Advocates: Use opioid funds now
Halting fentanyl epidemic should be top priority for millions of dollars from settlement, they say
There are innumerable ways to carve up the $300 million that will arrive in Connecticut over the next two decades under a landmark $26 billion settlement with the nation’s major pharmaceutical distributors and drugmaker Johnson & Johnson.
But confronted with a deepening opioid epidemic that last year claimed nearly 1,400 lives in Connecticut and 93,000 lives nationally, advocates and providers say the priorities for the funding should be clear: saving as many lives as possible now, while investing in long-term strategies to support those in recovery.
“We could invest in a lot of prevention programs that will make a difference 10 years from now, but we’ve got such an urgent need that has only been made worse by the COVID-19 pandemic. We really need to fast-track some of these responses,” said Dr. David Fiellin, a professor of medicine, emergency medicine and public health at the Yale School of Medicine and the director of the Yale
Program in Addiction Medicine.
Experts and clinicians agree that harm reduction — an approach that acknowledges the existence of drug use and offers services in a nonjudgmental manner, while seeking to mitigate damage — must be the cornerstone of the state’s response to the public health crisis.
“Our goal now is to keep people alive, and we know harm reduction does that. Everybody needs to get on board with that philosophy,” said Joanne Montgomery, chief clinical and outreach officer for Liberation Programs, a Fairfield County behavioral health organization that specializes in substance use disorders.
For one, the opioid overdose-reversing medication naloxone must be made more readily available in Connecticut, clinicians like Montgomery say. And programs that show promise in both treatment and recovery should be expanded.
“Right now, anybody who has a nonfatal overdose in the U.S. has a 5% likelihood of being dead in a year,” Fiellin said. “And we know that can be cut in half by getting them on buprenorphine or methadone.”
Currently, only 16% of nonfatal overdose survivors make it into treatment within 90 days of an overdose, Fiellin said. At Yale New Haven Hospital, a program that connects survivors directly to treatment could become a model for the rest of the state. If someone comes into the emergency room with an opioid use disorder, Yale New Haven physicians ensure that the person leaves the hospital with a prescription for a medication like buprenorphine. But a program like that is not standard practice for all emergency departments in the state.
Through the opioid settlement — which resolves thousands of lawsuits brought against pharmaceutical distributors McKesson Corp., Cardinal Health and AmerisourceBergen, as well as Johnson & Johnson — Connecticut expects to receive roughly $26 million each year for the first three years, followed by slightly varied sums over the next fifteen years.
While the funds from the opioid settlement are still far from being allocated — the first round could begin to arrive next April, according to state officials — providers say the support will help wage a new front in what can seem like an interminable war.
“We’ve put a lot of money and resources into the opiate epidemic, but we still have not been able to turn the tide as much as we have to,” Montgomery said. “There will be more overdoses this year than there was last year, than there was the year before, even with all of the resources that have come into the state. Will this totally change the game and get rid of the fentanyl epidemic? Probably not, but it’s a really good start.”
Changing ‘the trajectory of lives’
Recovery programs are a crucial part of saving lives and supporting livelihoods, advocates say. Montgomery wants to see the state close gaps in recovery services, including by expanding affordable recovery housing and investing in recovery coaches.
“We know that peer-to-peer support is huge for someone resistant to the recovery process,” she said, noting that currently, organizations like Liberation Programs cannot be reimbursed by the state for recovery coaches, but must pay for them out-of-pocket or through grants.
In addition to saving lives in the short term, advocates and providers emphasize that truly turning the tide of the opioid epidemic will require deep investments in how substance use disorders are perceived and addressed in settings beyond clinical ones.
Maria Coutant Skinner, executive director of the McCall Center for Behavioral Health, an addiction treatment center based in Torrington, said that embedding mental health professionals who are trained in recognizing early indicators of addiction in schools would “pay dividends.”
“Being able to have a system that’s adept at identifying and then intervening effectively with not only the child but also the broader family system, we’re going to be able to change the trajectory of lives,” she said. “That takes dollars, and it also takes a system that’s willing to hearing that we can all be part of that initiative.”
Another key area of focus, emphasized by multiple providers, is supporting programs that divert people away from the criminal justice system and toward treatment. One pilot initiative in the state, the Waterbury Warm Hand-Off Program — a partnership among the city health department, police department and UConn researchers — seeks to do just that, immediately connecting overdose survivors with clinicians who
discuss treatment options and can facilitate a path toward recovery.
Coutant Skinner said that there is burgeoning acceptance that enabling a “cycle of punishment” that returns people to their communities with limited resources merely creates a “revolving door,” not longterm solutions to the crisis.
“But we need an investment. We need dollars infused into the system to really change,” she said.
Mistakes of the past
At $26 billion, the nationwide opioid deal is the second-largest cash settlement in United States history, after the landmark Master Settlement Agreement, the deal signed by 52 states and territories with four of the nation’s largest cigarette manufacturers in 1998. For many, the tobacco deal presents a “cautionary tale” for the new opioid settlement.
The tobacco deal imposed restrictions on the sale and marketing of cigarettes and required the tobacco industry to pay the settling states billions of dollars each year, forever. The funds from that agreement were intended to help local governments fund smoking prevention and cessation programs, but only a fraction of the money has gone to those purposes. Connecticut is one of the worst offenders: The state has not used the funds for smoking prevention programs, merely counting the millions it receives each year as a revenue source for its general fund.
With the specter of the tobacco deal hanging over them at the state Capitol, Connecticut officials pledged to use the opioid settlement funds to directly combat the public health crisis.
Attorney General William Tong emphasized that the funds would “not be used to pave roads.”
“This money is going to go to treatment and prevention,” Gov. Ned Lamont said. “It’s not going to be siphoned off.”
Even so, Courtney Hunter, the vice president for state policy at Shatterproof, a Norwalk-based national nonprofit dedicated to
ending the addiction crisis, said that it is important for states to put “guardrails” around the settlement dollars and create a dedicated fund to protect the money from being diverted for other purposes.
“We want to help prevent the cautionary tale of tobacco and the tobacco settlement,” she said, adding that it is “crucial that the funds are protected this time around.”
While states like Connecticut have committed to using the settlement funds to address the opioid epidemic, it is essential to shore up those promises, Hunter said.
“We can trust the settlement, we can trust the attorneys general, we can trust the state, but anything can happen,” she said. “The best practice is, ‘Let’s double down and create a dedicated fund.’ These dollars are going to last over a period of 18 years, and there’s going to be a lot of political change within that time. We’re going to have different people in charge, different people in elected office. These agreements really need to stand the test of time.”
‘Treatment on demand’
Every few minutes, Mark Jenkins’ phone rings again: someone calling to coordinate the pickup of food, to arrange naloxone distribution, to ask where the mobile van is right now. He always picks up. There is always more to do.
A few extra thousand dollars — let alone a million — could go a long way at the Greater Hartford Harm Reduction Coalition, where Jenkins is the director.
The small, scrappy community organization has an outsized impact on fighting the opioid epidemic in Connecticut’s capital. In the past seven years, Jenkins and his team have distributed more than 20,000 doses of naloxone. They also hand out fentanyl test strips and safer sex kits, offer HIV testing, administer a syringe exchange and can connect anyone to medication-assisted treatment.
In the past year, Jenkins also started distributing hundreds of sandwiches per week, as food insecurity rose during the pandemic — and facilitated many COVID-19 vaccinations.
“We are a treatment-on-demand model,” Jenkins said in his office in the Frog Hollow neighborhood of Hartford. On the walls were photos chronicling the coalition’s effort to save lives, one by one; overdose prevention kits, containing nasal naloxone spray and resource packets, were stacked on every available surface.
Working with a community that doesn’t always “access services through the front door,” Jenkins said, his organization attempts to offer a “friendly face,” while distributing lifesaving resources to those with substance use disorders.
“Are we a necessity as far as a public health response?” he said. “We are the public health response.”
What makes Jenkins’ work so unrelenting is that fentanyl, a synthetic opioid 80 to 100 times stronger than morphine, permeates the regional drug supply.
“Fentanyl is no longer good bag, bad bag; every bag has the potential to be deadly because of how it’s being cut,” he said.
At his desk, Jenkins spread out empty packages of street drugs from the last six months, gathered from the Hartford area, all of which tested positive for fentanyl: “Bang Theory,” “House Wins,” “Death Angel.”
“It’s incredible, the amount of death,” he said. “It’s crazy what we see. We just don’t have the capacity to respond.”
Funds like those promised by Connecticut’s $300 million share of the opioid settlement could transform an organization like Jenkins’ — but he isn’t waiting around for the money.
For one, there is too much to do in the near term. The business model the Greater Hartford Harm Reduction Coalition tends to run on is, as Jenkins describes it, “We see need, meet need and then try and find money.” And despite the daily impact of his work, he said that his efforts are not always seen as “good for business,” due to the enduring stigmatization of those with substance use disorders and resistance, by some, to the harm reduction model.
“We’re accepted and we’re tolerated and we’re gaining more acceptance because of the sheer number of fatalities, and nationally, this is the movement. Now the buzzwords are saying ‘harm reduction,’ ” he said. “But again, politically, we are not good for business. And things that are not good for business are not the first things to be funded.”
Jenkins swept the packages, once laced with fentanyl, off his desk and back into his hand.
“I hate to say that we’re going to make whatever happens work,” he said. “But we’re going to make whatever happens work.”