KFF health news
Over the past two years, rural Greene County in northeast Tennessee has raised more than $2.7 million from regional and national communities with opioid manufacturers and distributors. But instead of helping people suffering from addiction, county officials are finding other ways to spend them.
They have put 2.4 million dollars to pay off the county’s debt and have directed another 1 million dollars arrived for more than ten years in the capital projects fund. In March, they allocated $50,000 from that fund to buy a “garbage truck,” a pickup truck used by inmates to collect trash along the county’s roads.
“It’s amazing,” said Nancy Schneck, a retired nurse who has seen addiction creep into a society where employers avoid drug testing for fear of losing too many employees, and mental health crises and homelessness are rampant. She wants the money to go towards mental health and addiction treatment. Why can’t county leaders “see that it can be beneficial to treat some people and maybe get them out of this cycle?” She said.
In 2021, the latest year for which comparable data is available, Green County’s drug overdose death rate exceeded state and national rates.
But Mayor Kevin Morrison said the county has been taking on the costs of the opioid epidemic for years: it has funded a beleaguered sheriff’s office, improved a prison that’s filled with people who have committed addiction crimes, and supported a drug court to redirect some people into care. It has also suffered the indirect costs of the crisis: people are leaving their jobs due to addiction, schools and social services are caring for more traumatized children, and some taxpayers are leaving the county altogether. Drug addiction is not the only cause of Green County’s economic problems, but it has contributed to more than 30 million dollars debt.
“We’ve been facing this crisis for quite some time, but nobody wants to pay the bills when they come,” Morrison said. “So when these funds become available, we are paying bills that should have been paid for quite some time now.”
The debate in this Appalachian county is playing out across the country as state and local governments get billions of dollars from companies that made, distributed, or sold opioid pain medications, such as Johnson & Johnson, Cardinal Health, and CVS. The companies have been accused of fueling the overdose epidemic, and the money is earmarked to remedy that harm. About 3 billion dollars already landed to state, county, and city coffers, with about $50 billion more expected over the next decade and beyond.
States are required to spend at least 85% of their money on opioid programs, but KFF Health News ongoing investigation in how cash is used—and misused—shows that this standard is widely interpreted and little controlled.
This restriction did not apply to Green County money transferred to its capital projects fund.
In many rural communities that have struggled for decades to cover the costs of addiction, local authorities justify using settlement funds to recoup past costs. Most of Tennessee’s 95 counties are heavily indebted, he said, which could make it difficult to decide how to use the money. Robert Packco-director of the Addiction Science Center at East Tennessee University.
However, he and many of his supporters hope that the settlement funds will be spent on fighting the current crisis. after all, more than 200 people across the country die of overdose every day. Investments in treatment and prevention can save lives and protect future generations, they say.
“There is no good reason to sit on funds or put them in a general fund,” he said. Trisha Christensenpolitical director of the non-profit Community Education Group. Organization tracking of estimated expenses through the Appalachians, which Christensen called the epicenter of the epidemic. “These dollars should be used to support the people most affected by the overdose crisis.”
At the national level, settlement dollars were largely ignored. Administration of President Joe Biden pledge to make sure the funds went towards overcoming the addiction crisis, but took little action. Accountability at the state level varies.
In Tennessee, 15% of the state’s opioid settlement funds are controlled by the legislature and another 15% by local governments. These two buckets have several limitations.
The remaining 70% are controlled Opioid Council, which has more stringent standards. When the council, which must give 35% of its funds to local governments, recently over $31 million given away districts, required funds to be spent on list of approved interventionssuch as building recovery housing and expanding drug treatment for uninsured people.
“I can guarantee that we are going to chase these funds,” he said. Stephen Loyd, chairman of the board and physician recovering from opioid addiction. If the counties use them for unauthorized purposes, he said, the counties will not receive payments in the future.
Green County’s reimbursement of its capital projects fund comes from its own pocket – 15%, which is entirely controlled by the local government.
In such cases, the public can hold officials accountable, Loyd said. “If you don’t like how the money is being spent, you have the option to vote.”
According to him, local leaders, as a rule, do not show “vileness” in these decisions. They make hundreds of budget choices a month and simply don’t have the addiction experience or health care policy to guide their use of the money.
Loyd and other local experts are trying to fill this gap. He meets with county officials and encourages them to talk to local anti-drug coalitions or hold listening sessions to hear from community members. Pack from East Tennessee urges them to expand access to medicines that proven effectiveness in the treatment of opioid dependence.
Both men point counties to online ecosystem recovery indexwhere leaders can see how their area’s recovery resources compare to those of others.
For example, in Greene County, the index shows that there are no recovery homes and the number of treatment facilities and mental health care providers per 100,000 residents is below the state and national averages.
“It’s a great place to start,” Loyd said.
Some Green County residents want opioid funds to go to local initiatives that are already in place. V Green County Anti-Drug Coalition, for instance, hosts performances to educate young people and their parents on the risks of drug use. They are meeting with convenience store owners to stress the importance of banning the sale of alcohol, cigarettes or vaping devices to minors. In the future, the coalition hopes to offer classes on life skills such as budgeting and decision making under stress.
“If we can do preventive work with children, we can change the trajectory of their adult life,” he said. Wendy Peisecretary of the anti-drug coalition and executive director of the United Way of Greene County.
The coalition has requested settlement funds from the county, but has yet to receive them.
Nearby in Carter County, a new inpatient treatment facility. takes shape on the site of the former prison. At least seven counties, cities, and towns in the region have committed a total of $10 million in opioid settlement funds to support it. stacy street, the criminal judge who came up with the idea. Green County is one of the few local governments that has not contributed.
The facility, which Street says he plans to open this summer, will initially accommodate 45 people for a year or more. It will become part of a regional drug enforcement system that sends drug addicts who commit crimes to resuscitation rather than prison.
There are currently no long-term homes for such patients in the area, Street said. Too often, people in his yard heal during the day and return home at night, “to the same sandbox, playing with the same sandboxes,” which increases the risk of relapse.
Street said the new facility would not offer drugs to treat opioid addiction – the gold standard of medical care – due to safety concerns. But some patients may be transported off-campus for appointments.
Morrison, the mayor of Green County, said he was worried about the contribution to the facility because it’s a recurring expense and funds for the settlement will stop coming in 2038.
“There is a lot of pressure on local organizations like Greene County to try to solve this problem with this limited amount of funding,” he said, when “the federal government, which has the ability to print money to solve these problems, is not in a position to this business.”
The county is still deciding how to spend nearly $334,000 of the settlement funds it recently received from the State Opioid Board. Morrison said they are considering using it for anti-drug coalition and district drug court outreach activities. Given the recommendations of the emission control board, these funds cannot be used to pay off old debts.