As counties debate how to allocate money from the national opioids settlement, a national leader among counties stresses listening to those who have experienced the brunt of substance use disorder.

Settlement plans developed by Rock County, Wis. and the state of Colorado were the inaugural honorees recognized by faculty at Johns Hopkins University and a coalition of national organizations steering The Principles for the Use of Funds From the Opioid Litigation.

“The most important thing is to really listen to the people that are most impacted, involve them in the process, because that’s how you’re going to make the change that’s going to matter,” said Shari Faber, a Rock County public health strategist who has participated on the county’s settlement task force.

Excellence in the application of the opioid litigation principles

These awards are designated by a coalition led by faculty at the Johns Hopkins Bloomberg School of Public Health and will be given to states and counties that have demonstrated adherence to the principles to highlight their efforts and share practical examples with other jurisdictions.

The principles are:

1. Spend the money to save lives.
2. Use evidence to guide spending.
3. Invest in youth prevention.
4. Focus on racial equity.
5. Develop a fair and transparent process for deciding where to spend the funding.

These awards will be given to states and counties on a quarterly basis throughout the year. The next deadline is March 31, and counties can be nominated here.

“I think in some places it’s getting politicized, it’s turning into the thing that the politicians want, or the lobbyists that are lobbying the politicians want, and you really need to focus on those people that have experienced it who have been impacted the most and make the changes that they’re identifying.”

The Rock County Public Health Department is in the process of winning approval from various county committees before taking the spending plan back to the Board of Supervisors.

The plan stresses increasing local treatments and services, providing assessments within the criminal justice system and focusing on youth prevention. The opioid settlement workgroup initially presented the plan to the Board in September 2022.

The plan was built from various public outreach and listening sessions to gauge community needs, along with an existing county substance use assessment and interviews with key informants.

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NACo's Opioid Solutions Center

The first of the roughly $8 million expected from the various settlements is coming none too soon for Rock County, which saw its opioid-involved death and hospitalization rates peak in 2021, with numbers projected to have come down slightly in 2022. The county saw over 200 opioid-involved deaths across the last decade.

What hasn’t helped, the working group learned, was the relative dearth of local options for treatment and recovery living, so when residents need help, they have to go elsewhere for it. The plan prioritizes increasing availability of both locally.    

“We currently have a one day-treatment program, we have no residential or inpatient treatment, so we are having to send people to other locations for those higher levels of treatment,” Faber said.

“We know the funds aren’t going to cover everything and pay for everything that we proposed in the recommendation, but we’re hopeful that we can expand capacity wherever possible to increase our ability to meet the current needs.”

The county’s working group includes representatives from the public health department, human services, county administration and sheriff’s office. The spending plan would add a full-time staffer to oversee its execution.

Faber said the most valuable feedback came from the working group’s listening session with residents who used drugs or had used drugs and their family and friends.

“We wanted to get some really honest feedback from those people and for instance, we didn’t allow media in that session because we really wanted to create a space where the people felt comfortable sharing,” she said.

“We gave them options to not put their real name on their ‘Zoom person’ if they wanted,” she noted.

“I feel like we got some really good information, particularly from family members working really hard to try to get their loved ones treatment and a lot of the barriers that they ran into,” she said.

“We got some really good information from that aspect, we did have some people who were [in] our drug court program and gave us some brief feedback about drug court and the services that they were provided through drug court,” she said.

The consequences of substance use disorder have moved beyond to immediate human service and criminal justice needs to add demand for all sorts of government services, but Rock County recognizes that even $8 million provided by the settlement has limited spending power.

So it has to be spend strategically, and one of the best deals is trying to prevent the problem from growing.

Although the National Opioids Settlement focused on the promotion and distribution of legal painkillers, the pattern of substance abuse disorder has evolved to synthetic drugs like fentanyl, so Rock County, like many, has to hit a moving target.

Prevention programs to try to avoid new users, particularly children, are paramount and pragmatic.

“That supply side is always going to be there,” Faber said. “It’s really important to look at the bigger picture and look at the whole the demand supply issue and looking at the demand side — why are people wanting these drugs?”

“What can we do to slow down that demand side? Because that supply side is always going to be there and it’s just going to keep changing,” she said.

“As we tamp down one drug, another drug’s going to pop up, so I like to try and think and figure out what can we do to reduce that demand for drugs locally.”