4 Areas Deserve Focus as Opioid Settlement Dollars Flow

While no amount of money can guarantee an end to the ongoing crisis of substance use disorder (SUD) in the United States, the billions of dollars now flowing from opioid settlements to state and local governments will surely make a vital difference for generations to come.

The more than $54 billion in settlement funding now being disbursed will help to combat the outsized public health crisis, which claimed over 100,000 American lives in 2020 alone. State and local governments have already received more than $3 billion combined, according to a national summary document created by BrownGreer, a court-appointed firm that is administering the settlement and handling the distribution of payments.

Many of the opioid settlements stipulate that states must spend at least 85% of the money they receive over the next 15 years on addiction treatment and prevention. But how the funds are actually spent will differ by locality, which may impede state and municipal officials from learning from each other’s mistakes or replicating each other’s successes.

So, while the funds may be allocated in different ways depending on locale, there are 4 universal areas of focused investment over time that will increase the impact of any settlement dollars:

There needs to be a greater capacity to treat individuals with substance use disorder. The ongoing national shortage of behavioral health counselors deeply impacts individuals with SUD, who often need treatment professionals trained in that specialty. Currently, 46.3 million Americans grapple with SUD, yet only a fraction of them—6%— receive specialized treatment, according to the 2021 National Survey on Drug Use and Health conducted by the Substance Abuse and Mental Health Services Administration (SAMHSA). With that in mind, an infusion of funds for increasing the number of qualified counselors will result in sustainable change, especially in underserved rural areas.

While expanding such access is essential, individuals in recovery need more than just counseling. The 167 hours between weekly in-person counseling visits should be supplemented with access to peer specialists, who provide a sense of community. The incorporation of peer support into every level of prevention and treatment for SUD is clinically proven and dramatically lessens the risk of relapse. In-person engagement may seem ideal, but creating this sense of community can also happen virtually, which would make this method of support available to more people.

Any investment in expanding capacity and supporting recovery will not be successful unless more individuals actually initiate treatment. As addiction has become recognized more widely as a health issue, people can now start treatment via myriad pathways in their communities, including emergency rooms, social services, and interactions with law enforcement (deflection programs). Making sure people stay in treatment still presents a formidable challenge, however, which is why community leaders and others should focus on the treatment referral process, ideally a combination of digital and human resources, to ensure success.  

While the allocation of settlement funds should benefit those currently struggling with SUD, local and state governments must do more in terms of prevention. Only then will we change the trajectory of a crisis that already has killed so many. Targeted efforts, rather than yet another ad campaign, would be most effective. For instance, a 15-year-old high schooler considering cannabis use as a salve for anxiety requires a different toolkit than a veteran addicted to opioids originally prescribed for chronic pain. Here, too, digital screening tools could be leveraged for maximum impact.

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To be sure, formidable challenges, such as the mental health crisis among US adolescents, will continue to emerge, complicating efforts to change course. Yet, the strategic allocation of settlement payments, which will continue through 2038, will undeniably aid in boosting prevention efforts, helping more people in recovery and saving lives.

We have no time to lose.

Hans Morefield is the CEO of CHESS Health.

The views expressed in Perspectives are solely those of the author and do not necessarily reflect the views of Behavioral Healthcare Executive, the Psychiatry & Behavioral Health Learning Network, or other Network authors. Perspectives entries are not medical advice.