Education Group, which is tracking settlement spending across Appalachia.

Safe storage and disposal can be accomplished with a locking cabinet and toilet, she said. The FDA lists opioids on its flush list for disposal and says there is no evidence that low levels of the medicines that end up in rivers harm human health.

But Milton Cohen, CEO of SafeRx’s parent company, Caring Closures International, said keeping prescription medicines secure addresses the root of the epidemic. Fentanyl kills, but often where people start, “where water is coming into the boat still, is the medicine cabinet,” he said. “We can bail all we want, but the right thing to do is to plug the hole first.”

Products to secure and dispose of drugs also provide an opportunity for education and destigmatization, said Melissa Lyon, director of the Delaware County Health Department in Pennsylvania. The county will be mailing Deterra pouches and postcards about preventing addiction to three-quarters of its residents.

“The Deterra pouch is to me a direct correlation” to the overprescribing that came from pharmaceutical companies’ aggressive marketing, she added. Since the settlement money is to compensate for that, “this is a good use of the funds.”

Tools for Law Enforcement That Superheroes Would Envy

Other businesses making pitches for settlement funds have a less clear relationship to opioids.

Wrap Technologies creates tools for law enforcement to reduce lethal uses of force. Its chief product, the BolaWrap, shoots a 7½-foot Kevlar tether more than a dozen feet through the air until it wraps around a person’s limbs or torso — almost like Wonder Woman’s Lasso of Truth.

Terry Nichols, director of business development for the company, said the BolaWrap can be used as an alternative to Tasers or pepper spray when officers need to detain someone experiencing a mental health crisis or committing crimes related to their addiction, like burglary.

“If you want to be more humane in the way you treat people in substance use disorder and crisis, this is an option,” he said.

The company posts body camera footage of officers using BolaWrap on YouTube and says that out of 192 field reports of its use, about 75% of situations were resolved without additional use of force.

When officers de-escalate situations, people are less likely to end up in jail, Nichols said. And diverting people from the criminal justice system is among the suggested investments in opioid settlement agreements.

That argument convinced the city of Brownwood, Texas, where Nichols was police chief until 2019. It has spent about $15,000 of opioid settlement funds to buy nine BolaWrap devices.

“Our goal is to avoid using force when a citizen is in need,” said James Fuller, assistant police chief in Brownwood. “If we’re going to take someone to get help, the last thing we want to do is poke holes in them with a Taser.”

After Brownwood’s purchase, Wrap Technologies issued a press release in which CEO Kevin Mullins encouraged more law enforcement agencies to “take the opportunity afforded by the opioid settlement funds to empower their officers.” The company has also sent a two-page document to police departments explaining how settlement funds can be used to buy BolaWraps.

Language from that document appeared nearly word-for-word in a briefing sheet given to Brownwood City Council before the BolaWrap purchase. The council voted unanimously in favor.

But the process hasn’t been as smooth elsewhere. In Hawthorne, California, the police department planned to buy 80 BolaWrap devices using opioid settlement funds. It paid its first installment of about $25,000 in June. However, it was later informed by the state Department of Health Care Services that the BolaWrap is not an allowable use of these dollars.

“Bola Wraps will not be purchased with the Settlement Funds in the future,” Hawthorne City Clerk Dayna Williams-Hunter wrote in an email.

Carolyn Williams, a member of the advocacy group Vocal-TX, said she doesn’t see how the devices will address the overdose crisis in Texas or elsewhere.

Her son Haison Akiem Williams dealt with mental health and addiction issues for years. Without insurance, he couldn’t afford rehab. When he sought case management services, there was a three-month wait, she said. Police charged him with misdemeanors but never connected him to care, she said.

In February, he died of an overdose at age 47. His mother misses how he used to make her laugh by calling her “Ms. Carol.”

She wants settlement funds to support services she thinks could have kept him alive: mental health treatment, case management, and housing. BolaWrap doesn’t make that list.

“It’s heartbreaking to see what the government is doing with this money,” she said. “Putting it in places they really don’t need it.”

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

The company filed for bankruptcy and agreed to pay settlements to governments, as well as individual victims of the opioid crisis. That bankruptcy provided Purdue Pharma liability protection from future civil cases about opioids. The family behind this company, the Sacklers, did not seek bankruptcy but requested the same liability protections.

Family members have offered to pay $6 billion from their personal fortune into the settlement, but only if they’re given immunity. It’s this stipulation that the Department of Justice opposes.

KFF Health News senior correspondent Aneri Pattani went to the site of the protests outside the Supreme Court building and talked to advocates and people affected by the opioid crisis to get their take on the case. She also was interviewed on WBUR’s “Here & Now.”

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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But like most dollars meant to address public health crises, settlement cash has nonetheless turned into a political issue.

Gubernatorial candidates in several states are clashing over who gets bragging rights for the funds — which total more than $50 billion and are being distributed to state and local governments over nearly two decades. Among the candidates are attorneys general who pursued the lawsuits that produced the payouts. And they’re eager to remind the public who brought home the bacon.

“Scoring money for your constituency almost always plays well,” said Stephen Voss, an associate professor of political science at the University of Kentucky. It “is a lot more compelling and unifying a political argument than taking a position on something like abortion,” for which you risk alienating someone no matter what you say.

In Kentucky, Attorney General Daniel Cameron, the Republican candidate for governor, wants sole credit for the hundreds of millions of dollars his state is receiving to fight the opioid epidemic. In a post on X, formerly known as Twitter, he wrote that his opponent, former attorney general and current Democratic Gov. Andy Beshear, “filed a lot of lawsuits during his time [in] office, but in this race, there is only one person who has actually delivered dollars to fight the opioid epidemic, and it’s not him.”

However, Beshear filed nine opioid lawsuits during his tenure as attorney general, several of which led to the current payouts. At a January news conference, Beshear defended his role: “That’s where these dollars are coming from — cases that I filed, and I personally argued many of them in court.”

Polls indicate that Beshear leads Cameron ahead of the Nov. 7 election.

Christine Minhee, founder of OpioidSettlementTracker.com, who is closely following how attorneys general handle the money nationwide, said voters likely don’t know that the opioid settlements are national deals crafted by a coalition of attorneys general and private lawyers. So when one candidate claims credit for the money, his constituents may believe “he’s the sole hero in all of this.”

Candidates in other states are touting their settlement credentials, too. North Carolina Attorney General Josh Stein, a Democrat, lists securing opioid settlement funds at the top of the “accomplishments” section of his 2024 gubernatorial campaign website. West Virginia Attorney General Patrick Morrisey, a Republican gubernatorial candidate for 2024, has repeatedly boasted of securing the “highest per capita settlements in the nation” in news conferences and on social media and his campaign website.

In Louisiana, Attorney General Jeff Landry, a Republican who was recently elected governor, ran on a tough-on-crime platform, with endorsements from sheriffs and prosecutors. As attorney general, he led negotiations on dividing opioid settlement funds within the state, resulting in an agreement to send 80% to parish governments and 20% to sheriffs’ departments — the largest direct allocation to law enforcement in the nation.

It’s a common joke that AG stands for “aspiring governor,” and officials in that role often use big legal cases to advance their political careers. Research shows that attorneys general who participate in multistate litigation — like that which led to the opioid settlements and the tobacco settlement before it — are more likely to run for governor or senator.

But for some advocates and people personally affected by the opioid epidemic, this injection of politics raises concerns about how settlement dollars are being spent, who is making the decisions, and whether the money will truly address the public health crisis. Last year, more than 100,000 Americans died of drug overdoses.

Average people “don’t really care about the bragging rights as much as they care about the ability to use that funding to improve and save lives,” said Shameka Parrish-Wright, director of VOCAL-KY, an advocacy group that champions investments in housing and health care.

“What I see in my state is a lot of press conferences and news pieces,” said Parrish-Wright, a Democrat who is active in local politics. “But what plays out doesn’t get to the people” — especially those deeply affected by addiction.

For example, when Beshear celebrated a decrease in the state’s overdose deaths, his announcement overlooked the increasing deaths among Black Kentuckians, Parrish-Wright said. And when Cameron’s appointee to the state’s opioid abatement advisory commission announced that $42 million of settlement funds were being considered to research ibogaine — a psychedelic drug that has shown potential to treat addiction — Parrish-Wright’s first thought was “most poor people can’t afford that.” To obtain it, people often have to travel out of the country.

The ibogaine announcement caused additional controversy. It’s an experimental drug, and, if approved, the $42 million allocation would be the single-largest investment from the commission, which is housed in Cameron’s agency. The Daily Beast reported that a billionaire Republican donor backing Cameron’s gubernatorial campaign stands to reap massive profits from the drug’s development.

Neither Cameron’s office nor his campaign responded to requests for comment.

Beshear’s office declined an interview request but referred California Healthline to his previous public statements, in which he criticized the potential investment in ibogaine. He has suggested Cameron — whose campaign has emphasized support for police — is not putting his money where his mouth is.

“If you only provide $1 million to law enforcement and 42 to pharma, it doesn’t seem like you’re backing the blue. It seems like you’re backing Big Pharma,” Beshear said at a May news conference.

He also said his two appointees to the commission were caught off guard by the public announcement on ibogaine, despite their role overseeing settlement funds.

Minhee, founder of OpioidSettlementTracker.com, said she’s concerned that mixing politics with settlement funds could result in ineffective investments nationwide.

“If some of this money is going to be politicized to advance careers of attorneys general who support the war on drugs, then that is literally using monies won by death to feed into more death,” she said.

Parrish-Wright, of VOCAL-KY, said she worries that candidates — and some voters — will forget about the significance of the money once ballots are cast.

“We cannot let it fade after the election cycle,” she said.

Her solution depends in part on politics. She’s on the ballot herself Nov. 7, for a seat on Louisville’s Metro Council. If she wins, she said, she intends to keep the settlement in the public conversation.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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In these cases and many others, state and local governments are turning to a new means to pay those bills: opioid settlement cash.

This money — totaling more than $50 billion across 18 years — comes from national settlements with more than a dozen companies that made, sold, or distributed opioid painkillers, including Johnson & Johnson, AmerisourceBergen, and Walmart, which were accused of fueling the epidemic that addicted and killed millions.

Directing the funds to police has triggered difficult questions about what the money was meant for and whether such spending truly helps save lives.

Terms vary slightly across settlements, but, in most cases, state and local governments must spend at least 85% of the cash on “opioid remediation.”

Paving roads or building schools is out of the question. But if a new cruiser helps officers reach the scene of an overdose, does that count?

Answers are being fleshed out in real time.

The money shouldn’t be spent on “things that have never really made a difference,” like arresting low-level drug dealers or throwing people in jail when they need treatment, said Brandon del Pozo, who served as a police officer for 23 years and is currently an assistant professor at Brown University researching policing and public health. At the same time, “you can’t just cut the police out of it. Nor would you want to.”

Many communities are finding it difficult to thread that needle. With fentanyl, a powerful synthetic opioid, flooding the streets and more than 100,000 Americans dying of overdoses each year, some people argue that efforts to crack down on drug trafficking warrant law enforcement spending. Others say their war on drugs failed and it’s time to emphasize treatment and social services. Then there are local officials who recognize the limits of what police and jails can do to stop addiction but see them as the only services in town.

What’s clear is that each decision — whether to fund a treatment facility or buy a squad car — is a trade-off. The settlements will deliver billions of dollars, but that windfall is dwarfed by the toll of the epidemic. So increasing funding for one approach means shortchanging another.

“We need to have a balance when it comes to spending opioid settlement funds,” said Patrick Patterson, vice chair of Michigan’s Opioid Advisory Commission, who is in recovery from opioid addiction. If a county funds a recovery coach inside the jail, but no recovery services in the community, then “where is that recovery coach going to take people upon release?” he asked.

Jail Technology Upgrades?

In Michigan, the debate over where to spend the money centers on body scanners for jails.

Email records obtained by KFF Health News show at least half a dozen sheriff departments discussed buying them with opioid settlement funds.

Kalamazoo County finalized its purchase in July: an Intercept body scanner marketed as a “next-generation” screening tool to help jails detect contraband someone might smuggle under clothing or inside their bodies. It takes a full-body X-ray in 3.8 seconds, the company website says. The price tag is close to $200,000.

Jail administrator and police Capt. Logan Bishop said they bought it because in 2016 a 26-year-old man died inside the jail after drug-filled balloons he’d hidden inside his body ruptured. And last year, staffers saved a man who was overdosing on opioids he’d smuggled in. In both cases, officers hadn’t found the drugs, but the scanner might have identified them, Bishop said.

“The ultimate goal is to save lives,” he added.

St. Clair County also approved the purchase of a scanner with settlement dollars. Jail administrator Tracy DeCaussin said six people overdosed inside the jail within the past year. Though they survived, the scanner would enhance “the safety and security of our facility.”

But at least three other counties came to a different decision.

“Our county attorney read over parameters of the settlement’s allowable expenses, and his opinion was that it would not qualify,” said Sheriff Kyle Rosa of Benzie County. “So we had to hit the brakes” on the scanner.

Macomb and Manistee counties used alternative funds to buy the devices.

Scanners are a reasonable purchase from a county’s general funds, said Matthew Costello, who worked at a Detroit jail for 29 years and now helps jails develop addiction treatment programs as part of Wayne State University’s Center for Behavioral Health and Justice.

After all, technology upgrades are “part and parcel of running a jail,” he said. But they shouldn’t be bought with opioid dollars because body scanners do “absolutely nothing to address substance use issues in jail other than potentially finding substances,” he said.

Many experts across the criminal justice and addiction treatment fields agree that settlement funds would be better spent increasing access to medications for opioid use disorder, which have been shown to save lives and keep people engaged in treatment longer, but are frequently absent from jail care.

Who Is on the Front Lines?

In August, more than 200 researchers and clinicians delivered a call to action to government officials in charge of opioid settlement funds.

“More policing is not the answer to the overdose crisis,” they wrote.

In fact, years of research suggests law enforcement and criminal justice initiatives have exacerbated the problem, they said. When officers respond to an overdose, they often arrest people. Fear of arrest can keep people from calling 911 in overdose emergencies. And even if police are accompanied by mental health professionals, people can be scared to engage with them and connect to treatment.

A study published this year linked seizures of opioids to a doubling of overdose deaths in the areas surrounding those seizures, as people turned to new dealers and unfamiliar drug supplies.

“Police activity is actually causing the very harms that police activity is supposed to be stemming,” said Jennifer Carroll, an author of that study and an addiction policy researcher who signed the call to action.

Officers are meant to enforce laws, not deliver public health interventions, she said. “The best thing that police can do is recognize that this is not their lane,” she added.

But if not police, who will fill that lane?

Rodney Stabler, chair of the board of commissioners in Bibb County, Alabama, said there are no specialized mental health treatment options nearby. When residents need care, they must drive 50 minutes to Birmingham. If they’re suicidal or in severe withdrawal, someone from the sheriff’s office will drive them.

So Stabler and other commissioners voted to spend about $91,000 of settlement funds on two Chevy pickups for the sheriff’s office.

“We’re going to have to have a dependable truck to do that,” he said.

Commissioners also approved $26,000 to outfit two new patrol vehicles with lights, sirens, and radios, and $5,500 to purchase roadside cameras that scan passing vehicles and flag wanted license plates.

Stabler said these investments support the county agencies that most directly deal with addiction-related issues: “I think we’re using it the right way. I really do.”

Shawn Bain, a retired captain of the Franklin County, Ohio, sheriff’s office, agrees.

“People need to look beyond, ‘Oh, it’s just a vest or it’s just a squad car,’ because those tools could impact and reduce drugs in their communities,” said Bain, who has more than 25 years of drug investigation experience. “That cruiser could very well stop the next guy with five kilos of cocaine,” and a vest “could save an officer’s life on the next drug raid.”

That’s not to say those tools are the solution, he added. They need to be paired with equally important education and prevention efforts, he said.

However, many advocates say the balance is off. Law enforcement has been well funded for years, while prevention and treatment efforts lag. As a result, law enforcement has become the de facto front line, even if they’re not well suited to it.

“If that’s the front lines, we’ve got to move the line,” said Elyse Stevens, a primary care doctor at University Medical Center New Orleans, who specializes in addiction. “By the time you’re putting someone in jail, you’ve missed 10,000 opportunities to help them.”

Stevens treats about 20 patients with substance use disorder daily and has appointments booked out two months. She skips lunch and takes patient calls after hours to meet the demand.

“The answer is treatment,” she said. “If we could just focus on treating the patient, I promise you all of this would disappear.”

Sheriffs to Be Paid Millions

In Louisiana, where Stevens works, 80% of settlement dollars are flowing to parish governments and 20% to sheriffs’ departments.

Over the lifetime of the settlements, sheriffs’ offices in the state will receive more than $65 million — the largest direct allocation to law enforcement nationwide.

And they do not have to account for how they spend it.

While parish governments must submit detailed annual expense reports to a statewide opioid task force, the state’s settlement agreement exempts sheriffs.

Louisiana Attorney General Jeff Landry, who authored that agreement and has since been elected governor, did not respond to questions about the discrepancy.

Chester Cedars, president of St. Martin parish and a member of the Louisiana Opioid Abatement Task Force, said he’s confident sheriffs will spend the money appropriately.

“I don’t see a whole lot of sheriffs trying to buy bullets and bulletproof vests,” he said. Most are “eager to find programs that will keep people with substance abuse problems out of their jails.”

Sheriffs are still subject to standard state audits and public records requests, he said.

But there’s room for skepticism.

“Why would you just give them a check” with nothing “to make sure it’s being used properly?” said Tonja Myles, a community activist and former military police officer who is in recovery from addiction. “Those are the kinds of things that mess with people’s trust.”

Still, Myles knows she has to work with law enforcement to address the crisis. She’s starting a pilot program with Baton Rouge police, in which trained people with personal addiction experience will accompany officers on overdose calls to connect people to treatment. East Baton Rouge Parish is funding the pilot with $200,000 of settlement funds.

“We have to learn how to coexist together in this space,” Myles said. “But everybody has to know their role.”

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

Video Reporter: Caresse Jackman, InvestigateTV; Video Editor: Scotty Smith, InvestigateTV

When three teenagers died of fentanyl overdoses last year in Larimer County, Colorado, it shocked the community and “flipped families upside down,” said Tom Gonzales, the county’s public health director.

Several schools began stocking naloxone, a medication that reverses opioid overdoses. Community organizations trained teens to use it. But county and school officials wanted to do more.

That’s when they turned to opioid settlement funds — money coming from national deals with health care companies like Johnson & Johnson, AmerisourceBergen, and CVS, which were accused of fueling the epidemic via prescription painkillers. The companies are paying out more than $50 billion to state and local governments over 18 years.

Much of that money is slated for addiction treatment and efforts to reduce drug trafficking. But some is going to school-based prevention programs to reduce the possibility of addiction before it begins. In some cases, school districts, which filed their own lawsuits that became part of the national settlements, are receiving direct payments. In other cases, state or local governments are setting aside part of their share for school-based initiatives.

Many parents, educators, and elected officials agree that investing in prevention is crucial to address the rising rates of youth overdoses, depression, and suicidal thoughts.

“We have to look at the root causes,” said Diana Fishbein, a senior scientist at the University of North Carolina-Chapel Hill and leading expert on applying prevention science to public policy. Otherwise, “we’re going to be chasing our tails forever.”

But the question of how to do that is fraught and will involve testing the comfort levels of many parents and local officials.

For generations of Americans, addiction prevention was synonymous with D.A.R.E., a Drug Abuse Resistance Education curriculum developed in the 1980s and taught by police officers in schools. It “dared” kids to resist drugs and was used in concert with other popular campaigns at the time, like “just say no” and a video of an egg in a frying pan with the narration, “This is your brain on drugs.”

But decades of research found those approaches didn’t work. In some cases, suburban students actually increased their drug use after participating in the D.A.R.E. program.

In contrast, prevention programs that today’s leading experts say show the most promise teach kids how to manage their emotions, communicate with others, be resilient, and build healthy relationships. They can have long-term health benefits while also saving society $18 for every dollar invested, per a federal analysis. But that approach is less intuitive than simply saying “no.”

If you tell parents, “‘We’re going to protect your child from dying of a fentanyl poisoning by teaching them social skills in third grade,’ they’re going to be angry at you,” said Linda Richter, who leads prevention-oriented research at the nonprofit Partnership to End Addiction. Selling them on the most effective approaches takes time.

That’s one of the reasons prevention experts worry that familiar programs like D.A.R.E. will be the go-to for elected officials and school administrators deciding how to use opioid settlement funds. When KFF Health News and InvestigateTV looked for evidence of local spending on prevention, even a cursory review found examples across half a dozen states where governments have already allocated $120,000 of settlement cash to D.A.R.E. programs. The curriculum has been revamped since the ’80s, but the effects of those changes are still being studied.

Budgeting Choices Reflect Deeper Debate

Researchers say putting money toward programs with uncertain outcomes — when more effective alternatives exist — could cost not only valuable resources but, ultimately, lives. Although $50 billion sounds like a lot, when compared with the toll of the epidemic, each penny must be spent efficiently.

“There’s tremendous potential for these funds to be wasted,” said Nathaniel Riggs, executive director of the Colorado State University Prevention Research Center.

But he has reason to be hopeful. Larimer County officials awarded Riggs’ team $400,000 of opioid settlement funds to build a prevention program based on the latest science.

Riggs and his colleagues are developing training for school staff and helping implement the Blues Program, a widely acclaimed intervention for students at risk of depression. The program, which will start in 10 middle and high schools this fall, teaches students about resilience and builds social support through six small group sessions, each an hour long. It’s been shown in multiple studies to decrease rates of depression and drug use among youth.

Natalie Lin, a 17-year-old senior at Fossil Ridge High School in Fort Collins, Colorado, is optimistic the program will help overcome the stigma her peers face with mental illness and addiction.

“Having it in school” prevents people from feeling “called out” for needing help, said Lin, who carries naloxone in her car so she’s prepared to reverse someone’s overdose. “It’s just acknowledging that anyone here could be battling” addiction, and “if you are, that’s all right.”

Across the country, investments in prevention run the gamut. Rhode Island is using about $1.5 million of settlement cash to increase the number of student assistance counselors in middle and high schools. Moore County, North Carolina, is spending $50,000 on a mentoring program for at-risk youth. Some communities are inviting guest speakers and, of course, many are turning to D.A.R.E.

New Hanover County, North Carolina, and the city of Wilmington, which it encompasses, pooled $60,000 of settlement money to train nearly 70 officers in the D.A.R.E. program, which they hope to launch in dozens of schools this fall.

County commissioner Rob Zapple said it’s one piece of a “multiprong approach” to show young people they can lead productive lives without drugs. Officials are also putting $25,000 of settlement cash toward public service announcements and $20,000 toward other outreach.

They acknowledged there’s little research on the updated D.A.R.E. curriculum but said the county views its investment as a pilot, which they will track closely. “Instead of committing everything at once, we’re going to let the spending of the money grow with the success of the program,” Zapple said.

Munster, Indiana, also decided to further its D.A.R.E. effort, using $6,000 — a small slice of its total settlement funds — annually. Jasper County, Iowa, is using $3,800 to cover materials for the program’s graduation ceremonies for several years.

In some places, officials are frank that they’re not getting enough money to do anything inventive.

Solon, Ohio, for example, received $9,500 in settlement funds this year and is expecting similar or smaller amounts in the future. “While the funding is welcome,” finance director Matt Rubino wrote in an email, it’s “not material enough to be transformational” to the budget. Putting it all toward the existing D.A.R.E. program made the most sense, he said.

Out With the Scare Tactics

Francisco Pegueros, CEO and president of D.A.R.E., said though the program has been in place since the ’80s, “it’s really significantly different” today. The curriculum was redone in 2009 to move away from scare tactics and lectures on specific drugs to focus instead on decision-making skills. Officers undergo intensive training, which includes understanding how children’s brains develop.

“Telling somebody a drug is harmful isn’t going to change their behaviors,” Pegueros said. “You really need to deliver a curriculum that’s going to build those skills to help them change behaviors.”

With the rise of fentanyl and some state legislatures mandating education on drugs, interest in D.A.R.E. has grown in recent years, Pegueros said. He believes it can be effective as part of a comprehensive, community approach to prevention.

“You’re not going to find one curriculum, one program, one action that’s going to achieve the results you want,” he said.

Still, D.A.R.E. can play an important role, he said, pointing to a recent study that found the new curriculum had a “positive effect in terms of deterring the onset of alcohol use and vaping” among fifth graders.

But many public health experts remain skeptical. They worry the changes are superficial. The few studies of D.A.R.E.’s new curriculum have been short-term, yielded mixed results, and in some cases had high dropout rates due to the covid-19 pandemic, which raises questions about how applicable the findings are for schools nationwide. According to some law enforcement officials and advocates, even the revamped program is often taught alongside campaigns like “One Pill Can Kill,” which warns youth that trying drugs can be fatal the first time.

That type of scare tactic seems futile to Kelli Caseman, executive director of Think Kids, a nonprofit that advocates for children’s health and well-being in West Virginia. “It’s not as if these kids are unsuspecting and have never seen the consequences of drug use before,” she said.

In 2017, West Virginia reported the highest rate in the nation of children living with their own or a parent’s opioid addiction.

“We need stronger communities that are willing to just give those kids more guidance and support than fear,” Caseman said. “They’ve already got enough fear as it is.”

Some local governments are trying to straddle both paths.

Take Chautauqua County in western New York. Last September, the county and a local child-development collaborative spent $26,000 — including $5,000 of opioid settlement cash — to bring former NBA player Chris Herren to speak at several assemblies about his past addictions to alcohol, heroin, and cocaine. Herren recounted to more than 1,500 students the first day he had a beer, at age 14; how addiction ended his career; and how he landed on the streets before entering recovery.

Patrick Smeraldo, a physical education teacher and the head of the local collaborative that organized Herren’s visit, said the basketball player’s story resonated with students, many of whom have parents with addiction. “When he talks about selling his kid’s Xbox to get drugs, I think he’s touching on facts that they’ve had to go through,” Smeraldo said.

But a one-time speaker event has little lasting impact, researchers and public health experts say.

That’s why the county is also investing opioid settlement funds in several other initiatives, said Steve Kilburn, who oversees addiction-related grants for Chautauqua County. A likely six-figure sum will go to Prevention Works, a local nonprofit that teaches a nationally acclaimed “Too Good for Drugs” curriculum in 23 schools and runs a “Teen Intervene” program that provides one-on-one coaching and support for students found using drugs or carrying drug paraphernalia in school.

Melanie Witkowski, executive director of Prevention Works, said some students are scared to come to school because their parents might overdose without someone at home to revive them.

Smeraldo, the physical education teacher, is planning to build on Herren’s talk with an after-school program, in which students will be able to discuss their mental health and transform interests like cooking into internships to help break the cycle of poverty that often contributes to addiction.

Herren is “the catalyst to get the kid to services that exist in the county,” Smeraldo said. It’s a starting point, not the end.

InvestigateTV is Gray Media Group’s national investigative team and provides innovative, original journalism from a dedicated investigative team and partners. InvestigateTV and its weekend and weekday programs are available on AppleTV, Roku, and Amazon Fire; at InvestigateTV.com; and across Gray’s 113 broadcast markets and digital media properties.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

But in at least one California county, history is repeating itself. And across the country, many local leaders are finding themselves in similar positions: choosing between paying bills due today or investing in the fight against an ongoing crisis.

Mendocino County in rural Northern California has reported the highest rate of overdose deaths in the state. Its board of supervisors decided to use more than $63,000 of opioid settlement funds — about 6.5% of all the settlement cash the county has received in the first two years of distribution— to help fill a budget shortfall of about $6 million. Specifically, the money has been allotted to cover employee health insurance premiums, wage increases, and cost-of-living adjustments. County officials plan to use that amount as a recurring source of payment, since opioid settlements are scheduled to arrive annually till 2038.

The board also used retirement reserves and delayed repair projects and equipment purchases to plug the gap.

“We have to balance our budget by law,” said Glenn McGourty, chair of the board of supervisors. “You find money where you can.”

Vice Chair Mo Mulheren added that health insurance deficits were caused, in part, by the overprescribing of opioids and the costs of addiction treatment for county employees or their family members. Now the settlement dollars can make the county “whole again,” she said.

But many people with substance use disorders and their loved ones want the money to be used to make their communities whole again in a different way — by supporting people in recovery and preventing opioid-related deaths. More than 100,000 Americans died of drug overdoses last year.

The settlement funds are the result of thousands of lawsuits filed against a host of health care companies, including Johnson & Johnson, McKesson, CVS Health, and Walmart, for aggressively promoting and distributing painkillers. The money should remediate the effects of that corporate behavior, say attorneys general, treatment providers, and those directly affected by the crisis.

In Mendocino County, McGourty said, “we certainly expend a lot of money on substance abuse.” But tourism and tax revenues, which were boosted at the height of the pandemic as Bay Area residents escaped to the rural county, have recently decreased. Meanwhile, costs for the sheriff’s office, jail, and behavioral health programs often run over budget, partly due to the opioid epidemic, he said.

The story is all too familiar to Matthew Myers, former president of the Campaign for Tobacco-Free Kids, which monitors how states spend money from the tobacco master settlement agreement of 1998.

Back then, states won more than $240 billion to be distributed over the first 25 years and continued annual payments for as long as the companies are selling cigarettes. In theory, the money was to be used to help people stop smoking, but there were no legal restrictions on how it was spent. In a 2007 report, the Government Accountability Office reported states had allocated $16.8 billion, or 30% of the money they’d received, to health care and $12.8 billion, or 23%, to budget shortfalls.

“Almost from the beginning, a significant number of states used the tobacco settlement money for anything but tobacco,” Myers said. “What’s most concerning, though, is that over time the track record of the states has gotten worse.”

People who made the original agreements left office, budget needs arose — especially during recessions — and oversight from the public and nonprofit organizations waned. Tobacco settlement money flowed to transportation departments to fill potholes, support corporate tax breaks, and even subsidize tobacco farmers. Today, less than 3% of the annual payouts is used for smoking cessation or prevention.

It’s a sobering statistic that many attorneys general kept in mind when negotiating the opioid settlements. To avoid the same scenarios, they set restrictions: At least 85% of the money has to be spent on opioid remediation, with a menu of suggested strategies.

Some states are stricter than others. In California, for example, 70% of the settlement funds funnel into an abatement account from which the state doles it out to counties and cities. All money from that account must be spent on future opioid remediation efforts, with at least half for creating treatment infrastructure, diverting people from the criminal justice system, preventing youth addiction, or other activities the state identified as high-impact. The state Department of Health Care Services has issued written guidance, held webinars, and offered customized assistance to local governments to ensure the money is used appropriately.

“We really want to make sure that all of this funding is for opioid remediation,” said Marlies Perez, who oversees opioid settlement funding at the department.

If her team finds examples of misspending, they can take local governments to court.

But there’s a caveat: The department has authority only over money that comes from the abatement fund and an additional 15% the state receives directly. The final 15% of the state’s settlement money goes straight to local governments and can be used for anything the localities define as opioid-related.

That’s why Mendocino County was able to use $63,000 to plug its budget hole and plan to spend a chunk of future funds similarly. (It has received roughly $780,000 more through the state abatement fund, which must be spent on opioid remediation.)

Even if that use of funds is legal, some people question whether it is appropriate.

Jacqueline Williams is executive director of the Ford Street Project, a nonprofit that runs a food bank, homeless shelter, and Mendocino County’s only adult residential addiction treatment program. “It’s disheartening that the need is so great,” she said, yet some of the settlement money is not going directly to the crisis.

She has asked the county for $4 million to build a 24-bed sober living facility, where clients — many of whom are homeless — can stay after completing residential treatment. “The hardest thing is when somebody asks for help if you don’t have a bed,” said Williams, who hasn’t received a final response to her request.

Jenine Miller, Mendocino County’s behavioral health director, said the county is using revenue from a local sales tax increase to build a psychiatric hospital, crisis respite facilities, and mobile response teams, but there is still a need for more residential treatment for addiction specifically.

“I can never say I have enough funds to do everything we need to do,” she said.

Miller signed off on a report the county is required to file with administrators of the settlement, saying it spent $63,000 on purposes that do not qualify as opioid remediation. She told California Healthline that she understands the county’s need to recuperate costs to its health insurance plan, “but the largest amount of the money needs to be in our community doing prevention, early intervention, and treatment.”

Mulheren, the vice chair of the board of supervisors, said if the county has savings in future years, it may be able to put some of the recurring $63,000 toward addiction initiatives. The county recently switched from being self-insured to a group health insurance plan for its roughly 900 employees.

“We’re trying to constantly figure out how we can save money, especially when it comes to the health insurance premiums.” Mulheren said.

But Myers, of the Campaign for Tobacco-Free Kids, said his experience with the tobacco settlement suggests the first few years of spending set the tone for the future.

“If states don’t start spending money for the designated purpose effectively and build it into the DNA of the budget process, the risks down the road only grow,” he said.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

In 14 states, these councils have the ultimate say on the money, which comes from companies that made, distributed, or sold opioid painkillers, including Purdue Pharma, Johnson & Johnson, and Walmart. In 24 other states, plus Washington, D.C., the councils establish budget priorities and make recommendations. Those will affect whether opioid settlement funds go, for example, to improve addiction treatment programs and recovery houses or for more narcotics detectives and prisons.

KFF Health News, along with Johns Hopkins University and Shatterproof, a national nonprofit focused on the addiction crisis, gathered and analyzed data on council members in all states to create the first database of its kind.

The data shows that councils are as unique as states are from one another. They vary in size, power, and the amount of funds they oversee. Members run the gamut from doctors, researchers, and county health directors to law enforcement officers, town managers, and business owners, as well as people in recovery and parents who’ve lost children to addiction.

“The overdose crisis is incredibly complex, and it demands more than just money,” said Rollie Martinson, a policy associate with the nonprofit Community Education Group, which is tracking settlement spending across Appalachia. “We also need the right people in charge of that money.”

That’s the $50 billion question: Are the right people steering the decisions? Already, criticism of the councils has been rife, with stakeholders pointing out shortcomings, from overrepresentation to underrepresentation and many issues in between. For example:

• Council membership doesn’t always align with the states’ hardest-hit populations — by race or geography.
• Heavy presence of specific professional groups — treatment providers, health care executives, or law enforcement officials, for example — might mean money gets directed to those particular interests at the expense of others.
• Few seats are reserved for people who’ve dealt with a substance use disorder themselves or supported a family member with one.

Admittedly, no one can design a perfect council. There’s no agreement on what that would even look like. But when a pile of money this big is at stake, everyone wants in on the action.

More than $3 billion of opioid settlement funds has already landed in government coffers, with installments to come through 2038. The money is meant as restitution for the hundreds of thousands of Americans who have died from drug overdoses in recent decades.

But what restitution looks like depends on whom you ask. People running syringe service programs might suggest spending money immediately on the overdose reversal medication naloxone, while hospital officials might advocate for longer-term investments to increase staffing and treatment beds.

“People naturally want money to go toward their own field or interest,” said Kristen Pendergrass, vice president of state policy at Shatterproof.

And that can trigger hand-wringing.

In many parts of the country, for instance, people who support syringe service programs or similar interventions worry that councils with high numbers of police officers and sheriffs will instead direct large portions of the money to buy squad cars and bulletproof vests. And vice versa.

In most states, though, law enforcement and criminal justice officials make up fewer than one-fifth of council members. In Alaska and Pennsylvania, for instance, they’re not represented at all.

Outliers exist, of course. Tennessee’s 15-member council has two sheriffs, one current and one former district attorney general, a criminal court judge, and a special agent from the state Bureau of Investigation. But like many other councils, it hasn’t awarded funds to specific groups yet, so it’s too soon to tell how the council makeup will influence those decisions.

Pendergrass and Johns Hopkins researcher Sara Whaley, who together compiled the list of council members, say criticism of councils drawing too heavily from one field, geographic area, or race is not just a matter of political correctness, but of practicality.

“Having diverse representation in the room is going to make sure there is a balance on how the funds are spent,” Pendergrass said.

To this end, Courtney Gary-Allen, organizing director for the Maine Recovery Advocacy Project, and her colleagues chose early on to ensure their state’s 15-member council included people who support what’s known as harm reduction, a politically controversial strategy that aims to minimize the risks of using drugs. Ultimately, this push led to the appointment of six candidates, including Gary-Allen, to the panel. Most have personal experience with addiction.

“I feel very strongly that if these six folks weren’t on the council, harm reduction wouldn’t get a single dollar,” she said.

Others are starting to focus on potential lost opportunities.

In New Jersey, Elizabeth Burke Beaty, who is in recovery from substance use disorder, has noticed that most members of her state’s council represent urban enclaves near New York City and Philadelphia. She worries they’ll direct money to their home bases and exclude rural counties, which have the highest rates of overdose deaths and unique barriers to recovery, such as a lack of doctors to treat addiction and transportation to faraway clinics.

Natalie Hamilton, a spokesperson for New Jersey Gov. Phil Murphy, a Democrat who appointed the members, said the council represents “a wide geographic region,” including seven of the state’s 21 counties.

But only two of those represented — Burlington and Hunterdon counties — are considered rural by the state’s Office of Rural Health needs assessment. The state’s hardest-hit rural counties lack a seat at the table.

Now that most of the council seats nationwide are filled, worries about racial equity are growing.

Louisiana, where nearly a third of the population is Black, has no Black council members. In Ohio, where Black residents are dying of overdoses at the highest rates, only one of the 29 council members is Black.

“There’s this perception that this money is not for people who look like me,” said Philip Rutherford, who is chief operating officer of Faces & Voices of Recovery and is Black. His group organizes people in recovery to advocate on addiction issues.

Research shows Black Americans have the fastest-rising overdose death rates and face the most barriers to gold-standard treatments.

In several states, residents have lamented the lack of council members with firsthand knowledge of addiction, who can direct settlement dollars based on personal experiences with the treatment and criminal justice systems. Instead, councils are saturated with treatment providers and health care organizations.

And this, too, raises eyebrows.

“Service providers are going to have a monetary interest,” said Tracie M. Gardner, who leads policy advocacy at the New York-based Legal Action Center. Although most are good people running good treatment programs, they have an inherent conflict with the goal of making people well and stable, she said.

“That is work to put treatment programs out of business,” Gardner said. “We must never forget the business model. It was there for HIV, it was there for covid, and it’s there for the overdose epidemic.”

Councils in South Carolina and New York have already seen some controversy in this vein — when organizations associated with members pursued or were awarded funding. It’s not a particularly surprising occurrence, since the members are chosen for their prominent work in the field.

Both states’ councils have robust conflict-of-interest policies, requiring members to disclose professional and financial connections. New York also has a law precluding council members from using their position for financial gain, and South Carolina uses a rubric to objectively score applications.

That these situations cause alarm regardless shows how much hope and desperation is tied up in this money — and the decisions over who controls it.

“This is the biggest infusion of funding into the addiction treatment field in at least 50 years,” said Gardner. “It’s money coming into a starved system.”

Database Methodology

The list of council members’ names used to build the database was compiled by Johns Hopkins University’s Sara Whaley and Henry Larweh and Shatterproof’s Kristen Pendergrass and Eesha Kulkarni. All council members, even those without voting power, were listed.

Although many states have councils to address the opioid crisis generally, the database focused specifically on councils overseeing the opioid settlement funds. A council’s scope of power was classified as “decision-making” if it directly controls allocations. “Advisory” means the council provides recommendations to another body, which makes final funding decisions.

The data is current as of June 9, 2023.

KFF Health News’ Aneri Pattani, Colleen DeGuzman, and Megan Kalata analyzed the data to determine which categories council members represent, based on the following rules:

— Each council member can be counted in only one category. There is no duplication.

— People should be given the most descriptive categorization possible. For example, attorneys general are “elected officials,” but it is more specific to say they are “law enforcement and criminal justice” officials.

— A “government representative” is typically a government employee who is not elected and does not fit into any other descriptive category — for example, a non-elected county manager.

— People who provide direct services to patients or clients, such as physicians, nurses, therapists, and social workers, are classified as “medical and social service providers.” People with more administrative roles are typically classified as “public” or “private health and human services,” based on their organization’s public or private affiliation.

— “Lived or shared experience” refers to someone who has personally experienced a substance use disorder, has a family member with one, or has lost a loved one to the disease. Because people’s addiction experiences are not always public, only individuals explicitly appointed because of their firsthand connection or to fill a seat reserved for someone with that experience were categorized as such.

KFF Health News’ Colleen DeGuzman and Megan Kalata contributed to this report.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

Credits

Until now.

After more than a month of communications with state attorneys general, private lawyers working on the settlement, and the settlement administrators, KFF Health News has obtained documents showing the exact dollar amounts — down to the cent — that local governments were allocated for 2022 and 2023. More than 200 spreadsheets detail the amounts paid by four of the companies involved in national settlements. (Several other opioid-related companies will start making payments later this year.)

For example, Jefferson County, Kentucky — home to Louisville — received $860,657.73 from three pharmaceutical distributors this year, while Knox County, a rural Kentucky county in Appalachia — the region many consider ground zero of the crisis — received $45,395.33.

In California, Los Angeles County was allocated $6.3 million from Janssen, the pharmaceutical subsidiary of Johnson & Johnson, this year. Mendocino County, which has one of the highest opioid overdose death rates in the state, was allocated about $185,000.

Access to “this information is revolutionary for people who care about how this money will be used,” said Dennis Cauchon, president of the nonprofit advocacy group Harm Reduction Ohio.

Some states, like North Carolina and Colorado, have posted their distribution specifics online. But in most other places, tracking payment amounts requires people to make phone calls, send emails, and file public records requests with every local government for which they want the information.

Thus, gathering the data across one state could mean contacting hundreds of places. For the country, that could translate to thousands.

Cauchon has been seeking this information for his state since April 2022. “Opioid remediation work is done at the local level, at the individual level, and, now, for the first time, local people working on the issues will know how much money is available in their community.”

The national opioid settlements are the second-largest public health settlement of all time, following the tobacco master settlement of the 1990s. The money is meant as remediation for the way corporations aggressively promoted opioid painkillers, fueling an overdose crisis that has now largely transitioned to illicit drugs, like fentanyl. More than 105,000 Americans died of drug overdoses last year.

So far, state and local governments have received more than $3 billion combined, according to a national summary document created by BrownGreer, a settlement administration and litigation management firm that was court-appointed to handle the distribution of payments. In each state, settlement funds are divided in varying percentages among state agencies, local governments, and, in some cases, councils that oversee opioid abatement trusts. Payments began in 2022 and will continue through 2038, setting up what public health experts and advocates are calling an unprecedented opportunity to make progress against an epidemic that has ravaged America for three decades. KFF Health News is tracking how governments use — and misuse — this cash in a yearlong investigation.

The latest trove of documents was obtained from BrownGreer. The firm is one of the few entities that knows exactly how much money each state and local government receives and when, since it oversees complex calculations involving the varying terms and timelines of each company’s settlement.

Even so, there are gaps in the information it shared. A handful of states opted not to receive their payments via BrownGreer. Some directed the firm to pay a lump sum to the state, which would then distribute it to local governments. In those cases, BrownGreer did not have figures for local allocations. A few states that settled with the opioid-related companies separately from the national deals are not part of BrownGreer’s data, either.

Roma Petkauskas, a partner at BrownGreer, said the settlement agreement requires the firm to send notices of payment amounts to state and local governments, as well as to the companies that settled. It shared documents when KFF Health News asked, but it is not clear if the firm will continue doing so.

Petkauskas wrote, “Settlement Agreements do not provide that such notices be made public,” indicating such disclosure was not a requirement.

People harmed by the opioid crisis say they want more transparency than the bare minimum requirements. They say, currently, it’s not only difficult to determine how much money governments receive, but also how those dollars are spent. Many people have reached out to local officials with questions or suggestions only to be turned away or ignored.

Christine Minhee, founder of OpioidSettlementTracker.com, found that, as of March, only 12 states had committed to publicly reporting the use of 100% of their settlement dollars. Since then, just three more states have promised to share detailed information on their use of the money.

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Legal and political experts watching the settlements say the lack of transparency may have to do with political leverage. State attorneys general have touted these deals as achievements in glowing press releases.

“Attorney General [Daniel] Cameron today delivered on his promise to fight back against the opioid epidemic by announcing a more than $53 million agreement with Walmart,” read one press release issued late last year by the state of Kentucky.

“Thousands of our neighbors have buried their loved ones throughout the opioid epidemic” and “I am proud to have delivered this great agreement to them,” said Louisiana Attorney General Jeff Landry, in a July 2021 announcement when one of the earliest settlements was finalized.

Greater transparency, including the specific payment amounts for each local government, may take the wind out of some of those press releases, Minhee said. “It’s hard to politicize things when you can’t present the numbers in a vacuum.”

If one community compares its several-hundred-dollar payout to another community’s multi-thousand-dollar payout, there may be political fallout. Concerns have already arisen in rural areas hit hard by the crisis that the distribution formula weighs population numbers too heavily, and they will not receive enough money to address decades of harm.

Still, experts say making this data public is a crucial step in ensuring the settlements fulfill the goal of saving lives and remediating this crisis.

Solutions have to be community-led, said Regina LaBelle, director of the addiction and public policy initiative at Georgetown University’s O’Neill Institute. “In order to do that, the communities themselves need to know how much money they’re getting.”

If their county is receiving $5,000 this year, it wouldn’t make sense to advocate for a $500,000 detox facility. Instead, they might focus on purchasing naloxone, a medication that reverses opioid overdoses. Knowing the yearly amount also allows people to track the funds and ensure they’re not being misspent, LaBelle added.

For Cauchon, of Harm Reduction Ohio, the local-level payment data is key to ensuring settlement dollars are put to good use in each Ohio county.

“Knowledge is power and, in this case, it’s the power to know how much money is available to be used to prevent overdoses,” he said.

This article was produced by KFF Health News, formerly known as Kaiser Health News (KHN), a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism. 

Hasta ahora.

Después de más de un mes de comunicaciones con fiscales generales estatales, abogados privados que trabajan en el acuerdo y los administradores del acuerdo, KFF Health News ha obtenido documentos que muestran las cantidades exactas en dólares que se asignaron a los gobiernos locales para 2022 y 2023. Más de 200 hojas de cálculo detallan las cantidades pagadas por cuatro de las empresas implicadas en los acuerdos nacionales. (Otras empresas relacionadas con los opioides comenzarán a hacer pagos a finales de este año).

Por ejemplo, el condado de Jefferson, Kentucky —donde se encuentra Louisville— recibió $860,657.73 de tres distribuidores farmacéuticos este año, mientras que el condado de Knox, un condado rural de Kentucky en los Apalaches —la región que muchos consideran la zona cero de la crisis— recibió $45,395.33.

En California, el condado de Los Angeles recibió este año $6,3 millones de Janssen, la filial farmacéutica de Johnson & Johnson. El condado de Mendocino, que tiene una de las tasas de mortalidad por sobredosis de opioides más altas del estado, recibió unos $185,000.

El acceso a “esta información es revolucionario para las personas que se preocupan por cómo se utilizará este dinero”, dijo Dennis Cauchon, presidente de la organización sin fines de lucro Harm Reduction Ohio.

Algunos estados, como Carolina del Norte y  Colorado, han publicado en internet los detalles de su distribución. Pero en la mayoría de los lugares, el seguimiento de los importes de los pagos exige llamar por teléfono, enviar correos electrónicos y presentar solicitudes de registros públicos a todas las administraciones locales de las que se desee obtener información.

Por lo tanto, recopilar los datos de un estado puede suponer ponerse en contacto con cientos de instituciones. En todo el país, podrían ser miles.

Cauchon lleva buscando esta información para su estado desde abril de 2022. “El trabajo de compensación por los opioides se realiza a nivel local, a nivel individual, y ahora por primera vez, quienes trabajan a nivel local sabrán cuánto dinero está disponible en su comunidad”.

Los acuerdos nacionales sobre opioides son el segundo mayor acuerdo de salud pública de todos los tiempos, tras el acuerdo marco sobre el tabaco de la década de 1990. El dinero se destina a remediar el modo agresivo en que las empresas promocionaron los analgésicos opioides, alimentando una crisis de sobredosis que ahora se ha trasladado en gran medida a las drogas ilícitas, como el fentanilo. El año pasado murieron más de 105,000 estadounidenses por sobredosis.

Hasta ahora, los gobiernos estatales y locales han recibido más de $3,000 millones en conjunto, según un documento de resumen nacional creado por BrownGreer, una empresa de administración de acuerdos y gestión de litigios designada por la corte para gestionar la distribución de los pagos. En cada estado, los fondos del acuerdo se dividen en porcentajes variables entre las agencias estatales, los gobiernos locales y, en algunos casos, los consejos que supervisan los fondos de reducción de opioides. Los pagos comenzaron en 2022 y continuarán hasta 2038, estableciendo lo que los expertos en salud pública y los activistas denominan una oportunidad sin precedentes para avanzar contra una epidemia que ha asolado a Estados Unidos durante tres décadas. KFF Health News sigue de cerca el uso —y el mal uso— que los gobiernos hacen de este dinero en una investigación de un año de duración.

Los últimos documentos se han obtenido de BrownGreer. La empresa es una de las pocas entidades que sabe exactamente cuánto dinero recibe cada gobierno estatal y local y cuándo lo recibe, ya que supervisa cálculos complejos que implican los distintos términos y plazos de los acuerdos de cada empresa.

Aun así, hay lagunas en la información que ha compartido. Algunos estados optaron por no recibir sus pagos a través de BrownGreer. Algunos pidieron a la empresa que pagara una suma global al estado, que luego la distribuiría entre los gobiernos locales. En esos casos, BrownGreer no disponía de cifras sobre las asignaciones locales. Tampoco figuran en los datos de BrownGreer algunos estados que llegaron a acuerdos con empresas relacionadas con los opioides al margen de los acuerdos nacionales.

Roma Petkauskas, de BrownGreer, señaló que el acuerdo de conciliación exige que el bufete de abogados envíe notificaciones de los importes de los pagos a los gobiernos estatales y locales, así como a las empresas que llegaron a un acuerdo. El bufete compartió los documentos cuando KFF Health News se lo pidió, pero no está claro si seguirá haciéndolo.

Petkauskas escribió: “Los acuerdos de conciliación no prevén que tales notificaciones se hagan públicas”, indicando que tal divulgación no era un requisito.

Las personas perjudicadas por la crisis de los opioides reclaman más transparencia que la que ofrecen los requisitos mínimos. Dicen que, actualmente, no sólo es difícil determinar cuánto dinero reciben los gobiernos, sino también cómo se gastan esos dólares. Muchos se han puesto en contacto con funcionarios locales con preguntas o sugerencias, sólo para ser rechazadas o ignoradas.

Christine Minhee, fundadora de OpioidSettlementTracker.com, descubrió que, en marzo, sólo 12 estados se habían comprometido a informar públicamente sobre el uso del 100% del dinero de sus acuerdos. Desde entonces, sólo tres estados más han prometido compartir información detallada sobre el uso que hacen del dinero.

Los expertos jurídicos y políticos que observan los acuerdos dicen que la falta de transparencia puede tener que ver con la influencia política. En sus elogiosos comunicados de prensa, los fiscales generales de los estados se han jactado de los logros de estos acuerdos.

“El fiscal general [Daniel] Cameron ha cumplido hoy su promesa de luchar contra la epidemia de opioides anunciando un acuerdo de más de $53 millones con Walmart”, decía un comunicado de prensa emitido a finales del año pasado por el estado de Kentucky.

“Miles de nuestros vecinos han enterrado a sus seres queridos a lo largo de la epidemia de opioides” y “estoy orgulloso de haberles entregado este gran acuerdo”, declaró el fiscal general de Louisiana, Jeff Landry, en un anuncio de julio de 2021, cuando se cerró uno de los primeros acuerdos.

Una mayor transparencia, incluidos los importes de pago específicos para cada gobierno local, puede restar fuerza a algunos de esos comunicados de prensa, dijo Minhee. “Es difícil politizar las cosas cuando no puedes presentar las cifras en el vacío”.

Si una comunidad compara su reparto de varios cientos de dólares con el reparto de varios miles de dólares de otra comunidad, puede haber consecuencias políticas. En las zonas rurales más afectadas por la crisis ya ha surgido la preocupación de que la fórmula de reparto tenga demasiado en cuenta el número de habitantes y no reciban dinero suficiente para hacer frente a los daños sufridos durante décadas.

Aun así, los expertos afirman que hacer públicos estos datos es un paso crucial para garantizar que los acuerdos cumplan el objetivo de salvar vidas y remediar esta crisis.

Las soluciones tienen que estar lideradas por la comunidad, afirmó Regina LaBelle, directora de la iniciativa sobre adicción y política pública del Instituto O’Neill de la Universidad de Georgetown. “Para ello, las propias comunidades tienen que saber cuánto dinero reciben”.

Si su condado recibe $5,000 este año, no tendría sentido abogar por un centro de desintoxicación de $500,000. En su lugar, podrían centrarse en la compra de naloxona, un medicamento que revierte las sobredosis de opioides. Conocer el importe anual también permite hacer un seguimiento de los fondos y asegurarse de que no se malgastan, añadió LaBelle.

Para Cauchon, de Harm Reduction Ohio, los datos de los pagos a nivel local son fundamentales para garantizar que el dinero de los acuerdos se destina a un buen uso en cada condado de Ohio.

“El conocimiento es poder y, en este caso, es el poder de saber cuánto dinero está disponible para ser utilizado en la prevención de sobredosis”, señaló.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.

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