If we knew what to do we'd have done it already

In which I wear my local government nerd hat

Let me put a full disclaimer up top: I am running for the NY State Assembly district 122. I would love your support, if you think I’d be a good fit for AD122.¹ But that is only tangentially related to why I’m telling you about how “curing the opioid epidemic” is much, much, much more challenging than you might think.

John Oliver and the Last Week Tonight team² did an excellent piece on the opioid settlement dollars that are being pushed out to counties³ who participated in class action suits against drug companies. I can’t comment on how other counties (and LGUs⁴) are handling this influx⁵ of dough but I suspect some of our issues likely rhyme.

Anyhoo - it’s well worth a watch:

Welcome back.

The fundamentals outlined above are a great primer, especially the parts about how so very many companies popped up just to try to separate local governments from this settlement money. We’ve been pitched by a bunch of them, including Deterra.⁶ When some businesses smell a settlement, they’ll gin up all kinds of products to help officials spend it.⁷

Most⁸ of us in the government, mind, are doing our best to learn what we can about all of the issues facing our communities and are willing to ask questions of the experts so that we can be responsible stewards of public funds. We live where we serve and want it to be a decent place, otherwise why even bother being in a local government?⁹

But even the experts are flummoxed by issues like the opioid epidemic, otherwise they’d be solved already.

(This should probably be a footnote but Imma put it here. The county admin and I have a routine we do. I’ll ask him, “how do we solve homelessness, Steve?” And he’ll say, “Give people houses, Adrienne.” And then we laugh and laugh because if it were that easy we’d have done it by now.¹⁰)

All of the easy solutions to the opioid epidemic are in place.¹¹ And, yes, getting a big bucket of money from the distributors and manufacturers who profited from this rolling nightmare is great. But there are two really big problems¹² related to the money bucket that most folks can’t see.

Problem 1: One of our budget guys put together a spreadsheet that explains how the disbursements will come in. As of February ‘24, we anticipated funds from nine companies and those payouts will go until 2040. The amounts are divided up between restricted and unrestricted funds. Oliver told you about what those are in the segment above.

My copy of said spreadsheet. Enjoy my notes, I guess? Sadly, you can’t see the one that says “projection, not commitment,” which will be relevant in a minute.

Now let’s throw in the rest of the information:

There are half-a-dozen suits still ongoing (including the Purdue/Sackler one) and we have no idea what we’ll see from those. Also: any of the companies currently paying into the fund could declare bankruptcy and stop paying. Once the chart moves beyond about 2028, the numbers cannot be relied upon because of the way some settlements are structured (and each one has its own structure because of course it does.)

Why is this a problem? Let’s say we want to pool all of the money and use it for something big like a drop-in shelter/treatment center. We have the funds to start it¹³ right now. What we can’t do is budget out its ongoing financial support because we have no idea if this money will arrive or when.

If I were funding this with my own cash, I’d be like let’s just do it and figure it out as we go. But you can’t do that when using the public’s funds, nor should you.

You can’t just build it and cross your fingers. What happens when the settlement money runs out? Will we actually have more money once everyone settles? Should we plan something bigger? Or smaller? Should we just sit on the money until we know truly what we have despite *waves hand around?* Or use it all up on smaller thing? Like what, tho? And on and on and on.

If we had a finite figure and timespan, planning would be possible. But right now…oy.

Problem 2: one way to use the money is to hire more addiction counsellors/social workers/etc. What we most need are more people who know what they are doing moving here to do that thing. I’d argue there is absolutely no one in the government who disagrees.¹⁴ We want to hire qualified people.¹⁵ PLEASE.

Here’s the problem: there’s no one to hire.

I don’t mean that in a “no one wants to work” way¹⁶ but in a “there is literally a shortage of these kinds of workers who want to work a) in a rural community and b) for a county agency.”

While the state and Feds keep pushing out grants to recruit to underserved areas, we can’t take their money and give it to workers because no one applies for the jobs.¹⁷ We just sent $40,000 back to Albany (which hurt more than I can say) because we couldn’t spend it on new employees because there weren’t any.¹⁸

Maybe our opioid dollars are better spent on student load forgiveness in desirable fields in order to lure counselors and addiction professionals to us? Maybe we should build a training center rather than a treatment center.¹⁹ But there also seems to be a shortage of teachers in health care fields because most of them can make a lot more money working as nurse practitioner than as adjunct faculty.

And then you get into the larger issues in rural areas, like if we somehow recruit and hire, where will the person actually live? Apartments for working professionals are a) rare and b) expensive. Don’t even get me started on our housing stock. Again: there are programs working to alleviate this but not nearly enough to make a difference quickly.

So where does that leave us w/r/t the settlement cash?

We’re working on it. While we’ve rejected the solutions that make it look like we’re doing something without actually getting us closer to our goals, we are keeping an eye out for equally rural counties who have a firmer grip on the problem and talking to folks in the field who know what might actually help.²⁰ An idea involves better data collection, which isn’t sexy or a thing you can simply buy²¹ but might be incredibly effective when it comes to the actual problem.

It’s slow-going—and while we all want to fix it right now, speed will only yield dumb decisions. This crisis has been here for years. The easy stuff hasn’t made it go away. The hard stuff is, unsurprisingly, hard.²²

1. This whole post will likely be linked over there in some form or fashion. It’s still unclear where the boundaries are between me-as-candidate and me-as-county-rep and me-as-thinking-human begin and end. One could argue all of those membranes are highly permeable and that is why my IBS has been extra excitable lately. Which really might be more information that you need but HERE WE ARE.

2. My dream job would be to be in the writer’s room for this show. Like I’d be happy to get coffee or do shoulder rubs or pitch the odd (and they would be odd) joke. Seriously. Call me.

3. and other local government units (like addiction recovery agencies, some towns and cities and villages and …. it gets complicated because of course it does).

4. see #3

5. should read, maybe, “influx-ish”

6. Which I keep confusing with DoTERRA, which is … apt.

7. Perhaps the biggest, most useful investment we’ve made thus far has been getting ONEboxes installed everywhere we can. Step one is saving a life.

8. Am I overstating with my “most?” Maybe. But I will always assume good intent.

9. One rep once described the job as having “none of the power and all of the blame.” BUT THERE IS SO MUCH GLORY.

10. Of course “give people houses” is the correct answer—but how?

11. You think it’s bad now? Imagine what it would look like without shutting down pill mills, suing manufacturers, and pushing out Narcan. Shit would be much, much, much worse.

12. There is a third one, which is more a gripe than a problem. Most of the amounts that these folks have to pay out will do them little lasting harm. The amounts are rounding errors rather than true punishments. Welcome to our style of capitalism.

13. That’s another issue—the amounts were looking at are not enough to do something revolutionary (unless we can partner up with other counties (which we’re looking at but being so rural causes some serious logistical issues because where would we put it where it is easy to get to for all of the partner counties and how would we transport clients across miles and miles of roads when we don’t have that kind of bus system and they don’t have cars and where would the staff live and where would we put it where NIMBY won’t be triggered but where it’ll still be easy to get to and OMG WHY ISN’T THIS SIMPLE.))

14. Remember: good intent assumed.

15. In about a dozen different fields but let’s focus on this one

16. which is a bunch of bullshit to begin with but this is already too long

17. And yes our salaries and benefits are competitive, thanks for asking.

18. not for nothin’ but most counties and healthcare systems have this problem.

19. A multi-focus job training center did just open up here. It’ll be a couple of years before we know how that turns out.

20. and if you know of any, drop a comment or send an email. Please.

21. like Narcan or new tasers or whatever

22. (that’s what she said)