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News

Opioid Settlement Dollars May Be Harder To Divert Than CT’s Payments From Tobacco Industry

Members of P.A.I.N. (Prescription Addiction Intervention Now
Erik McGregor/LightRocket via Getty Images
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LightRocket
Members of P.A.I.N. (Prescription Addiction Intervention Now) and Truth Pharm staged a protest on Sept. 12, 2019, outside Purdue Pharma headquarters in Stamford, over their recent controversial opioid settlement. Participants dropped hundreds prescription bottles of OxyContin while holding tombstones with the names of opioids casualties and banners reading “Shame on Sackler” and “200 Dead Each Day.”

Health care advocates had dreams of epic proportions when the tobacco industry agreed to pay Connecticut more than $2 billion to settle a landmark lawsuit over its youth marketing practices.

But those dreams became a nightmare over the next two decades when only a tiny fraction of Connecticut’s bounty was designated for anti-smoking efforts.

Now, with the ink barely dry on a $300 million settlement with opioid manufacturers, advocates are cautious yethopeful that things will be different this time.

“We’re in a relatively flush situation, so there’s less temptation to divert” dollars, said Rep. Jonathan Steinberg, D-Westport, co-chairman of the legislature’s Public Health Committee.

And if the state’s $3 billion-plus rainy day fund isn’t enough to persuade officials to invest big in new programs to abate the crisis, Steinberg said, he hopes the chilling health statistics will finish the job.

Overdose cases continue to rise
The Statewide Opioid Reporting Directive, run by the Department of Public Health, tracked 4,859 overdoses between June 2019 and May 2020, according to its latest annual report — an increase of 8% over the previous year.

Accidental overdoses killed 1,374 people in 2020, up 14.5% from the previous year, the report states.

Opioids are the main drug driving overdoses, involved in 93% of fatal incidents in 2020 — an 83% increase since 2012.

“We’re still wringing our hands at the end of the day because the numbers just aren’t coming down,” Steinberg added.

Connecticut will get $300 million in total over the next 18 years to help drive these numbers down. While 15% or about $45 million, will go to municipalities, that leaves the state with an average of about $14 million per year.

In the scope of an annual budget that currently stands at $22.7 billion, that’s barely a rounding error.

But Steinberg and others said those funds could make a big difference in the battle against opioids.

Connecticut needs to enhance Medicaid rates so community nonprofits — which deliver the bulk of state-sponsored social services — can expand staffing and services, said Heather Gates, president and CEO of Windsor-based Community Health Resources.

CHR runs nine adult clinics and six for children struggling with substance abuse issues, while also providing in-home treatment.

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Connecticut Attorney General William Tong

Connecticut needs more nurses and other medical providers who can prescribe medications and provide other immediate treatment on the same day patients seek help with addiction, said Gates.

“They’ve made the decision they want help, and you want to respond immediately to that,” she said, adding that “every day they use, there is a risk they will overdose and die.”

Steinberg’s committee raised a bill this year to help communities establish intervenors, emergency response personnel with backgrounds in addiction issues who can not only save overdose victims but get them started on recovery. “They can be the connective tissue to get them into the appropriate support networks,” Steinberg said.

The bill was gutted, though, due to a lack of funding, reduced instead to a study on how best to implement such a system statewide.

Tobacco settlement funds were raided again and again
But anti-smoking forces also thought they had both a compelling argument for more action — and a ton of new resources to pay for it — two decades ago, when Connecticut and 45 other states settled in court with the nation’s four largest tobacco manufacturers for a collective $246 billion.

While the settlement didn’t require the money be used on anti-smoking efforts, Connecticut legislators created the Tobacco and Health Trust and entitled it to all settlement funds not designated for some other purpose. But since 2000, only about 10% of the $2 billion-plus Connecticut received from the settlement has gone to the trust — just under $200 million.

And even money that’s gone into the trust fund hasn’t always been available for anti-smoking efforts. Six times in the past decade, lawmakers took the trust fund’s money to help balance the budget — a total of more than $113 million.

As Connecticut struggled with rising pension costs and major budget deficits throughout much of the 2000s and 2010s, the annual infusion of cash from the lawsuit — at times more than $130 million per year — simply became another source of revenue for the General Fund.

By 2018, legislators had suspended indefinitely any contributions to the trust program.

“We remain dismayed and disappointed that the state of Connecticut continues to receive over $100 million annually from the [settlement] yet spends zero of those funds on tobacco control programs at a time when tobacco use continues to kill 4,900 people annually in Connecticut,” said Bryte Johnson, the government relations director for the American Cancer Society’s Cancer Action Network.

Tobacco use also adds $2 billion annually to public and private health care costs statewide, he said.

Tong: Opioid settlement puts bright spotlight on how states use dollars
When Gov. Ned Lamont announced the opioid settlement earlier this month, he called the funds “an incredible support in our state and local efforts to halt opioid addiction before it starts and get help to those who need it most.”

And Attorney General William Tong told The CT Mirror on Thursday that state policymakers won’t find it easy to use the settlement dollars for anything other than battling opioid use.

“This has been a guiding principle from the very beginning,” Tong said.

Leaders of the Senate Republican minority wrote to Tong and Lamont recently asking for a meeting regarding the opioid dollars to ensure the state takes a different approach.

“We must not repeat the infamous misuse of the state’s tobacco settlement funds,” GOP senators wrote. “In Connecticut, funds promised to curb smoking have far too often been relied upon as a budgetary escape hatch. We must learn from the past and do better because people’s lives are in the balance.”

The settlement stipulates at least 85% of the state’s proceeds must go toward remediation, Tong said. The remainder could go toward administrative, legal, or data analysis services related to these efforts.

But states have often gotten around such directives simply by using such funds to pay for programs already in place — thereby freeing up resources that could be redeployed in some unrelated fashion.

But Tong said the settlement has strong public reporting requirements, any anyone suggesting a fiscal end-run will find themselves in an uncomfortable spotlight.

“There’s a lot of attention on it,” he added, “and there’s going to be a lot of public accountability.”