Securing Opioid Settlement Funding Grants for your EMS Agency

Our nation’s opioid crisis continues unabated. According to the National Center for Health Statistics (NCHS), part of the Centers for Disease Control and Prevention (CDC), 107,941 Americans died by drug overdose in 2022 (the last year we have full reporting on). Of those, 81,806 involved opioids. Compare that to 70,630 deaths, fewer than 50,000 related to opioids, in 2019. It’s obvious this national health emergency is not simply going away but opioid settlement funding can provide some help.

Meanwhile, legislation and settlements regarding the opioid crisis continue to evolve. It is estimated settlements related to the opioid epidemic will exceed $50 billion.

Manufacturer and Distributor Settlements

In 2021, states and municipalities reached nationwide settlements to resolve litigation brought against three large pharmaceutical distributors — McKesson, Cardinal Health and AmerisourceBergen — as well as manufacturer Janssen Pharmaceuticals (and its parent company Johnson & Johnson). The three distributors are committed to paying up to $21 billion over 18 years, while Johnson & Johnson is obligated to pay an additional $5 billion over nine years.

Now that the terms of the national settlements have been finalized, funds have begun to be distributed. Note that some states did not participate in the various settlements due to previously reached agreements. Funds awarded through the national settlement do not include separate agreements between Johnson & Johnson and distributors and non-participating states, nor do they include previously decided or ongoing litigation with other manufacturers, pharmacy retailers or other entities.

In addition to their settlement with states and localities, Johnson & Johnson and the three major distributors have agreed to a separate $590 million settlement with native tribes, who have experienced some of the highest overdose rates, and their health organizations.

Retailer Settlements

State and local lawsuits against major opioid distributors, manufacturers and retailers continue to wind their way through the courts, with varying levels of funding being awarded to participating states. In November 2022, CVS, Walgreens and Walmart agreed to resolve lawsuits with state, local and tribal governments through a $13.8 billion settlement. In January 2023, these pharmacy chains and manufacturers confirmed enough states had agreed to the settlements to move forward. The first payments were received in mid-2023.

In addition to the $13.8 billion settlement, Teva is to pay up to $3.34 billion over 13 years and to provide either $1.2 billion of its generic version of the drug Narcan over 10 years or $240 million of cash in lieu of the product, depending on each state’s preference. Additionally, Allergan will pay up to $2.02 billion over 7 years. Four more lawsuits in the amount of $2.4 billion — against Publix, Hikma, Endo and Kroger — were settled in late 2023 and early 2024.

Two lawsuits are pending against Purdue and Rite Aid that could amount to billions more in settlements.

First Responder Uses

In an effort to ensure opioid settlement funding is used to appropriately, those receiving payout funds are required to spend at least 85% of monies on issues directly related to the opioid crisis. A document incorporated into the most of the final agreements (“Exhibit E”) provides a list of allowable uses for spending of the settlement funds.

This “List of Opioid Remediation Uses” is organized in two main sections: “Core Strategies” and “Approved Uses.” This constitutes a non-exhaustive list, meaning it includes some (but not all) of the possible ways opioid settlement funds can be spent. Core Strategies are intended to be prioritized over Approved Uses, however all items in the document represent allowable uses of opioid settlement funds.

A few of the core strategies that are applicable to the EMS community include:

Schedule A, Section A: Naloxone or other FDA-approved drug to reverse opioid overdoses

1. Expand training for first responders, schools, community support groups and families,
2. Increase distribution to individuals who are uninsured or whose insurance does not cover the needed service.

Part Two, Section H: Prevent overdose deaths and other harms (harm reduction)

1. Increased availability and distribution of naloxone and other drugs that treat overdoses for first responders, overdose patients, individuals with OUD and their friends and family members, schools, community navigators and outreach workers, persons being released from jail or prison, or other members of the general public.
2. Public health entities providing free naloxone to anyone in the community.
3. Training and education regarding naloxone and other drugs that treat overdoses for first responders, overdose patients, patients taking opioids, families, schools, community support groups, and other members of the general public.
4. Enabling school nurses and other school staff to respond to opioid overdoses, and provide them with naloxone, training, and support.
5. Expanding, improving, or developing data tracking software and applications for overdoses/naloxone revivals.
6. Public education relating to emergency responses to overdoses.
7. Public education relating to immunity and Good Samaritan laws.
8. Educating first responders regarding the existence and operation of immunity and Good Samaritan laws.
9. Syringe service programs and other evidence-informed programs to reduce harms associated with intravenous drug use, including supplies, staffing, space, peer support services, referrals to treatment, fentanyl checking, connections to care, and the full range of harm reduction and treatment services provided by these programs.
10. Expanding access to testing and treatment for infectious diseases such as HIV and Hepatitis C resulting from intravenous opioid use.
11. Supporting mobile units that offer or provide referrals to harm reduction services, treatment, recovery supports, health care, or other appropriate services to persons that use opioids or persons with OUD and any co-occurring SUD/MH conditions.
12. Providing training in harm reduction strategies to health care providers, students, peer recovery coaches, recovery outreach specialists, or other professionals that provide care to persons who use opioids or persons with OUD and any cooccurring SUD/MH conditions.
13. Supporting screening for fentanyl in routine clinical toxicology testing.

Part Three, Other Strategies, Section I: First responders

1. Education of law enforcement or other first responders regarding appropriate practices and precautions when dealing with fentanyl or other drugs.
2. Provision of wellness and support services for first responders and others who experience secondary trauma associated with opioid-related emergency events.

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Settlement Specifics

As part of the agreements negotiated between opioid manufacturers, distributors and state attorneys general, the national settlement outlines terms for states and localities receiving opioid settlement funding, including the allocation and use of settlement funds. Although states and localities have significant leeway in crafting individual approaches to budgeting, planning, and disbursement, key settlement provisions and requirements are driving forces.

Payments will be made to states in multiple installments over an 11- to 18-year period using a formula that considers overall population, number of overdose deaths, quantity of opioids delivered and prevalence of substance use disorder.

The settlement agreement creates a default allocation to subdivisions within states, with 15% allocated to the state fund, 70% to the abatement accounts fund, and 15% to the subdivision fund. Individual states may change this allocation through a qualifying agreement, statute, or statutory trust.

The state share: Settlement funding awarded directly to the state, with final spending authority residing with legislative appropriation, attorneys general, the department of health or the state agencies responsible for substance abuse services.

The local share: Settlement funding allocated directly to participating political subdivisions, including cities and counties. Local entities may be required to report spending but retain authority for spending decisions.

The statewide abatement fund: Many states create a statewide “abatement fund” to distribute funding across the state. While the abatement fund may be administered by a state agency, a number of legal frameworks create a single entity or trust charged with disbursing funding.

Each state has developed unique processes and administrative structures for allocating funding across state and local entities. Some states have set up grant programs via a portal or through a foundation, while others allow local agencies to hold meetings to review requests.

While all states are following slightly different structures, the basic flow of funding remains largely the same:

1. Legislation started at the federal level — at the U.S. attorney general’s office.
2. Once funding is secured, disbursement is based on a specific formula in place for states, counties and local governments.
3. Funding will originate at the state attorney general’s office and then be allocated as specified.

It is estimated settlements related to the opioid epidemic will exceed $50 billion.

How to Start

1. Review how much funding your state, county or city will be getting.
2. Reach out to your local resource (mayor, city attorney, etc.) to see if they have details on how funds are being allocated and distributed.
3. Contact your state’s attorney general and inquire about the process to request funding for your project.
4. You can also search opioid settlement funds by just Googling your location (state, county or city) to research information on the process.
5. It may also be beneficial to determine who the abatement task force members are and reach out to them directly.

Opioid settlement funds are crucial in addressing the widespread impact of the opioid crisis by providing financial resources to the states and communities most heavily affected by opioid abuse. These funds can be strategically used by EMS agencies by investing in advanced training, purchasing necessary medical equipment and improving response infrastructure. It’s important for EMS leaders to act quickly to secure their agencies’ share of these funds. They won’t last forever!

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Not sure where to start? Lexipol’s team of expert grant writers, researchers and project managers can help your agency through custom grant solutions geared toward getting your department the funds it needs to meet its safety and wellness mandates.