Stretching small opioid settlement allocations helps funding do more

Key Takeaways

Experts in substance use prevention, harm reduction and recovery advised counties last month with small opioid settlement allocations on best practices for leveraging funding across the continuum of care, at NACo’s Opioid Solutions Leadership Network peer exchange in Washington, D.C. 

States and localities are set to receive $56 billion in opioid settlement dollars over an 18-year period, but not every county that receives settlement funding will get enough to build out infrastructure — some counties will only receive hundreds of dollars — but effectively using small allocations can still lead to meaningful impact, according to Dr. Abby Winiker, director of Johns Hopkins Bloomberg School of Public Health’s Bloomberg Overdose Prevention Initiative.

Prevention work is often under-resourced and underutilized, but effective prevention programming tackles substance use disorder before it starts, saving lives and costs associated with treatment and recovery for localities, said Robyn Oster, associate director of health law and policy for Partnership to End Addiction.

“Without [prevention], at a very basic level, cycles of addiction are going to continue,” Oster said. “If we don’t prevent it, it doesn’t matter how much treatment you have, the problem is just going to continue.”

Substance use prevention work, such as school and community-based life skills programming and mentoring, also prevents against other negative outcomes that share the same underlying risk and protective factors, such as mental health challenges, violence and dropping out of school, Oster noted. 

“The innovation that I think is promising is the shift toward prevention programs that are addressing youth resilience and coping skills and mental health and all those sorts of things that start earlier in the lifespan and really address the broad array of factors that can underlie substance use,” Oster said. “Rather than the ‘Just Say No’ era of prevention that really emphasized scare tactics and ineffective media campaigns and punitive responses, that really ignored a lot of the factors that lead people to use substances.”

Allotments under $50,000

For counties receiving opioid settlement allotments under $50,000, the most effective ways to invest in prevention work are to scale up existing prevention programming, which could be adding another component or making it universal, and train existing workforce (such as people in the community working with or mentoring youth) on substance use prevention, according to Oster. Counties receiving a bit more funding could also use their funding to hire a prevention specialist in the school system, she noted.

Studies show that people who utilize harm reduction programming are five times more likely to enter treatment and three times more likely to stop using drugs than people who don’t, said Roxanne Saucier, an Open Society Foundations consultant. And syringe service programs, which provide substance users with sterile injecting equipment and collect used syringes to get them out of the community and safely dispose of them, have resulted in 50% reductions in incidence of HIV and Hepatitis C, she added.

“Harm reduction is really an on-ramp to care for so many folks,” Saucier said. “Harm reduction programs are a place where people can come as they are, be accepted and welcomed as they are and have their humanity and dignity affirmed as they are. And you don’t have to make a change in order to come in the door and get care. Once people are there, we’re giving people tools that they want to use to protect themselves, protect their health.”

Allotments under $5,000

For counties receiving opioid settlement allotments under $5,000, the most effective way to invest in harm reduction is to buy and widely distribute naloxone, the medication that rapidly reverses opioid overdoses, according to Saucier. 

Buying the generic intramuscular product instead of the nasal product (which is at least 10 times more expensive) can also cut down on costs and allow counties to distribute it more widely, Saucier said. Investing in test strips and wound care, particularly in areas with high rates of xylazine (an animal tranquilizer) use, also provides large benefits at relatively small costs, she added.

If counties have a bit more funding to work with, funding the local syringe service program is a beneficial way to use settlement dollars, especially amid changing federal guidelines around harm reduction, according to Saucier. Martinsville, Va. used funding to ensure it is able to distribute safety supplies in isolated rural areas through mail-based and delivery services, she noted.

“The federal environment for harm reduction funding may be constricting, or at least there may be the perception that it’s constricting,” Saucier said. “So, the opioid settlement dollars are one place where we do have the flexibility to spend money on this.”

Drug checking, using fourier-transform infrared (FTIR) spectrometers, is a way counties can invest in harm reduction beyond test trips, according to Saucier. It promotes safer drug use and helps public health communities understand trends in the drug supply, she noted.

“More and more harm reduction programs are starting to have drug checking on site with FTIR machines,” Saucier said. “Where people can bring a residue of a batch of drugs and have it tested, so they can find out what’s in it. 

“Not just ‘Yes or no, is fentanyl present?’ but really find out all of the ingredients in a batch of drugs, which can lead to safer decisions about use — whether that’s deciding not to use a certain batch because it has an ingredient that somebody’s really trying to avoid or using with other people to make sure that somebody is there to help you in the event of an overdose.”

Marianna Reid, Faces and Voices of Recovery’s director of programs, echoed the importance of drug checking, and said that an innovative approach she’s seen harm reduction organizations take is to text substance users who utilize their services when a batch of drug supply is creating increased overdoses in a specific area, as a reminder to test their supply. 

It’s important to bring services to substance users instead of expecting them to seek them out, and mobile syringe exchange services and mobile treatment are a great way to offer that, according to Saucier. The “health hub” model, in which there are co-locating services at one site, such as syringe services and legal aid services, has also been effective, she noted.

Recovery programming, including peer support, saves lives, said Reid, who celebrated 13 years of sobriety last month. Funding transportation services and peer support are effective ways counties can invest in recovery work, at any scale, she said. 

“If you want to know what those community-based services can do for your communities, I’m a product of that,” Reid said. Local recovery organizations “work across systems to provide supports for medical needs, employment needs, safe housing, things like that. And they also support establishing a sense of purpose and belonging in the community.”

Stigma reduction is crucial — especially in rural communities — both in helping local residents understand addiction and removing barriers to accessing treatment, Reid said. Many counties have already integrated peer recovery support into their emergency rooms, but peer recovery support has also shown to be beneficial in the child welfare and legal systems, she noted. 

For counties receiving opioid settlement allotments under $5,000, the most effective way to invest in recovery work is to fund peer and professional development and create listening sessions and community assessments, Reid said. She noted that partnering with social work students from nearby state or community colleges offers a strategic, low-cost way to conduct a community assessment.

“Those students need that real experience,” Reid said. “Especially with rural communities, if they’re already there, that’s a way to kind of root them in their communities and allow them to be part of the broader community solution, while continuing to grow as a professional. So, definitely, with those small amounts [of funding], really looking at that community investment, community buy-in and what can I do now that we can use to support us long term?”

If a county has more funding to work with, investing in a data collection method and putting a planning grant in place to create a recovery community organization (if the county doesn’t have one), are other beneficial ways to leverage the dollars, according to Reid.

For counties receiving small settlement allocations, it’s important to collaborate with community organizations, leveraging their expertise and investing in scaling up work that has already shown to be successful, according to Winiker. 

“You don't need to reinvent the wheel,” Winiker said. “There are experts in every state who are doing prevention and harm reduction and recovery work. It’s a really classic academia problem where everyone wants to start at the beginning and solve the problem themselves, but people are out there doing this work already, and there’re experts that know what each of these sectors needs. 

“So, work together and build upon efforts that are already in place — that cuts a ton of infrastructure cost and saves when you’re looking at these small dollar investments.”