Tennessee counties using opioid settlement dollars for treatment and recovery


Maddie McCarthy


Behavioral healthcare and policy experts discussed initiatives opioid settlement dollars will support at the 2023 Tennessee State of Reform Health Policy Conference last month.

Tennessee will receive a share of national settlement funds after CVS, Walgreens, and two drug manufacturers agreed to settle in lawsuits that claim the companies contributed to the US opioid crisis. Settlement dollars will be used by state and local governments to combat the epidemic in Tennessee.

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Mary Shelton, executive director of the Tennessee Opioid Abatement Council (OAC), discussed Tennessee’s settlement funds. Of the more than $50 billion the US garnered from the settlements, Tennessee has been allotted $1.1 billion to use over 18 years. She said that number may change as more settlements are finalized.

“When the money comes into Tennessee, it splits three times,” Shelton said. “Fifteen percent goes to the state general fund, 15 percent goes to the counties and a few municipalities, and then 70 percent goes into the opioid abatement trust fund.”  

Once money goes into the trust, it splits again: 35 percent goes to the counties and 65 percent goes to the communities. 

Tennessee counties have already received some of the settlement money.

“We have already paid the counties a total of $31.5 million,” Shelton said. “We were able to get those funds out [in] late February and early March of this year.”

OAC held its first round of funding applications from Sept. 1 to Oct. 23. About 28 percent of those applications were submitted for treatment purposes, seven percent were for harm reduction, 16 percent were for primary prevention, two percent were for research, 10 percent were for education and training, and 37 percent were for recovery support.

Mary Linden Salter, executive director of the Tennessee Association of Alcohol, Drug, and Other Addiction Services (TAADAS), said different entities in the state have different ways to use the funds in order to cater to the needs of that area.

“Every part of the state is approaching this differently, so there’s no one answer about how things are getting done,” Salter said.

Amanda Myatt Bracht, senior vice president of clinical services at the Mental Health Cooperative, emphasized the need to allow different communities to decide what to do with their funds.

“What I really appreciate about this process is that it’s allowing the local communities to decide what works best in their community, because in our state we know we’ve got a lot of different communities and different community needs, from the urban areas in Nashville, Memphis, and Knoxville, to the more rural areas where you have counties coming together to say, ‘We need to pool our resources.’”

— Bracht 

As a provider, Bracht’s passion is her patients’ ability to access immediate care, which is something she wants to see the settlement dollars used for. A challenge she sees is that often, when people with substance abuse disorders are finally ready to seek help, they are put on a waiting list instead of getting treatment right away.

“The flexibility with how these dollars have come out and the way with which many of the communities have approached it is really focusing on the immediacy of that treatment and the importance of that,” Bracht said.

A challenge the panelists identified within the settlement fund distribution process is the state’s healthcare workforce shortage. If funds are used to create more spaces for patients seeking care, there may not be enough workers to staff new facilities.

“There are a bunch of rural counties that I know have [requested] treatment beds to be built, which is great, but right now we have a worker shortage. We can’t staff the beds we have now,” Salter said. “I worry that we’re going to have all these facilities out there that we can’t support because we can’t staff them and we can’t adequately get people where they need to go to be able to access that treatment … We need to figure out some coordination of all that in order to make it make sense.”

Salter said the use of certified peer recovery specialists can help fill in some of the gaps.

An overarching aspect of the ongoing opioid settlement fund distribution the panelists discussed was collaboration. For example, Bracht spoke about increasing partnerships with first responders, because they are often the first to respond to overdose calls.

“We have to collaborate with other organizations or we’re not going to be able to even make a dent in addressing the issue because we’re all trying to stretch our resources to try to attract the right talent,” Bracht said.

TAADAS, Salter said, has an abatement committee that is in charge of attending all opioid council meetings and hearings to ensure they are aware of what is going on during the rollout of funds. Each month, they meet to discuss information and coordination efforts.

The OAC is also focused on collaborating in the process. Before spending county money, the council must first hear from the community, as well as the Tennessee Department of Mental Health and Substance Abuse Services Planning and Policy Council. The council has a state needs assessment list, which Shelton said is helpful for OAC in ensuring funds are flowing in the right direction.

Shelton addressed some concerns about where settlement funds are going. She said the council tries to work transparently with the public.

“The council is a set group of members, so the work is done by the council and the opioid abatement council office, but all of our meetings are open to the public. They are all Sunshine … We definitely invite the public to come to the meetings, and at the end of every meeting, we have an opportunity for public comment.”

— Shelton

The meetings are videotaped and posted to the council’s web page, and there is a contact form on the page anyone can use to reach out to the council.

Shelton said the council also has a filtering process in order to make sure entities receiving funds are qualified. 

The two qualifications every applicant must meet include having a physical presence in Tennessee at the time of application, and to either be registered with the secretary of state or another governmental agency. This means they also must have submitted a certificate of existence with the secretary of state.

If an entity is applying for funding for treatment services or recovery housing, they have to meet further qualifications as outlined in the council’s announcement of funding.

The council does not decide how counties use their portion of settlement money.

“The OAC office cannot consult with the counties on how to spend the money, but we can hopefully just point [them] in a direction,” Shelton said.

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