Communities ravaged by America’s opioid epidemic are starting to get their share of a $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 that places look more like the area around Findlay. Here, conservative Hancock County has built a comprehensive system focused 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 who heads the county’s addiction and mental health efforts. “We have to build recovery-oriented communities that support individuals.”
It was 2007 when Ms. Stuby began hearing from officials about prescription opioids being misused. The recovery system then included only some outpatient services and Alcoholics Anonymous.
“We were grossly underprepared, like I think many places across the country were, for the opioid epidemic,” Ms. Stuby said.
From 1999 through 2020, 131 deaths in the county were attributed to opioids. Across the country, it was more than 500,000. The county’s opioid-linked death rate over that period paralleled the nation’s.
But the county took a path that many places did not.
Officials created a plan with the help of the federally funded Addiction Technology Transfer Center that stressed recovery and built upon a local recognition that “this is our family, our friends, our brothers, our sisters,” Ms. Stuby said.
The settlement funds from drugmakers, wholesalers, and pharmacies will not be enough for every harm reduction, treatment, recovery, and prevention program that might be needed to fight the nation’s opioid epidemic.
But it could be enough to jumpstart major changes to the efforts.
Since its implementation began a decade ago, Hancock County has brought in more than $19 million in grants, largely from the federal government. Other funding comes from a county tax levy and the state. Health insurance helps pay for treatment.
Like hundreds of U.S. communities, it’s launched a drug court where people can avoid jail if they work on recovery. At a recent session in the county’s historic courthouse, applause rang out as one woman advanced toward graduation. The judge also ordered an immediate drug test to determine whether one man could continue in the program.
Some advocates urge communities not to spend settlement funds on drug courts, saying there’s limited evidence they work and that participants who return to drugs can end up with harsh jail sentences.
Kerri Kostic, who had been using drugs for 30 years, said drug court helped her stop using.
“It was just an endless, ridiculous, awful cycle,” said Ms. Kostic, now a peer 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 an entry-level certificate for work in the field – a partial answer to a recovery workforce crunch.
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 teens.
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 showing up at the recovery center can be connected in a “warm handoff” to a treatment provider because of personal connections between the programs.
The idea, which echoes experts’ recommendations for use of the settlement money, is that people with the right support can recover from addiction. Every person who stays in recovery is a person who will not die of an overdose.
“It’s not just about how to get people off of 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, for families to not give up hope that their loved one will be able to get and stay in remission,” he said.
The first step is keeping people who use drugs alive using practices known collectively as harm reduction.
There’s evidence that the efforts are helping. After 28 overdose deaths from all drugs last year, Hancock County has three confirmed overdose deaths and five suspected ones so far in 2023.
The county launched a needle exchange, providing supplies to reduce needle sharing and the risk of HIV and hepatitis C. These are policy staples in larger cities, but less common in smaller ones, in part because critics worry they enable illegal and unsafe behavior.
At the Family Resource Center, the quick response team compiles lists of overdose survivors and people with substance use disorder who are being released from jail or prison.
One afternoon, Misty Weaver, the team coordinator, went out to check on two recent overdose survivors. One who overdosed in a Walmart parking lot gave a home address that didn’t exist. The person who answered the door for the other said the man had gone to a rehab facility. Ms. Weaver left a bag full of materials and information about other services.
Christina McCarver, then living in Toledo, did a 30-day treatment program to address her opioid addiction. Within 24 hours of being released, she relapsed and returned to the treatment center.
The center found a place for her in its Findlay facility. After that program, she moved into a room at the women’s recovery home. It turned out to be an important part of her recovery.
“We keep each other in check,” she said. Instead of talking about drugs with “using friends,” she said, “we kind of do it the other way, where we talk ourselves into, ‘Let’s go to a meeting instead.’”
For Ms. McCarver, who’s survived a half-dozen overdoses in a life rife with trauma, being in the house made her feel like she was trusted and needed again.
After eight months of living there, Ms. McCarver became the on-staff coordinator for the house. After three years with that job, she’s now serving in 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.