County, city strategize on opioid settlement spending

In November 2017, Buncombe was the first county in North Carolina to file a lawsuit against pharmaceutical companies for their role in the opioid epidemic.

Counties and municipalities nationwide later consolidated lawsuits into multidistrict litigation. This years-long battle concluded in February with the final approval of the National Opioid Settlement, ending litigation in federal and state courts between companies in the opioid supply chain and 3,300 communities nationwide.

The litigation secured $26 billion from Johnson & Johnson, a former opioid manufacturer, and three pharmaceutical distributors: Cardinal Health, McKesson and AmerisourceBergen.

Asheville will receive $1,519,518, while Buncombe County will get $16,175,039 over 17 years. (Asheville did not file a lawsuit against pharmaceutical companies but received settlement funds as a recipient in the class-action lawsuit, says City Attorney Brad Branham.)

Settlement funds will go toward addressing the opioid epidemic that continues to ravage Western North Carolina. An average of nine people died from a drug overdose each day in 2020 in North Carolina, according to the most recent N.C. Department of Health and Human Services data. The Buncombe County Emergency Services Department tells Xpress it is dispatched to multiple 911 calls a day for drug overdoses, primarily heroin, fentanyl and prescription drugs like OxyContin and Percocet.

“The urgency of [the opioid epidemic] is as real as it’s ever been,” Buncombe County Commissioner Jasmine Beach-Ferrera, who served on the state’s opioid settlement working group (known as the 555 committee), tells Xpress. “What’s different now is we know a lot more each and every year about how to help people effectively get treatment — things like access to medication-assisted treatment.”

Responsible spending

In some ways, litigation against the opioid industry stems from the historic 1998 settlement by the four largest tobacco companies in the U.S.

The tobacco settlement paid out $246 billion over 25 years, according to The Harvard Gazette. However, it provided few restrictions on how funds would be spent, and many were disappointed with the expenditures. “In many states, much of the money has gone not to anti-smoking efforts, or even to general spending on health, but instead to closing budget shortfalls, lowering taxes, and funding infrastructure,” The New Yorker reported.

Wary of a repeat performance, the National Opioid Settlement established 12 evidence-based, high-impact strategies of which funds can be spent. North Carolina established a memorandum of agreement directing how the settlement can be spent in the state; it allocates 85% to counties and municipalities and 15% to the state. At least 70% of the settlement’s total funds must be used on future opioid remediation efforts, according to NationalOpioidSettlement.com.

Each local government must file an annual financial audit of its expenditures to the North Carolina attorney general.

‘Get this right’

Buncombe County received $621,438 this spring and will get another $1.36 million this summer. The payments will be disbursed each summer through 2038, with allocations ranging between $700,000 and $1.3 million each year.

Beach-Ferrera tells Xpress what “makes North Carolina stand out is how much of the funding is being directed to local communities, so that there can be really homegrown solutions.”

North Carolina’s memorandum of agreement outlines 12 programs and services that include recovery support services, recovery housing, evidence-based addiction treatment, naloxone (Narcan) distribution, syringe programs and post-overdose response teams.

Representatives from the city and county recognize their respective spending must be thoughtful and intentional in focus, as well as coordinated with each other’s work. “There’s a lot to really think through,” says Victoria Reichard, Buncombe County behavioral health manager, who was hired in February in part to address settlement spending in the county’s new Behavioral Justice Health Collaborative, which is part of the Justice Resource Advisory Council. “We could just put money out, but then are we really going to make that impact? Are we going to be equitable?”

Reichard adds, “Here’s your opportunity to slow down, get this right and make a long-term impact.”

County plans

On April 19, the Buncombe County Board of Commissioners approved a budget amendment for $621,438, the first fund transfer of the settlement. At that same meeting, Reichard explained how Buncombe County plans to get community input for developing a plan for the $16 million it will receive over the next 17 years.

In a July 19 update, Reichard told the Board of Commissioners that the Behavioral Justice Health Collaborative will gather data and stakeholder feedback through September, including through a public engagement dashboard. Reichard said the Behavioral Justice Health Collaborative’s immediate priorities include more accessible housing, reentry services following incarceration and a reduction in the number of criminal sentences for people with substance use disorder.

These emphases align with those of Philip Cooper, the Investments Supporting Partnerships in Recovery Ecosystems, or INspire, coordinator at Land of Sky Regional Council, an organization supporting local governments. Cooper is a member of a working group gathering weekly with Reichard and others to assess priorities. “My biggest concern has always been equity,” he says. “How can we make sure that all people get services whenever they start making decisions about this money?”

Overdose rates in historically marginalized communities in the state are increasing faster than non-Hispanic white people, the NCDHHS opioid action plan says. But “when you look at the (county) programs, and all the other stuff, they’re not serving many people of color,” Cooper says. “But I know for a fact from the work that I do that people of color have substance use disorder.”

Reentry services after incarceration need to be prioritized, Cooper says, and that requires “realistic expectations for where Black people that have substance use disorder are going. They might not go to treatment, but guess what? They go to prison.” Cooper says he thinks some people are listening to him, but as to how funds will actually be disbursed, he says “we shall see.”

A draft financial plan will be submitted in August and funding recommendations will be submitted to the Board of Commissioners for approval in September.

City’s plans

Meanwhile, the city of Asheville is relying on Dogwood Health Trust to help plan its payout. Dogwood issued a request for proposals aimed at local governments receiving settlement funding in the National Opioid Settlement.

Asheville city staff submitted a request for proposals for $375,500 to be spent over two years to fund a temporary staff position focusing on how to best spend the city’s opioid settlement funds.

This temporary position will be in the Homeless Strategy Division of the Community and Economic Development Department, and aims to address the intersection of housing instability and substance use disorder.