How states can use $50B in opioid funds

by Kelly A. O’Connor

Kudos to John Oliver and HBO’s “Last Week Tonight” for their coverage of the opioid crisis and the resultant settlement. Many states are struggling to use the settlement funds effectively, and some are already repeating the waste, fraud and abuse involving Big Tobacco settlement funds ($206 billion) in the 1990s. But it’s still early, and states can course-correct and optimize use of the money.

Opioid settlement funds began coming to states in 2022. More than $50 billion will be distributed to states and municipalities to fix the opioid crisis over the next 18 years, but so far, results have been underwhelming. The lack of transparency prevents us from knowing where money is being spent — and understanding what’s working and what’s not.

States are struggling to balance speed with efficacy. State and local leaders are facing pressure from individuals and families, community members, companies (including fraudsters), potential grant recipients and the media for money to be dispersed quickly. But few states have a strategic plan or the capabilities in place to ensure transparency, effective oversight and performance measurement to ensure dollars are spent on the right things.

Despite the pressure to spend and urgency of this mission, it’s a big mistake to hand out money without a clearly defined strategy, based on user research in communities to understand needs and root causes, and measurable outcomes. Executing the strategy will require an implementation plan across an ecosystem of opioid crisis drivers such as treatment, education, prevention, law enforcement and criminal justice, employment, housing, harm reduction and other social services. States need to start small, measure and improve continuously based on data and feedback.

Assemble the right team. States need a core team of experts in substance use disorder and large-scale program management. Key roles would include a chief financial manager, grants manager, medical experts, technology experts, outreach lead and senior program manager. Small, empowered teams with the right skills could make a tremendous amount of progress and work with bureaucracy to get things done quickly.

Understand needs and root causes before any “solutioning.” A common problem that comes with large amounts of funding is that teams start to build solutions right away — before they talk to the people they are trying to help. It’s critical to work directly with individuals struggling with addiction and their families, in addition to service providers such as social workers, clinicians, educators, first responders, community organizations and other stakeholders to understand root causes and needs. It’s likely that 80% of needs are similar across all 50 states, so identifying the 20% of unique needs in a state is critical to success.

Create a strategic plan. You can’t fix just one part of the opioid crisis (e.g., law enforcement) without addressing the entire ecosystem. Understanding how dependencies work across treatment, education and prevention, law enforcement and criminal justice, mental health, housing, employment, harm reduction and other social services is critical to success.

Set up secure technology to enable accountability and oversight. States will need secure, digital tools to not only track, allocate and report on settlement funds, but also to communicate progress. Hiring skilled technology leaders would ensure states have good digital tools to share information with each other and the public. Most importantly, this would enable states to collaborate on lessons learned, reuse successful solutions, minimize risk and optimize funding.

Start small — with everything. States should not be awarding multimillion-dollar grants immediately. Start with micro-grants (less than $50,000) and measure results, so recipients can prove their capabilities before getting larger sums of funding. Not everything is going to work — and that’s OK. Fail fast, and don’t sink good money after bad. Launch new processes, standards and programs using an iterative (agile) approach to speed deployment. Take a “test-and-learn” approach with everything.

Take a transparent approach from Day 1.  A well-designed, secure website that communicates spending, strategic plan, success metrics, user needs assessment, grant process and criteria, recordings of community meetings and other relevant information is a proactive way to keep stakeholders informed. Enhance the website as you go with more functionality (e.g., online grant applications, spending tracker, performance scorecards, stakeholder feedback and human success stories, etc.).

The opioid crisis continues to metastasize across the country, ravaging communities and destroying families. States can balance speed with efficacy by taking a more strategic, results-driven and iterative approach, while building a culture of collaboration and transparency from the start.

Kelly A. O’Connor lives in Washington and worked with the Barack Obama and Donald Trump administrations. She lost her sister Jenny to the opioid crisis in 2017.