All 50 states are set to receive significant amounts of funding intended to abate the opioid epidemic through settlements with opioid manufacturers, distributors, and other companies contributing to the epidemic. As states and localities begin making initial spending decisions, using new and existing forums for collaboration will become increasingly important for ensuring that all those involved are maximizing the impact of these funds and making lasting investments in community prevention, treatment, and recovery infrastructure. To support states in collaborating with local partners, we outline promising strategies for state-local collaboration for opioid settlement funding. Promising approaches to state and local collaboration in Nevada and Wisconsin were both featured in NASHP’s webinar on January 11, 2023.
Background
Per the terms of the national settlement agreement, a default allocation of 15 percent of settlement funds are awarded to the state government, 15 percent to participating local governments, and 70 percent to a statewide abatement fund. However, most states have developed unique qualifying agreements with participating political subdivisions that establish how funding will be split between state and local governments, as well as requirements for spending and coordination.
As a result of differences in these agreements, there is a wide state-to-state variation as to whether the bulk of opioid settlement decisions are occurring at the state or local level. For example, upwards of 80 percent of settlement funding is allocated to local governments in North Carolina, Louisiana, and Pennsylvania, while 100 percent of funding is allocated to a statewide abatement fund in Delaware.
Regardless of whether funding is being administered at the state or local level, officials charged with administering opioid settlement funding have recognized that information-sharing, coordination, and alignment are essential to reducing duplication of efforts and ensuring that limited settlement funds are targeted to the areas of highest need. In some states, agencies or established opioid settlement trusts play a central role in establishing statewide priorities and allowable uses for funds, as well as providing oversight for spending decisions. In other states, states may have more limited authority over local spending but can still provide important data, resources, and tools to support effective decision-making, while facilitating ongoing communication and information sharing.
Strategies for Promoting Collaboration within States
Although each state’s settlement structure is different, states are working within their own unique administrative structures to share data, resources, and strategies to ensure that both state and local officials administering settlement funds have the resources to support decision-making. Promising strategies include:
Supporting Local Governments with Resources and Best Practices
In multiple states, state-level entities such as a department of health or settlement-specific advisory groups play a role in developing and disseminating best practices, tools, or other resources that local decision-makers can use to support effective utilization of funding. Many states work with their state county association or use other existing local or regional forums to support exchange of best practices and dialogue. For example:
- The Pennsylvania Department of Drug and Alcohol Programs provides presentations to county commissioners on allowable uses for settlement and important factors to consider in awarding funds.
- The New Jersey Department of Human Services will provide information and guidance to county and municipal subdivisions to foster a shared understanding of settlement fund allowances. The state’s Opioid Advisory Council may assist county-level abatement councils in assessing gaps between state and county-level settlement spending and implementation activities.
- Virginia’s settlement funds can only be distributed to cities, counties, and state agencies, a number of which may have varying levels of experience or expertise in administering opioid-related funding. State officials have provided a toolkit and other resources to support evidence-based practices.
- The Colorado attorney general’s office holds monthly regional learning forums to foster regional collaboration and an annual Colorado Opioid Abatement Conference and maintains a resource page to encourage the adoption of best practices.
- Nevada supports local requests for needs assessment concerns and technical assistance.
Sharing Data to Support Decision-Making
Many state-level leaders and groups have completed or are currently completing formalized assessments of abatement needs in different areas of their state. Through these needs assessments, state and local officials can identify community priorities and gaps in prevention, treatment, and recovery infrastructure. As an example, Hawaii’s advisory committee began with a statewide needs assessment to further understand its counties’ unique needs, initiate an open dialogue, and avoid duplicative spending between state and local efforts.
Nevada’s One Nevada allocation agreement requires the state, counties, and cities to collaborate on needs assessments and county plans. To support alignment of efforts, the state developed local needs assessment templates that foster multi-county approaches. This collaboration is intended to support counties’ pursuit of projects and plans that complement the State Needs Assessment and State Plan rather than duplicating or confounding state efforts.
Facilitating Ongoing Communication
To facilitate ongoing communication and coordination of funding decisions, many states are using forums or coordination structures (such as county associations or regional bodies) to support alignment across initiatives funded at the state and local level. Nevada has a variety of preexisting groups that contribute to collaboration between states and localities. Rather than create new structures, the state has leveraged these forums to support continued communication and collaboration. The Nevada Substance Use Response Working Group, which predates the settlement and focuses on the interfaces between law enforcement and public health, has been engaged throughout the state planning process. Additionally, state government officials maintain frequent communication with the Nevada Association of Counties.
In Wisconsin, the state closely coordinates outreach to county officials with the Wisconsin County Association, which hosted a summit in August 2022 for counties and state officials to discuss opioid abatement and strategies to avoid duplicative spending.
Some states have also supported coordination by designating formal roles for local representatives on state decision-making bodies or requiring input from local and community leaders on state activities. In Colorado, Rhode Island, and Alaska, local leaders are on the state’s advisory committee. In Wisconsin, state officials have convened listening sessions across the state and are actively working to ensure that localities, Tribes, and the state share an understanding of the goals of the settlement, needs of the states’ residents, and mechanisms for distribution of funds. These activities are guided by the decision-making structure, legislative requirements, and leveraging existing relationships among all levels of government.
State Approaches for Distribution of National Opioid Settlement Funding
Incentivizing Alignment with State Priorities and Supporting Regional Approaches
Using the state portion of opioid settlement funds to match local funds allows states to bolster promising or historically effective local initiatives. Indiana has dedicated $25 million from the first share of state settlement funds received to match local efforts, particularly to promote collaboration and regionalization of efforts. These funds can be used to match local opioid spending from any source.
Some states, such as Massachusetts, are seeking to promote greater efficiency by allowing localities to combine their money to fund initiatives that may be too expensive to be covered solely through the budget of one local government. This is particularly valuable for small jurisdictions set to receive small amounts of money that would be more effectively used as part of a combined effort.
Considerations for Other States
Multiple methods for collaboration — reporting, education, state-driven, locally driven — will ensure transparency, protect against duplication of funds, and coordinate efforts. The opioid settlement spending process is in early phases. As participants at all levels of community and government accumulate experience and lessons learned, bidirectional communication and exchange can help state and local officials implement best practices and adapt to emerging challenges.
Acknowledgements
The National Academy for State Health Policy would like to thank the Foundation for Opioid Response Efforts (FORE) for its ongoing support. Additionally, NASHP would like to thank Samantha Karon and the National Association of Counties (NACo) for their collaboration on this topic. NACo’s Opioid Solutions Center has settlement resources for county officials.
