Over the past two years, rural Greene County in northeastern Tennessee has collected more than $2.7 million from regional and national settlements with opioid manufacturers and distributors. But instead of helping people harmed by addiction, county officials are finding other ways to spend it.
They have toward paying off the county鈥檚 debt and have another arriving over more than a decade into a capital projects fund. In March, they appropriated $50,000 from that fund to buy a 鈥渓itter crew vehicle鈥 鈥 a pickup truck to drive inmates to collect trash along county roads.
鈥淚t鈥檚 astounding,鈥 said Nancy Schneck, a retired nurse who has seen addiction infiltrate the community, where employers avoid drug testing for fear of losing too many employees and mental health crises and homelessness are rampant. She wants to see the money go toward mental health and addiction treatment. Why can鈥檛 county leaders 鈥渟ee treating some people and maybe getting them out of this cycle might be advantageous?鈥 she said.
In 2021, the latest year for which comparable data is available, Greene County鈥檚 rate of drug overdose deaths topped state and national figures.
But said the county has borne the costs of the opioid epidemic for years: It has funded a beleaguered sheriff鈥檚 office, improved the jail 鈥 which is packed with people who鈥檝e committed addiction-related crimes 鈥 and supported a drug court to divert some people to treatment. It has also suffered indirect costs of the crisis: people dropping out of the workforce due to addiction, schools and welfare services caring for more children who鈥檝e experienced trauma, and some taxpayers leaving the county altogether. Addiction is not the sole reason for Greene County鈥檚 economic woes, but it has contributed to of debt.
鈥淲e鈥檝e been dealing with this crisis for quite some time, but nobody wants to pay the bill as it comes,鈥 Morrison said. 鈥淪o when these funds are made available, then we are paying bills that have been due for quite some time.鈥
The debate in this Appalachian county is reverberating nationwide as state and local governments receive billions of dollars from companies that made, distributed, or sold opioid painkillers, like Johnson & Johnson, Cardinal Health, and CVS. The companies were accused of fueling the overdose epidemic, and the money is meant to remediate that harm. About $3 billion in state, county, and city coffers, and about $50 billion more is expected in the coming decade and beyond.
States are required to spend at least 85% of the money on opioid-related programs, but 素人色情片Health News鈥 ongoing investigation into how the cash is used 鈥 and misused 鈥 shows there is wide interpretation of that standard and little oversight.
That restriction didn鈥檛 apply to the money Greene County moved to its capital projects fund.
In many rural communities, which have been struggling to pay addiction-related costs for decades, local officials justify using the settlement funds to reimburse past expenses. Most of Tennessee鈥檚 95 counties are in significant debt, which can present difficult choices about how to use this money, said , co-director of East Tennessee State University鈥檚 Addiction Science Center.
Still, he and many advocates hope the settlement funds are spent on tackling the current crisis. After all, nationwide are dying of overdoses each day. Investing in treatment and prevention can save lives and protect future generations, they say.
鈥淭here is no good excuse to sit on the funds or put them into a general fund,鈥 said , policy director for the nonprofit . The organization is across Appalachia, which Christensen called the epidemic鈥檚 ground zero. 鈥淭hese dollars should be used to support people who have been most impacted by the overdose crisis.鈥
Nationally, there has been little oversight of the settlement dollars. President Joe Biden鈥檚 administration pledged to ensure the funds went toward tackling the addiction crisis, but has taken little action. Accountability at the state level varies.
In Tennessee, 15% of the state鈥檚 opioid settlement funds are controlled by the legislature and another 15% by local governments. Those two buckets have few restrictions.
The other 70% is controlled by an , which has more rigorous standards. When the council, which must give 35% of its funds to local governments, recently to counties, it required the funds be spent on a , such as building recovery housing and increasing addiction treatment for uninsured people.
鈥淚 can guarantee we鈥檙e going to bird-dog鈥 those funds, said , chair of the council and a physician in recovery from opioid addiction. If counties use them for unapproved purposes, the counties will not receive future payouts, he said.
Greene County鈥檚 reimbursement of its capital projects fund comes from its own pot 鈥 the 15% that is controlled entirely by local governments.
In such cases, the public can hold officials accountable, Loyd said. 鈥淚f you don鈥檛 like the way the money is being spent, you have the ability to vote.鈥
Local leaders are generally not being 鈥渘efarious鈥 with these decisions, he said. They make hundreds of budgetary choices a month and simply don鈥檛 have experience with addiction or health policy to guide them in using the money.
Loyd and other local experts are trying to fill that gap. He meets with county officials and recommends they speak with their local anti-drug coalitions or hold listening sessions to hear from community members. Pack, from East Tennessee State, urges them to increase access to medications that have in treating opioid addiction.
Both men point counties to an online , where leaders can see how their area鈥檚 resources for recovery compare with those of others.
In Greene County, for example, the index indicates there are no recovery residences and the number of treatment facilities and mental health providers per 100,000 residents is below state and national averages.
鈥淭hat鈥檚 a great place to get started,鈥 Loyd said.
Some Greene County residents want to see opioid settlement funds go to local initiatives that are already operating on the ground. The , for instance, hosts presentations to educate young people and their parents on the risks of drug use. They meet with convenience store owners to reinforce the importance of not selling alcohol, cigarettes, or vaping devices to minors. In the future, the coalition hopes to offer classes on life skills, such as how to budget and make decisions under pressure.
鈥淚f we can do prevention work with kids, we can change the trajectory of their lives as adults,鈥 said , secretary of the anti-drug coalition and executive director of United Way of Greene County.
The coalition has asked the county for settlement funds but has not received any yet.
Nearby in Carter County, a new residential treatment facility at the site of a former prison. At least seven counties, cities, and towns in the region have committed a combined $10 million in opioid settlement funds to support it, said , a criminal court judge who came up with the idea. Greene County is among the few local governments that did not contribute.
It will be part of the region鈥檚 drug recovery court system, in which people with addiction who have committed crimes are diverted to intensive treatment instead of prison.
Currently there are no long-term residential facilities in the area for such patients, Street said. Too often, people in his court receive treatment during the day but return home at night to 鈥渢he same sandbox, playing with the same sand-mates,鈥 increasing their risk of relapse.
Street said the new facility will not offer medications to treat opioid addiction 鈥 the gold standard of medical care 鈥 because of security concerns. But some patients may be taken to receive them off campus.
Morrison, the Greene County mayor, said he worried about contributing to the facility because it is a recurring cost and the settlement funds will stop flowing in 2038.
鈥淭here鈥檚 been great pressure put on local entities like Greene County to try to solve this problem with this limited amount of funding,鈥 he said, when 鈥渢he federal government, which has the ability to print money to solve these problems, is not in this business.鈥
The county is still deciding how to spend nearly $334,000 of settlement funds it recently received from the state鈥檚 Opioid Abatement Council. Morrison said they鈥檙e considering using it for the anti-drug coalition鈥檚 education efforts and the county drug court. Given the guidelines from the abatement council, these funds can鈥檛 be used to pay old debts.
