County with high rate of overdose deaths doesn't use opioid settlement funds for addiction program

KFF Health News

In the last two years, Greene County has received more than $2.7million from settlements made with manufacturers and distributors of opioids. County officials spend the money on other things, rather than helping those who are affected by addiction.

The county has spent $2.4 million to pay off its debt. Another $1 million will be deposited over the next decade in a fund for capital projects. In March, $50,000 was appropriated from this fund to purchase a "litter crew vehicle" -- a pick-up truck that inmates would use to collect trash on county roads.

Nancy Schneck, retired nurse, said, "It is astounding." She has witnessed addiction spread throughout the community. Employers avoid drug tests for fear of losing employees, and mental health issues and homelessness are common. She wants the money to go towards mental health and addiction treatments. Why are county leaders not able to'see that treating some people, and getting them out of the cycle could be beneficial?' She said.

Greene County, which has the most recent data available for 2021, had the highest rate of drug overdoses in the state and nation.

Mayor Kevin Morrison, however, said that the county had been bearing the costs of the epidemic for many years. It had funded an overburdened sheriff's department, upgraded the jail - which was crammed with addicts committing crimes - and supported a court to divert people into treatment. The county has also been hit by indirect costs: more people leaving the workforce because of addiction, schools and welfare agencies caring for children with trauma and some taxpayers abandoning the county. Greene County is not solely responsible for its economic problems, but addiction has contributed to a debt of more than $30,000,000.

Morrison stated that despite the fact that we have been dealing with the crisis for a long time, no one wants to pay bills as they come. When these funds become available, we will be able to pay bills that are past due.

The debate in Appalachia is reverberating across the country as state and local government receives billions of dollars each year from companies like Johnson & Johnson and Cardinal Health that make, distribute, or sell opioid painkillers. The companies are accused of fueling an overdose epidemic and the money will be used to remedy that harm. Around $3 billion is already in state, city, and county coffers. Another $50 billion will be expected over the next decade.

States must spend at least 85 percent of their money on programs related to opioids. However, KFF Health News has been investigating how this money is being spent and misappropriated.

Greene County's capital projects fund was not subject to this restriction.

Local officials in many rural areas, who have struggled to pay addiction costs for years, justify the use of settlement funds to cover past expenses. Robert Pack, the co-director at East Tennessee State University’s Addiction Science Center, says that most of Tennessee’s 95 counties have significant debts, making it difficult to decide how best to spend this money.

He and many other advocates still hope that the settlement money is spent to address the current crisis. Overdoses kill more than 200 Americans every day. They say that investing in prevention and treatment can save lives and safeguard future generations.

Tricia Christensen is the policy director at the nonprofit Community Education Group. She said, 'There's no reason to keep the money or place it in a general fund.' The group is tracking settlement expenditures across Appalachia - which Christensen calls the epicenter of the epidemic. These dollars should go to people most affected by the overdose epidemic.

There has been very little oversight at the national level. The administration of President Joe Biden pledged that the settlement funds would be used to combat the drug addiction crisis but took little action. State accountability varies.

In Tennessee, the legislature controls 15% of the settlement funds for opioids in the state and local governments control another 15%. These two buckets are subject to few restrictions.

The Opioid Abatement Council has stricter standards and controls the other 70%. The council, which is required to give 35% of their funds to local governments and recently distributed over $31 million to counties in the state, demanded that the funds were spent on approved interventions such as building recovery homes and increasing addiction treatment to uninsured individuals.

Stephen Loyd said, 'I'm sure we'll bird-dog' these funds. He is the chair of this council and an opioid addict in recovery. He said that if counties misuse the funds, they will lose future payments.

Greene County reimburses its capital projects funds from its own pot - the 15% controlled by local governments.

Loyd stated that the public could hold officials accountable in such situations. If you don't agree with the way money is spent, you can vote.

He said that local leaders do not make 'nefarious decisions'. They make hundreds budgetary decisions a month, and lack the experience to know how best to use their money.

Loyd, along with other local experts, are working to close this gap. He meets with officials in the county and suggests they talk to their local antidrug coalitions, or host listening sessions for community members. Pack, a professor at East Tennessee State University, urges county officials to make medications more accessible that are effective in treating opioid dependence.

Both men direct counties to an online index of recovery ecosystems, which allows leaders to compare their own area's recovery resources with others.

The index shows that there are no recovery homes in Greene County and the number mental health and treatment providers per 100,000 people is lower than the state and national averages.

Loyd stated, 'That is a good place to start.

Greene County residents are asking for funds from the opioid settlement to be used to fund local initiatives already in place. Greene County Anti-Drug Coalition hosts presentations, for example, to educate parents and children about the dangers of drug abuse. They also meet with convenience-store owners to emphasize the importance of not selling cigarettes, alcohol or vaping devices, to minors. The coalition plans to offer life skills classes in the future. These will include budgeting and making decisions under pressure.

Wendy Peay is the executive director of United Way of Greene County and secretary of the antidrug coalition.

The coalition has requested settlement funds from the county but has yet to receive any.

A new residential treatment center is being built on the former site of a prison in Carter County. Stacy Street is a criminal court judge and the person who had the idea. She said that at least seven counties, towns, and cities in the area have contributed a total of $10 million from opioid settlement funds. Greene County was one of the few local governments to not contribute.

Street expects the facility to open in the summer of this year. It will house initially 45 people, for stays up to a year. The facility will be part the drug recovery court system in the region, where people who are addicted and have committed crimes can instead receive intensive treatment rather than go to prison.

Street stated that there are currently no residential facilities for these patients in the locality. Street said that too often people who attend his court for treatment receive it during the day, but then return to their homes at night and play with their same sandmates. This increases the risk of relapse.

Security concerns, according to Street, will prevent the facility from offering medications that treat opioid addiction - the gold standard in medical care. Some patients will be transported to another campus for treatment.

Morrison, Greene County Mayor, expressed concern about his contribution to the facility, as it is a recurring expense and settlement funds will cease flowing in 2038.

He said that 'the federal governments, who have the power to print money, are not in this business'.

The county has yet to decide how it will spend the nearly $334,000 settlement money that was recently given by the Opioid Abatement Council of California. Morrison stated that they are considering using the money for education and drug court efforts by the anti-drug council. According to the guidelines of the abatement Council, the funds cannot be used for old debts.

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