TLDR;
This YouTube video features a panel discussion and presentation on innovations in opioid settlement funding. The discussion covers the history of opioid litigation, principles for fund usage, and the opioid settlement fund tracking project. Panelists share insights on effective spending strategies, including prioritizing racial equity, improving transparency, and avoiding misuse of funds. The conversation also touches on the importance of incorporating lived experiences, working across silos, and ensuring the sustainability of programs.
- Opioid settlement funds should be used to save lives and address the harms of the opioid crisis.
- Investing in evidence-based programs and prioritizing racial equity are crucial for effective spending.
- Transparency and public accountability are essential for ensuring the quality and impact of expenditures.
Introduction [0:19]
Matthew Eisenberg welcomes attendees to the event on Innovations in Opioid Settlement Funding, which is the capstone event to a year-long series. He thanks the Provos office, the Bloomberg American Health Initiative, and the Bloomberg Overdose Prevention Initiative for funding and acknowledges the faculty leads and coordinator for their contributions.
Background on Opioid Settlement Funds [1:33]
Abby Wker provides background on opioid settlement funds, explaining that states and local governments have litigated against companies along the opioid supply chain. National settlements in 2021 committed over $56 billion to states, local, and tribal governments over 18 years. These funds are controlled by distinct entities within each state and allocated based on the public health impact within each state.
Principles for the Use of Funds [3:22]
Abby discusses the tobacco master settlement agreements of 1998, where little money went to prevention efforts. To avoid similar misuse with opioid settlement funds, public health leaders developed five principles: spending money to save lives, investing in evidence-based programs, focusing on prevention, prioritizing racial equity, and ensuring transparency. These principles serve as a gold standard for aligning expenditures with the settlements' intention.
Opioid Settlement Fund Tracking Project [8:25]
The opioid settlement fund tracking project, a partnership between KFF Health News, Shatterproof, and Hopkins, identifies and compiles publicly available expenditure data across all shares. The project characterizes each expenditure by a coding scheme, including core strategies and special interest tags. Initial findings show the largest proportion of funds going towards treatment, harm reduction, and recovery services, with a lower proportion for prevention.
Future Directions [11:25]
Key issues for the future include ensuring racial equity, improving transparency and reporting consistency, avoiding misuse and supplementation of existing funding, monitoring and evaluating the impact of spending, and assessing the quality of investments. Identifying and raising examples of best practices and innovations in settlement fund expenditures is also crucial.
Panel Introductions [14:04]
Aneri Patani introduces the panelists: Tracy Gardner, executive director of the National Black Harm Reduction Network; Liz Al, administrator of Countryside Public Health; Dalton Barrett, opioid settlement program director and post overdose response team manager in Edgecom County; and Alyssa Kitless, opioid settlement program manager in Wake County.
Innovations in Spending: Next Distro [16:46]
Tracy Gardner discusses Next Distro, a mail-order harm reduction program addressing stigma and barriers to accessing harm reduction services. It provides naloxone, test strips, and one-to-one support via email, prioritizing privacy and confidentiality. The model aims to replicate engagement with people alienated from traditional systems.
Innovations in Spending: Pooling Resources [21:29]
Liz Al shares her innovation of pooling resources across five small counties to create a larger fund of $2.7 million over 18 years. This allows for innovative funding through evidence-based programming for youth and community response programs, crossing county lines and maximizing impact.
Innovations in Spending: EMS Buprenorphine [24:01]
Dalton Barrett discusses Edgecom County's EMS-based buprenorphine program, which addresses gaps in harm reduction and treatment access. Field initiations of buprenorphine by EMS provide immediate relief from withdrawal and facilitate entry into treatment, with a patient-centered approach.
Innovations in Spending: Comprehensive Wraparound Services [26:46]
Alyssa Kitless highlights Wake County's focus on comprehensive wraparound services, particularly peer support, to navigate complex systems. The county invests in programs like Arise Collective, which provides re-entry support for women released from incarceration, offering a hub for accessing transitional housing, treatment, and peer connections.
Centering Marginalized Communities [30:14]
Tracy and Alyssa discuss the importance of centering marginalized communities and individuals with lived experience in program design and implementation. This approach ensures autonomy in care, addresses systemic inequities, and incorporates real-time feedback for effective solutions.
Working Across Silos [37:06]
Liz and Dalton discuss the importance of breaking down silos and working collaboratively across counties and fields. Joint powers agreements, relationship building, and consistent communication are key to overcoming territoriality and ensuring patient-centered care.
Harm Reduction and Evidence-Based Practices [43:42]
The panel discusses the definitions of harm reduction and evidence-based practices, emphasizing the need to consider evidence-informed approaches and anecdotal evidence alongside traditional metrics. This allows for innovation and responsiveness to community needs.
Sustainability of Programs [45:30]
The panelists discuss the challenge of sustaining programs started with opioid settlement funds, considering the front-loaded nature of the funding. Strategies include building relationships, seeking billing options, and creating mechanisms for continued support, while also acknowledging the uncertainty of future funding.
Prevention Spending [54:20]
The panel explores the complexities of using opioid settlement money for prevention, noting restrictions in some states and the importance of defining prevention broadly. They emphasize the need for primary prevention efforts and the value of combining data with anecdotal stories to demonstrate impact.
Tracking EMS Buprenorphine [1:00:40]
Dalton explains how North Carolina tracks EMS-delivered buprenorphine through a data team at the Office of EMS, using NISS data points. He acknowledges the difficulty for the public to find out which counties offer this service due to varying protocols and adoption rates.
Pressure to Misallocate Funds [1:02:51]
Panelists share experiences of pressure to allocate funds in ways that do not align with opioid remediation, including marketing from companies and requests for non-evidence-based interventions. They emphasize the importance of building systems, guardrails, and community engagement to ensure funds are used appropriately.
Federal Funding Squeezes [1:09:15]
The panel discusses the impact of federal funding squeezes on the use of settlement money, noting the potential for jurisdictions to dip into these funds to make up for gaps. They highlight the importance of earmarking funds, building relationships, and creating bylaws to protect them from being swept into general funds.
Reflections on the Federal Landscape [1:14:41]
Regina Label provides reflections on the panel discussion and puts it in the context of the broader federal landscape. She emphasizes the importance of storytelling, avoiding well-trodden roads, and bringing new voices to the issue. She argues that substance use disorder is a fundamental public health issue, not a niche one, and highlights the potential domino effect of Medicaid cuts on the SAMA block grant and abatement funds.
Vision for the Future [1:23:24]
Regina stresses the importance of remembering what got us here and envisioning what we want the system to look like in 20 years, beyond just rescuing people. She calls for a system that serves people and ensures that science and compassion are the operating system for our national response.
