In many states, opioid settlement funds going to local governments do not reflect communities' extreme losses

Rural America was the first to herald the incoming opioid crisis: "In the 1990s, misleading marketing by opioid companies helped drive up prescription rates, particularly in coal, lumber, and manufacturing towns across Appalachia and Maine," report Aneri Pattani and Rae Ellen Bichell of Kaiser Health News. "As painkillers flooded communities, some residents became addicted. Over time, they started using heroin and fentanyl, and the deadly epidemic spilled into suburbs and cities across the nation."

Now that settlements of lawsuits over the epidemic are being paid out, the award calculations in many states seem skewed against rural areas gaining a share that reflects their losses. Pamlico County, North Carolina, pop. 12,000, is an example Pattani and Bichell cite: "Over the past decade, it’s had the highest rate of opioid overdose deaths in North Carolina. . . . Now, the county is receiving money from national settlements with opioid manufacturers and distributors to address the crisis. But by the time those billions of dollars are divided among states and localities, using formulas partially based on population, what trickles down to hard-hit places like Pamlico County can be a trifling sum."

The disparities are born out in the numbers. They report, "Out of one multibillion-dollar national settlement, Pamlico County is set to receive about $773,000 over nearly two decades. By contrast, Wake County, home to the capital city of Raleigh, is set to receive $36 million during the same period, even though its opioid overdose death rate for the past decade ranked 87th in the state."

Some states do it differently. Pennsylvania considers "opioid-related hospitalizations and first responders’ administration of naloxone, an overdose reversal medication," Kaiser reports. "When that formula left 11 rural counties without 'enough money to make an impact,' the state decided each county would receive a minimum of $1 million over the 18-year settlement period, said Glenn Sterner, an assistant professor at Penn State who helped develop the state formula and co-authored a paper on it. In Colorado, pooling funds is built into the state’s model for managing opioid settlement money. The lion’s share of funds is going to 19 newly formed regions, about half of which comprise multiple counties."

Many rural communities are grateful for any financial assistance and are working creatively to make the most of what they do receive, Pattani and Bichell write. "But others worry such an approach misses an opportunity to use that money to make a difference in rural communities that have been disproportionately affected for decades."