To date, hundreds of lawsuits have been filed against pharmaceutical companies to resolve their liability in creating the opioid epidemic. These lawsuits involve multiple levels of government, with some cases brought by individual counties, cities or states and others brought by multiple states and their political subdivisions. As a result, the opioid settlement landscape varies greatly across the country. While each county is navigating a unique combination of legal and administrative processes, all counties are working commendably to ensure these funds make the greatest possible difference in our communities. The examples below provide a snapshot of how counties are quickly and strategically employing settlement funds to save lives and address the underlying causes of substance use disorder.

Clay County, Iowa

Population: 16,400

Two small neighboring counties in the Midwest are teaming up to find the best solution for how to use opioid settlement funds to help those in their communities.

The idea stemmed from a district court judge in Clay County, Iowa who wanted to establish a drug treatment court to divert people struggling with substance use issues from the justice system.

Given the small population in Clay County (around 16,000), a regional collaboration was necessary to finance the program. Thus began the partnership with Dickinson County, Clay County’s neighbor to the north.

The drug court will divert individuals who are charged with qualifying non-violent offenses from jail to treatment. Upon pleading guilty to drug-related charges, qualifying individuals are sentenced to drug court probation instead of prison. Both Clay and Dickinson counties are allotted 15 spots each for individuals to participate in drug court.

Clay and Dickinson Counties received initial funding from the state’s department of corrections to establish the program. Opioid settlement funds will be used to sustain a full-time probation officer position and compensate individuals that serve on a community board, which meets with drug court participants twice a month to evaluate their progress. The board is comprised of experts in mental health and substance use disorders.

For more information about the Clay County’s drug treatment court, contact Clay County Attorney Travis Johnson at tjohnson@claycounty.iowa.gov.

Chester County, Pa.

Population: 539,000

The Chester County Department of Drug and Alcohol Services established a multi-pronged framework that outlines different tactics for using the $19.7 million in opioid settlement funds the county is set to receive over 18 years.

The department collaborated with several stakeholders to develop the framework, including the county’s longstanding Overdose Prevention Task Force. The resulting Opioid Settlement Strategy will guide the Chester County Commissioners in allocating settlement funds across departments to continue, expand or establish indicated services without duplication or redundancy.

The framework includes proposals for how to treat opioid use disorders, support those in treatment and recovery and connect individuals to appropriate services. It makes note of services targeting the needs of individuals in the criminal justice system, pregnant or parenting women and babies with neonatal abstinence syndrome.

Additionally, the framework includes strategies to collaborate with local emergency service providers and county or community-based organizations, as well as provides training opportunities that encourage workforce development strategies.

For more information about the county’s framework, contact Chester County Department of Drug and Alcohol Services Director Jamie Johnson at jajohnson@chesco.org.

Maricopa County, Ariz.

Population: 4.4 million

Maricopa County has received nearly $15 million of an estimated $80 million from drugmakers and distributors in opioid settlement funds. The funds will be allocated over the course of 18 years.

Maricopa County leaders plan to use a portion of this funding to establish a framework for a countywide substance use prevention and response plan. To ensure funds are distributed with community input, the department will launch a community assessment to inform the framework’s goals and structure.

The assessment will gather input from community members and other stakeholders, mirroring previous efforts to collect community recommendations to form health needs assessments, health improvement plans and other initiatives.

Maricopa County’s substance use response plan will identify priorities that prevent overdose deaths and reduce harms of substance use, specifically in communities that are at an increased risk of overdose or substance use disorders. From 2012 to 2021, overdose deaths from synthetic opioids like fentanyl increased more than 6000% throughout the county.

The Maricopa County Public Health Department will administer the funds and arrange payments to municipalities.

The needs assessment will collect data over the course of five months to determine how to support community-based organizations, providers and other stakeholders when establishing substance use abatement strategies.

For more information about how Maricopa County plans to use its funding, contact Shilpika Devarachetty, the substance use strategic initiatives project manager, at substanceuse@maricopa.gov.

Jackson County, Ore.

Population: 224,000

Jackson County is using settlement funds to get its syringe services program on the road. By purchasing a vehicle for the county’s Syringe Exchange Services (SES) program, which currently operates in a fixed site model, the county will deliver harm reduction services to underserved parts of the county. Specifically, the vehicle will help Jackson County Public Health serve rural areas of the county and reach residents who may not have reliable transportation to access services.

Jackson County’s mobile SES arm will aid in expanding access to care for people with substance use disorders, including offering peer support services, substance use treatment and medical care. The county-run program has received wide support from community partners such as law enforcement, mental health providers and drug and alcohol treatment providers that collaborate to reduce the risk of overdose among people who use drugs.

The county plans to hire additional staff to assist with the expansion of these services and ensure they remain available for residents.

For more information about the county’s Syringe Exchange Services, contact Jackson County Public Health’s Tanya Phillips at PhilliTF@jacksoncounty.org.

Eau Claire County, Wis.

Population: 104,000

The Eau Claire County Board of Supervisors passed a resolution to use opioid settlement funds to form an Opioid Task Force. The task force will recommend uses for the funding, allotting amounts to enhancing addiction treatment, evaluating and implementing community-based prevention and increasing the adoption of best practices.

Funds from the national distributor settlement include two payments – one nearly $500,000 over the course of nine years and the second of $2.1 million to be allocated over the course of 15 years.

The task force will consist of 11 members appointed by the county board chair and confirmed by the county board. Members will include three supervisors from the county board; one public health official; a member from both the sheriff’s office and the City of Eau Claire Police Department; a member of the department of human services; the county criminal justice services director and three members of the public – one who has or is working in opioid abatement and two others with lived experience.

Members of the task force will be charged with starting discussions on the current state of the opioid crisis in Eau Claire County and identifying gaps in programing and funding. The task force will support projects and programs such as medication-assisted treatment in the county jail, sober living opportunities, peer support programs, naloxone supply and distribution and opioid disposal options.

The task force will also recommend holding public listening sessions for community input on how best to use the settlement funds.

The county is currently recruiting members for the task force.

For more information about Eau Claire County’s Opioid Task Force, contact Assistant to the County Administrator Samantha Kraegenbrink at samantha.kraegenbrink@eauclairecounty.gov.

Burke County, N.C.

Population: 87,600

Officials in Burke County, N.C., are using opioid settlement funds to take a regional approach to solving problems around addiction. The county is working to create a facility that will be the hub for acute response and long-term treatment for those living with substance use disorder.

The 68-bed treatment center will be located in a former corrections facility already owned by the county. Individuals will be referred by physicians, law enforcement or the department of social services. A clinician and peer support specialists will be available around the clock.

Burke County isn’t planning to tackle substance use problems on its own. The county is seeking collaboration with western North Carolina counties to form a consortium to share resources and ensure individuals served as the treatment center can return to any community in the region and receive ongoing care and support.

Each participating county will pledge 50 percent of their opioid settlement funds to the regional approach. The long-term facility will have beds that are allotted per the counties within the consortium. The five-to-seven-year goal is a self-sustaining facility where each county department of social services can contribute two full-time social workers to staff the center.

The county has also created a working group that includes a variety of key organizations and individuals: Burke County Health Department; Burke County Department of Social Services; individuals in recovery; peer counselors; a chief of police; Partners in Health; UNC Blue Ridge Hospital’s Chief Medical Officer and Behavioral Health Nursing Supervisor and the pastor of a local church to represent the faith-based community.

Burke County’s next steps are to hire a project manager and a consultant to assist with work moving forward. The county will conduct a program inventory in each prospective partner county with the expectation that each will contribute harm reduction services, medication assisted treatment, naloxone distribution, community paramedicine, drug court and peer support facilities in this regional approach.

For more information about Burke County’s plans for its opioid settlement funds, please contact Burke County Public Health Director Danny Scalise at danny.scalise@burkenc.org.