Roadmap to wise spending of opioid settlement funds released

133 organizations nationwide sign onto roadmap

Calls for impacted population to be involved in decision

The New York Times reports today that early opioid spending has been spent on a mixed bag of programs that is, overall, worrisome.

Significant amounts of settlement money is going to law enforcement for non-evidence-based spending that isn’t mentioned in the settlement’s “List of Opioid Remediation Uses,” a 15-page document that outlines permissible spending. On the other hand, though, some money is being spent on beneficial things, including by states that neighbor Ohio. “Michigan’s plans include adding rooms in hospitals so that new mothers can stay with infants born with neonatal abstinence syndrome. Kentucky is giving $1 million to four legal aid groups to represent people with opioid-related cases,” the newspaper says.

Roadmap to effective spending

Click to read Roadmap

The article also highlights a new document — A Roadmap for Opioid Settlement Funds: Supporting Communities & Ending the Overdose Crisis — signed by 133 addiction medicine specialists, legal aid groups, street outreach groups and other organizations. Harm Reduction Ohio is a signer of this document.

The roadmap calls for settlement money to be spent on “proven public health interventions — including harm reduction — as well as hopeful innovations.”

The roadmap also calls for “transparency and accountability.” In Ohio, this will not be possible after the OneOhio opioid settlement board goes dark on October 3. The legislature recently passed a law to let the government officials who distribute the money legally accept bribes and keep spending details secret. (The constitutionality of the law, which takes effect October 3, will be challenged soon in court by Harm Reduction Ohio.)

The roadmap also says: “There must be inclusion of directly impacted people and communities, including people who are actively using drugs.” In Ohio, the impacted population has been excluded nearly universally. Inclusion has meant county commissioners, township trustees and several executive directors of local mental health boards. OneOhio recently added a second Black member, so the racial make-up of the 29-member board is now 27 White directors and two Black directors. No board members report having lost a child, spouse or parent to overdose death.

Ohio opioid settlement spending

The opioid settlement requires that settlement money — Ohio will receive $2 billion — be spent on evidence-based efforts to reduce problems related to opioids. The settlement lays out 15 pages of examples in Exhibit E. The first item listed is increasing naloxone distribution. (Harm Reduction Ohio distributed 42,077 naloxone kits in 2022.)

Ohio’s share of of the opioid settlement is being divided among 700+ local governments, so generalizations on spending are difficult. But, so far, the prioritization and execution of opioid settlement spending appears to be going poorly overall at the local level (with exceptions). The secretive OneOhio Recovery Foundation, a government-controlled non-profit that will distribute $1.1 billion of Ohio’s settlement, hasn’t started spending money yet, but the warning signs of disaster are present..

National spending overview

The New York Times doesn’t mention Ohio but describes the status of opioid spending nationally this way:

(T)hough the payments come with stacks of guidance outlining core strategies for drug prevention and addiction treatment, the first wave of awards is setting off heated debates over the best use of the money, including the role that law enforcement should play in grappling with a public health disaster.

States and local governments are designating millions of dollars for overdose reversal drugs, addiction treatment medication, and wound care vans for people with infections from injecting drugs. But law enforcement departments are receiving opioid settlement money for policing resources like new cruisers, overtime pay for narcotics investigators, phone-hacking equipment, body scanners to detect drugs on inmates and restraint devices.

“I have a great deal of ambivalence towards the use of the opioid money for that purpose,” said Chester Cedars, chairman of Louisiana’s advisory opioid task force and president of St. Martin Parish. The state’s directives say only “law enforcement expenditures related to the opioid epidemic,” added Mr. Cedars, a retired prosecutor. “That is wide open as to what that exactly means.”