States are currently in the process of distributing settlements from various opioid-related lawsuits, with the funding intended to abate ongoing harms of the opioid epidemic through investment in substance use prevention, treatment, recovery, and harm reduction infrastructure. NASHP works to support states and facilitate collaboration as they implement processes for opioid settlement decision-making through NASHP’s State Opioid Settlement (SOS) Learning Network. The SOS Learning Network brings together leaders from over 34 states to facilitate state-to-state learning and discussion of emerging challenges related to opioid settlement administration.
During the #NASHPCONF23 preconference, NASHP convened the SOS Network in person for the first time, providing a forum for 28 participating states to share their current successes and challenges in navigating settlement dollars and discuss strategies for addressing common challenges such as promoting transparency of settlement spending, fostering collaboration between state and local policymakers, communicating with state legislators, and supporting equity through settlement dollars.
Later in the day, the public preconference session “In It for the Long Run: Strategies for Maximizing the Impact of Opioid Settlement Funding across the Continuum of Care” provided a bigger picture opportunity to consider the role of settlements as a part of a state’s larger strategy for addressing the opioid and substance use crisis as a whole. Federal leaders, including Jean Ko, deputy director for scientific programs at the Centers for Disease Control and Prevention (CDC), and Tom Coderre, acting deputy assistant secretary for mental health and substance use at the Substance Abuse and Mental Health Services Administration (SAMHSA) shared current trends in the evolving substance use crisis and described federal priorities for expanding access to care.
During the “Maximizing the Impact of Opioid Settlements to Build a Continuum of Care” panel, Minnesota representative Dave Baker and Alaska Commissioner of Health Heidi Hedberg shared their states’ respective approaches for aligning state and federal resources toward a long-term vision for addiction. Regina LaBelle shared promising opportunities and best practices for states to break down funding and operational silos. Later, state leaders Malik Burnett and Katherine Marks were joined by researcher Amanda Latimore to discuss strategies and considerations for addressing rising disparities in overdose rates among across racial and ethnic groups, including respective state approaches in Maryland and Kentucky.
Key Challenges and Priorities for Maximizing the Impact of Settlement Spending
Although each state faces unique challenges and may be at different points in settlement distribution processes, conversations throughout the day reflected a number of common priorities for settlements and other statewide efforts to address the opioid and substance use crisis, such as:
Aligning Settlement Spending with Existing Opioid Strategies and Resources
Opioid settlements represent a relatively small proportion of overall federal and state spending to address the opioid and substance use crisis. While many states have stood up opioid abatement trusts and other unique structures to distribute funding, it is important to consider this opportunity of opioid settlements as a part of a larger addiction strategy that blends and braids multiple funding streams. Looking across funding streams and identifying gaps can ultimately lead to more efficient spending targeted to communities most in need. The O’Neill Institute’s publication “Transcending MET (Money, Ego, Turf): A Whole Person, Whole Government Approach to Addressing Substance Use Disorder Through Aligned Funding Streams and Coordinated Outcomes” dives further into recommendations along this theme.
Featured Strategy: Alaska
Alaska offers both state and local-level strategies for aligning settlement spending with existing substance use strategies. The state facilitates local collaboration by hosting “Community Cafes,” which are meeting times for local partners to discuss statewide priorities and gain perspective on needs and potential overlap of funding or projects. In the past, these gatherings informed development of the Statewide Opioid Action Plan
Targeting Disparities in Overdose and Access to Services
Data show widening disparities in overdoses across race and ethnicity, with rates rising most significantly for communities of color. Additionally, racial and ethnic minority groups are less likely to receive treatment, thereby contributing to an increased risk of overdose. Maintaining an equity-focused approach in settlement decision-making can help break down structural barriers to treatment and resource accessibility. Strategies highlighted by states included using data to inform areas where interventions are most needed, involving disproportionately impacted community members in decision-making and program development, and ensuring that offered services are person-centered and culturally informed.
Featured Strategy: Kentucky
Kentucky recognized that community-based organizations (CBOs) serving communities disproportionately affected by the opioid crisis may lack the resources and capacity to compete for state grants. Therefore, the state implemented a series of initiatives to support CBOs in delivering culturally relevant and innovative overdose prevention, awareness, outreach, and engagement interventions. These efforts relied on partnerships with trusted community leaders, built in technical assistance to the grant-writing and project implementation process, and reduced financial barriers involved with applications to help achieve its success. Ultimately, 10 organizations were funded, offering resources such as discussion forums, educational materials, and naloxone at local events and centers, all of which actively benefit communities that may have otherwise not been reached.
Supporting Transparency in Settlement Decision-Making
With an eye toward avoiding previous mistakes of the tobacco settlement — in which much of the funding awarded to states did not go toward the intended purpose of tobacco prevention — many states are prioritizing transparency and accountability for opioid settlement spending. States have varied structures and processes for allocating funding at the state and local levels, with different requirements for collaboration and reporting expenditures. To support greater transparency across different state structures, states described their unique approaches for sharing information and data across state and local administrators, implementing reporting guidelines for grant awardees or localities, building out data dashboards that are easily accessible to the public, and evaluating the impact of abatement activities. Clear insight into funding allocations helps to identify gaps and needs in services, holds entities accountable to properly spend settlement funding, and promotes public trust in the use of funds.
Featured Strategy: North Carolina
North Carolina remains a leader for settlement spending transparency, offering robust settlement data reporting infrastructure and public-facing data dashboards. Some of the state’s available data dashboards include local spending plans, payment schedules, and key indicators of opioid harm. In these, North Carolina found success by building in reporting guidelines to the memorandum of agreement between state and local governments and limiting barriers to reporting. To assist local entities in complying with these reporting guidelines, the state offers one-pagers that detail frequently asked questions for each required data submission — people can find an explanation of the report, a checklist of necessary materials, and submission instructions all in one place. By offering clear, accessible guidelines and templates for reporting, as well as technical assistance, the state simplifies compliance for local grantees.
Investing in Harm Reduction
Harm reduction strategies, which work to lessen adverse outcomes of drug use and equip people with resources, allow for the chance to decrease the real-time burden of the opioid epidemic. States are incorporating harm reduction methods (including naloxone distribution, syringe service programs, and fentanyl and xylazine test strip distribution) into their settlement spending as a means to support a continuum of care across populations. States across varying political landscapes have invested in prioritizing low-barrier access to services and partnering with local organizations to distribute materials. SAMHSA’s Harm Reduction Framework helps to outline more strategies for harm reduction implementation.
Featured Strategy: Maryland
Maryland’s Center for Harm Reduction Services is a one-stop shop responsible for overseeing harm reduction centers (overdose response programs and syringe service programs), grant management, centralized naloxone purchasing and distribution, and development of educational materials. By taking the burden off local entities to work through the various logistical and legal challenges surrounding harm reduction strategies, Maryland has been able to rapidly expand its services. For example, overdose response and syringe service programs are dispersed across the state, and localities have a central place to access technical assistance or educational programming to bring back to their own communities. The state’s harm reduction toolkit also helps inform local community members and providers on best practices and strategies for integrating harm reduction into their own communities.
Moving Forward
Opioid settlement funding provide a unique opportunity to address current gaps in the addiction care system as a whole. Though #NASHPCONF23 programming featured a variety of perspectives on the current opioid settlement landscape, state leaders are also making decisions around investing settlement funding as a part of a larger strategy to address the opioid crisis. As states gain their footing in settlement funding allocation and program implementation, NASHP will continue providing support and facilitating conversations for sharing of innovative and promising practices across states.
NASHP thanks the Foundation for Opioid Response Efforts for its continued support of these projects.
