Opioid Settlement Funds: Enough Narcan, Already

States are clueless how to spend these billions

A wealthy St. Louis suburb made local headlines recently when they purchased a snow plow using opioid settlement funds.

“During emergencies, we have to be receptive for all different types of emergencies,” said Kirkwood Fire Chief Jim Silvernail, “…to get into hard places or, for example, the last snowstorm; we would use that vehicle to access patients.”

…He said he could not recall an instance the truck has been used to assist in responding to an overdose.

This story is a head scratcher. But expect to hear about corruption as states distribute the tens of billions now being paid out by opioid retailers and manufacturers. With so much cash sloshing around, misappropriation is guaranteed.

Some states even seem to be deliberately obscuring how they spend it.

Still, I would never have guessed that this issue is dwarfed by another problem: that many states don’t know how to use the money.

It’s true. According to administrators, many state governments — and also the counties and municipalities they distribute the money to — are downright clueless.

“This is a nationwide problem,” says Percy Menzies, who runs a St. Louis treatment center called ARCA and has been consulted on this issue. “Not a single city or county has come up with a [reasonable] plan on how to spend the settlement funds.”

The default position has been to spend the money on Narcan. Lots and lots of Narcan. Wisconsin, for example, which has 6 million people, has budgeted $5 million on Narcan and fentanyl test strips. Annually.

But that’s just the tip of the iceberg. As part of a 2022 settlement, Teva* agreed to provide states with $1.2 billion in naloxone, which is generic Narcan.

*Teva, not to be confused with the sandal maker, is the pharma company that until recently made the fentanyl lollipop Actiq.

$1.2 billion can buy a lot of Narcan, about 48 million doses by my calculations. And presumably the generic would be cheaper.

Now, listen, I’m a big Narcan booster. It’s a miracle drug that has saved millions of lives. Where I’m sitting now, it’s at arm’s length!

So absolutely, let’s get it out to everyone who needs it.

But for all of Narcan’s benefits, it fails to address the root cause of the opioid crisis. As Menzies says, focusing on Narcan is basically like buying defibrillators to try to end heart disease.