Opioid settlement plan allows millions to be spent on purposes other than the public health crisis

Associated Press

2 days ago

In the fallout of over 9,000 Mississippians dying of overdoses since 2000, lawyers and lawmakers have set up a plan to distribute the hundreds of millions of dollars from corporations that catalyzed the crisis. But public health advocates and Mississippians closest to the public health catastrophe worry the setup could enable these dollars to be spent on purposes other than ending the overdose epidemic.
Mississippi is expected to receive $370 million from pharmaceutical companies that profited while people struggled with addiction. That payout is set to be split between the state and local governments, with 85%, or about $315 million, being controlled by the Legislature. For years after the state attorney general's office helped finalize the first settlements in 2021, it was unclear how the state would distribute its share and how much would be used to prevent the crisis from persisting.
State senators and representatives took a major step toward answering these questions earlier this year. They nearly unanimously passed Senate Bill 2767, a law that outlines a general framework for how about $259 million of the funds will be distributed.
A 15-person advisory council — made up of representatives for state government agencies, elected officials and law enforcement officials — will develop a grant application process for organizations focused on addressing the opioid addiction crisis.
After evaluating the applications and making a list of which grants should be funded, the Legislature will decide whether to approve or deny each of the council's recommendations.
The state lawmakers can spend the remaining $56 million they control for any purpose — related or unrelated to addressing addiction.
House Speaker Jason White and Lt. Gov. Delbert Hosemann, who wield massive power over lawmakers and how state funds are spent, did not respond to questions from Mississippi Today about their priorities for the funds.
Sen. Nicole Boyd, a Republican from Oxford and the bill's lead sponsor, said she and other senators borrowed some ideas from surrounding states to determine how these funds could best prevent more fallout from the opioid crisis.
'It involves everything, from child welfare services to the judicial system to medical care to mental health services,' she said. 'It is a crisis that has affected every aspect of society, and we needed a comprehensive group of people making those recommendations.'
However, the bill leaves some questions unanswered, like how the application process will work, when it will open to the public and how grants will be evaluated.
Public health advocates and Mississippians impacted by addiction expressed concern about the advisory council's makeup, the $56 million carveout for expenses unrelated to the opioid crisis and the Legislature's final decision-making power. They said those provisions could cause some of the corporate defendants' dollars to be spent on issues other than addressing and preventing overdoses.
Jane Clair Tyner, a Hattiesburg resident, lost her 23-year-old son Asa Henderson in 2019 after he struggled for years with substance use disorder. Until last month, through her former job with the Mississippi overdose prevention nonprofit End It For Good, she worked to ensure that fewer parents have to go through the pain her family experienced.
She said the only ways these state settlement dollars should be spent are on improving Mississippi public health and keeping people who are at risk of overdosing safe.
'That's what it should go towards, but not to the Legislature,' she said. 'This is not a rainy day slush fund.'
An evolving plan
It wasn't always the plan for the Legislature to control so much of the settlement dollars. In 2021, when Mississippi and other states were in the midst of negotiating settlements, State Attorney General Lynn Fitch published an agreement between the state and local governments that would send only 15% to the Legislature's general fund.
The agreement said that the bulk of the money – 70% – would be sent to the University of Mississippi Medical Center to build a new addiction medicine institute. But Mississippi law says the Legislature is the ultimate decision maker for how this type of state settlement money gets spent, according to Fitch's Chief of Staff Michelle Williams.
So lawmakers passed their bill to change the plan.
The Legislature changed the arrangement to make sure the money goes to where the state's most pressing addiction needs are, said Boyd. The advisory council, which will be supplemented by at least 22 additional nonvoting members, is a good way to have those needs captured, she said.
As for the Legislature having final approval power, Boyd said that and other provisions were put into the bill to keep some power with lawmakers if the council becomes ineffective or political.
It's the highest percentage of any state's opioid settlement share that will be controlled by a Legislature, according to the Vital Strategies Overdose Prevention Program and OpioidSettlementTracker.com's state guides.
Dr. Caleb Alexander, an epidemiology professor at the Johns Hopkins Bloomberg School of Public Health, served as one of the plaintiffs' expert witnesses for some of the opioid lawsuits. Alexander has also helped U.S. cities and counties develop blueprints for how to use the settlements to quell their opioid crises.
He said using the money on a variety of prevention, treatment and recovery strategies, rather than one big project, is likely a better way to save lives and prevent more addiction. But having the Legislature, rather than an apolitical body of addiction experts, play such a large role is not the setup he would suggest.
'I would have some concerns that it may gum things up,' he said.
Additionally, Alexander said creating ways for funds to not be used to address the opioid epidemic, as the 2025 bill does, is 'a shame.' While the settlement agreements say that 70% of the funds must be spent on addressing addiction, there is nothing that prevents all the money from being used for the crisis, and most statesare doing that.
He said the settlements define a wide variety of uses as addressing the epidemic — from first responder training to medication research and development — and he doesn't see a scenario where it makes sense to spend the money on other uses.
'The costs of abatement far outweigh the available funds for every city or county that I've examined,' he said.
Boyd said she believes her colleagues in the House and Senate are all motivated to use this money to address addiction as a mental health condition. She said the new bill categorizes some funds as 'nonabatement' to free them up for ways to address addiction that may not fit neatly into the settlements' list of uses.
The attorney general's original plan was the first to categorize a percentage of the funds as not needing to be used to stop the opioid crisis. Williams said it was written that way to match the terms of the national settlement agreements, although the settlement for the largest payout says spending on purposes other than addressing the opioid crisis is 'disfavored by the parties.'
She said Fitch would love to see all the funds be spent on addiction response and prevention, like the One Pill Can Kill campaign the office runs.
'But it's the Legislature's prerogative,' she said.
'Where are the people in recovery?'
Jason McCarty, the Mississippi Harm Reduction Initiative's former executive director, said he's glad the plan is no longer to send such a large portion of the settlement funds to UMMC. Organizations like the Initiative, he said, also could use additional support to keep Mississippians from dying.
And he's concerned that while a peer recovery specialist will serve as a nonvoting member, none of the committee's 15 voting members must be people who've experienced addiction.
'Where are the people in recovery?' he asked. 'We're the subject matter experts.'
Boyd said many of the voting committee roles are representatives of state agencies that she expects will help administer the settlement grants, like the Department of Mental Health. And there were only so many people who the Legislature can assign spots.
'It was no slight to anybody,' she said. 'It's just, this is a completely complex issue.'
The Mississippi governor, lieutenant governor and speaker of the house will each assign two people to the committee, and Boyd said it's possible they will choose people in recovery.
The bill says council members need to be appointed by early June.
However the process plays out, McCarty hopes all the state's funds go to reputable organizations focused on preventing more opioid-related harm. In Mississippi, he sees a lack of housing and treatment options, especially for new parents, as areas that this money can help address.
And as hundreds of Mississippians continue to die from overdoses each year, he said the state government has to move quickly and responsibly to make these funds available.
'We don't have a year to wait. It needs to go out quicker.'
___
This story was originally published by Mississippi Today and distributed through a partnership with The Associated Press.