The Lancaster County commissioners will take a fresh look later this month at how the county is spending its opioid settlement dollars.
They are not scheduled to meet this coming week, meaning the discussion would likely start at their work session the following week, on Tuesday, March 12.
The money comes from multibillion dollar legal settlements reached nationwide with opioid manufacturers and distributors. It is to be spent on preventing and treating opioid addiction; in Pennsylvania, the funding is overseen by the state Opioid Misuse and Addiction Abatement Trust.
The county has received three payments so far, totaling $2.67 million, toward an 18-year total of around $15.7 million. Each payment must be spent within 18 months, though the county is allowed to request an extension.
To date, the commissioners have allocated $827,097 to fund five initiatives, as follows:
- Neonatal Abstinence Supports Coordinator ($69,037)
- A caseworker who works with parents and infants to prevent neonatal abstinence syndrome, which affects infants exposed to drugs during their mothers’ pregnancy.
- Pathways to Recovery ($300,000)
- A diversion program allowing defendants in certain drug cases to seek treatment in lieu of prosecution.
- Student Assistance Program ($140,000)
- Provides voluntary assessments and treatment referrals to high school students dealing with mental health or substance abuse issues.
- Drug Task Force ($193,000)
- Supports a detective who deals with drug education and takebacks and a prosecutor who handles cases in the county’s treatment courts.
- Medication Assisted Treatment (MAT) ($125,060)
- Provides medication for substance abuse disorder at the County Prison.
. At Tuesday’s work session, they learned that two of them are using less money than expected, while two others could use significantly more support.
The Student Assistance Program could definitely use more funding, and it would be a top priority, said Rick Kastner, executive director of the county Drug & Alcohol Commission. The program was hit hard by budget cuts about a dozen years ago, and its roster of assessors — the individuals who visit schools and meet with students — has still not returned to former staffing levels, despite higher demand.
The County Prison, meanwhile, would like to expand its MAT program, Warden Cheryl Steberger said. Right now, it only provides MAT on a maintenance basis to inmates with prescriptions started before their incarceration. Within the next few months, it’s looking to start induction: providing MAT for eligible inmates who currently aren’t on it.
That will require significantly more staff, she said. Meanwhile, it’s aware that one of the funding sources it used to launch the program is running out: a $500,000 state grant, which will be exhausted at the end of September.
Conversely, District Attorney Heather Adams said Pathways to Recovery and the Drug Task Force will both have money left over.
Pathways to Recovery is likely to spend no more than $166,000 over its funding period, she said, freeing up at least $134,000; while the Drug Task Force is likely to need only $100,000 to $110,000, freeing up at least $83 million.
That suggests there is more than $210 million available for reallocation. That’s in addition to about $330,000 that Chief Clerk Larry George said needs to be allocated as well.
The commissioners agreed that both MAT and the Student Assistance Program were valuable. Commissioner Josh Parsons suggested confirming the budget needs for the other three programs, reauthorizing them, then considering a substantial increase for MAT and Student Assistance Program funding.
Commissioner Alice Yoder, who previously headed Penn Medicine Lancaster General Health’s community health operation, and Parsons have co-chaired Joining Forces, a coalition formed to fight the opioid epidemic.
Its existence means the county doesn’t have to reinvent the wheel, Yoder said. She suggested that the commissioners draw on the coalition’s expertise and consider whether there are existing programs that could be “taken to scale.”
‘We have a crisis’
Gail Groves Scott is the founder of the Health Policy Network, an opioid policy research and advocacy organization. She has been a vehement critic of the county’s opioid settlement strategy, saying the commissioners have moved too slowly and failed to put money where it would do the most good.
On Tuesday, she said it’s the county’s own fault if it’s struggling to understand the state settlement trust’s guidance or meet its deadlines.
“We have a crisis of people dying,” she said, “and what I’m seeing here is money sitting in the bank.”
Scott had argued at the time against putting opioid settlement money toward the Drug Task Force, saying it would not qualify as an approved use. On Tuesday, she said her views had been vindicated, and called again for the county to fund front-line harm reduction.
She contended that having county departments weigh in on their funding needs amounts to self-dealing and said county staff aren’t experts in opioid policy. Instead, she suggested the commissioners follow other counties’ lead and put out a request for proposals. Third-party organizations should be welcomed to the table, she said, including faith-based entities and those from Black and Latino communities.
Commissioners Ray D’Agostino and Parsons pushed back sharply, accusing Scott of twisting the facts. County departments do in fact have expertise in fighting the opioid epidemic, Parsons said, and consulting with them on funding is neither unusual nor problematic: It’s the normal way any government works.
Lancaster County’s results vindicate its approach to the crisis, he said. Law enforcement has been part of the mix all along, appropriately so.
“It takes enforcement and it takes treatment and it takes prevention,” he said. “It takes all of it.”
D’Agostino said the county has already made adjustments to its policy and will make more. Future options could indeed include issuing an RFP and providing grants to community organizations.
“This is the beginning of a process,” he said.
In 2017, the year before Joining Forces was established, Lancaster County saw 168 overdose deaths, an all-time high. The pandemic reversed gains made in 2018 and 2019, but deaths are coming down again. For 2023, the county coroner recorded 83 overdose deaths, according to LG Health.
In Pennsylvania as a whole, overdose rates have been higher and there was no post-pandemic decline through 2022.
In follow-up comments on Wednesday, Scott urged the commissioners to fund the Lancaster Harm Reduction Project, a mobile syringe service and counseling program. Doing so, she said, would help mitigate the harm coming from the spread of xylazine, known on the street as “tranq.” It is a sedative that causes severe wounds — leading, Scott said, to hugely expensive healthcare needs.
“That’s what you should be using the rest of your funds for,” she said.
Parsons thanked her; the commissioners did not otherwise respond. Parsons and D’Agostino have said they oppose syringe exchanges, calling them both illegal and detrimental.
