Opioid settlement funding update: The impact on first responders

Nationwide, communities continue to battle the effects of the opioid crisis. Litigation brought by states against drug distributors, manufacturers and pharmacy chains has produced opioid settlement funding designed to bring relief to communities affected by the epidemic.

For public safety agencies, including EMS, fire service, law enforcement and corrections, opioid settlement funding may be tapped for a variety of purposes. For this reason, public safety leaders must understand the basics of the settlements, how funds will be distributed and how your agency may be able to tap into funding in a responsible manner.

The Settlements

In 2022, opioid settlements were reached with the drug distributors AmerisourceBergen, Cardinal Health and McKesson, along with opioid manufacturer Johnson & Johnson.

A total of $26 billion was included in the settlement, with the three distributors paying $21 billion and Johnson & Johnson paying $5 billion.

In late 2022, additional opioid settlement funding agreements were announced with three pharmacy chains – CVS, Walgreens and Walmart – and two additional manufacturers, Allergan and Teva.

The agreements are structured so that the greater the level of subdivision participation, the more funds will ultimately be paid out for abatement.

Assuming maximum participation, these settlements require:

• Teva to pay up to $3.34 billion over 13 years and to provide either $1.2 billion of its generic version of the drug Narcan over 10 years or pay $240 million in cash in lieu of product, as each state may elect
• Allergan to pay up to $2.02 billion over 7 years
• CVS to pay up to $4.9 billion over 10 years
• Walgreens to pay up to $5.52 billion over 15 years
• Walmart to pay up to $2.74 billion in 2023 within 6 years

How Will Funds Be Distributed?

Every state’s strategy to spend opioid settlement funding varies, as does the distribution process. Funding is originating from the federal Attorney General’s office and is landing first at each state Attorney General’s office. Some states are running the funds through regional task forces and others through foundations.

States will receive funds based on the impact of the opioid epidemic in their state. The share of the impact is calculated using data such as the amount of opioids shipped to the state, the number of opioid‐related deaths that occurred in the state and the number of people who suffer opioid use disorder in the state.

The settlements require 85% of funds be allocated to programs that will help address the ongoing opioid crisis through treatment, education and prevention efforts. A majority of states have already passed agreements that dictate how funds will be distributed between state and local subdivision governments, and funds started reaching communities last year.

How Can the Funds Be Used?

The settlements allow for a broad range of approved abatement uses by state and local governments. The list of pre-approved uses includes a wide range of intervention, treatment, education and recovery services so that state and local governments can decide what will best serve their communities. Although specifics vary by state, we can expect police, corrections, fire and EMS to benefit from the effects of the opioid-remediation efforts funded by the settlements and the injunctive relief the settlements provide.

Eligible uses of funds generally include:

• Medication-assisted treatment (also called medications for opioid use disorder)
• Mental health treatment and capacity building
• Screening, intervention and referral services
• Training and support to emergency services professionals re: opioid overdoses and opioid-related adverse events
• Community education, outreach and prevention activities (special efforts are given to youth, criminal justice-involved populations and pregnant women)
• Narcan and opioid-reversal interventions
• Revisions to prescribing practices

How Will the Funds Support First Responders?

While the funds will be used for programs across local government—including schools, health care providers, community outreach and recovery programs—there are obvious alignments with public safety needs.

• Fire and EMS: Opioid settlement funding can be used to help protect responders (PPE, decontamination equipment, detection equipment) when responding to a possible call for opioid/drug overdose. This funding could also be sought for equipment to provide care to overdose patients (airway management, resuscitation equipment). As the funding priorities morph over the years, other areas of equipment and needs may open up.
• Law enforcement: Opioid settlement funding could be sought for the protection of officers (PPE, decontamination equipment, de-escalation equipment) and to manage the scene (narcotic detection, Narcan, etc.). Funding priorities may change over the years as areas of concern or need are identified.
• Corrections: As with other areas of public safety, settlement funding could be used for correctional officer PPE and the supply of essential overdose and withdrawal medications for incarcerated persons. But there’s another key area correctional leaders should consider. Opioid use disorder is recognized under the Americans with Disabilities Act, which means inmates coming into the jail who are currently taking prescriptions for opioid use disorder (e.g., methadone) must be accommodated. But creating a medications for opioid use disorder (MOUD) program requires planning and budget. Opioid settlement funding is an obvious resource to tap to start or continue funding for your program. To learn more about creating an MOUD program, watch the on-demand webinar, “Medications for Opioid Use Disorder (MOUD): Critical Considerations for Your Jail Facility.”

State Plan Examples

State plans also outline many uses that will have a direct impact on first responders. States have developed guidance for distributing the opioid settlement funding. Here are some examples specific to how the funds may be used to support public safety:

Arizona

• Expand first responder training in the use of naloxone or other FDA-approved drugs to reverse opioid overdoses
• Increase availability and distribution of naloxone and other overdose treatment drugs for use by first responders and other impacted groups
• Support current and future law enforcement expenditures relating to the opioid epidemic
• Educate law enforcement or other first responders regarding appropriate practices and precautions when dealing with fentanyl or other drugs

Florida

• Provide medication-assisted treatment education and awareness training to healthcare providers, EMTs, law enforcement and other first responders
• Provide funding and training for first responders to participate in pre-arrest diversion programs, post-overdose response teams or similar strategies that connect at-risk individuals to behavioral health services and support
• Provide training for law enforcement, correctional and judicial personnel on best practices for addressing the needs of criminal justice-involved persons with opioid use disorder
• Educate law enforcement or other first responders regarding appropriate practices and precautions when dealing with fentanyl or other drugs
• Increase availability and distribution of naloxone and other overdose treatment drugs for use by first responders
• Provide wellness and support services for first responders and others who experience secondary trauma associated with opioid-related emergency events

Ohio

• Increase availability and distribution of naloxone and other overdose treatment drugs for use by first responders
• Provide funds for first responders and criminal justice professionals for expenditures relating to community and statewide opioid supply-and-demand reduction strategies, including criminal interdiction efforts
• Train public safety officials and responders in safe-handling practices and precautions when dealing with fentanyl or other drugs
• Provide trauma-informed resiliency training and support, including services that address compassion fatigue and increased suicide risk of public safety responders

What’s Next?

What steps should public safety leaders take next? In a word, advocate for your needs. Contact your state Attorney General’s office for guidance on how to present your request. As stated, each state, county, city and local area will determine how funds can be spent.

Review the guidance from your state MOU and federal Attorney General’s list of opioid remediation uses before you contact your local government. Be prepared to address which abatement and mitigation efforts will help address the crisis in your community. What has the opioid epidemic done to your community? How has it affected your department in terms of response times, training and equipment? Is your local government body aware? What data supports your needs for training, wellness programs, equipment, etc.?

Advocacy is a means to get your response agency needs in front of the local government decision channel. Identify your needs based on the parameters of what opioid settlement funding can be used for and meet with your local government leaders now. They need to know how this funding will impact your department, address response needs and mitigate the impact this epidemic has had.

It’s also important to ensure opioid settlement funding is used ethically and transparently, supporting the intent behind the settlements. Some uses of the funding have already come under scrutiny. Open, clear communication with constituents is key to helping build support for your agency’s use of these funds. Getting “creative” will only erode public trust and backfire in the long run.

Opioid settlement funding will continue for 11 to 18 years, and it is expected that more settlements will be forthcoming. Many of the same advocacy strategies used to tap American Rescue Plan funds apply to opioid settlement funding as well. Start those conversations with your local leaders today!

Resources

• State Participation Status in Opioid Settlement Funding: Shows the states participating in each settlement. Many states have also provided additional documentation about how they intend to use the funding.

• States’ Opioid Settlement Spending Plans: Provides state-level guides that can help you understand how funds are being distributed in your state and advocate for your share.

• National Opioids Settlement website
• Federal Attorney General List of Opioid Remediation Uses
• State Attorney General locator