This comprehensive RAND book provides a nuanced assessment of America's opioid ecosystem and includes chapters on ten major components: substance use disorder treatment, harm reduction, medical care, the criminal legal system, illegal supply and supply control, first responders, the child welfare system, income support and homeless services, employment, and education. Researchers offer several portfolios of action that could help decisionmakers prioritize and organize their efforts to address problems associated with opioid use.
Strategies for Effectively Allocating Opioid Settlement Funds
Opioid settlements with pharmaceutical companies have already occurred, and there are more to come. Settlement funds could save lives and mitigate lifelong harms from opioid misuse if they are allocated to the most effective interventions. States and communities have one chance to get the allocation right and to avoid some of the missteps that substantially diminished the potential public health impact of the tobacco settlement.
In support of that goal, OPTIC researchers have compiled:
- guiding principles for allocating opioid settlement funds
- recommendations for addressing the root causes of overdose death
- profiles of studies assessing the effectiveness of specific programs and policies.
These materials have different perspectives, focus on different aspects of the crisis, and use different methods to derive their assessments. However, we offer four key takeaways:
- The root causes of opioid deaths are diverse across individuals. However, they share some common socioeconomic and public health themes—e.g., lack of economic opportunity, financial and/or housing instability, persistent physical pain, feelings of despair, helplessness, and untreated mental health issues. In both the short and the long term, address those issues directly rather than focusing only on opioid analgesic agents as the cause of harm.
- The science demonstrates that no single policy or program can address the unique characteristics of the opioid crisis in your community. Before adopting an approach, weigh the evidence that it would work in your environment. Then clearly define how you will know if your approach is achieving its intended goals.
- Multiple studies show that giving individuals access to evidence-based treatment for opioid use disorder and keeping them in treatment are effective ways to reduce opioid-related harms. Pursuing these goals does not necessarily require enormous spending. For example, barriers to access can be reduced by expanding insurance coverage for buprenorphine treatment, reducing cost sharing, eliminating prior authorization for treatment, and incentivizing providers to treat these patients by offering higher reimbursements.
- It is clear that what started as an opioid crisis has quickly evolved into a polysubstance crisis in many communities. When looking for short- and long-run solutions within your community, consider how the strategies being considered influence use and treatment of other addictive substances. Consider the multiple benefits of comprehensive strategies targeting the use of various substances when appropriate rather than narrowly considering impacts only on opioid outcomes and harm.
Stay Informed: How are opioid settlement funds being allocated?
The sum of opioid settlements reached between corporations, states, and localities now exceeds $54 billion. Decisionmakers at all levels may wish to know how the funds are being allocated.
Real time information about allocations is available at opioidsettlementtracker.com, curated by Christine Minhee, J.D.:
- The settlement spending page documents how states are planning to allocate their opioid settlement funds. No two states have similar approaches.
- The public reporting page documents states’ initial promises to public report their opioid settlement expenditures and summarizes public reporting requirements.