A coastal Alabama summit focused on the opioid epidemic Thursday featured expert panels discussing drug crime statistics, education, and innovative solutions toward ending an epidemic that killed approximately 1,200 Alabamians in 2023.

But behind the harrowing statistics released during the Mobile event is a reality looming over the current and future influx of settlement funding to Alabama aimed to combat drug deaths: How are mayors, city councils and county commissions supposed to best utilize the money?

Generally, settlements are to be used by local governments to combat the crisis, but details are cloudy in Alabama. It’s also unclear how or even if transparency will come on how the money is spent.

Alabama Attorney General Steve Marshall, during remarks at the summit, admitted he has concerns over how the money will be used by small towns and big cities around Alabama that might not have the capability to put the money to its best use.

“We have $800 million to be spent over the next 10 years and, candidly, what worries me the most is that money was going to the cities and counties and, not because I didn’t trust those leaders … but we are giving cities and counties money they are not equipped to (allocate). Uniquely, I have had mayors come up to me asking how to spend the money.”

The stakes, and the settlement amounts, are huge. Alabama is poised to receive more than $500 million to resolve claims against drug manufacturers and distributors over their roles in the crisis. Cities and counties will get approximately $300 million.

Marshall’s visit to Mobile did include praise toward the approach pitched by the non-profit Helios Alliance to utilize technology toward identifying solutions on best how to spend the money. Walker County, Marshall also said, is using long-term planning to find effective ways to spend the money. That county had the third highest rate of nonfatal opioid overdoses in the country in 2022.

Uncertainty

Marshall, later in comments to AL.com, credited the Alabama League of Municipalities and the Alabama Association of County Commissions for assisting the local governments who have begun receiving settlement funds.

But it’s unclear how much cities have received, or what they have spent the money on. Alabama does not have a database nor any information immediately available about local settlement money. The state does provide an annual report on the crisis through the Alabama Opioid Overdose and Addiction Council.

KFF, a nonprofit health policy organization, does not have any statewide or local data from Alabama. The reason, according to KFF is that Alabama declined to join several national settlements and instead reached individual settlements with the companies, and therefore the data wasn’t reported.

Alabama and West Virginia are the only two states within KFF’s database without any state and local data.

“While we do not have a comprehensive list of how the opioid settlement funds are being utilized, we have partnered with the attorney general’s office on several occasions, from speaking opportunities to written communications, to share information about the opioid settlement,” said Gregory Cochran, executive director with the Alabama League of Municipalities. “We continue to encourage local officials to seek advice from their legal counsel, to collaborate with their citizens and community partners, and to consult with the attorney general’s office as they determine strategies to best help their municipalities through this terrible opioid crisis.”

Sonny Brasfield, executive director of the ACCA, said one of the difficulties in tracking the information is that each settlement is “a little different in how the money is allocated and how the payouts” will be disbursed over future years.

Each settlement, Brasfield also said, has different language on how funds can be spent. The major opioid settlements that include deals with Walgreen Co., CVS Health, Walmart, Johnson & Johnson require most of the funds be used to combat the crisis.

“This has generated some level of confusion in some localities,” Brasfield said.

Finding focus

Marshall, in a Nov. 13, 2023, letter, wrote to the counties and cities that they utilize the settlement funds “judiciously” and highlighted in bold that “we owe it to the people of Alabama to get this right.”

Marshall also said in the letter that if the funds are spent on non-approved purposes, it could cost Alabama – including the cities and counties – future payments from opioid defendants.

Marshall said the money generally should be spent on three broad categories: Education, prevention, and treatment. He also warned cities and counties to proceed with caution on public-private partnerships and to invest in outside vendors only after thorough examination of their performances in other cities or states.

“I am of the strong conviction that local governments know best how to combat the opioid epidemic in their communities,” Marshall wrote.

Brasfield said that for counties, the ACCA is focused on addressing mental health issues and advocated for legislation passed earlier this year that allows probate judges to issue commitment orders recognizing mental illness that often co-occurs with substance abuse disorders.

“We have strongly advocated that counties hold their funds as we work with the Department of Mental Health on a joint plan to fund additional treatment beds around the state,” Brasfield said.

Brasfield said the ACCA is waiting on the plan before moving forward.

“A very large percentage of the people being held in our county jails are facing mental illness and substance abuse,” he said. “It’s an epidemic and we are grateful to the commissioner of the Department of Mental Health for the partnership we have established on the issue.”

In Mobile, the city is working with Rayford Etherton, founder of the Helios Alliance – which consists of approximately 10 entities – to develop a high-tech modeling and simulation system to predict the likely impacts of policies and procedures to combat overdoses and deaths before settlement money is spent.

Mobile has not selected any proposals to be funded, but it has spent $154,000 on a contract with the Helios Alliance to develop a request for proposal toward exploring the most impactful uses of its settlement money. The city has approximately $2.2 million to distribute during its first round of funding.

“Working with Helios is helping city officials solicit, receive, evaluate and select the most impactful proposals from organizations seeking funding from the City of Mobile’s settlements in opioid-related lawsuits,” said Jason Johnson, a spokesperson with the City of Mobile.

The only other commitments to Helios are $500,000 from the Poarch Band of Creek Indians and $250,000 from an Alabama veterans’ group. The goal is to raise $1.5 million to develop a simulation model that can be used to create a simulation model for Alabama.

Dangers loom

Marshall said he hopes a similar technology approach under development in Mobile could spread to other larger areas of the state – namely, Montgomery, Huntsville, and Birmingham. Helios Alliance is also focusing on spreading its model outside of Alabama to other states, according to KFF reporting from earlier this year.

The work is occurring while opioid overdoses and deaths remain at a high rate in Mobile County, and a mixture of other narcotics – heroin, cocaine, and methamphetamines – is behind half of the tragedies in recent years, according to Sage Analysis Group.

The worst might not be over. According to Mobile County Sheriff’s Deputy Terry Sexton, the drug xylazine – also called tranq, a horse tranquilizer that’s mixed in with fentanyl – poses an even worse threat than elicit fentanyl that has led to a surge of overdose deaths in recent years.

“Tranq is an opioid and Narcan doesn’t work,” Sexton said, referring to the opioid overdose antidote that can save someone’s life from a fentanyl drug overdose. “It’s here in Mobile. It’s probably been here longer than we know. And the Narcan doesn’t work on this stuff.”

How has the City of Mobile spent its opioid settlement money?

The City of Mobile has received approximately $2,323,000 to date.

Of those funds, the City of Mobile has previously spent roughly $210,000 and has approximately $2.2 million left to distribute.

The previous expenditures were made through performance contracts with Veterans Recovery ($200,000) and the Drug Education Council ($10,000). These contracts were approved during the normal budgeting process in 2023, and both organizations have done work with the City of Mobile or received city support in the past.

The contract with the Helios Alliance for the RFP process is $154,000.

The information was provided by city spokesperson Jason Johnson. There is no database that lists how Mobile or any city in Alabama is allocating its funding.