After nearly nine months and eight meetings, Maine Recovery Council hasn’t spent any of the millions available from opioid settlement cases
In a brightly lit conference room on the first floor of the Department of Health and Human Services in Augusta on Thursday, the Maine Recovery Council met for the eighth time in as many months and, perhaps for the first time, discussed how it should spend nearly $118 million in settlement funds from companies accused of fueling the opioid epidemic.
The 15-member council is charged with overseeing distribution of half of Maine’s $235 million share in settlement funds. With bankruptcy proceedings pending for two drug manufacturers — Purdue Pharma and Endo International – there may be even more money on the way.
The council already has $17 million in payments but has yet to spend any of it. Instead it has spent 8 1/2 months working through administrative and bureaucratic details, such as establishing bylaws and creating subcommittees. Some of that work is ongoing. Early allotments from the half of the settlements that isn’t controlled by the recovery council have begun to be distributed.
Meanwhile, an average of 12 Mainers weekly died of a drug overdose in the first six months of this year, according to the June monthly overdose report. More than 4,700 nonfatal overdoses were reported in the same period.
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At Thursday’s meeting, some members expressed frustration at the slow pace of their work. Gordon Smith, Gov. Janet Mills’ director of opioid response, put it bluntly: “I don’t think any of us want to be here in November on the first anniversary date of receiving this money and say that we haven’t spent any of it.
“Pretty soon people are going to look at Maine and say they’re falling behind.”
Council chair Pat Kimball said Friday that “although I think you could sense some frustration, I think it was a meeting that needed to take place in regards to people really, really (starting) to ask those questions, and where are we and how do we do this.”
Asked why administrative items, like a conflict of interest policy — which is still not finalized — weren’t completed sooner, Kimball said “it’s growing pains.”
The council wants to get the money out there, she said, but also needs to do it responsibly.
“We know it’s not going to be perfect.”
Courtney Gary-Allen, the organizing director for the Maine Recovery Advocacy Project, said Friday she feels the urgency for the council to ramp up its work.
“I think that as a person who spends a lot of time on the front lines of the addiction crisis, and watching my friends and family die, often I am frustrated with the amount of time that it takes us to get money out the door and choose the people that need most.”
At the same time, “I think that the decisions of this first council are going to be some of the most impactful decisions for the next 18 years,” she said.
Likewise, Chastity Tuell said Friday she believes “everybody wants to get the money out to where it needs to go as quick as possible. But we also want to do it right.”
As frustrating as it might be, “I feel really confident that we’re covering all of our bases to do it right,” she said.
Gary-Allen, Tuell and others said Thursday that the council was still missing critical input from the public and other stakeholders.
“I just don’t feel like I can make those decisions without also not just hearing from the state about what they say we need, but also hearing from communities and making sure that we have a public process for applications,” Gary-Allen said.
The council has not had a public listening session, said Liz Blackwell-Moore, the public health director for Cumberland County.
Blackwell-Moore volunteered to take the lead on writing and distributing a public survey. Kimball said she hopes it will go out next month so the council can discuss the results at its October meeting.
That will “help us decide on priorities,” she said.
In the meantime, the finance committee is working on an annual budget, she said, and the programs and grants committee should meet for the first time soon.
Kimball said she remains hopeful that the council can award its first tranche of money by the end of the year.
Mountain State Spotlight explains: West Virginia’s opioid settlement foundation will soon have board members. Here’s how they’re picked
In the coming days, local government leaders across West Virginia are set to elect five board members for the foundation tasked with managing the majority of the state’s opioid settlement funds, a sum that totals right around $1 billion as of July. The new members of the West Virginia First Foundation will join Dr. Tom Kelly, an emergency medicine physician who was elected last week, and five members chosen by Gov. Jim Justice. The governor has also indicated that he’ll make his selections “really soon.”
Selecting the right people for these positions is essential, says Drema Hill, a West Virginia School of Osteopathic Medicine professor who helped the Attorney General’s Office determine how the state can spend its opioid settlement winnings.
“It is really going to have the power to make the decisions over these funds,” Hill said. “That’s why it’s very important who is elected to be on this board.”
We break down how West Virginia local governments are choosing their board members, how the foundation can spend its settlement funds, how well those members will represent areas most impacted by the substance use crisis and how transparent the foundation’s operations will be.
How are the opioid settlement foundation board members chosen for each region?
While West Virginia Attorney General Patrick Morrisey and other state lawyers were pursuing lawsuits against pharmaceutical supply chain companies, they developed a Memorandum of Understanding for the money from the lawsuits. The memorandum guides how the state can spend this money and established governing guidelines for the West Virginia First Foundation.
The document split the state into six regionsbased on existing designations from the state’s Bureau for Behavioral Health. Each region will have one resident serving as a board member for the foundation.
Officials from the towns, cities and counties of each region — with the exception of people from seven small local governments that never signed on to the memorandum — can nominate one person to be their region’s board member. Once all the nominations are in, the regions will host public meetings, where representatives from each local government included will vote on the candidates.
So far, the only meeting that’s taken place has been the one for Region Six, a series of southern West Virginia counties that were targeted by prescription drug distributors. Its local elected officials selected Kelly. The other five regions will choose their representatives on July 12 and July 13.
Who can be nominated?
The memorandum says board members should have expertise that could be helpful for guiding the foundation; examples range from substance use treatment practitioners to people experienced in finance.
A letter from Morrisey’s office to local governments says that nominating current elected officials is “highly discouraged.” According to his press secretary, that’s an attempt to prevent the selection from becoming political.
But that hasn’t stopped local governments from nominating elected officials. Mercer County Commissioner Greg Puckett was nominated for Region Six’s board seat but ultimately not selected.
In Region Three, an area made up of counties in the Mid-Ohio Valley, Parkersburg Mayor Tom Joyce will be on the ballot. Over the past two years, Joyce has, contrary to local data, attributed rises in Wood County crime to local substance use treatment efforts and successfully lobbied for state legislation that prevents Wood County from adding more treatment facilities. He did not respond to phone and email interview requests for this story.
Vienna Mayor Randall Rapp, who nominated the Parkersburg mayor for the board, cited Joyce’s professional experience working for hospitals as a major reason why he nominated him.
“I just think that [with] his background and his character, Tom will do the right thing,” Rapp said.
Wood County Commissioner Blair Couch was less comfortable with the prospect of Joyce as the Region Three representative. His commission nominated Westbrook Health Services president Kevin Trippett, and Couch said he would prefer someone like Kelly.
“I think politicians can be swayed more than a doctor from Raleigh County,” Couch said.
Will the foundation board be fair to the places most impacted by the crisis?
The money will be split according to a formula that assigns percentages — based on a municipality’s population, number of prescription pain pills received, and overdose death count — of how much of West Virginia’s total opioid crisis took place in an area.
For example, the formula determined that about 9% of the total crisis took place in Cabell County and Huntington. It calculated a similar estimate for Kanawha County and Charleston.
But each region will still only get one vote on the foundation. That means that despite the calculation that Region Five, which includes both Kanawha and Cabell counties, was affected more than other regions, it will have the same vote on the board as Couch’s Region Three.
“How can you have Cabell and Kanawha in the same region?” Couch asked. “Those two big ass counties, who have suffered a lot through the opioid [epidemic], are going to have one vote on this 11-member panel.”
How transparent will the foundation be?
Drema Hill says the West Virginia First Foundation is being set up as a private nonprofit to discourage the funds from being politicized and misused. But this has raised questions about whether the foundation will be subject to the same rules as government organizations.
Morrisey’s press secretary did not respond to phone and email questions asking whether the foundation will be subject to the state’s Freedom of Information Act. But courts have previously ruled that private foundations created by state authorities are subject to the law, according to Suzanne Weise, a West Virginia University law professor who specializes in government transparency.
A list of “frequently asked questions” developed by the Attorney General’s Office says that the foundation won’t be subject to the state’s Open Meetings Act. The memorandum does say that all meetings related to the foundation should be open to the public and gives the state’s attorney general the power to audit it. But some local government officials have already raised concerns about whether those provisions will create enough accountability for the organization.
How will the foundation spend the settlement money?
Once the attorneys’ fees for the settlements are finalized, the West Virginia First Foundation will be responsible for managing hundreds of millions of dollars. The board members are supposed to invest the majority of that sum, but the memorandum also instructs them to distribute 20% of the foundation’s yearly budget to the six regions each of the next seven years.
Each regional board member will also double as their area’s director; that job entails leading regional governing groups that decide how their shares of the money get spent. The foundation’s board members will collectively be responsible for determining the process by which West Virginia government and non-government organizations can apply for regional funds.
Conny Priddy, the program coordinator of Huntington’s Quick Response Team, is confident the money will help reduce the damage of the state’s opioid crisis. But she worries it won’t be enough.
In the 2021 trial that pitted Huntington and Cabell County against drug distribution companies, an epidemiologist and a forensic economist estimated that it would take $2.5 billion just to address the problem in that county. In the wake of U.S. District Judge David Faber’s ruling in favor of the drug distributors, lawyers for Huntington and Cabell have appealed the decision to the 4th U.S. Circuit.
Now, the foundation will only have access to a portion of $1 billion to address problems throughout the entire state. Priddy said some money is better than nothing, but she doesn’t know what impact it will ultimately have for the West Virginia families who have suffered the most.
“I hate to say it, but you can’t throw a little bit of money at it and then expect the problem to go away,” she said. “It has become generational.”
Disclaimer: Weise is the secretary of Mountain State Spotlight’s Board of Directors.
Fentanyl use in Montana driving spike in overdose deaths
Deaths by drug overdose in Montana continue to rise.
Nearly 200 people in Montana died due to drug overdoses in 2021, the last year that comprehensive data is available, according to the state’s health department. That’s nearly 40 more lives lost than in 2020 and 80 more than in 2017.
Yellowstone County, the state’s most populous, had the highest number of fatal overdoses, followed by Missoula County.
Neither autopsies nor toxicological testing are performed on every person who dies from an overdose, according to Jon Ebelt, a spokesperson from the Montana Department Public Health and Human Services, so even those numbers could be an undercount.
Health care practitioners, law enforcement agencies and othersattribute the increase to the proliferation of fentanyl, a synthetic opioid that, according to the Centers for Disease Control and Prevention, can be up to 50 times more potent than heroin and 100 times stronger than morphine.
And there’s no sign of the trend slowing. During the first quarter of 2023 year, Yellowstone County reported 41 calls related to opioid overdoses, followed by Missoula County with 32 and Cascade County with 28, according to a report from the state’s emergency medical services. Across the state in 2022, there were 1,041 opioid overdose-related 911 responses by EMS agencies, an average of 87 per month, up from 76 per month the year prior.
“What’s happening right now is that people are literally walking down that path in the dark. They have no idea what is going to be laced, what is going to be a dose that could kill you.”
Nikki Russell, peer mentor, Montana Peer Network
And Narcan, an over-the-counter nasal spray that reverses overdose effects, has become a household name. Clinics and local health departments around Montana are training the public on its use, and advocates and officials are encouraging people to carry Narcan if they believe they might know someone using opioids.
For years in Montana, methamphetamine has been the drug most gravely impacting communities. A public health department report from August 2020 determined that the number of deaths, hospitalizations and emergency room visits related to methamphetamine had all increased substantially since 2015. Crime related to methamphetamine use also increased.
Montana also suffers from an alcohol-induced death rate far greater than the national average. The alcohol-induced death rate in 2019 for adults over the age of 25 was 30.9 per 1,000 residents, compared with 17.3 per 1,000 nationally, and 18% of high-school students in Montana reported engaging in binge drinking, 4% higher than their national peers.
But the arrival of fentanyl, a cheaper and more potent opioid, has created a new crisis. While methamphetamine and alcohol are still more prevalent, the rate of deaths from opioid-related drug overdoses in Montana nearly tripled between 2017-2018 and 2019-2020, according to the state Department of Public Health and Human Services. Nikki Russell, who struggled with substance abuse for nearly a decade and now serves as a peer mentor for Montana Peer Network — a statewide nonprofit that helps people struggling with addiction — said it felt like things changed overnight.
“It felt quick. I absolutely feel like I turned a corner and there [fentanyl] was,” Russell said. “I was hearing about one [overdose] after another after another.”
For example, the Northwest Montana Drug Task Force, responsible for covering six counties, including Lincoln, Lake and Flathead, equaling roughly 17,600 square miles, made 56 fentanyl-related arrests in 2022 and removed more than $2 million in illicit drugs from communities. Throughout Montana, there were 488 opioid seizures by law enforcement in 2021, nearly double the number in 2017, according to the Montana Board of Crime Control.
Ka Mua, a nurse practitioner at Ideal Option, which operates nine clinics across Montana that provide medication-assisted treatment to treat opioid dependence, said she has seen a significant rise in the use of fentanyl among patients in the last 18 months.
Among the many risks posed by fentanyl, according to Mua, is that the symptoms of withdrawal — intense nausea, fever or debilitating muscle aches — can start much quicker and be much more intense than with other opioids.
More than half of patients at Ideal Option clinics across the state test positive for at least two substances, and 24% test positive for three or more. That circumstance, called polysubstance use, often reveals that people don’t know how their drugs are getting cut or mixed. It’s not uncommon, then, for people to think they are taking one drug but to learn later that it was laced by illegal manufacturers with fentanyl, which is partly why the overdose risk is so high, Mua said.
There’s “no way to measure the correct dose of fentanyl as a street drug,” Russell said.
“At the time when I was using substances, it was a dangerous road, but I could kind of see where I was going, even though I was, so to speak, lost,” Russell said. “What’s happening right now is that people are literally walking down that path in the dark. They have no idea what is going to be laced, what is going to be a dose that could kill you.”
THE ROLE OF LAW ENFORCEMENT
Steve Holton has worked for the Ravalli County Sheriff’s Office for more than 25 years, and he’s been the sheriff for six. While substance use is nothing new in the Bitterroot Valley, he said, the pervasiveness of drugs and the impact substance use is having on the community is notably different.
“Fentantyl is definitely on the rise, even down here,” Holton said. “We’re seeing a lot of distribution. It’s super easy to get. It’s super pure. There was a time when our problem was methamphetamine labs, and that is simply not the case anymore.”
Although the number of fatal overdoses in Ravalli County is low — according to the public health department, six people died in 2021 — Holton said those numbers don’t adequately reflect the threat of the drug crisis in the community.
All deputies in the sheriff’s office carry Narcan, and Holton said access to naloxone — the generic name for the medication — has prevented many overdoses from resulting in death. But he cautions that people shouldn’t assume that low fatalities means overdoses are uncommon.
“People tend to have a that-can’t-happen-here attitude,” Holton said. “I don’t think people understand just how prevalent the dangerous drugs are in Ravalli County.”
That’s a lot of area to cover with few people. Such remoteness makes responding to possible overdoses or investigating the origin of drugs in the community difficult, Holton said. Emergency calls “are a long ways away from each other, so to get people the help they need, law enforcement is often the answer,” he said.
REDUCING STIGMA
A compelling and growing body of research, including from the National Institute of Health, shows that criminalization of drug use prevents people from seeking treatment, which can push people struggling with addiction even further to the margins of society.
As a result, there has been an increasing effort nationally to reduce the prominence of traditional law enforcement in moments of mental health crises, including for people who may be using drugs. Missoula and Flathead counties, for example, have both created programs within their police departments that pair mental health counselors with law enforcement officers.
Community organizations are stepping up across the state, too. Safe syringe exchanges, like those offered by Missoula’s Open Aid Alliance, and medication-assisted treatment clinics are becoming more common. Those interventions are considered part of harm-reduction practices, a school of thought that aims to reduce the stigma around drug use.
“People tend to have a that-can’t-happen-here attitude. I don’t think people understand just how prevalent the dangerous drugs are in Ravalli County.”
Ravalli County Sheriff Steve Holton
Advocates say public health interventions such as needle exchanges reduce some of the potential harm that drug use can cause. People struggling with addiction, they maintain, should feel comfortable seeking treatment and support. Russell added that the stigma around substance abuse, especially in rural communities, often discourages the people she works with from joining support groups, seeking help or taking advantage of existing resources.
The Montana State Legislature is doing work of its own to reduce the number of opioid-related drug overdoses in the state. A bill signed into law in May exempts fentanyl testing strips from the list of illegal drug paraphernalia so that people can better avoid unknowingly consuming the powerful opiate when they are using other substances.
Fentanyl’s hold on communities in Montana, experts agree, has forced something of a reckoning in how society can best help drug users prevent overdoses.
“If somebody’s not alive, how can they recover?” Russell said.
In-depth, independent reporting on the stories impacting your community from reporters who call it home.
‘We are now there’: Door County catches up with national opioid, meth trends
Maine will receive at least $235 million in settlements from companies accused of fueling the opioid crisis
Maine stands to receive at least $235 million over the next nearly two decades as the result of national settlements with some of the companies accused of supercharging the opioid epidemic.
The settlements end years of litigation filed by dozens of states and other plaintiffs against the companies, alleging they led a misleading, dangerous and ultimately deadly campaign for more than two decades to put pharmaceutical opioids into the medicine cabinets of people across the country.
This campaign, the plaintiffs say, created the opioid crisis and contributed to the situation that saw 105,000 people die of drug overdoses in the United States last year, largely fueled by increasingly lethal drugs like the synthetic opioid fentanyl. More than 932,000 people have died from a drug overdose between 1999 and 2020, according to the latest data from the U.S. Centers for Disease Control and Prevention. Nearly two-thirds of those deaths involved an opioid.
“Our communities have suffered tremendously,” Maine Attorney General Aaron Frey said in a statement last December.
“While no amount of money can ever remedy the pain experienced by so many, I’m hopeful that a settlement could mean more funds for critical treatment, prevention and recovery efforts that can make a meaningful difference in lives across the state,” he said.
The complicated task of how to distribute the money to municipalities, recovery groups and others has begun in Maine. The state has received approximately $28 million with millions more expected.
The Maine Monitor examined the web of legal agreements and spoke to key players to understand who stands to benefit from this money and why it matters.
Purdue Pharma’s role
To understand the significance of these settlements, it requires going back to December 1995, when the U.S. Food and Drug Administration approved OxyContin, Purdue Pharma’s extended-release formulation of the powerful synthetic opioid oxycodone.
The formulation doled out the drug every 12 hours instead of every four to six. The FDA by its own admission said at the time it believed this formulation “would result in less abuse potential, since the drug would be absorbed slowly and there would not be an immediate ‘rush’ or high that would promote abuse.”
Oxycodone, however, is a highly addictive substance, one-and-a-half times more powerful than morphine and hydrocodone. And someone looking to get that rush could easily bypass the controlled-release mechanism by crushing or dissolving the pills, which ranged from 10 to 160 milligrams, to snort or inject.
The FDA said there was “no evidence to suggest at the time” that doing so “would become widespread and lead to a high level of abuse.”
Over the years, Purdue spent hundreds of millions of dollars on an aggressive marketing campaign. Drug representatives camped out in doctor’s offices to offer lavish lunches, free gifts and a chance to hear about Purdue’s new wonder drug. Unsealed documents show the manufacturer often targeted primary care physicians with little to no formal training in pain medicine.
They encouraged providers, many initially reluctant to prescribe an opioid painkiller, to think of pain as the “Fifth Vital Sign” and pushed the misleading claim that “less than 1% of patients” treated with an opioid became addicted, according to court documents and reporting.
In 1997, just one year after OxyContin came on the market, 30 people in Maine died from a pharmaceutical drug overdose, 16 involving opioids, according to reports from the University of Maine Margaret Chase Smith Policy Center. In all, 34 Mainers died from a drug overdose that year.
Last year, 715 Mainers died of drug overdoses. Slightly more than a fifth, or 155 deaths, involved pharmaceutical opioids, alone or in combination with other drugs. Illicitly manufactured fentanyl, which first showed up in toxicology reports in Maine in 2013, claimed nearly 80% of drug deaths in 2022. There were 9,859 reported nonfatal overdoses, though that number is likely higher.
This April alone there were nearly 800 fatal and nonfatal overdoses in Maine.
“Purdue and the Sackler defendants misled Maine consumers, and in doing so played a significant role in accelerating the opioid epidemic,” Frey said in a June 2019 statement announcing he had filed a complaint against the OxyContin manufacturer and its billionaire owners, members of the Sackler family.
“Our complaint alleges that their unrelenting sales visits to doctors and deceptive practices led to a marked increase in opioid prescriptions, and a corresponding increase in the number of Mainers suffering from opioid use disorder,” he said.
In filing suit, Maine joined nearly every other state, plus about 2,000 local and tribal governments, in pursuing legal action against Purdue, Frey said.
The settlements
Maine’s suit was just one of thousands of complaints filed against Purdue and other companies accused of fueling the opioid epidemic. The lawsuits have been playing out in courts across the country for years. Nationwide, they have led to some $50 billion in settlements.
In 2017, a federal judicial panel ordered that thousands of pending lawsuits be consolidated into a massive multidistrict litigation case called the National Prescription Opiate Litigation. In 2021, a $26 billion settlement agreement was reached with the “big three” wholesale pharmaceutical companies who distribute 80-90% of all prescription drugs in the United States — McKesson Corporation, AmerisourceBergen and Cardinal Health — and pharmaceutical manufacturer Johnson & Johnson and its subsidiary, Janssen Pharmaceuticals.
Maine signed on to the agreement and in January 2022 executed a “Memorandum of Understanding” with political subdivisions — counties, towns and cities — and separate MOU with school districts that were part of the consolidated opiate litigation case. Maine stands to receive at least $130 million over the next nearly two decades from this batch of settlements involving the “Big Three” and Johnson & Johnson.
Litigation against Purdue has yet to reach its conclusion. In September 2019, the company filed for Chapter 11 bankruptcy, just days after reaching a tentative settlement with more than 2,000 local governments. Purdue’s bankruptcy case remains caught up in appeals, with the latest decision in a federal appeals court, granting members of the Sackler family legal immunity, coming down late last month.
Separately, Maine was part of a multistate agreement with manufacturer Mallinckrodt, which filed for Chapter 11 bankruptcy in 2020. Maine is slated to receive $5.8 million over nine years under that agreement, which will also be governed by the MOUs.
About $819,000 in payments have already been made to Maine in the Mallinckrodt case, though future payments may be in limbo: Earlier this month, Mallinckrodt floated the possibility that the company could file for a second bankruptcy.
In March, Frey announced another $100 million in payments as part of five additional settlements reached earlier this year. The settlements are with manufacturers Teva and Allergan, and three retailers, CVS, Walgreens and Walmart.
Frey’s office confirmed earlier this month that 100% of eligible subdivisions — all 16 of Maine’s counties, and 23 cities and towns — have signed on to the five additional agreements, which will pay out over 15 years.
One pending settlement remains: Endo International, a manufacturer, filed for Chapter 11 bankruptcy last August. While the restructuring process remains in progress, Frey’s office said last week it expects about $500 million to be distributed to states, though the exact allocation hasn’t been determined.
“There’s a lot of money here and there’s also a lot to learn in regards to how the money can be spent and what the money can be spent on,” Pat Kimball, the chair of the Maine Recovery Council, which oversees half of the money coming into the state, said earlier this month.
Another $3.3 million will go to Maine’s five federally recognized tribes over 15 years as part of a separate set of agreements between Native American tribes and tribal health organizations and the same companies. The Maine Monitor’s analysis does not include those agreements.
‘Due diligence’
Although payments from the Distributors and Johnson & Johnson settlements brought in approximately $28 million since last year, some recipients are getting restless with the slow progress to actually put dollars toward combating the opioid crisis, according to some involved in the process.
Yet the Maine Recovery Council — which has yet to disburse any of the approximately $14.5 million already in its coffers — insists it’s doing “due diligence,” Kimball, the council chair, said earlier this month.
A Hermon resident, Kimball retired in 2016 after 15 years as executive director of Wellspring in Bangor, which provides inpatient and outpatient mental health and substance use disorder counseling.
“As frustrated as everyone is, including the Council members, it takes time,” Kimball said. “And we’re trying to push it as quickly as we can, but at the same time being responsible to make sure that these dollars are well spent.”
The council has met nearly every month since its first meeting last November, though the MOU only requires they meet twice annually. At its latest meeting June 8, the council was still settling into its role overseeing what will amount to nearly $118 million in settlement payments over the next decade and a half, spending most of the meeting discussing officer elections, potential subcommittees and a remote meeting policy.
There was no discussion during the 90-minute meeting on how to disburse the funds and to whom.
Kimball said the council is focused on “getting ourselves organized” and “getting to know what’s going on around the state” to understand where funding gaps exist.
“Part of it is that we want to spend this money, we want it to get to people, we want to save lives. But at the same time we don’t want to put money where money has already been spent,” she said.
The council needs to create a “fair process as to how people can tell us, to share with us, what their needs are.”
Asked about a timeline for when the council expects to have a process to begin disbursing funds, Kimball said her goal would be by the fall.
“I’m not sometimes a patient woman. Sometimes I think the process is slow. But I also know from experience that slow and steady wins that race,” she said.
Because the direct share subdivisions do not have public reporting requirements, it is not immediately clear how each of the 39 counties, cities and towns have spent or plan to spend the $9 million already paid out.
Council members at the June 8 meeting said they heard from some counties and towns that they don’t know where to even begin.
“There’s a lot of collaboration, a lot of conversations that need to be taking place,” said Bruce Noddin, the founder and executive director of the Maine Prisoner Re-Entry Network.
“Municipalities are in the dark right now. They have no idea what they’re doing and they’re just begging for somebody to give them some guidance. And they want to collaborate,” he said.
A spokesperson for the Office of the Attorney General said they have spent a portion of the approximately $5.8 million it received as of the spring, but did not provide a detailed breakdown.
“The Attorney General will continue to work closely with the legislature, the Mills administration, community partners and impacted communities to use the settlement funds allocated to the Office to enhance treatment, prevention, recovery and harm reduction efforts across the state,” according to a statement provided by spokesperson Danna Hayes.
“The AG has already committed over $4 million to expand family drug court dockets and the OPTIONS program, in addition to the naloxone the Office has been purchasing and distributing to law enforcement agencies across Maine since 2016. The OAG’s share of the settlement funding is, by design, intended to be flexible and responsive to meet urgent programming and resource needs and as such, the OAG will be paying close attention to opportunities to make an impact for Maine communities.”
Who are the settlement agreements with, and how much money will Maine receive?
The “big three” wholesale pharmaceutical companies, Texas-based McKesson Corporation, Pennsylvania-based AmerisourceBergen and Ohio-based Cardinal Health, collectively known as the “Distributors,” will pay $106.7 million to Maine over 18 years. Payments began last fall and total about $10.7 million so far.
New Jersey-based pharmaceutical manufacturer Johnson & Johnson and its subsidiary, Belgium-based Janssen Pharmaceuticals, will pay $24.6 million over nine years. Payments began last fall and total about $16.8 million so far.
Maine expects to receive about $5.8 million as part of manufacturer Mallinckrodt’s bankruptcy restructuring plan, which has its operational headquarters in Missouri. The state has already received $819,000.
Allergan, a global pharmaceutical manufacturer headquartered in Ireland, will pay $11.3 million over seven years beginning this year.
Teva, an Israeli multinational pharmaceutical manufacturer, will pay $20.5 million over 13 years beginning this year.
Rhode Island-based CVS Pharmacy, the largest pharmacy chain in the U.S., will pay $25 million over 10 years beginning this year.
Illinois-based Walgreens, the second-largest pharmacy chain in the U.S., will pay $27.3 million over 15 years starting this year.
Walmart, the Arkansas-based multinational retail corporation and pharmacy chain, will pay its entire $14.2 million settlement this year.
Who controls the money?
Maine has two memoranda of understanding with the political subdivisions and school districts that were independent of the Attorney General’s complaints party to the multidistrict litigation.
These MOUs determine which bank accounts the money is deposited into, how the money can be allocated or spent and any oversight. The settlement payments, with some caveats, are divided as such:
20% to the Office of the Attorney General, which will oversee the “state fund.”
30% to the litigating subdivisions (the “subdivision fund”), otherwise known as “direct share subdivisions.” Payments from the settling companies or trusts go directly to these 39 counties, cities and towns.
50% to the Maine Recovery Council, which oversees the Maine Recovery Fund, or “abatement fund.” (More on this later.)
The caveats:
To pay for litigating subdivisions’ attorney fees, the settlement agreements for the Distributors and Johnson & Johnson state that 7% of their payments must go into a “backstop fund.” Each subdivision’s allocation is calculated from the net total (the total subdivision fund minus the backstop fund.)
Per the MOU with school administrative districts, at least 3% of the Maine Recovery Fund must go to school districts for special education purposes. The MOU states that any school district can apply, but the 30 litigating school districts will be given a “reasonable plus factor in consideration of grants.”
What’s the Maine Recovery Council?
The 15-member Maine Recovery Council will oversee the Recovery Fund, which accounts for 50% of all payments coming to Maine. Gov. Janet Mills signed into law LD 1722 in April 2022, establishing the council. The MOUs govern the scope and power of the council.
The members are appointed by the governor, Senate President, House Speaker, litigating subdivisions and the Office of the Attorney General, and are limited to two consecutive two-year terms.
The council’s primary task is to distribute the Recovery Fund and ensure that the funds are being spent in compliance with the MOU. While it has no rulemaking authority, the MOU also tasks the council with facilitating “collaboration” among the state, subdivisions and other “stakeholders for the purposes of sharing data, outcomes, strategies and other relevant information related to abating the opioid crisis in Maine.”
How can the money be spent?
The settlement funds must be used for opioid abatement strategies. Examples of abatement strategies are treatment and prevention, such as the expansion of medication-assisted treatment for uninsured individuals or harm reduction initiatives, like education on and distribution of the opioid overdose-reversing drug naloxone. Other strategies include research, training and technical assistance.
The state subdivision MOU provides a list of potential strategies that come directly from the National Opioid Settlement and filings from the Purdue Pharma bankruptcy case.
Does spending have to be publicly reported?
Only 15 states have explicitly promised to publicly report 100% of their settlement expenditures, according to a 50-state survey from OpioidSettlementTracker.com author Christine Minhee. Maine is not one of them.
Maine has only committed to publicly reporting on 50% of its settlement expenditures, all from the Maine Recovery Council, which oversees the Maine Recovery Fund. The council is required to develop a “centralized public dashboard or other repository for publication of expenditure data,” according to the MOU. The council can request fund recipients submit certain data, including on outcomes to support this.
The Recovery Fund also appears to be the only bucket of money with any reporting requirements. This includes various annual reports to the state legislature from the Attorney General, whose office provides legal counsel and administrative support to the council.
There are no requirements under Maine law or the MOUs that the Office of the Attorney General or the direct share subdivisions publicly disclose how they are spending settlement money.
