Misuse of opioid settlement funds repeats tobacco-era missteps 

More than 107,000 people died of a drug overdose last year — enough to fill nearly every seat in the nation’s largest college football stadium at the University of Michigan. It’s a number that should make us stop in our tracks and recognize that drug addiction in America is a national emergency.  

This grim statistic should also remind states and municipalities of the responsibility they share as they decide how to spend billions pouring in from legal settlements with pharmaceutical companies — $50 billion over 15 years to be more precise.  

These funds can make a difference. They can save lives, prevent suffering and begin the process of alleviating the day-to-day trauma experienced by families and communities ravaged by drug addiction. 

For this to be true, however, states will need to allocate the money to attack the very problem that caused the settlements in the first place.  

Most settlements require recipient states to designate a minimum of 85 percent on addiction treatment and prevention. How states classify this is often a game of creative and political interpretation.  

Some states have used the money to replace existing funding for addiction programs and services, shifting previously dedicated resources to other state and local needs. Replacement funding is not the answer for programs that were perilously underfunded to begin with.   

The Washington Post found a county in Pennsylvania used over $300,000 in settlement proceeds to support a drug court that had received funding from other sources for over 20 years.   

New York’s governor proposed a budget that allegedly directs millions in settlement resources to replace some of the state’s current addiction agency funding. 

And a county in Indiana spent almost half of the $570,000 it received on salaries for its health director and medical emergency staff. Some existing salary money was used to create a contingency fund for the local health department.  

Robert Kent, ex-general counsel for the Office of National Drug Control Policy, called these practices out: “The spirit of the settlements wasn’t to keep doing what you’re doing. It was to do more.”  

A majority of states aren’t being fully transparent about where the settlement money is going. Last year, states and local municipalities received an estimated $1.5 billion — yet only 19 states are being completely open in disclosing how they are distributing it.      

Most settlement agreements require states and counties to disclose how the 15 percent of non-addiction-specific settlement proceeds they receive are being spent. Few are doing it. At the end of March, only three had filed reports; not one specified where the money went. 

And as the old saying goes, “Just because you can doesn’t mean you should.” That 15 percent could help combat the overdose crisis by advancing additional treatment and addiction services. States owe it to impacted families and communities to spend the funds they receive on programs to treat and prevent opioid addiction.  

Lessons from the historic master settlement agreement between states and the tobacco industry should loom large. The largest civil settlement of its time, tobacco companies were forced to pay states a record $206 billion over 25 years, and fund even more in perpetuity, as a result of deliberate marketing practices and denial of the addictive nature of nicotine.  

Despite assurances by attorneys general and governors, the vast majority of states used tobacco settlement resources in ways that had little or nothing to do with smoking prevention.  

States can’t afford to make this same mistake. And they have new tools to help them pinpoint how to best deliver drug addiction resources to meet the greatest needs of their communities.  

In Mobile, Ala., predictive technology and artificial intelligence (AI) are driving state decisions to ensure settlement funds are being deployed efficiently and responsibly. More states should follow their lead. 

States and counties are on the front lines of America’s drug crisis; they should decide how to use settlement resources to best address it. But they can’t be handed a blank checkbook and escape accountability for the way the money is spent. A national policy and federal guidance are needed to ensure funds are responsibly managed. 

Opioid settlements shouldn’t be interpreted as a sign our nation’s drug epidemic is over. As America’s young die from fentanyl overdose at record numbers, states shouldn’t be balancing their budgets with funds that can save lives. States now have a chance to be creative and bold in building new community-based responses to this epidemic. 

A once-in-a-lifetime opportunity to confront this crisis has fallen into the laps of states across the country. Will they have the conviction to take it?  

Lyndon Haviland, DrPH, MPH, is a distinguished scholar at the CUNY School of Public Health and Health Policy.