Over the course of 18 years, Ohio and its communities are receiving nearly $2 billion from pharmaceutical companies to compensate for harm caused by opioids.
The massive payout is historic. But it’s not the first time the state has received billions of dollars to recover from the impact of an addictive drug. Back in the late ‘90s, Ohio, alongside 42 other states, settled with Big Tobacco. The state was set to get more than $10 billion dollars over 25 years.
While many hoped that money could be used to address the harm of smoking, those funds largely weren’t used on tobacco prevention efforts at all. But Ken Slenkovich, an instructor at Kent State University’s college of public health, said the state has learned from its past mistakes.
“We don't want this opioid crisis to continue. We need to stop it. And therefore, we're going to invest these dollars in a way that's going to make that happen,” Slenkovich said.
Ohio’s tobacco settlement
In 1998, Ohio got a windfall of cash for its tobacco settlement. But Slenkovich said there was something very important missing from the fine print.
“There was no requirement that they use those monies for reducing tobacco use,” Slenkovich said.
The state promised to use a portion of the funds to prevent smoking, and it created a government run agency to do so. The Tobacco Use Prevention and Control Foundation (TUPCF) helped create community programming, statewide educational initiatives and a tobacco quit line.
Slenkovich helped lead the efforts, and he said they were working. Between 2002 and 2009, the rate of smoking among adults in the state dropped from 27.6% to 20.1%, according to an analysis by Slenkovich.
Then, the 2008 recession hit, and the state needed cash.
“The legislature decided that those funds that had been set aside for reducing tobacco use could be better spent on other priorities,” he said.
The state decided that instead of receiving the money for years to come, they’d take a lump sum immediately. And instead of going to tobacco prevention efforts, it all went to the state’s operating budget and job creation fund.
When the TUPCF tried to stop the state from taking the money, Slenkovich said the state simply dissolved the foundation altogether.
A new structure
The opioid settlement money is protected from that same fate.
Instead of having a government-run foundation that can be dissolved at the will of politicians, the state created a new structure to distribute funds: a private non-profit called the OneOhio Recovery Foundation.
“I don't think anyone wants to see what happened with the tobacco settlements happening again here with the opioid settlements,” said Alisha Nelson, OneOhio’s executive director.
This time around, politicians don’t get to control all the money. Instead, 55% of opioid settlement funds, totalling more than $860 million dollars, goes through OneOhio. The 29-person board and its 300 local volunteers all have a say in how the money is used. That makes it near impossible to divert funds to fill potholes, said Nelson.
“We were very intentional about the structure of the foundation this time,” Nelson said. “Funds from the settlement come straight from the settlement administrator to this nonprofit organization.”
And, unlike the tobacco settlement, the opioid settlement agreement spells out that these funds must be used to prevent opioid deaths. Most settlements specify that 85% of the funds must go toward approved opioid-related uses, including treatment, recovery services, law enforcement and prevention, among others.
Slenkovich said that’s a crucial difference.
“Words matter,” he said. “And the language of the opioid settlement and the language that Ohio has put together in terms of how it intends to use the opioid settlement dollars is much more focused on the problem.”
Transparency
While this structure may ensure the state won’t repeat its past mistakes, it hasn’t evaded scrutiny. The private organization has received criticism – and a lawsuit – over holding closed meetings when it first formed. This summer, state legislators passed a law exempting OneOhio from public records requests.
The foundation says it is acting transparently. Its board meetings are now public and posted online, alongside its financial statements.
“It's really one of our goals to be the most transparent nonprofit organization in the state,” Nelson said.
But there’s still distrust. Dennis Cauchon, with Harm Reduction Ohio, said he’s happy that the money is safeguarded for opioid prevention, but he wants to see more people who have been directly impacted by overdoses have a say.
“This is money paid in compensation for the deaths of Ohio residents. And the people who have suffered have no representation on their state board,” Cauchon said.
OneOhio says it has many members with lived experiences involved in its decision-making, including board members in recovery and volunteers who have lost loved ones to the epidemic.
Put to the test
The funds will begin to be distributed throughout Ohio’s communities soon. Last week, the foundation voted to allocate around $900,000 in grants to northwest Ohio counties.
Cindy Koumoutzis, chair of the Ohio Partnership of Impacted Families, is hopeful the money can make an impact. Her organization is one of nearly 1,500 applicants that have requested a portion of the settlement money. Koumoutzis wants the money to go to an emergency fund to help families deal with the aftermath of opioid deaths, like handling funeral costs, lost wages or childcare after the loss of a parent.
“I’ve heard too many promises from attorney generals, from governors, from senators, past and current. Everyone is going to help,” she said. “But the money goes to the same people. It goes to the mental health and recovery boards. It goes to the treatment providers. It's not going to the people who are paying the bills.”
Slenkovich, from Kent State, said the board should consider formally adding families like Koumoutzis into the settlement distribution process.
“I think there probably should be a panel of users and their families, the folks who are most affected by this, to find out what their lived experience is really like,” Slenkovich said.
That’s something, he said, both settlement agreements critically missed.
