States Face a $50 Billion Test on Opioids
For more than two decades, the opioid crisis has steadily tightened its grip on communities nationally, cutting across geography, income, and politics.
What began as a wave of prescription drug misuse has evolved into a far more dangerous and complex public health emergency driven by synthetic opioids like fentanyl.
This emergency is leaving hundreds of thousands of Americans dead and countless families and communities struggling to cope with its aftermath.
The financial toll has been staggering as well, straining state budgets through increased healthcare costs, lost productivity, law enforcement demands and long-term social services.
Following years of litigation, a series of opioid lawsuit settlements totaling more than $57 billion is now being distributed to states and local governments.
These funds, drawn from pharmaceutical manufacturers, distributors, and related entities, are intended to address the damage caused by the crisis and to support efforts to prevent it from worsening.
States will now administer these resources on behalf of the hundreds of thousands of Americans who have been killed or injured by opioids, making decisions that will shape the trajectory of the crisis for years to come.
That responsibility comes with both opportunity and risk. Many have already warned that states could misuse these funds, missing what is arguably a once-in-a-generation chance to invest in programs that meaningfully reduce addiction and save lives.
I raised similar concerns more than a year ago, noting both innovative approaches in some states and a troubling lack of transparency in others.
Fortunately, most settlement agreements include guardrails requiring that roughly 85% of funds be spent on opioid remediation, with a portion reserved for future programs.
But those requirements are not always as airtight as they appear. States facing fiscal pressure remain capable cheating the settlement and diverting funds toward existing budget gaps, often through vague or loosely defined spending categories.
Weasel-wording imposed requirements is sadly a way of life in some state houses.
In some cases, "opioid-related" expenditures have stretched to cover activities that do little to directly address addiction, treatment, or prevention. Consumer Action for a Strong Economy (CASE), for example, highlighted questionable expenditures in a recently released report.
In Jackson County, Mississippi, more than $500,000 was spent on office-related upgrades, including fiber optic cable installation and new shelving systems.
In Farmington Hills, Michigan, $120,000 was used to backfill public safety budgets, with nothing directed toward treatment or recovery services.
And in Irvington, New Jersey, $632,000 went toward "opioid awareness" concerts and promotional materials that failed to connect individuals with actual treatment options.
At the same time, transparency remains uneven across the country.
The National Academy for State Health Policy (NASHP) has been tracking how states are planning to allocate these funds.
Of the jurisdictions, 31 have published their overall spending recommendations.
Twenty have not. My own state of Illinois (with the highest per capita burden of public debt in the nation) has been almost secretive about its planned use of the funds.
The stresses to raid this fund in states like Illinois are colossal and the threat is growing.
States must resist that temptation. These settlements present a once-in-a-lifetime opportunity to set up permanent programs that will mitigate and even eliminate the opioid crisis in each state.
Investments made today — if properly targeted — could significantly reduce long-term costs associated with healthcare, homelessness, criminal justice, and lost economic productivity.
States should spend now to eliminate the problem for the sake of their future budgets if for no other reason.
There are already examples of states putting these principles into practice.
Wisconsin has directed portions of its funding to local law enforcement agencies through competitive grants aimed at expanding community drug disposal programs.
Teaming with mental healthclinicians, they are effectively treating the users rather than jailing them.
In Washington state, monies are being spent on long-term treatment, mobile treatment vans to address the homeless and brick and mortar facilities to rehabilitate users.
In Florida, millions are being spent on training and retraining police officers in crisis intervention resulting in a dramatic drop in arrests and shootings in drug fueled situations.
The opioid crisis is not a past matter.
The illegal trade in opioids is alive and well.
Although U.S. Customs and Border Protection (CBP) drug seizure statistics indicate a significant decrease in fentanyl and heroin smuggling activity since the border was closed and drug interdiction started to be pursued aggressively, these drugs and their other analogues continue to kill Americans by the hundreds of thousands annually.
Additionally, a new terror is emerging to make fentanyl look like baby aspirin. Xylazine — an animal tranquilizer often referred to as "tranq" — has been increasingly found in the illicit drug supply.
This new nightmare has been used to cut fentanyl and heroin and leaves users with unhealing necrotic ulcers leading to loss limbs and also limits the effectiveness of naloxone to reverse overdoses.
This narcotic "upgrade" will not only kill the user, but the anguish and suffering while being maimed before death is not to be believed.
Clearly the problem is evolving, and effective measures are needed for both the current crisis and future horrors to come.
If the state legislators can remain focused on the reason for this money coming to them, the spending cannot help but to be appropriate.
If they forget that charge, this moment will be remembered as a missed opportunity of historic proportions.
Mike Flanagan represented the 5th District of Illinois in the U.S. House of Representatives. Read more Micael Flanagan's Insider articles — Click Here Now.