Scrutiny and secrecy defined Pennsylvania debates over how to spend opioid settlement billions in 2024

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Ed Mahon reported this story while participating in the USC Annenberg Center for Health Journalism’s 2024 Data Fellowship.

HARRISBURG — This was a crucial year for opioid settlement money in Pennsylvania.

For the first time, counties across the state faced serious accountability from a powerful state oversight board. The board scrutinized their decisions on how to spend initial payments from what is expected to total billions of dollars.

But even as the Pennsylvania Opioid Misuse and Addiction Abatement Trust took on increased oversight, board members conducted much of their work behind closed doors. The secrecy prompted objections from advocates, local government officials, and even one of the board’s own members.

As the public was blocked from attending some meetings and silenced at the ones they could witness, Spotlight PA partnered with other news outlets to bring more transparency and accountability to the process.

Members of the opioid board tackled a range of issues, including programs that provide clean needles to drug users, fund public defender offices, and support Kensington residents. The decisions they made could shape how settlement money is spent for years to come.

Here are five key takeaways from the year in opioid settlement spending, as Pennsylvania responds to an epidemic that continues to kill thousands of people annually.

1. Debates over handing out clean needles to drug users

There’s a contradiction between opioid settlement documents and Pennsylvania’s drug laws. The consequences played out in a rural Western Pennsylvania community this year, as a proposed solution stalled in the legislature.

At the center of the debate are programs that provide clean syringes and other supplies to drug users. These programs have widespread support in the medical community, and they typically connect people to other services, such as overdose reversal medication, wound care, and substance use treatment.

The settlements reached between drug companies and state attorneys general identify expanding these programs as one of the core strategies for the billions of dollars that are coming to states.

But in Pennsylvania, these programs are widely considered illegal — or at least in a gray area. Pennsylvania is one of 12 states that do not implicitly or explicitly authorize syringe services programs through statute or regulation, according to an analysis last year. And the state’s definition of illegal drug paraphernalia includes hypodermic syringes, needles, and other objects used for injecting banned drugs. That means people who run these programs risk getting arrested in much of the state.

Legal concerns over these programs led commissioners in Westmoreland County to pull $150,000 in opioid money from a nonprofit, Spotlight PA and WESA reported earlier this year.

Following the newsrooms’ coverage, a state House committee for the first time in at least 10 years approved a bill to authorize these programs across the state. Still, the measure failed to clear the legislature. And these programs faced separate setbacks in Philadelphia, where Mayor Cherelle Parker opposed using public money for them.

Allegheny County, where officials took action years ago to allow these programs locally, did use opioid settlement money for syringe services, according to publicly released records.

The opioid trust earlier this year approved Allegheny County’s decision to dedicate about $325,000 for those services, despite opposition from one board member.

2. Prosecutors vs. public defenders

While prosecutor offices around Pennsylvania are eligible to receive millions of dollars from opioid settlements, their counterparts on the other side of the courtroom have been shut out.

Guidance from the opioid trust discouraged counties from spending their funds on public defender positions, Spotlight PA reported in April. A lawsuit from the ACLU of Pennsylvania cited this reporting as an example of how indigent defense is often excluded from funding.

A report from a national coalition cited Spotlight PA’s reporting and listed the disparity between public defenders and prosecutors as an example of problematic spending. The Public Defender Association of Pennsylvania asked the trust to reconsider and clarify the issue.

In May, the chair of the trust, Tom VanKirk, publicly reiterated the opposition to using the money for public defenders. But he suggested that a social worker within a public defender’s office might be allowed.

Bucks County later reported dedicating $97,000 in opioid settlement funds for that type of social worker position. Connecting people to services early in their case helps them access services and achieve better outcomes, according to the program description for Bucks County. The trust in November approved that use.

District attorney offices can also expect to face more scrutiny in 2025. An amended court order from October clarifies that those offices have to file spending reports with the trust at least once a year. That addresses a disparity in accountability that Spotlight PA and WESA first reported on in 2023.

3. Fights go to court

Trust members have the power to withhold future funding from counties if they decide they spent the money in ways that don’t align with settlement requirements.

This past year, the trust rejected a number of programs from counties, including $17,500 for a Lawrence County program involving police cruiser upgrades, $20,000 for a detective initiative in Cameron County, and about $323,000 for a Blair County drug court program.

A few counties took the disputes to court.

Somerset County appealed the denial of $30,000 for a youth program. Philadelphia is objecting to the denial of millions of dollars aimed at supporting Kensington residents. And most recently, Northampton County filed an appeal over the trust rejecting a portion of a newsletter program.

Whatever Commonwealth Court decides, it could have an impact beyond those three counties. Philadelphia, for instance, is asking the court to issue guidance that offers a broad interpretation of spending requirements and is deferential to county decisions.

Those cases were pending as of Dec. 18, court records show.

4. Public involvement limited

Members of the public have been routinely shut out of having a meaningful say in how opioid settlement money should be used, a first-of-its-kind national survey conducted by KFF Health News and Spotlight PA found earlier this year. The people who are shut out include those who have lost loved ones to the opioid crisis or are dealing with it daily.

The story highlighted the issue in Philadelphia’s Kensington neighborhood, which has received international attention because of the toll the opioid crisis has had on the community. The trust in June rejected $7.5 million meant to help residents of the area, and one local leader called the action “a retraumatizing moment.”

Two state senators who serve on the trust later toured the Kensington area, and the experience in the neighborhood prompted state Sen. Greg Rothman (R., Cumberland) to change his view on the issue, Kensington Voice reported in September. A committee of the trust in October reversed some of the Kensington rejections.

Pennsylvania’s trust continues to not allow public comment at its meetings. Advocates have pushed for more involvement here and in other states as well.

In Maine, a former member of that state’s opioid council cited one of Spotlight PA and KFF Health News’ findings at a recent public forum. Courtney Gary-Allen, an advocate on substance use issues and who is in long-term recovery, urged that state’s council to allow comment at all regular meetings.

“We have to have all of these discussions in a public and transparent way,” she told Spotlight PA in December.

5. More information, clarity on spending

Two crucial questions surround the opioid settlements. Where is the money going? And is it being used well?

That’s been hard to say in many cases, especially in a place like Pennsylvania where so many decisions happen locally.

To answer those questions, Spotlight PA and WESA earlier this year filed open records requests with every county in the state to make spending reports available to the public, advocates, researchers, and other journalists. In November, Spotlight PA published a searchable database that tracks spending decisions by county governments and whether the trust has approved them.

Efforts from others have brought greater clarity on spending as well, including in Wyoming, Michigan, California, and nationally.

More money is on its way. The opioid trust in November approved distributing about $247 million more in payments to local governments. That’s part of the large share Pennsylvania expects to receive over many years, including up to about $1.8 billion from two waves of agreements with multiple companies, according to a recent court order.

KFF Health News’ Aneri Pattani and Henry Larweh contributed to this report.

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