Communities ravaged by America’s opioid epidemic are beginning to get their share of the $50 billion pie from legal settlements.
Most of that money comes with a requirement that it be used to address the overdose crisis and prevent more deaths.
But how?
It could mean places are more like the Findlay area. Here, conservative Hancock County has built a comprehensive system that focuses on both treatment and recovery by adding housing, a needle exchange, outreach workers and a community center.
“People recover in a community,” said Precia Stuby, the official leading the county’s addiction and mental health efforts. “We need to build recovery-oriented communities that support individuals.”
It was 2007 when Ms. Stuby learned from officials that prescription opioids were being misused. The recovery system then included only a few outpatient services and Alcoholics Anonymous.
“We were, as I think in many places around the country, grossly underprepared for the opioid epidemic,” Ms. Stuby said.
From 1999 through 2020, 131 deaths in the county were attributed to opioids. There were more than 500,000 nationwide. The opioid-related death rate during that period paralleled that of the country.
But the province took a path that was not followed in many places.
Officials created a plan with the help of the federally funded Addiction Technology Transfer Center that emphasized recovery and built on local recognition that “this is our family, our friends, our brothers, our sisters,” Ms. Stuby said.
The settlement funds from drug manufacturers, wholesalers and pharmacies will not be sufficient for every harm reduction, treatment, recovery and prevention program that might be needed to combat the nation’s opioid epidemic.
But it could be enough to spark major changes in efforts.
Since implementation began a decade ago, Hancock County has secured more than $19 million in grants, much of it from the federal government. Other funding comes from a county tax levy and the state. Health insurance pays for the treatment.
Like hundreds of American communities, it has launched a drug court where people can avoid jail as they work toward recovery. At a recent hearing at the county’s historic courthouse, there was applause as a woman approached her diploma. The judge also ordered an immediate drug test to determine if one man could continue in the program.
Some advocates are urging communities not to spend settlement funds on drug courts, saying there is little evidence they work and participants who return to drugs could face harsh prison sentences.
Kerri Kostic, who had been using drugs for 30 years, said drug court helped her stop using.
“It was just an endless, ridiculous, horrible cycle,” said Ms. Kostic, now a fellow support worker in a neighboring county. “Thank God I went to drug court here in Hancock County.”
At Ms. Stuby’s urging, the University of Findlay launched classes on addiction. They can lead to entry-level certification for field work – a partial answer to the recovery workforce shortage.
There are three recovery homes and a community center where people can attend 12-step meetings, play video games or learn to crochet – and a similar place for teenagers.
Hancock’s network amounts to a “no wrong door” system, said Meelee Kim, a Brandeis University social scientist who evaluates some of the county’s federal grants. Someone who comes into the recovery center may be connected to a practitioner through a “warm handoff” because of personal connections between the programs.
The idea, which aligns with expert recommendations on how to use the settlement money, is that with the right support, people can recover from their addiction. Every person who remains in recovery is a person who will not die from an overdose.
“It’s not just about how do we get people off opioids, but how do we keep them in remission and increase their stable recovery?” said John F. Kelly of Harvard Medical School. His research has shown that recovery support services – such as housing, community centers and peer coaching – can help.
“That’s something to be optimistic about, that families don’t give up hope that their loved one can get into remission and stay in it,” he said.
The first step is keeping people who use drugs alive, using practices collectively known as harm reduction.
There is some evidence that the efforts are helping. After 28 overdose deaths last year, Hancock County has three confirmed overdose deaths and five probable deaths so far in 2023.
The province launched a needle exchange, providing supplies to reduce needle sharing and the risk of HIV and hepatitis C. These are policy issues in larger cities, but less common in smaller cities, in part because critics worry that they enable illegal and unsafe behavior.
At the Family Resource Center, the rapid response team compiles lists of overdose survivors and people with substance use disorders being released from jail.
One afternoon, Misty Weaver, the team coordinator, went out to check on two survivors of a recent overdose. Someone who overdosed in a Walmart parking lot gave a home address that didn’t exist. The person who answered the door said the man had gone to rehab. Mrs. Weaver left a bag full of materials and information about other services.
Christina McCarver, then living in Toledo, entered a 30-day treatment program to address her opioid addiction. Within 24 hours of her release, she relapsed and returned to the treatment center.
The center found a place for her at the Findlay facility. After that program, she moved to a room in the women’s recovery home. It turned out to be an important part of her recovery.
“We keep an eye on each other,” she said. Instead of talking about drugs with “friends using,” she said, “we actually do it the other way, telling ourselves, ‘Let’s go to a meeting instead.’
For Ms. McCarver, who has survived a half-dozen overdoses in a life of trauma, being home made her feel trusted and needed again.
After living there for eight months, Mrs. McCarver became the home’s coordinator. After three years in that job, she now holds a similar position at a home for mothers in recovery.
This story was reported by The Associated Press. Patrick Orsagos also contributed to this article.
