Health leaders from Maryland’s Cecil County held a meeting last month to discuss ways in which they will use money from the opioid settlement fund. Key areas of focus include prevention and education, and centering the voices of those with previous substance use experiences.
Maryland established the Opioid Restitution Fund (ORF) in 2019 to receive state funds from settlement agreements. The ORF places restrictions on the use of settlement funds, and the allocation of funding varies by settlement.
“About seven Marylanders—our loved ones, our friends, our neighbors—lose their lives every day to an overdose,” Emily Keller, Maryland’s special secretary of opioid response, said.
The McKinsey and Company settlement was a response to prescription opioid marketing practices, and Maryland’s share of the national settlement is more than $12 million. McKinsey charged millions of dollars for consulting services for numerous opioid manufacturers that are alleged to have engaged in unfair trade practices relating to the marketing and selling of opioids.
According to the Maryland attorney general, McKinsey counseled these opioid manufacturers, and targeted prescribers—who were already prescribing large amounts of opioids—to coerce them into prescribing more opioids in greater strengths. So far, more than $10.5 million from the McKinsey and Company settlement has been issued to states.
The Janssen settlement, which involves Johnson & Johnson and three prescription opioid distributors, is meant to resolve claims that the company deceptively marketed fentanyl products to healthcare providers and their patients. Maryland’s share of the national settlement is for $395 million over 18 years, beginning in 2022. To date, Maryland has received over $60.4 million.
Cecil County has created a comprehensive plan for responding to the opioid crisis and the use of these funds, and noted that considerable progress has been made in recent years in addressing overdoses and overdose-related deaths. Keller said that under Gov. Wes Moore, record investments have been made in behavioral health services, and increased funding for substance use services has increased by 40 percent under his leadership.
“We are supporting youth prevention programming through a competitive grant to the Drug Free Cecil Youth Coalition. And through a block grant program, Cecil County is supporting peer recovery services in hospitals and post-overdose survivor outreach.”
— Keller
Keller said the response covers five categories. The first pillar is focused on the prevention of current and future opioid use, and includes addressing trauma and adverse childhood experiences, which may lead to substance use. The second pillar involves harm reduction.
“Our current harm reduction focus includes working towards universal access to naloxone, and expanding access to wound care, syringe services, and drug checking initiatives,” Keller said.
Increasing access to treatment through promoting equitable access to care through transportation and telehealth services, and increasing access to medications are another focus category. Recovery efforts include supporting the long-term success of those exiting treatment, and promoting recovery and employment.
Public safety also has a role to play in improving access to care, due to the fact that law enforcement officials are generally the first point of contact for those experiencing crises or substance use, Keller said.
Under the Janssen settlement, 15 percent of the funding can be used at the state’s discretion for opioid abatement purposes, and is subject to ORF Advisory Council recommendations. The settlement designates 45 percent of funding to be used for a targeted abatement fund, which includes state-administered funding distributions to local subdivisions. The targeted abatement fund requires local subdivisions to implement local abatement plans, and that funding is not subject to ORF Advisory Council recommendations.
The settlement also allocated 15 percent of funds to a state discretionary abatement fund, which is distributed through a competitive process, with eligible recipients including state and local government agencies, and private and nonprofit grassroots and community-based organizations. These funds are subject to ORF Advisory Council recommendations.
Direct payments to local subdivisions will account for the remaining 25 percent of the Janssen settlement funds, and will not be allocated through ORF or subject to the advisory council.
Cecil County has been implementing its strategic plan since November last year, with the primary goal of reducing the number of opioid-related deaths. In January, the county launched the Medications for Opioid Use Disorder program, which provides access to care and served 189 individuals within the first six months of implementation.
The county has also partnered with Voices of Hope, a nonprofit that provides support to individuals and families in recovery, and operates primarily in Cecil and Harford counties. This partnership allows for a 24/7 hotline, walk-in access to a peer support recovery specialist, and linkages to care. So far this year, there have been 2,465 total encounters, connecting 753 individuals to behavioral health treatment.
Lauren Levy, health officer for Cecil County, shared additional ways in which the opioid settlement funds will support addressing the opioid crisis.
“We are hoping to dedicate some of the opioid settlement funds to conducting a behavioral health landscape assessment,” Levy said. “Our goal will be to assess the gaps in our current continuum of care, and identify strategies to address unmet needs.”
Cecil County is contracting with a vendor to develop a data warehouse—which remains under development—and has plans to include a publicly available data dashboard in the future.
Aaron Wright, on behalf of Voices of Hope, shared his past experiences of using heroin. He said he had a positive experience with a syringe service program operating from a former ice cream truck. He said having both access to the syringe service program and available service workers assisted him in getting the care he needed.
“What we’ve done here in Cecil County, is we’ve attached that [syringe service program] to 24/7 treatment navigators.”
— Wright
Cecil County currently has two syringe service programs, which Wright is proud of because they have proven to be effective. While Cecil County is developing and implementing its initiatives, the state is also taking action with these funds through programs.
The Examination and Treatment Act Grant Program, which is designed to support local jurisdictions with implementing the requirements of the 2019 Opioid Use Disorder Examination and Treatment Act, has received almost $7.7 million. The grant program is supporting projects in 16 local detention facilities related to opioid services.
The Access to Recovery Emergency Gap Fund, which distributes funds to cover emergency expenses, including extended stays in recovery programs and transportation, has received $248,925. Furthermore this year, the Opioid Operational Command Center (OOCC), which serves as the main coordinating office of the state’s opioid response, is supporting the Data-Informed Opioid Risk Mitigation initiative, known as DORM.
The purpose of DORM is to examine the prescription and treatment history of individuals in the state who have died from an overdose to establish overdose risk profiles and help inform policy. OOCC chose DORM to promote the assessment of data that supports evidence-based decisions for future ORF spending. Over the next two years, DORM is estimated to cost $2 million, which has already been allocated.
Although the state has experienced a 300-percent increase in overdoses and opioid-related fatalities within the past decade, Cecil County is already seeing improvements in the numbers—which Keller cited as a “sharp drop” over the past three years. In 2020, there were a total of 532 recorded overdoses. In 2021, there were 440 recorded overdoses. The following year, the number of recorded overdoses dropped to 315.