Michigan is in the early stages of rolling out funds from its $1.5 billion settlement from a national opioid lawsuit, and communities will initially plan to focus on prevention and harm reduction programs to combat the epidemic.
About half of those funds will go to the state, while the rest will go to counties, townships, and cities over an 18-year period. Those responsible for distributing funds updated lawmakers on progress during an Appropriations Subcommittee on the Michigan Department of Health & Human Services (DHHS) meeting last week.
Dr. Natasha Bagdasarian, chief medical executive for the state, said the opioid epidemic is worsening in Michigan and across the country.
“In large part, this has to do with contamination of the drug supply with fentanyl, carfentanil, and now xylazine,” Bagdasarian said. “Not only are the opioid drugs contaminated with these substances, but now nonopioid drugs are contaminated, including cocaine and methamphetamine. We have folks dying of opioid-related overdoses who are not knowingly taking opioids.”
Amy Dolinky, technical adviser for opioid settlement funds for the Michigan Association of Counties (MAC), said the MAC has created numerous tools and resources to assist counties with the distribution process.
“We’ve developed a guide for local spending, a toolkit, a resource library, (and) a dashboard about expected dollar amounts for each county,” Dolinky said. “They did a baseline assessment last spring to gauge readiness for spending and what counties were doing with funds. Most counties have not yet spent funds. They are deeply engaged in their planning efforts and stakeholder engagement at the local level. I expect we’ll see more spending within this year.”
Most counties have developed a steering committee to guide their process, Dolinky said. The MAC is also tracking key focus areas to determine where counties are looking to spend funds.
“We’re seeing an interest in primary prevention, expanding recovery supports, and linkage to care and coordination of services,” Dolinky said.
Bagdasarian said Michigan spent over $300 million on substance use disorder (SUD) expenditures in 2023 (when the state started using settlement funds), compared to about $250 million in 2021. A small portion of 2023’s SUD funds came from the settlement.
“Even before the settlement money was a part of this landscape, the state had been investing large amounts tackling this problem. The benefit of the opioid settlement funds is that we can use this funding to fill gaps and approach problems in new ways that have not been funded before. This is a way to supplement the funding that’s been devoted to this area. This problem is not going anywhere. In fact, it’s an arms race. For everything we do to try and prevent overdose deaths, there are folks out there making the drug supply deadly and contributing to more deaths.”
— Bagdasarian
DHHS’ fiscal year 2025 opioid settlement proposed spending plan includes $23.2 million, with $8.10 million for treatment, $7.75 million for harm reduction, and $2.25 million for primary prevention services.
Settlement funds allowed the NARCAN Direct Portal to distribute an additional 147,000 narcan kits to 404 unique organizations, and perform 2,605 overdose reversals in 2023. Settlement funds also covered the cost of 58,450 fentanyl test strips and 5,530 xylazine test strips through Michigan syringe service programs in 2023.
“We’ve got folks out there taking drugs, and they don’t know their drugs are contaminated with things like fentanyl or xylazine,” Bagdasarian said. “We’ve done a robust job of distributing fentanyl and xylazine testing kits so folks can test their drug supply. If they’re going to use, they can at least be informed about what is in their drug supply that they’re taking, and be prepared for a potential overdose by having a naloxone reversal kit at hand.”
The Opioid Advisory Commission (OAC) coordinates with DHHS on opioid settlement work, and OAC Coordinator Tara King discussed the commission’s 2024 annual report.
“The OAC is statutorily charged with making recommendations to the legislature, primarily for the purpose of funding initiatives to address SUD and co-occurring mental health conditions. Through this report, we’ve compiled a set of recommendations to help guide decision-making around the planning and use of state opioid settlement funds.”
— King
The OAC’s recommendations for 2024 include listening to communities; investing in communities; prioritizing communities most impacted; developing a plan; optimizing existing efforts; investing for impact and sustainability; and building trust through transparency and engagement.
The OAC recommended three funding priorities, which include:
- Supporting the governor’s recommendation for an appropriation from the Michigan Opioid Healing and Recovery Fund to the DHHS
- Supporting a $6 million increase of settlement appropriations for a fiscal year 2025 “community investments set-aside”
- Prioritizing tribal communities by ensuring an appropriation from the Michigan Opioid Healing and Recovery Fund to tribal nations for fiscal year 2025
OAC Chair Cara Anne Poland said the commission has had some problems in coordinating with DHHS, however. Sen. Rick Outman (R-Six Lakes) asked what type of information the OAC was not able to receive from DHHS, and if it was controversial or adversarial in nature.
“Part of our statutory requirement is to provide a gap analysis to the legislature,” Poland said. “So we were looking for data that would support our ability to do that. Last spring, we submitted a data request, and the department explained to me that they had no obligation to provide that information, and we were advised to utilize Google to access the information.”
Michigan ranks near the bottom of the nation in transparency and public accountability over opioid settlement funds, according to the Opioid Settlement Expenditure Report Tracker. The state plans to publicly disclose half the settlement money it will receive. But the half that will be distributed to counties, townships, and cities does not need to be publicly disclosed, and Michigan plans not to do so. While Michigan will report 50 percent of its spending, 20 states plan to report all of their spending.
Those who want to learn more about mental health challenges in Michigan can register for the 2024 Michigan State of Reform Health Policy Conference, which will be held on April 4 at the Lansing Center.