Florida is set to receive an estimated $3.2 billion in settlement money from opioid manufacturers and distributors.
This year begins the rollout of most of that money, which comes after yearslong, nationwide lawsuits. All across the country, states are getting money they can use to try to curb the opioid crisis.
Now, states and municipalities are deciding exactly how to spend their money, and how to weigh the different needs of a community when it comes to fixing the opioid crisis.
Florida’s payout is budgeted to last about 18 years. Here’s what you need to know about the money headed toward the state and what it will be used for.
Why is this money available?
Governments across the nation took companies that made, sold and distributed opioids to court, a massive undertaking that will force the companies to pay more than $50 billion combined.
Florida’s estimated $3.2 billion comes from eight different settlement agreements. The money is divided into different pots for state and local use. The state is also receiving $84 million worth of naloxone, which reverses opioid overdose, from Teva Pharmaceuticals.
A collection of drug distributors, including Cardinal Health, McKesson and AmerisourceBergen, have the highest settlement payment at about $1.3 billion, according to a presentation given by the state attorney general’s office.
Florida also struck deals with Johnson & Johnson, Endo Health Solutions Inc., Allergan, Teva Pharmaceuticals, CVS, Walgreens and Walmart.
In Florida, some money has already been dispensed to large counties and municipalities. For state dollars, because the fiscal year began July 1, a large portion of the money is only being rolled out now.
How is the money divided?
Different states are all taking slightly different approaches to how the opioid settlement money is controlled and distributed.
Unlike in some other states, no money in Florida will be controlled by the attorney general’s office, which litigated the claim.
Instead, there are three main arms of disbursement: a state-controlled fund, a regional fund to be spread among counties and a third fund given directly to cities and counties that joined onto settlements.
The state also created the Statewide Council on Opioid Abatement, which will help monitor the spending across the state and advise governments on what to do with their dollars.
Money does not go directly to family members of people who died from opioid overdoses.
What is the state fund?
The state fund is getting the largest amount of money from the settlement over the 18-year payout.
The state money will be appropriated by the Legislature in its budget, which is then signed or vetoed by the governor.
This first year, the Legislature had about $205 million available, and appropriated more than $173 million. The rest can go back into an investment fund, with profits also available to the state.
About $27 million of the money will go toward expanding the Coordinated Opioid Recovery program, or CORE, to 17 new counties. The program was established last year and focuses on three ideas: immediate life-saving care, addiction-focused specialists to help patients stabilize, and then recovery aided by a variety of social services. Twelve counties currently have the program.
About $20 million will go toward expanding treatment and recovery services, including residential treatment programs, and $8.7 million will go toward expanding recovery housing.
The funds will also be used to expand medication-assisted treatment, with $6 million to create a mobile program for people with limited access to standing clinics, like homeless people or rural communities, and $2 million to allow people to continue their treatment in jail.
About $4 million will also help establish the Office of Opioid Recovery, which will monitor how the settlement funds are spent.
What is the regional fund?
The regional fund has the next-highest amount of money from the settlement, and is intended to spread funds to all of Florida’s 67 counties.
The 20 counties with populations of 300,000 or more — including Hillsborough, Pasco and Pinellas — get money directly from this fund, and county commissioners decide how to spend it.
Before some counties even received their money, they set up advisory task forces to help weigh in on how it should be spent. In Pasco, for example, a task force meant to guide the county commission received 24 applications for community projects, which the task force will rank at an upcoming August meeting.
Pinellas also has an opioid funding advisory board. In June, the Pinellas County Commission approved a priority list from the advisory board, which included expanding medication-assisted treatment, which uses drugs like methadone along with counseling to help people recover, and expanding treatment for uninsured mothers with addiction.
For Florida’s smaller counties, money will go to the Department of Children and Families, which will pay it out to area managing entities. Managing entities oversee state and federal substance abuse and mental health systems throughout Florida, and include groups like the Central Florida Behavioral Health Network.
In this first year, the regional fund is getting about $169 million total, between money spent directly to each large county and money spent through managing entities.
Counties with higher populations do not automatically get more money. For example, Miami-Dade, Florida’s largest county, will get only 5.2% of the regional fund’s settlement dollars.
Counties and cities worked out the metrics they would use to determine the settlement breakdown themselves.
What is the city/county fund?
Counties will get money through the regional fund — but a third fund also gives them even more.
Per the settlement agreement, 15% of Florida’s total payout will be given directly to cities and counties that signed onto the settlement. That money will be sent to the individual municipalities, and their governments decide how to spend it.
Cities and counties can choose to pool their money with another county or city if they create a written agreement and present it to the state.
So how does that work?
For example, in Pinellas, the county received $13.4 million from the regional fund, sent to the county in April. Then, from the city/county fund, Pinellas received an additional $1 million. The county will get an additional $20 million over the next 18 years from just the city/county fund, on top of the $90 million it will receive from the regional fund.
Multiple cities in Pinellas also signed on to get settlement money. St. Petersburg will get $6 million spread over 18 years, and the city government would then decide how to spend it.
In the first year, Hillsborough received about $15 million from the regional fund, and another $1.3 million from the city/county fund.
The math for how much money goes to each city and county was set in the settlement agreement and can be seen here.
Who decides how to spend the money?
The Legislature decides how to disburse the state fund. Cities and counties will decide for themselves how to spend the money they receive using their own commissions and councils.
But the newly created Statewide Council on Opioid Abatement will advise governments on how they could and should spend the money. The council will consist of 10 people, chaired by the attorney general, who each will serve unpaid two-year terms.
Not all members of the council have been appointed yet. According to state statute, the council must have their first meeting by Aug. 31.
Along with the attorney general, the council will include the Department of Children and Families secretary; one person appointed by the governor; one person appointed by the Senate president; one appointed by the House speaker; two mayors or commissioners appointed by the Florida League of Cities, including one from a municipality of fewer than 50,000 people; two who are county commissioners or mayors appointed by the Florida Association of Counties; and one appointed in an alternating cycle between the city league and the association of counties.
The council will meet quarterly and will work with the existing Statewide Drug Policy Advisory Council to review recommendations on curbing the opioid crisis and review data on how the settlement money is being spent.
All counties, cities, managing entities or state agencies that receive money from the opioid settlement need to report to the council how they intend to spend it and how they ultimately spend it.
If money is not being spent in line with the opioid settlement guidelines, or is being misused, the state could challenge cities or counties, or cities and counties could challenge the state, in court to determine whether the money should be clawed back or repaid.
How should the money be spent?
The settlement agreement requires that money should only be used to try to curb the opioid crisis.
Approved spending options reflect the multifaceted nature of the crisis, and the various communities that have been affected — including the uninsured, people with low income, people without affordable housing access and more.
It also reflects different groups who may have interest in receiving funding — including law enforcement and emergency medical technicians, behavioral health groups struggling with workforce shortages and medical researchers.
The U.S. government prioritizes a group of “core strategies” for local and state spending, including expanding naloxone access to the uninsured; expanding recovery treatments for pregnant women and providing services including housing, transportation and job training; expanding treatment for babies suffering from conditions caused by being exposed to opioids in the womb; and treating incarcerated people suffering from addiction.
To see the detailed list of core strategies, read the segment of the agreement here.
Other options for treatment are also eligible for funding. The settlement divides those approved uses into treatment, prevention and other strategies, like expanding research on how to treat chronic pain.
A full list of appropriate available uses is here.