Nevada is among the many state and local governments that are confronting significant budgetary challenges in the coming year. Carefully closing these budget gaps by reining in spending or finding new revenue streams will be a priority for lawmakers across the country, and will require creative thinking and engagement with the public.
What these governments must not do, however, is drain the life-saving funds from the $50 billion national opioids settlements to cover their shortfalls. These dollars — which will be spread out over nearly two decades after an arduous legal battle between pharmaceutical companies and a bipartisan group of attorneys general — supply funding for treatment and prevention programs which have already provided vital services to countless people since the money began flowing to state and local governments in 2021.
We have already experienced what can happen when budgets tighten and legislators raid the coffers of any accounts available to them. The 1998 settlement with the tobacco industry provides a cautionary tale. Less than 3 percent of tobacco settlement funds are spent on mitigation and response initiatives, and even less on evidence-based tobacco prevention and cessation efforts.
Today, an estimated 2.5 million adults in the U.S. suffer from opioid use disorder. Even with a slight decrease from the previous year in the number of drug overdose deaths involving synthetic opioids, the age-adjusted mortality rate was more than 22 deaths per 100,000 people in 2023, higher than the rates for COVID-19 and kidney disease.
These are the deadly statistics that the $50 billion settlements — reached between over 3,000 state and local governments and the companies responsible for the over-prescription of addictive opioids — are intended to address and improve. In 2019, before the settlement was reached, nearly 9 out of 10 patients with opioid use disorder were not receiving any sort of evidence-based treatments, and almost two-thirds of outpatient substance use treatment facilities did not provide any medications to treat those in need. Since settlement money began to flow, there have been promising signs that the worst of the epidemic may be behind us.
Even so, the opioid mortality rate remains 20 times higher than it was a decade ago. Robbing victims and their families of these settlement dollars in order to plug unrelated budget gaps puts any further progress in serious jeopardy — and risks the lives of thousands of people in the process.
When it was agreed to, the national opioids settlement included some guardrails to prevent mismanagement of the funds, but they were incomplete and subjectively interpreted. In Bibb County, Alabama, the police department spent nearly $100,000 in settlement funds to purchase two new pickup trucks for the sheriff’s office. In Greene County, Tennessee, lawmakers used $2.4 million of the first $2.7 million settlement payout they received to plug the county’s debt.
And right now in Nevada, lawmakers are grappling with a provision in Gov. Joe Lombardo’s latest budget proposal that would redirect $5 million in opioid settlement funds away from their intended use to try and plug expected shortfalls in other safety net programs. Similar fights are unfolding in Connecticut, Maryland and other statehouses.
Instead, Nevada should look to other states and local governments that are acting in good faith to support those affected by the opioid epidemic. In Minnesota, fund supervisors are requiring practices that are identified as evidence-based by the Substance Abuse and Mental Health Services Administration to treat opioid use disorder. In Durham County, North Carolina, officials created an opioid settlement manager position, and surveyed community members on how the settlement funds should be allocated, arriving at three priorities: evidence-based addiction treatment, evidence-based recovery support services and recovery support housing.
By investing in effective, evidence-based programs that treat those directly affected by this epidemic, states can prevent future instances of this disease, and help affected families get back on track toward self-sufficiency. An analysis we conducted at Results for America estimated that if just 50 percent of the current settlement funds were spent on evidence-based interventions, it could reduce or halt the misuse of opioids in almost 200,000 people and prevent roughly 90,000 deaths over a 10-year period.
All settlement funds — in Nevada and elsewhere — should be used exclusively for opioid remediation, with an implementation mandate for evaluation and reporting requirements to provide maximum transparency and accountability. Decision-makers should commit to using evidence in how they invest these resources. When they identify programs and initiatives that work, they should share those examples so they can be replicated in other places.
The purposeful, criminal and largely unchecked spread of over-prescribed opioids caused irreparable damage nationwide, and we will be dealing with the effects for decades to come. But today we stand at a crossroads. Whether we chart a course toward finally ending this epidemic and alleviating the suffering it has caused depends on whether our leaders have the courage to shoulder their ledgers themselves instead of on the backs of victims of the opioid crisis.
Patrick Carter is vice president and state practice lead at Results for America, a bipartisan nonprofit that aims to help government leaders harness the power of evidence and data to fund solutions that accelerate economic mobility and improve lives. Kristen Pendergrass is vice president for state policy at Shatterproof, a nonprofit focused on ending the addiction crisis in the U.S.
