This story was originally published by the Kansas City Beacon.

In February, Missouri was awarded $458 million in a settlement from the nation’s top opioid producers. Now, as lawmakers and state departments prepare to receive and distribute those funds, advocates hope Missouri will use the money wisely to respond to an opioid crisis that has taken thousands of lives.

The state will receive the dollars from Johnson & Johnson and other major opioid distributors. The payments will be spread over a period of 18 years, with most of the money to be deployed within the first decade. Payments could start appearing as early as this month, according to officials.

Jackson County will get around $13 million total from the settlement and Kansas City will receive $15 million. Clay County was estimated to receive $1.4 million, according to Attorney General Eric Schmitt’s office. Missouri met the sign-on requirements to receive the maximum payout, Schmitt’s office said. A full list of the percent allocated of the opioid settlement funds for each city and county that joined is online. 

“This settlement won’t bring our loved ones back, it won’t provide any solace for those losses, but it can bring desperately needed resources to treatment centers, rehab facilities, law enforcement, and others who are on the frontlines of fighting this opioid epidemic in our state,” Schmitt, who is also running for U.S. Senate, said in a news release. 

From October 2020 to October 2021, according to the CDC, 2,131 people in Missouri died from overdoses. That marked an 11.2% increase from the year before.

The Missouri Hospital Association has suggested that part of the increase may be a drop in substance use-related visits to hospitals in the early months of the pandemic. Those visits fell significantly as hospitals reduced care, possibly resulting in lost opportunities for intervention.

The drug distributors deny the claims of wrongdoing made in the litigation. As part of the agreement, they will establish a home for consolidated data from all of the distributors, which will be available to states and territories.

State sets parameters for where funds can go

Much is still unclear about how exactly the state will use the opioid settlement funds. The state’s money will be controlled by its agencies, where it can be accessed through grants. The state will get 60% of the money, and the additional 40% will go to individual counties or localities.

With the opioid settlement came the state’s creation of the Opioid Addiction Treatment and Recovery Fund. Sen. Dan Hegeman, R-Cosby, amended a bill last week that would allow various state agencies, like the departments of Health and Senior Services, Corrections or the judiciary, to have access to the money.

“Under no circumstances shall such settlement moneys be utilized to fund other services, programs, or expenses not reasonably related to opioid addiction treatment and prevention,” the statute specifies. The bill Hegeman amended was placed on a calendar for further action by the Senate as soon as this week.

Missouri participated in a similar settlement with tobacco companies in 1998. But the state’s handling of its payout – about $130 million a year – has been a source of contention, as critics note that few dollars are spent to prevent or offset the harm of smoking.

In fiscal years 2020 and 2021, no settlement funds were used for tobacco prevention or education through the Department of Mental Health. The bulk of the money is used to fund early childhood education programs and Medicaid payments.

For 2021, the national health advocacy group Campaign For Tobacco Free Kids ranked Missouri 49th among the states for effective use of the settlement money. The state allocated .2% of what the CDC recommended it spend on prevention and cessation efforts.

As they await the opioid settlement money, advocates worry that this “once in a lifetime” opportunity to bolster treatment and prevention for substance use disorders may be lost if the money isn’t used properly.

“There’s been this very consistent message out that the states really fumbled with the tobacco settlement,” said Emily Hage, the president and CEO of First Call Alcohol/Drug Prevention and Recovery, an organization based out of Kansas City.

“It’s the reason why cities and counties filed their own suits, so that they could adequately address the needs of their local populations,” she added.

City priorities include housing, support throughout incarceration

According to resolutions passed by the Kansas City Council in early March, priorities for its settlement funds will include: increasing behavioral health services for those who are incarcerated, treatment services for incarcerated Missourians, expanding housing access and providing mental health support for young people who may be at risk of opioid misuse.

Kansas City City Manager Brian Platt has 120 days to present a specific plan for using the opioid settlement funds to the City Council. The city will also assemble a plan for how it will receive and distribute money with the state.

The city declined to comment through a spokesperson.

Hage said it isn’t yet clear how the city, county and state will collaborate when it comes to allocating the settlement over the next two decades, and said she would have prefered to see a “blueprint” in place while the settlements were being hammered out.

“I’m grateful that the state and then the municipalities and local governments are taking time to do some strategic thinking and planning before we start disseminating dollars,” Hage said. “I think the ideal would be a collaborative solution between those two entities. But I think that all really remains to be seen. There isn’t much clarity between the city and the county.”