Service providers have ideas on how WV’s $1 billion in opioid settlement money should be spent
As $1 billion in opioid settlement money comes to West Virginia, service providers have ideas on where the funds should go. (Getty Images)
Over the next few years West Virginia is set to receive a record $1 billion in opioid settlement funds that are meant to help quell the ongoing drug and overdose epidemic, but for those who work with people who use drugs and those in recovery, questions remain on the best use of that money.
The funds will be distributed by the board of the West Virginia First Foundation, a private nonprofit created through a state law passed by the Legislature earlier this year. Board members — who are both appointed and regionally elected — span from corrections and law enforcement officials, lawyers, doctors and, against the advice of Attorney General Patrick Morrisey, local elected officials.
Critics have noted the board’s lack of diversity: of its 11 members, only two are women, there are no people of color and its representation of people who use drugs or who are in recovery is questionable.
“It really is hard to say if the right decisions for this money are going to be made when we don’t have the input of not just one person, but several people, who have different backgrounds and experiences with substance use disorder and recovery systems helping to inform the decision making,” said Laura Jones, executive director of Milan Puskar Health Right, in Morgantown. “Every program we offer, every resource we have that works, exists because of the needs shared with us by people who use drugs. You can’t just tell people, ‘we know what’s best for you,’ without listening to the experts first.”
And the experts in this case, Jones said, are people who currently use or have used drugs.
“The further away you get from involving the actual people who are served by your program in the decision making for any program, the less likely it is that you will have a successful program,” Jones said. “That’s a fact.”
This lesson was learned by leadership at Milan Puskar Health Right through practice. Certain services and programs offered by the clinic have been tailored over time based on recommendations by people who use drugs.
“And that’s the way it should be,” Jones said. “That’s the way it has to be to work.”
Jones would like to see the state use settlement money to support alternative programming, like creating community programs and support systems for people who are transitioning out of active addiction.
The most important thing, she said, is more funding for housing.
There are currently at least 174 people living either on the street or at shelters in Morgantown.
“That’s the highest we’ve had that number be in decades,” Jones said. “We need to understand that most people living on the streets who are using drugs are not going to quit using drugs while on the street.”
And even when folks are able to get into detox or rehab programs, the lack of support once they finish often means slipping back into old environments and habits, Jones said.
Housing options in the state for people who use drugs are limited. Many people are waitlisted for low income housing programs, unqualified because of anything from drug use and previous drug-related convictions to a lack of identification and, in general, adequate housing options are in short supply, Jones said.
And along with housing comes the need for dependable, robust public transportation; an issue that has been noted by officials across the state for years when it comes to recovery programs.
As the interim executive director of the West Virginia Family of Convicted People, a nonprofit that supports people who are incarcerated and their loved ones, Deborah Ujevich has seen first hand what a lack of funding in diversion and prevention infrastructure has meant for people who develop substance use disorder in the state.
She spends several days a week working at a detox center for people who use drugs. It’s not uncommon, she said, to see people successfully complete the detox program but then get left behind when there are no beds available at a rehab center or they don’t have the resources to travel to a program potentially counties away.
Ujevich worries a lot about the center of the state, where public transportation between small counties to bigger cities is sparse and the programming available is limited.
“We are setting people up to fail, and that’s the hard truth right now,” Ujevich said. “We need to put our focus on rehabilitation — accessible, realistic rehabilitation — and diversion. That is the only way we’re going to see things change.”
Ujevich is in long term recovery from heroin use and spent nearly two years behind bars in West Virginia. Through those experiences and, in more recent years, her work as an advocate, she is intimately familiar with how the current systems often fail vulnerable people.
West Virginia, she said, puts too much focus on law enforcement and corrections when it comes to confronting the drug epidemic. This kind of system, she said, makes for more victims than success stories.
“People are dying in our jails when they haven’t even been sentenced for a crime,” Ujevich said. “We are in a crisis mode here, and the one thing I know is that putting any of this [settlement] money toward law enforcement and corrections is going to be a mistake — a huge mistake.”
Ujevich said she’s been “screaming for years” for the state to put funding toward a work-release pilot program that would divert certain non-violent offenders from serving jail time to working and attending a rehabilitation or treatment program for mental health or substance use disorders.
The Legislature, she said, has passed this law, but there hasn’t been any money allocated toward it from the state budget.
“Well today we have the money — there it is, now use it,” Ujevich said.
Another use for the money, Ujevich said, should go toward preparing people who are incarcerated for drug-related crimes for release back into communities.
She knows a number of people who have served their time and gotten sober, only to come out of incarceration without a place to live or a support system to help them settle back into society.
“I’m very lucky that I had a supportive family, that I was resourceful when I got out of jail,” Ujevich said. “The reality is, though, not everyone has that.”
There are few limits to what the opioid settlement funds can be used for, according to the memorandum of understanding filed when the West Virginia First Foundation was formed. The only stipulation is that programs funded with the money must be evidence-based or evidence-informed — terms that are not defined in the document.
At a recent meeting in Charleston, members of the federal Presidential Advisory Council on HIV/AIDS floated the idea of using the state’s monumental settlement funds to help respond to the ongoing HIV crisis in the state.
But state laws limiting harm reduction complicate the ability to do so. Jones runs the largest syringe service program in the state. She said she would “love” to see money from the opioid settlements go toward evidence-based programming that are proven to both divert people to recovery and keep people safer while they use drugs by limiting the chance of contracting diseases.
In the last six months, Milan Puskar Health Right has offered information and counseling for rehab services to 108 of its participants. That’s more than 32% of the clients the clinic reports serving annually through its syringe service program.
“I do believe in harm reduction as a vehicle to get people in recovery because I’ve seen it happen,” Jones said. “I’m not aware of any other program that has had the success we have, and we’ve been able to achieve that because of how robust our programs are in spite of the laws that exist.”
In a dream world, Jones said, she would like to see two specific things happen with the opioid settlement money that she believes would change the tide of the drug epidemic in West Virginia: decriminalization of personal drug use and the creation of safe injection sites.
Those initiatives would certainly save lives, she said, and people can only make it to recovery if they are alive.
“If we’re going to continue our war on drugs, we need to make sure it’s not a war against the victims, against the people who are addicted,” Jones said. “It’s sad to think that, because of where we are in the state, the two most effective things I can think of to help our people are not possible here. I wish that weren’t the case.”
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