More than $600 million will come to Connecticut over the next 20 years to address the opioid epidemic. How will the state and its municipalities use the money?
WSHU’s Ebong Udoma spoke with CT Mirror’s Andrew Brown to discuss his article written with Jenna Carlesso and José Luis Martínez, “The big question: How to spend $600M in CT opioid settlement funds,” as part of the collaborative podcast Long Story Short.
You can read the story here.
WSHU: Hello, Andrew, why is there a big question about how the state will spend its opioid settlement money?
AB: I think the answer to that question is that there is now an influx of resources that Connecticut has at its disposal to tackle the epidemic. And this money is starting to come to the state at a time when overdose deaths linked to heroin, fentanyl and prescription pain pills continue to rise. We are about three decades into what many medical professionals consider to be this opioid epidemic. And it shows no signs of slowing as far as the number of people dying every year. So it’s a rather important time and some rather important decisions that state officials and local officials have to make here.
WSHU: Well, we have a stream of money pouring in. So we have a problem. We know we have a problem. We have the money coming in. Why is it so difficult to decide how to use that money?
AB: I think there’s a couple of issues at play here. One is the state has set up a rather rigid process for how they’re going to spend their funds. And that’s because they are trying to avoid the mistakes that were made with the tobacco settlements of the 1990s.
WSHU: Tobacco settlement money was a universal settlement with tobacco companies. And all states got quite a bit of money, the money went into the general fund. And so it didn’t go specifically to tobacco prevention programs.
AB: Right. And there was a major flaw in that system, most public health officials would say, and so what Connecticut did is they set up at the state level, a special committee to oversee the new opioid settlement funds, and they specifically created a new account so that none of this money is commingled with the state’s general fund, which the state lawmakers have control of, that has slowed the process a little bit.
People want to make sure that this money is going to the correct uses. They also want to make sure that there’s evidence behind where they’re spending the money. So right now the state is trying to determine what providers and kind of what priorities this money should go towards. That’s going to be a difficult choice in the coming months and years because there’s needs across the board.
According to people I spoke to, there’s needs in making sure that children are less susceptible to opioid addiction, you know, that includes addiction awareness programming, there is a huge need for treatment capacity, including medication assisted treatment, which utilizes things like methadone and buprenorphine and to medication assisted treatments for opioids. And then there’s also just a vast need for harm reduction, which is syringe exchanges and blood testing medical supplies for drug users. Those types of services are really needed right now, just because of the number of people who are dying from this epidemic every day.
WSHU: Now there’s a breakdown, there’s some money that the state is spending directly. There’s other money that’s been spent on the local level. Could you just tell us a little bit about the breakdown and on how that has formed?
AB: The state is a party to these lawsuits as were the 169 towns and cities in Connecticut, all of the towns and cities signed on to these national lawsuits against drug distributors, pill manufacturers and the pharmacies that distributed pain pills throughout the past decades. So the state received the bulk of that money coming from the settlements. But in several of the class action suits, the municipalities will receive up to 15% of the settlement funds over a decade and beyond.
So for some of the larger cities like New Haven, Bridgeport, Hartford over an 18-year period, or somewhere around there, they could see $2 million – $1.5 million coming into their city for the same type of opioid treatment abatement, that type of thing. But they have none of the strictures, they have none of the rules that the state placed on themselves.
WSHU: So the state advisory board doesn’t oversee what the individual towns and cities are doing.
AB: That’s correct. So they will do some monitoring, but they have no control. It’s ultimately up to the mayors, up to the first selectman or selectwomen, up to the city councils and the town members in those towns and cities to decide how the money is used. Now they have to operate within the settlement agreements themselves and the rules that were set up as part of those settlement agreements. But there’s not the same type of transparency measures that the state has set up and not the same type of multi-step process to having money allocated.
So some towns and cities we found in our reporting are already putting the money to use for opioid treatment and different types of addiction counseling or help for people who are suffering from an opioid use disorder. Other towns, however, kind of sitting back and waiting, the state has suggested that they will put out some type of guidance document for towns and cities, maybe, on best practices of how to use the funds. But ultimately, state officials don’t have control over the 15% of the proceeds that are going to these municipalities.
WSHU: Now I read in your article that you contacted 15 towns and cities, and they’re very different in how they have approached this. And what jumped out at me was that New Haven hasn’t decided yet.
AB: That’s correct. That’s what their public health director told me. We thought like Hartford, and like some of the larger cities like New London, they would have already put those monies to use, the monies that have already come in from the settlements, but they want to make sure according to the public health director, that the money is being allocated properly, that it’s going to efforts that will really make a dent in the opioid epidemic. And so they’re waiting on some further guidance from the state. So even though the state doesn’t have control over what New Haven does with this money, New Haven wants to make sure it’s on strong footing whenever it comes to making those decisions.
WSHU: Now, in the meantime, we have an ongoing crisis that needs to be dealt with.
AB: I think most people don’t look at overdose deaths per year. They’re well tracked at this point, especially here in Connecticut. The coroner, you know, the chief medical examiner looks at causes of overdoses. If you look at the numbers in the past four years, it’s quite striking the number of people who are overdosing from some type of opioid and that includes heroin, prescription painkillers or fentanyl, it’s been up over 1,000 every year for the past three years. For a small state. That’s a lot of people who are dying.
WSHU: That also affects small communities as well, not just the larger cities.
AB: Right, I actually went out to the town of Griswold, which is on the border with Rhode Island. And if you calculated the overdose death rate, that’s the number of overdoses per the town’s population, they were in the top 10. They were actually I think, in the top six over the past five years. And so I went out there to get a sense of how they’re using their money. And I talked to a coordinator who’s working with the town to set up a program where if someone overdoses, and they’re taken to an emergency room setting, they’ll be provided with a package and it will include a prepaid cell phone so that those people will have access to recovery coaches and treatment providers and essentially a way to connect with people once they leave the emergency room.
And the thing that I heard from the first selectwoman out there and other people in town is that, you know, we’re a small town, but they are being hit extremely hard by the epidemic and have been for years. They kind of equate that to the fact that they’re not far from Interstate-95. The supply of illicit drugs is probably pretty prevalent there. But it has resulted in just a large loss of life in that town.
Another frequent expenditure that we heard from municipalities, including cities like New London, they’re using these the first couple payments from the settlement funds to buy Naloxone, which is the overdose reversing drug, simply because that is the immediate need that they see. There are so many people that are overdosing, that they want to make those overdose reversal drugs more widely available. And so New London bought a huge supply to provide to police officers, firefighters, everybody who’s on the front lines responding to emergency calls.
WSHU: Wow. And also they have been buying back prescription drugs.
AB: Yes, that’s one of the things that this money could be used for is to set up buyback programs so that prescription pain pills that are legally prescribed to people don’t end up being misused or diverted to other places. But from what I’m hearing from people, while this epidemic started as a prescription pill problem, addiction fed by the oversupply of prescription pills. We are now largely in an epidemic where it is the illicit supply of narcotics that are killing the most people. Doctors are far more cognizant now of not over prescribing prescription pain pills. And so we’re in a situation now where it really is fentanyl that is being sold on the streets that is killing most of the people in Connecticut.
WSHU: A bit of the money has also been targeted at education.
AB: Yeah, towns and cities have full discretion to use the money to do prevention programs and educational programs. You know, one of the women that I spoke to who heads up several of the regional organizations that deal with mental health and addiction in Connecticut said that prevention is the key aspect to Connecticut getting its hands around this epidemic and starting to reduce the number of deaths. It’s just as important as treating the people who already have an opioid use disorder and making sure that they stay alive long enough to get into treatment.
WSHU: Officials are all confident that all of the $600 million will go toward opioid -elated programs?
AB: Yes, I think that is fully the goal. But I think the tough thing is that it’s not only people paying attention to how the money is being used right now, these funds are going to come in over an 18-year period. It’s also important 18 years from now that officials have a full recognition that the monies shouldn’t be diverted to build a budget gap or to pay for some other public investment. So that will be a really tough task.