From Settlement to Solution: Analyzing the Impact of Opioid Settlement Funds on Remediation Efforts

open_access
Open Access
Author:
Altstaedter, Alyssa
Area of Honors:
Health Policy and Administration
Degree:
Bachelor of Science
Document Type:
Thesis
Thesis Supervisors:
Dennis Patrick Scanlon, Thesis Supervisor
Dennis Patrick Scanlon, Thesis Honors Advisor
Joel E Segel, Faculty Reader
Keywords:
opioids
opioid settlement
substance use disorder
evidence-based treatment
evidence-based practice
cross-state comparisons
Abstract:
Purpose: The opioid epidemic is a significant public health crisis in the United States. The recent national opioid settlements have provided financial resources to abate the crisis; however, several questions have emerged regarding how stakeholders are allocating the money, how expenditures vary between states, and the impact and effectiveness of programs implemented. As a result, the objective of the following chapters is to assess if the opioid settlement funds have had their intended impact of abating the opioid epidemic. Methods: To understand the firsthand experiences of various stakeholders involved in the national opioid settlement, fifteen semi-structured interviews were conducted via Zoom between July 2024 and October 2024. Questions pertaining to the impact of the opioid crisis, comparisons to the tobacco settlement, patterns in opioid settlement spending, barriers to program evaluation and implementation, and future directions for the opioid crisis were asked. To assess opioid settlement expenditures across comparable states, a methodology was created that ultimately identified Minnesota and North Carolina as most comparable to Pennsylvania. Each state’s public facing data dashboards, memorandums of agreement, and approaches to opioid remediation and abatement were considered for the comparison. Another facet of analyzing the impact of the opioid settlement was understanding the use of evidence base in opioid remediation programs in Pennsylvania. To achieve this, a sample of 20 counties was selected. Their submissions to their opioid settlement expenditure reporting tool were analyzed to discern the extent of evidence base in the programs implemented. Programs were categorized as “Yes,” “No,” or “Unclear,” as well as “Well-Supported,” “Supported,” and “Promising” depending on the amount of information available about each program. Results: Key emergent themes included tensions between county and administrative stakeholder groups, challenges in the applicability of guidelines set forth by the national opioid settlement to community-level program implementation, and uncertainty about the future of opioid abatement. It is critical for stakeholders to consider how to translate legal documents into applicable guidelines for public health professionals and community stakeholders, ensure that administrative stakeholders understand substance use disorder (SUD) treatment, prevention, and programming, and continue education efforts to destigmatize people impacted by SUD. Even among comparable states, significant variation exists in the approach to the distribution and expenditure of national opioid settlement funds and program implementation; however, treatment is a consistently supported remediation effort. Medication assisted treatment (MAT) and the purchase and distribution of naloxone were consistently evidence-based remediation efforts. On the other hand, expenditures such as building renovations and salary expenses were not evidence-based. Several commonly used strategies, such as certified recovery specialists, could not be definitively labeled as evidence based because of the lack of standardization of training and program implementation. More detailed community-level data collection is necessary to definitively evaluate programs for an evidence base. Conclusion: As the opioid crisis and subsequent and remediation efforts evolve, so will the needs of impacted communities. Providing local autonomy in national settlement funds is beneficial; however, the current administrative systems in place are not equipped to address the short and long-term challenges that have subsequently arisen. This highlights the need for additional investments in long-term, data-driven strategies, perhaps in consultation with private sector organizations, to manage and measure the impact of national opioid settlement dollars and hold all stakeholders involved accountable.