Opioid settlement funds come through as overdose numbers keep climbing

As the federal government begins to divvy up millions of dollars in opioid settlement funds and states face decisions on  how to best use the one-time payouts, deaths from opioid drugs are continuing to increase, according to state and local authorities.

More than 1,400 people died of an opioid overdose in 2021 across the state of Wisconsin, the Wisconsin Department of Health Services reported. In Milwaukee County, the Milwaukee County Medical Examiner’s Office documented 523 drug-related deaths in 2022. Karen Domagalski, operations manager for the office, told Wisconsin Examiner that the cause of death is still pending for an additional 318 cases from 2022. “Not all the pending cases will be overdose deaths,” said Domagalski. So far for 2023, 67 deaths are already pending.

As in much of the U.S., overdose deaths in Milwaukee have steadily risen over the last several years. In 2021,  644 county residents died from drug-related causes, an all-time record, overshadowing the previous year’s record number of 544 deaths.

Fentanyl analogs are continuing to drive the surge of deaths. According to the DHS, 91% of opioid overdose deaths statewide involve synthetic drugs, primarily fentanyl. Some types of fentanyl can be up to 15 times more potent than heroin.

Interactive maps produced by the Wisconsin Examiner annually show that unadulterated heroin has become all but nonexistent in Milwaukee County. Deaths related to cocaine use are also rising, particularly in younger populations, due to fentanyl contamination, according to data from the Milwaukee County Medical Examiner’s Office.

About $8 million will be made available to support existing or new harm reduction projects across the state as part of a multi-state settlement of a lawsuit against companies involved in manufacturing and distributing opioid drugs. Potential uses include boosting availability of fentanyl testing strips or of the anti-overdose medication Narcan. There are also proposals to augment treatment options. The DHS will also be accepting ideas from the public on how the funds should be spent until Feb. 17, including through a survey, available in both English and Spanish.

“The responses we received from the public and partners during listening sessions last year reminded us that addressing opioid use disorder in communities is not one-size-fits-all,” Paul Krupski, DHS director of opioid initiatives, said in a press statement. “Our plan reflects the specific needs of Wisconsinites, and we intend to use feedback from this year’s survey to do the same.”

Settlement funds flowing from the lawsuits, which were aimed at major pharmaceutical distributors including Cardinal, McKesson, AmisourceBergen, Johnson & Johnson, and others, will continue for 18 years. Payments from Johnson & Johnson will continue another nine years.

The lawsuits charged that companies like Purdue Pharma, owned by the mega-wealthy Sackler family, seeded the overdose crisis for years producing drugs such as  Oxycotin, with companies such as Walgreens and others accused of being  distributors. The gradual downfall of Purdue Pharma, has done little to stop the still evolving epidemic, however. Settlement funds were envisioned as a step towards reversing the societal damage wrought by these companies.

Through the state Department of Justice (DOJ), Wisconsin was among the states taking part in the litigation,

“The funds that Wisconsin DOJ  helped secure from opioid companies will aid communities across Wisconsin in combating the opioid epidemic,” said Attorney General Josh Kaul. “Input from those impacted by the epidemic will help maximize the good that these funds can do for Wisconsinites.”

A plan for how to use the funds was submitted by DHS to the state’s Joint Finance Committee in July 2022. The plan included support for data collection, surveillance, prevention, harm reduction, treatment, recovery, capital projects and funding for tribal nations.

The Republican-controlled committee approved a modified version of the $31 million plan. Some $250,000 are allocated for school-based prevention programs, and another $750,000 for community intervention programs. The Narcan Direct Program will get $3 million in support, and $2 million will prop up a fentanyl testing strip program. Medication-assisted treatment programs will receive $2 million, and another $2.5 million will support room and board costs for Medicaid members in residential treatment programs. An overdose alert system will be started with $500,000, $6 million will go to tribal communities, and $3 million to law enforcement.

In its second year, funding can be used for existing programs or towards new projects. “Currently we have about $20 million,” said Krupski at a Jan. 26 press conference.The department will be taking applications in the coming months.

According to Wisconsin Public Radio, in its 2022 fiscal year, the DHS received $16.9 million from the State Opioid Response Grant program. The Stockbridge-Munsee Band of Mohican Indians also received $238,700, and the St. Croix Chippewa Indians of Wisconsin received $500,000.

Some local areas are already trying new ideas. By the summer, vending machines stocked with fentanyl testing strips, gun locks and narcan will be deployed to Milwaukee County. Residents will be able to get supplies from the machines free of charge. The county also has treatment facilities, including residential and medication-assisted treatment options for its residents.

In 2020, the area around a medication-assisted treatment facility in West Allis showed fewer overdose deaths than a year prior. The county’s treatment and prevention apparatus, however, has been called under-funded and fragmented. An analysis by the Wisconsin Policy Forum recommended that the county invest in treatment options.

“Deaths from opioids are preventable,” said Krupski. “We look forward to hearing ideas for using this next round of settlement funds toward that goal.”