Allocate opioid settlement dollars to real addiction-ending solutions

The crisis of opioid overdose deaths that sparked the multitude of lawsuits leading to a historic settlement continues to rage, with overdose deaths at an all-time high despite heightened national awareness and more resources than ever dedicated to treatment and overdose prevention. The persistence of this crisis underscores the dire need for well-informed and sustainable solutions that work — and funding for them.

Expediency dictates that the current crisis, marked by skyrocketing overdose deaths due to the infiltration of the drug supply with the deadly synthetic opioid, fentanyl, must be met head on. Efforts to spread the word to the public that “one pill can kill” and expediting universal access to naloxone, a drug that can reverse an opioid overdose, are urgently needed and essential for staunching the immediate crisis.

But even if public health experts and agencies manage to inform the public and eliminate fentanyl from the drug supply, misuse of addictive substances and their devastating and costly consequences will not disappear. It’s high time to take a comprehensive, proactive, and sustained approach to substance use and addiction, the most prevalent and preventable health problems the U.S. faces.

The blueprints for doing this right are available and, for once, there may even be enough funding on the horizon to launch key initiatives where they are most needed. The National Prescription Opiate Litigation, which consolidated thousands of lawsuits against some of the companies responsible for the prescription opioid epidemic, as well as other ongoing litigation against responsible parties, are resulting in billions of dollars of settlement funds flowing to states and localities throughout the country. Some guardrails have been put in place, forged in part from hard lessons learned when states misused or inappropriately used funds from the 1998 Master Settlement Agreement with the tobacco industry.

Despite amassing substantial knowledge and best practices that offer workable solutions, there are alarming trends in how state and local governments are planning to spend opioid settlement dollars. Many are planning to allocate these funds to law enforcement and other measures that attempt to address problems that have already surfaced and become entrenched.

In many cases, the funds allocated to addressing the end-stage consequences of opioid addiction, such as through law enforcement and expanding naloxone access, dwarf the funds allocated to effective means of preventing opioid addiction in the first place. If this pattern repeats across states and localities that receive settlement funds, it will be a colossal missed opportunity to finally stem the tide of substance use and addiction in the U.S.

A good example of this trend can be seen in Wisconsin. After receiving its first $31 million payment from the settlement, the Republican co-chairs of the state’s Joint Committee on Finance cut or significantly reduced allocations for key provisions that the state’s Department of Health Services had recommended be allocated to a family support program and a school substance use prevention curriculum and shifted them instead to law enforcement. This is despite research and several high-profile academic and policy committees deeming these family- and school-based prevention supports essential for abating the harms of the opioid epidemic and reducing the odds of facing a similar crisis in the near future.

Most alarming about Wisconsin’s maneuvers is the decision to eliminate a crucial piece of the proposed allocation of $1 million for a prevention services program focused on the “root causes” or systemic contributors to substance use and addiction, including housing instability and trauma.

Research shows that addressing adverse social determinants of health and well-being and promoting protective and supportive environments significantly reduce substance use and prevent escalation to addiction and other health and social problems. Investments in this approach are cost-effective, reducing levels of systems involvement and need for substance use treatment, and forestalling the enormous financial, productivity, health, and social costs of untreated addiction.

Prevention is increasingly recognized as an essential element for tackling pandemics, social and racial injustices, health disparities, and other adversities. As states are about to receive heavy infusions of money from opioid settlements, they have the unique and urgent opportunity to promote the scaling up and scaling out of effective prevention programs and policies, including building supportive infrastructures, across communities and social systems.

We hope that Wisconsin represents an isolated case, and that other state and local governments will follow the science rather than hew to short-sighted political ideology or expediency, but worry that is unlikely.

Undervaluing the importance of preventing family instability, childhood trauma and stress, and youth exposure to addictive substances — all of which have proven time and again to be among the primary contributors to problem substance use and addiction — is tantamount to giving up on ever solving the nation’s enduring addiction problem and instead ensuring an ongoing game of Whac-A-Mole with an inevitable stream of future drug epidemics.

At this critical juncture, we urge legislators and policymakers on the local, state, and federal levels to take seriously the deeply considered recommendations that have been made for most productively and effectively allocating funds from the opioid settlement. These include substantial allocations to prevention initiatives, alongside immediate funding for evidence-based treatment, recovery support, and overdose reversals.

Instructive resources designed to help guide legislators and policymakers are readily available and include “Principles for the Use of Funds from the Opioid Litigation,” developed by the Johns Hopkins Bloomberg School of Public Health; “Evidence Based Strategies for Abatement of Harms from the Opioid Epidemic,” from a team of interdisciplinary experts directed by a leading Harvard economist; and “Strategy for Preventing Opioid Use Disorders in Communities,” developed by the National Prevention Science Coalition to Save Lives, which one of us (D.F.) leads.

As Americans grow increasingly attuned to the national mental health and substance use crisis the country is facing, which is only partially due to Covid-19, let’s use the mounds of evidence that have been accumulated to make smart decisions and ensure that settlement funds are being heavily invested in prevention and children’s health and well-being, and not just plugging up holes in the addiction-crisis dam.

Linda Richter is the vice president of prevention research and analysis at Partnership to End Addiction in New York. Diana Fishbein is a senior scientist in the Frank Porter Graham Child Development Institute at the University of North Carolina-Chapel Hill, president of the National Prevention Science Coalition to Improve Lives, and part-time research faculty member at The Pennsylvania State University.