Opioid Settlement Funds: Will “Once-in-a-Generation” Chance Be Wasted?

    As opioid settlement dollars start rolling into jurisdictions across the United States, debate has intensified around how they should be used. Over $50 billion in settlement money, to be distributed over 18 years, comes from lawsuits against various businesses, including major pharmaceutical companies, for their alleged roles in a crisis of addiction and opioid-involved overdose.

    For drug policy researchers at Open Society Foundations (OSF), there are right and wrong ways to spend this money. On August 31, to coincide with International Overdose Awareness Day, they published a call to action—urging state, county and other sub-national governments to allocate the funds to a variety of harm reduction interventions, rather than to policing and the criminal-legal system.

    “If used inappropriately or inefficiently, it could be a real wasted opportunity, and could even make the overdose situation worse.”

    “We wanted to use that day to draw attention to this huge issue because it’s billions of dollars, right? And if used appropriately, it could really change the way we treat addiction, addiction treatment in this country and really mitigate the overdose crisis,” Sarah Evans, division director of Drug Policy and Global Programs with OSF, told Filter

    “But if used inappropriately or inefficiently,” she warned, “it could be a real wasted opportunity, and could even make the overdose situation worse.”

    The call to action garnered more than 200 signatures from prominent researchers and advocates across the country.

    It urges governments that receive settlement money to fund multiple areas of harm reduction. These include safe consumption sites (also known as overdose prevention centers); naloxone distribution; syringe service programs; drug-checking services; and low-barrier programs offering medications for opioid use disorder—with “special efforts” for people in prisons and jails, when overdose risk is acutely high after release.

    It also urges funding for housing-first programs, which house vulnerable people without demanding abstinence or treatment engagement as a precondition. Research, the authors point out, has shown such programs reducing homelessness by 88 percent in US and Canadian cities studied—more effectively than programs that require participants to be “housing ready.” 

    The document also outlines areas where it says settlement funds “should not be spent.” These include law enforcement agencies, jails and prisons, drug courts and abstinence-only treatment programs. 

    The “family regulation system” is also named here, as the authors detail widespread harms arising from investigations that often relate to drug use. “Rather than putting more money into systems that disproportionately remove Black, Brown, and Indigenous children from their homes,” they write, “money should be used for supportive services that allow families to remain together.”

    “We owe it to the people directly impacted to spend these funds in ways that will prevent further deaths,” the call to action concludes. “We encourage … stakeholders to consult with people who use drugs and their loved ones to ensure that these programs are implemented in ways that are respectful, appropriate, and effective.”

    According to Evans, one of the biggest problems with funding allocation is that funded governments haven’t universally been transparent.

    The document is part of OSF’s ongoing efforts in this area, which include its previously published Roadmap on Opioid Settlement Spending.

    According to Evans, one of the biggest problems with funding allocation is that funded governments haven’t universally been transparent on where the money is going, though one website called the Opioid Settlement Tracker provides available data.

    “There isn’t clear accountability in terms of setting up state- or county-level commissions that include people impacted by overdose in advising how the money should be spent,” she said.

    But we do know of some notable cases, Evans continued, where either good or bad ideas have been proposed for the settlement money. 

    Among those she condemns, County Commission President Blair Couch of Wood County, West Virginia, proposed using the money to reimburse the government for costs associated with law enforcement and the legal system. According to reporting by the News and Sentinel, Couch said: “The money is basically to reimburse us for our jail bill, for our sheriff’s expense, for our prosecuting attorney’s office expense and all the things that came into play over the opioids … We will see how everything comes out in the wash.”

    A recent press release from the city of Brownwood, Texas, meanwhile suggested using the funds to purchase a law enforcement tool called the BolaWrap—a device that shoots out a length of Kevlar to wrap around suspects’ limbs from 10-25 feet away. 

    And the state of Louisiana has proposed giving 20 percent of the funds it receives to sheriffs.

    These and similar approaches, Evans said, are just “doubling down on the War on Drugs,” and will result in “sending more people to jail.”

    “We know the solutions and we have the money. We just really need to be able to hold states and counties accountable.”

    Some states are, however, providing funding to harm reduction efforts. For instance, Rhode Island has allocated $2.6 million of its settlement cash toward an overdose prevention center. 

    North Carolina has also allocated $380,000 to a state-wide drug checking program using a mass spectrometer out of the University of North Carolina at Chapel Hill. The state is one of a few to be particularly transparent about where the funding is going, and runs a dashboard showing this information.

    In all, the influx of settlement cash represents a “once-in-a-generation” opportunity, Evans said, and it’s vital to use it for evidence-based practices that reduce harms. 

    “We know the solutions and we have the money,” she said. “We just really need to be able to hold states and counties accountable for doing the right thing with that money.”



    Photograph via Pxfuel/Public Domain

    The Influence Foundation, which operates Filter, has received restricted grants from OSF to support film production and promotion projects. Filter‘s Editorial Independence Policy applies.


    • Doug is a writer, editor and journalist whose work has appeared in National Geographic, Undark Magazine, New Scientist and Hakai, among others. He lives in Alberta, Canada.

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