Since last year, more than $95 million from a federal opioid settlement has been distributed to New Jersey, its 21 counties and 241 municipalities to fight addiction. But investing that capital is off to a slow start — about 6.2% has been appropriated — even as the Office of the Chief State Medical Examiner reports nearly 2,300 suspected drug deaths so far in 2023.
The money is part of a national settlement with drug manufacturers and distributors and retail pharmacy chains to resolve their alleged roles in fostering the opioid crisis throughout the country. New Jersey and 262 of its local governments opted into that settlement, which will send more than $1 billion throughout the Garden State over 18 years.
Addiction recovery advocates say they are trying to be patient as state, county and local officials sort out how to best manage the influx of dollars dedicated to opioid use disorder, credit the state for dedicating a half-million of its appropriated dollars to emergency responses and acknowledge that the settlement fund is an opportunity to address larger structural issues including housing and transportation — and that may take time.
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Still, they say, some urgency is needed. And despite government’s efforts at transparency, advocates are concerned about the monitoring of opioid settlement spending, having already flagged some troubling appropriations, and question how the state and its 262 subdivisions will be held accountable for their disbursement decisions.
“There needs to be some balance between getting the money out but also some strategic planning,” said Ken Musgrove, director of recovery support at Community in Crisis, a nonprofit dedicated to addressing the opioid epidemic. “The need is so great that some portion of the funds need to be spent immediately.”
“And what are the ramifications for not following the conditions of litigation?” he asked.
The national settlement agreement spells out 12 approved uses, with most falling under the umbrellas of treatment and prevention.
According to a memorandum of agreement between the state and the participating subdivisions, New Jersey will get half of the expected $1 billion and the other half will be split among the subdivisions.
The state received nearly $54.8 million by the end of June, according to its annual Opioid Abatement Report, and in addition to the $500,000 allocated for emergency responses, it also appropriated $275,000 toward the development of a strategic plan.
In the first year, more than $40.6 million was sent to the 262 local governments, according to a Press of Atlantic City analysis of the 685-page Subdivision Annual Opioid Abatement Report that was made public in late September.
The documents show seven counties and 71 municipalities as of June 30 spent or earmarked approximately $5.1 million for various programs. The remaining local government opioid settlement fund dollars, roughly $35.5 million, is sitting in government coffers.
Yet those numbers could grow higher, as 23 local governments didn’t submit the required annual report and four others handed in an incomplete record, failing to answer at least 13 questions.
In a statement, the Department of Human Services said it “has continued to reach out to subdivisions that did not submit or complete reports to encourage late filing. It is our intention to update the report once we have received all missing filings.”
DHS is responsible for collecting the annual reports, but it does not have any oversight role.
The Office of the State Comptroller is expected to monitor expenditures, but its work typically ends with an audit and it is not tasked with any enforcement.
Meanwhile, dozens of local participating governments have yet to form their advisory councils or strategic plans.
“I’m getting five phone calls a week from people begging for money for recovery, housing. That’s just me. I know 10 other people in South Jersey who are getting calls, too,” said Tonia Ahern, a Cape May County-based advocacy coordinator for the National Center for Advocacy and Recovery. “There are things people need, and we’re not doing it.”
Not only is a check needed to verify spending adheres to those uses, Musgrove said, but to make sure, for example, when a county says it will purchase and install a dozen Narcan boxes, that the procurement and placement of those kits actually happens.
“Who’s holding them accountable that they’re actually delivering on what they say they’re spending the money on?” Musgrove asked.
Data from the Atlantic County Overdose Fatality Response Team released this week show that mental health, criminal history and lack of housing remain top influencers of drug overdoses in the county.
Among the red flags for advocates are two municipalities in Bergen County each dedicating $20,000 in initial funding for a law enforcement K-9 to sniff out opioids.
Both Mahwah Township and Ramsey categorized this spending as falling under harm reduction, one of the 12 approved uses listed in the settlement agreement.
“Drug sniffing dogs is not appropriate,” Ahern said. “Law enforcement in general I don’t mind, as long as it is an evidence-based supportive program, not a punitive program.”
Mahwah officials did not respond to requests for comment.
Bruce Vozeh, the Ramsey borough administrator, said before deciding on the K-9, the county contacted the Department of Human Services and the Office of the Attorney General to make sure it would fall under the approved uses for settlement fund spending.
“We were advised that the guidelines were broadly written with intention,” he said via email.
A spokesperson for the Office of the State Comptroller backed up Vozeh’s comment. While subject to state oversight, OSC spokesperson Pamela Kruger said, the 21 counties and 241 municipalities have a lot of discretion over how their settlement dollars can be spent.
“OSC is actively coordinating with DHS and the Attorney General’s Office to ensure all settlement funds designated for opioid remediation are being used in an evidence-based and evidence-informed manner,” Kruger said.
But it remains unclear what will happen if the OSC deems an expenditure as failing to meet the approved uses.
DHS, referencing the national settlement agreement, said it “is not permitted to approve, deny or direct local government on how to spend their settlement funds.”
In a statement, the Office of the Attorney General said, “The office cannot comment or speculate about actions that may be taken in the future.”
Vozeh described the K-9, named Jack, as an “indispensable asset” and “part of a multilayered effort” to address the opioid epidemic. He noted that the dog’s presence in the community has already prompted more discussion of opioid misuse.
“Most importantly, Jack will help prevent future overdoses by locating the drug itself,” he said. “Every dose of fentanyl that is prevented from sale is a potential life saved.”
Advocates also worry that without proper enforcement, governments will use their opioid settlement money to replace other funding that has supported long-standing programs or exceed the maximums that can be used for administrative purposes — direct violations of the agreement.
“Opioid funds shall be used to supplement and shall not supplant federal, state, county or municipal funds,” according to the memorandum of agreement, which also says no more than 5% of each government entity’s share can be spent on administrative expenses.
At least eight municipalities set aside part of their opioid settlement fund to support Law Enforcement Against Drugs, or L.E.A.D., a drug deterrence curriculum led by trained police officers that often takes place in schools. At least six others dedicated money toward National Night Out, a long-running annual neighborhood event that aims to build relationships between law enforcement and the communities they serve.
“That really needs to be looked at in terms of ‘What did you do the year before?’,” Musgrove said.
The OSC did not answer a question asking for a description of its oversight process, but Kruger in a statement encouraged members of the public to help the agency.
“When hundreds of local entities are making these kinds of spending decisions, an effective first line of defense is transparency and accountability. That means mayors, council members and other public officials need to be clear with residents about how they intend to spend funds and how it will serve the larger purpose of helping to prevent opioid overdoses and deaths. We also welcome tips and complaints of fraud, waste and abuse,” Kruger said.
With just 6.2% of the fund appropriated, advocates are hoping the money communities have yet to spend will be used on evidence-based solutions.
“We want money spent to save lives and to make things better for people,” Ahern said.
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Since fall 2022, the New Jersey Opioid Recovery and Remediation Fund Advisory Council, formed in December 2022, collected public input during three in-person and two virtual listening sessions, and via its online portal.
Angels in Motion was among the dozens of nonprofits that submitted a written proposal to the state requesting funds.
Supported solely by donations and volunteers, Angels in Motion conducts outreach to connect individuals with inpatient and outpatient support services, helps finance sober living, offers overdose prevention training and the overdose reversal medication Narcan, and provides food and transportation to those in need.
It asked the state for $1 million over three years so it can hire four full-time and one part-time staff members, and cover other expenses.
“I don’t even know if anyone looked at it. I never heard anything about it,” said Susan Long, Angels in Motion’s New Jersey chapter director and a full-time social worker.
Long noted that Atlantic County, where she predominantly does outreach, has set up an infrastructure so nonprofits can apply for funds, and she hopes grassroots groups, not just large organizations with extensive grant writing experience, get a shot at the pot.
“I have a purpose, but it’s starting to get where it’s exhausting,” she said.
Eva Loayza-McBride, deputy communications director for the Department of Human Services, said the New Jersey Opioid Recovery and Remediation Fund Advisory Council has shared all of the proposals it has received and is now reviewing them. Awards will be made following a formal procurement process, she said.
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Long’s organization is not the only one wondering what happened to its proposal, as some are calling for better messaging from the state and more clarity on processes.
“There’s an incredible lack of communication on all levels regarding this funding,” wrote Musgrove in his testimony to the state. “Grassroots and family members are completely unaware of funding and their ability to provide input on how these funds should be spent. As those most impacted, their voices should be the loudest and their concerns given the respect they deserve.”
There were hundreds of submissions, many of which came from the recovery community and touched on the same needs: scarce housing and transportation services; few supports for children with a deceased parent and the relatives who are now raising them, as well as for pregnant women who are either in recovery or lost a partner to opioid use disorder; a dearth of juvenile recovery services including alternative schools; insufficient funding for peer recovery support centers; and few job opportunities and little workforce development assistance for those in recovery.
That information will now be used by a vendor, which DHS is in the final stages of procuring at a cost of $275,000, to form a strategic plan.
Initially expected to be released in spring 2024, DHS now says the plan may arrive later.
“Based on input from the Council, we have asked the intended vendor to undertake additional public facing events with the community, which will extend the completion timeframe,” DHS said.
The delay could cause a hold on spending by local municipalities as some — including Cape May, Atlantic and Salem counties — say they are hesitant to dip into their settlement fund until the state’s plan is released.
“The state holds 50% of the funds, and we have 1.28% of the funds,” said Peter Belasco, the Cape May County drug and alcohol director, referencing the proportions of the overall settlement dollars each is set to receive.
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Cape May County, as of June 30, reported receiving $665,018 in opioid settlement funds, which remain untouched.
“It would make sense to wait until they come out with their strategic plan to then look at what gaps are left over so that we can use the small amount of funding that we do receive in the most effective way,” he said.
In the meantime, Cape May County and others are continuing to use separate funding sources for opioid abatement and prevention, like grants from the Governor’s Council on Alcoholism and Drug Abuse.
As localities make due with other dollars and await the state plan, the recovery community has a reminder about the source of the opioid settlement fund and how it should be used.
“These are settlement dollars proffered from the opioid manufacturers, distributors and collaborators to ameliorate the devastation of the wanton disregard for human life,” Musgrove wrote in his testimony to the state. “What you do here today will have a lasting impact on how we can remember and honor those lost, how we help those left behind and those that are still struggling. We need to move swiftly, deliberately and with purpose.”