Note from the Codirector

Over the past several years, communities have received generous funds from the federal government through the CURES and CARES acts to tackle the opioid crisis. Yet the crisis endures, intensifying and evolving. The nation has used some of the federal funds to constrain use of prescription opioid analgesics, but with unanticipated consequences: a market shift to illicit suppliers or new and more harmful substances. The core infrastructure needed to confront the crisis in a comprehensive way has been lacking because federal funding has often been piece-meal, very specifically focused, and short lived.

The more than $54 billion opioid litigation dollars represent a unique opportunity to finally assemble the infrastructure many communities have lacked to tackle the addiction crisis head on. Communities will have the capacity to build treatment infrastructure, linking health centers with the specialty treatment system physically, electronically, and financially; community-based recovery services to better support those who struggle to maintain their recovery; and linkages and data coordination between public health and public safety to identify new drugs entering communities, determine their source, and relay that information effectively to the public to protect naïve casual users from the mortal risks of street drugs.

Whether communities will take the necessary steps is a question that will be answered in different ways across the country over the next decade. Near real-time assessment of how settlement funds are allocated and how allocation affects public health outcomes can help identify any necessary midcourse corrections. This newsletter highlights a valuable source of reliable information about the settlement, including the idiosyncrasies of state-specific agreements and reporting requirements. As always, our goal at OPTIC is to provide empirical support for decisionmakers and researchers dedicated to improving community health.

Stay safe, stay healthy, and care for your communities.

– Rosalie Liccardo Pacula, Co-Director OPTIC

Stay Informed: How Are Opioid Settlement Funds Being Allocated?

Opioid settlements between corporations, states, and localities now exceed $54 billion. A central policy question is will the funds be spent as intended to strengthen the public health response to drug addiction and to make whole the communities and individuals ravaged by the opioid crisis.

Decisionmakers entrusted with making allocation decisions might find it useful to understand how other jurisdictions are spending their funds. Researchers are eager to know who received funds, how the funds were spent, and how the allocations affected outcomes. Both decisionmakers and researchers need reliable data about what’s happening on the ground but finding that information is extremely challenging.

• There are separate settlement agreements between multiple firms and multiple states. Not all states have accepted the settlement offers that have been made. Some states have rejected offers and scheduled trials.
• Some settlement agreements require states that accept the settlement to spend 70% of the allocation on “future opioid remediation.” But states have interpreted that requirement differently. There are real risks that funds will be spent in ways not intended by the settlement agreements—for example, substituting for activities usually supported by the state's general fund.
• Some states are using contracts between the state and local governments to ensure that funds are used to respond to the opioid crisis.
• A dozen states have promised to publicly report how they spend their opioid settlement dollars, and 20 additional states and DC have promised to report part of their expenditures. But most settlement agreements don’t require states to publicly report allocations. As a result, about 75% of the $54 billion settlement is currently not constrained by any public reporting requirement.

In sum: The settlement landscape is complicated and volatile.

Given the importance of these policy issues, we wanted to make members of the OPTIC community aware of reliable real-time information about allocation that is available at opioidsettlementtracker.com. This site, created and curated by Christine Minhee, J.D., tracks opioid settlements and states’ opioid settlement spending. The site is updated on an ongoing basis.

• 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.

Members of the OPTIC community can also visit our page Strategies for Effectively Allocating Opioid Settlement Funds where we have compiled: guiding principles for allocating opioid settlement funds; recommendations for addressing the root causes of overdose death; and profiles of studies assessing the effectiveness of specific programs and policies.

In Memoriam

All of us at OPTIC were deeply saddened to learn that Erin Bagalman, a valued member of our Advisory Board, died in mid-March of metastatic cancer. Erin held what she described as her dream job: directing the Division of Behavioral Health Policy in the Office of the Assistant Secretary of Planning and Evaluation, where she managed an interdisciplinary team conducting policy analysis and research on mental health; substance use; and related topics such as fetal alcohol spectrum disorders and neonatal abstinence syndrome.

Erin made valuable contributions to OPTIC's work, keeping us abreast of policies and programs being implemented that are relevant to the Center's research activities and alerting us to opportunities to make contributions in key policy areas. She was especially enthusiastic about helping us to hone our dissemination approaches based on her experiences as the lead analyst for behavioral health policy at the Congressional Research Service.

We will greatly miss her wise guidance, her intelligence, and her quirky sense of humor.

– Brad Stein, Rosalie Liccardo Pacula, and the OPTIC team