By Ishara Nanayakkara
In July 2021, four U.S. pharmaceutical corporations agreed to pay $26 billion to settle thousands of civil lawsuits. Multiple state and local governments and tribal nations pursued litigation against these businesses alleging corporate responsibility for the severity of the ongoing opioid crisis. Three drug distributors and one manufacturer agreed to pay $21 billion and $5 billion respectively to provide healthcare, rehabilitation and prevention services to help mitigate the crisis.
States are using these opioid settlement funds for a variety of purposes that assist individuals suffering from substance use disorders (Table 1 below provides a complete list of proposed and enacted legislation). Most commonly, funds are being allocated to create and maintain committees or commissions to make recommendations on how funds should be allocated. These committees also oversee the distribution of resources and ensure they are properly utilized to temper the crisis – and not diverted to unrelated programs. Members are appointed by officials such as governors and attorney generals based on established criteria.
For example, in Colorado, the membership must include at least one medically-certified professional, at least one pharmacist and at least one individual directly impacted by the opioid crisis. In Kentucky, the membership must include representation of crisis victims, law enforcement and the drug treatment and prevention communities.
Examples of newly established committees include Colorado’s Opioid Recovery Crisis Funds Advisory Committee that provides input and recommendations to the Attorney General on [SN1] effective expenditure of settlement funds. The Prescription Opioid Distribution Commission in Delaware ensures funding is used to mitigate the opioid crisis and not diverted. A report regarding the receipt and allocation of funds must be provided annually to the Commission. Kentucky instituted the Opioid Abatement Advisory Commission [SN2] and Illinois created the Opioid Settlement Fund. [SN3]
In addition to the settlement requirements, states have established additional guidelines for distributing funds. In Florida, funds are only allocated to counties that have an abatement plan and a population of over 300,000 people. Eligible counties must have treatment and prevention programs in place alongside an opioid task force to collect information related to substance abuse disorders and makes recommendations regarding responding to the epidemic.
Several oversight entities incorporate the views and recommendations of affected communities when making funding decisions. Delaware’s Opioid Distribution Commission is one such committee. Counties and municipal governments provide input, and these recommendations are considered when funds are allocated and programs are implemented. Idaho takes on a similar approach by creating a state-directed fund used to support prevention and recovery efforts. The Joint-Finance Appropriations Committee will make take recommendations from the Behavioral Health Council on how to apportion funding.
States are also taking similar approaches to investing funds in response to the opioid crisis emergency. These methods include revamping existing programs as well as creating new ones. Some programs provide direct treatment and rehabilitation services while others provide broader, long-term support to recovering individuals, such as housing assistance and job training.
In Illinois, all opioid settlement-related dollars are deposited in the Opioid Settlement Fund, where resources are allocated to provide access to and ensure availability of effective usage disorder treatment; invest funding in safety nets for substance abuse providers; and maximize the opportunity to draw matching federal resources related to the alleviation of the crisis. It is also mandated that $100,000 be allocated annually to the Illinois Alcohol and Other Drug Abuse Professional Certification Association to cover application and testing costs for human services professionals who provide substance use disorder and mental health supports.
The Advisory Commission in Kentucky will reimburse expenses for services provided to individuals in the justice system, support for medication-assisted and abstinence-based treatment programs, investment in recovery and other services provided by community health centers, emergency response services provided by law enforcement and naloxone costs. It will also fund projects that support intervention, treatment and recovery services including medical detoxification, supportive or recovery housing, employment training and transportation to recovery services and programs. Colorado expanded a similar program that provides housing vouchers for those with mental health, behavioral and substance use disorders.
North Carolina also funds housing support programs, including assistance with rent, move-in deposits and utilities as well as recovery housing programs for those receiving medication-assisted treatment for opioid use disorder. This model differs from Colorado by including assistance for individuals who are currently using substances and are not in recovery. Funding goes to programs that offer employment support services such as job training, job placement, interview coaching, resume review, professional attire advice and relevant courses at community colleges or vocational school to people in treatment or currently using. Transportation services and vouchers also are provided. North Carolina also funds evidence-based recovery support services like peer support specialists and care navigators who assist with treatment or recovery in detention facilities, social service offices and local health departments.
The Council of State Governments Justice Center has resources available to states looking for evidence-based strategies to improve outcomes for people with substance abuse disorders. Additionally, the Justice Center provides resources on best practices for successful reentry for people with opioid addictions and screening and assessment for those in the criminal justice system.
Proposed and enacted legislation regarding the use of opioid settlement funds
(Links included in first column for state opioid settlement websites, as available)
*Status as of May 4, 2022