Public drug rehabilitation programs in Alabama only have enough capacity for half the patients who need them, but a coalition of treatment providers hopes their plan for opioid settlement spending could expand services to all.

The Alabama Fentanyl Abuse Treatment and Prevention Coalition consists of addiction treatment providers from across the state, as well as peer organizations led by people in recovery. Their plan would steer $100 million of an estimated $120 million in settlement funds from three major drug and distribution companies into existing treatment and prevention programs. The money could start flowing into Alabama this year.

Chris Retan, executive director of Aletheia House, a network of addiction treatment and prevention clinics, said it could potentially be the largest infusion of funding for drug rehabilitation services in the state in decades.

“It’s literally a once in a lifetime opportunity,” Retan said.

Alabama Attorney General Steve Marshall announced settlements last year with several different drug companies. In total, the settlements could bring more than $275 million to the state and cities over the next several years. Members of Gov. Kay Ivey’s Opioid Overdose and Addiction Council identified several spending priorities in November, but the final vote on settlement spending will come from the Alabama legislature.

Retan said the coalition’s plan builds off the work of the opioid council. Their plan sends funding to service providers in each of Alabama’s 67 counties. The goal is to show legislators how these funds could help their communities.

Retan said the organizations wants to keep the focus on fentanyl treatment. Additional treatment capacity would be earmarked for those grappling with addiction to fentanyl or other opioids.

The opioid epidemic – which began with prescription pain pills – has morphed into the deadliest drug crisis in U.S. history. In recent years, heroin and fentanyl have overtaken prescription pills as the cause of most fatal overdoses. The number of drug overdose deaths hit all-time highs in Alabama and across the U.S. in 2021.

Retan, who has spent 40 years working in drug treatment, said the current crisis is different from drug epidemics that have come before.

“More people are dying from fentanyl and other opioid overdoses than at any time in our state’s history,” Retan said. “We’ve had other epidemics, like the crack epidemic, which caused a great deal of suffering and pain. But not so many people were dying. This is a deadly disease in a way that it’s never been in the history of our state.”

Alabama does not have the resources to treat all the people who need it, Retan said. Those with private insurance can usually find care, but uninsured people face long waits for treatment beds.

“If you are uninsured, you have a greater than 50-50 chance that you will drop off the waiting list,” Retan said. “Meaning you go back to addiction, or you get arrested, or you die before you get the care that you need.”

Currently, about a third of the state’s counties don’t have opioid treatment programs to provide medication and care to people with opioid use disorder. Programs for pregnant women are also in short supply. The only two residential programs specifically for pregnant women in Alabama are in Jefferson County. The plan from the fentanyl abuse coalition would add two residential facilities for pregnant women, one in north Alabama and one in the south.

“The best way for us to make sure that babies aren’t born addicted to fentanyl and other drugs is to make sure we have easy access to residential treatment for pregnant women,” Retan said. “I don’t think anybody in Alabama doesn’t want a pregnant woman who’s using fentanyl to be able to get into treatment quickly.”

States are not required to disclose the specifics of how they will spend opioid settlement money, but the agreements with drug companies require that most of the spending directly help current and future users. States are not supposed to use the money on law enforcement spending, but Louisiana has already earmarked a portion for sheriff’s departments, according to the Associated Press.

Legislators have not yet considered plans for spending the opioid settlement money. Federal COVID recovery funds have been the bigger priority this session, Retan said. Members of the coalition have been reaching out to lawmakers to ensure that opioid settlement funds also get consideration.

“This plan, it will result in every Alabama county having access to substance use treatment services and every county having access to prevention services as well as expanding residential treatment services,” Retan said. “We’ve not had a significant increase in residential treatment services in Alabama in 40 years. This could be the biggest increase in residential treatment in recent history.”