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Many local governments are sitting on millions in opioid settlement payouts

An illustration shows a person casting a long shadow. Inside the shadow there are flowers and pill bottles.
Angela Hsieh
Local governments in Missouri are receiving millions in opioid settlement funds, but many haven't spent any of it.

Local governments in Missouri spent just 11% of the millions in opioid settlement payouts they had received through the end of 2023, according to the state health department.

The settlements came after city, county and state officials sued multiple drug companies and distributors for their role in the opioid crisis. The state and local governments expect to receive hundreds of millions in settlement funds over several decades. Missouri law requires that the money be used for treatment, prevention and other addiction abatement.

Since 2022, counties and other local jurisdictions have received more than $28 million in payments. By the end of 2023, local governments in the state had spent just over $3 million of the current payout. More than two-thirds of local governments had not spent any of the funds they received.

“Many local governments reported 2023 was spent planning how to budget, track and allocate these funds,” state officials wrote in Missouri’s first settlement spending report, released earlier this year.

Drug overdoses have killed more than 23,000 Missourians in the last two decades. Many of those were attributed to fentanyl and other potent opioids.

“We aren’t in a rush to spend it, because we’re trying to come up with a plan that would get the most bang out of these dollars,” said St. Louis County spokesman Doug Moore. “We want to obviously be thoughtful so that this has a lasting impact on the efforts.”

The county has formed a committee that is discussing how to spend the money, he said.

“The number of overdose deaths that we’re seeing is still very high – more than homicides in St. Louis County – and it touches all demographics,” Moore said. “It’s leaving a real indelible mark on our society, and we don’t want to be hasty.”

Local governments taking their time isn’t necessarily a red flag, said Shelly Weizman, an addiction policy expert at the O'Neill Institute at the Georgetown Law Center.

“Sometimes, when you have a windfall of funding like this, there can be a real rush to spend,” she said. “You actually don't always want to see a rush to just get the money out the door without taking a closer look at where it could be most maximized.”

She said it’s important to look at how officials are planning to use the funds, and if there’s an organized effort to spend the money with a specific end goal in mind.

Local governments are also working to spend federal coronavirus relief funds. St. Louis County Executive Sam Page last year said officials are focused on spending those dollars, which have to be used by a certain date, before spending opioid settlement funds.

Jefferson, Franklin and Phelps counties had not spent any opioid settlement payouts through the end of 2023. O’Fallon, St. Peters, Florissant and St. Charles recorded zero spending, according to the state report.

St. Charles County has spent more than $16,000 of the $2.7 million it has so far received, according to the state report. Around $2,600 of that money went to a corrections peer recovery coach, and the rest went to shirts and a speaker fee for a teen drug summit.

The St. Louis Department of Health since the beginning of 2024 has spent more than $1 million on harm reduction and education efforts in the city’s neighborhoods most affected by opioid overdoses, spokeswoman Erin Ford said. The newly formed Behavioral Health Bureau is in charge of allotting remaining funds.

That spending is not reflected in the state report, which catalogs spending through the end of last year.

In Chesterfield, around $30,000 of settlement payments have helped establish an alternative municipal court that directs people to treatment, said Prosecuting Attorney Tim Engelmeyer.

“The easy way to judge a case is just to assess a fine and move on,” he said. “The problem with that is it doesn't really address recidivism. People seeing the same people with the same crimes over and over.”

It’s likely Chesterfield was able to get its money spent quickly because city officials already were discussing establishing a special circumstances court when the settlement money arrived, Engelmeyer said.

Most non-traffic related charges in municipal courts are drug-related, Engelmeyer said. Yet drug treatment and other alternative courts are most often seen at the state level.

“Whether it's a shoplifting case that's driven by somebody who needs to steal to support a habit, whether it's somebody driving while suspended who has to drive to support their habit. I would say the [largest] percentage of cases that we're dealing with in our special circumstances court are driven by opioid addiction,” he said.

Sarah Fentem is the health reporter at St. Louis Public Radio.