As states start to get opioid settlement cash, few are sharing how they spend it
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KHN
Marianne Sinisi, of Altoona, Pennsylvania, lost her 26-year-old son, Shawn, to an opioid overdose in 2018. She wants the opioid settlement dollars to be spent in ways that help spare other parents similar grief.
Since last spring, drugmakers and distributors have sent out about $3 billion in opioid settlement funds to thousands of state and local governments. It's a start on paying what the companies agreed to after they were accused of flooding communities around the country with opioid painkillers that have left millions addicted or dead.
All told, these companies, along with several large retail pharmacies, will pay more than $50 billion over the next 15 years. That's an enormous amount of money double NASA's budget and five times the revenue of an NBA season.
But how state and local governments choose to deploy that massive windfall seems to be shrouded in mystery. Reporting requirements are scant, and documents filed so far are often so vague as to be useless.
Most of the settlements stipulate that states must spend at least 85% of the money on addiction treatment and prevention. But defining those concepts depends on stakeholders' views and state politics. To some, it might mean opening more treatment sites. To others, buying police cruisers.
Spending the money effectively and equitably is a tall order, given the persistence and complexity of addiction, which affects individuals and communities, and is the topic of heated debates in scientific research, social services, politics, criminal justice, and even at kitchen tables.
What's more, many states are not being transparent about where the funds go and who will benefit. An investigation by KHN and Christine Minhee, founder of OpioidSettlementTracker.com, concluded only 12 states have committed to detailed public reporting of all their spending.
The analysis involved scouring hundreds of legal documents, laws, and public statements to determine how each state is divvying up its settlement money among state agencies, city or county governments, and councils that oversee dedicated trusts. The next step was to determine the level and detail of public reporting required. The finding: Few states promise to report in ways that are accessible to the average person, and many are silent on the issue of transparency altogether.
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More than $3 billion has gone out to state and local governments so far. KHN will be following how that cash and the billions set to arrive in coming years is used.
Per most of the settlements, governments are required to report only on the 15% of the money that can be used for things unrelated to the epidemic, like offsetting budget shortfalls or fixing old roads. As of March 28, only three states and counties had filed such reports. Although they listed dollar amounts, none said precisely how the money was spent.
State and local governments can enact more rigorous reporting protocols for example, requiring a publicly available list of every place that receives money and for what purpose but few have so far.
Families left in the dark
More than 250,000
Americans have died of overdoses from prescription opioids, which were aggressively promoted as painkillers and distributed by a host of health care companies, including Johnson & Johnson, AmerisourceBergen, McKesson, and Walmart. The settlements are meant to compensate and remediate the effects of that corporate behavior.
Many people affected by the opioid epidemic and those working to fight it have high hopes for the money.
Nancy Andrews / KHN
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KHN
After her 26-year-old son died of an overdose, Marianne Sinisi led the creation of the Circle of Hope statue at Tuckahoe Park in Altoona, Pennsylvania, as a place of support for those affected by addiction.
To David Garbark, who is in recovery from opioid addiction, it's a way to give others in his eastern North Carolina community a second chance, too. To Steve Alsum, who works with people who use drugs in Grand Rapids, Michigan, it's an opportunity to finally reach all those in need. And to Marianne Sinisi, who lost her 26-year-old son, Shawn, to overdose in western Pennsylvania, the settlement funds are "blood money" that she hopes can spare other parents similar grief.
But as they observe how the settlement money is being handled, many people whose lives have been upended are again feeling traumatized.
So far, Sinisi said she and other parents who've lost kids to addiction have been left in the dark or, worse, treated like nuisances by officials in charge of the money.
"They want to look at you as this angry parent who lost a child," she said, "rather than a concerned citizen who wants to see a difference made for other mothers, fathers, and their children."
In Michigan, even the state's Opioid Advisory Commission, which is tasked with evaluating the use of settlement money, has struggled to track the cash.
For six months after the state legislature allotted $39 million of settlement funds to the health department last summer, little information was made public about how that money would be spent. No news releases. No way for organizations to apply for funds.
"We can't really identify the impact of those dollars if we don't know how they're being used," said Dr. Cara Poland, the commission's chair and an addiction-medicine doctor.
With scant oversight nationwide, many people fear dollars may flow to efforts that research has proven mostly useless but jibe with the local political bent, like arresting people who use drugs, expanding jails, and favoring abstinence-only recovery over medications. They may go to the loudest bidder, with companies promising to find the next groundbreaking treatment and rehab facilities some with shoddy track records eyeing the cash.
Not to mention concerns that money will flow to activities that have little to nothing to do with opioid treatment: building new stadiums or public schools. Back in the '90s, these day-to-day budget priorities consumed most of what states won from cigarette companies in the national tobacco settlement, leaving little for anti-smoking programs.
The opioid settlement funds will be different, say state attorneys general who fought for them. In addition to requiring at least 85% of the money be used on opioid-related expenses, most agreements include a list of suggested interventions like increasing addiction treatment for the uninsured and expanding recovery housing.
Nancy Andrews / KHN
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KHN
Marianne Sinisi, of Altoona, Pennsylvania, lost her 26-year-old son, Shawn, to an opioid overdose in 2018. She wants the opioid settlement dollars to be spent in ways that help spare other parents similar grief.
"We wanted to give states flexibility on what approaches they wanted to adopt," while ensuring money didn't go to "provide corporate tax relief" as the tobacco dollars did, said North Carolina Attorney General Josh Stein, who led negotiations for the national settlements.
But enforcement of the 85% standard is, oddly, left to the companies that paid out the money.
Thursday, March 30, 2023 at 9:01 am