By David Larson, Carolina Journal

The opioid epidemic is killing more than 100,000 Americans each year. Fentanyl alone — not counting other opioids such as heroin, oxycodone, and morphine — now top the list as the No. 1 cause of death for adults 45 and younger. That's more than suicides, car wrecks, and COVID-19. 

The second-largest attorney-general settlement in history is between the states and pharmaceutical companies that had a large hand in starting the epidemic. There may be, however, hope for addicts and the people who want to help them. In North Carolina, people may wonder how this state’s $750 million cut will be distributed starting in early April. Some, too, are wondering whether the settlement will become akin to the genesis of the Golden Leaf Foundation, established with money from the tobacco settlement.

Critics of that foundation have said some of the large sums go toward projects 0r causes unrelated to tobacco use and smoking cessation, for example.

N.C.Rep. Wayne Sasser, R-Stanly, is a retired pharmacist who co-chairs the House Health Appropriations Committee. Sasser on March 16 told Carolina Journal he understands why people may think that, as the Golden Leaf money “wasn’t handled very well.” But, because of the way this distribution plan is set up, he doesn’t “think there’s any danger” of that happening again. 

“I have preached that from day one,” Sasser said. “I said, we are not going to do what we did with the tobacco settlement. We didn’t stop anybody from smoking. We didn’t cure any cancer. … If we do the same with the opioid settlement money as they did with the tobacco settlement deal, I’ll vote against myself. We are going to save some lives. We are going to improve some quality of life for those who have no quality of life because of addiction.”

The difference for Sasser this time is, “Every dime of this is transparent. There’s nothing going anywhere that anybody can’t access and find.”

He asks that people look at a website created by the N.C. Department of Justice on the settlements, which details how it will be spent. On another linked site, people can see how much each of the 100 counties, as well as the 20 cities with more than 100,000 people, will receive. 

The details of the deal

According to the agreement between N.C. Attorney General Josh Stein and the N.C. Association of County Commissioners on allocating the money, the bulk of it (85%) will go to the counties and municipalities to be spent according to guidelines and oversight from the state. The remaining 15% will be allocated by the General Assembly.

The companies that signed on to the agreement — McKesson, Cardinal Health, AmerisourceBergen and Janssen Pharmaceuticals (owned by Johnson & Johnson) — will pay the money out over 18 years. But Sasser said the money will be largely front-loaded to the first three years. 

The counties and municipalities will have strict limits on how the money they receive can be spent, following one of two options. In Option A, a local government entity can fund a strategy from a short list of possibilities (like drug treatment, early intervention, Naloxone distribution and re-entry programs). One controversial possibility are “syringe service programs” that distribute clean needles. Option B allows the local government to choose from programs on a longer list of possibilities in a “collaborative strategic planning process.”

Sasser said he has been among those taking the lead on how the General Assembly will spend its 15%. Before that, lawmakers will they need to pass a bill for the governor showing how the money will be distributed.

“It will definitely go through Health Appropriations,” Sasser said of the committee he co-chairs. “It was partially my responsibility over on the House side to get this bill introduced and passed and signed by the governor, where we can get our money. And I think I could have gotten it done on the House side, but over on the Senate side, I got no traction over there on anybody to take up any new bill before we adjourned last Thursday. So, I’m going to be doing that language, and as soon as we get back the day after the primary election, then that bill will hopefully be sitting on the desk, and we can get it signed.”

Channeling settlement money to local needs

He said how that money is spent would involve discussions with stakeholders in legislative committee meetings. “But I would hope it would be supportive of things that are already being done in the counties with the settlement money.” Sasser thinks the $30 million provided for opioid treatment in the state budget has gotten the ball rolling for local governments to find their own ways of addressing the problem. 

“It looks like an enormous amount of money until you start dividing it up 120 times.” he said. “The smaller counties are not going to get enough money to help a lot. But if they all group their money, they can work together.”

H offered as an example the Brunswick Christian Recovery Center, which is got $2.2 million and is collaborating with surrounding counties that didn’t have the resources to build their own facilities. 

“So, it’s encouraging when we see people come together with a common interest, and that’s what a lot of these people in these small counties are going to have to do.”

Sasser hopes future budgets retain about $20 million, or as much as $40 million,  to continue helping smaller counties unable to fund these programs long term via their local tax bases. In Stanly County, the small rural county he represents, Sasser said he knows of more than 10 programs dedicated to the opioid crisis.

“Some are larger than others. Some have different approaches, whether it’s a MAT program, whether it’s faith based, whether it’s a 12-step, and that’s all good. And the reason it’s good is all these people are different.” 

MAT programs, which are medication-assisted treatment programs, may require much more funding, and expanding Medicaid would help pay for them, Sasser says.

As a pharmacist, Sasser remembers when the crisis began, and how he and his colleagues were told the drugs were safe. He said he remembers when hydrocodone pills were a Schedule 3 drug, so they weren't strictly controlled, and people would get five refills on 120 or 150 pills before needing to return to get a new prescription. 

“I think the government was convinced, and I know we were convinced, that these drugs were safe.”