Recommendations for how to spend almost $7.4 million in funds from the settlement of lawsuits against opioid manufacturers and distributors reached legislative appropriations committees earlier this month.
But former opioid users appointed to a committee created to shape those recommendations said on Thursday that the process had not given them time to advocate for projects beyond what had been prepared by the Vermont Department of Health.
The result, they told the House Human Services Committee on Thursday, was a missed opportunity to consider alternative ideas and make projects better.
“None of my experience, none of my research, none of my professional work was able to be inserted into this process,” said Scott Pavek, who added that he recently marked his 10-year anniversary in recovery from opioids and alcohol.
Pavek works for the city of Burlington as a substance use policy analyst. But he said here he was speaking just for himself, one of seven people appointed to the 16-member Opioid Settlement Advisory Committee by the Vermont League of Cities and Towns.
The recommendations presented to and supported by the committee focused on proven methods that could go into effect as quickly as possible to prevent overdose deaths, which are increasing every year, said David Englander, a senior policy advisor for the Department of Health. In 2022, at least 237 Vermonters died from an opioid overdose.
“Given the number of opioid overdoses, we are looking to find ways to save lives as soon as possible,” Englander told the committee.
The recommendations presented to the Legislature in a memo from Dr. Mark Levine, the state’s health commissioner, are:
- $1.98 million to expand the distribution of naloxone, an overdose reversal drug branded as Narcan, including through kiosks and home delivery; plus $200,000 to expand the distribution of fentanyl test strips.
- $2 million to open four additional medication dosing locations, including at least one in a correctional facility.
- $2.2 million to fund 26 new outreach workers for preferred provider organizations, including those running syringe exchange programs.
- $840,000 for motivational incentives aimed at stimulant use disorders.
- $100,000 to pilot a clinical program that would provide telehealth drop-in appointments for the care and cleaning of wounds, which can be caused by xylazine, a now-common opioid additive.
Funding for these measures comes from the first year allocation of a national $26 billion opioid lawsuit settlement reached in 2021 against manufacturer Johnson & Johnson and three drug distributors.
Part of the challenge for the department and the committee has been knowing how much money would be available to spend in fiscal year 2024, said Rep. Dane Whitman, D-Bennington, a member of both House Human Services and the opioid settlement advisory committee.
The settlement involved 46 states and thousands of counties and municipalities. It is governed by a complex formula directing payments in various tranches to states, municipalities, counties and lawyers, some divided into 10 years of payments and some into 18 years. When announced, the combined total expected for Vermont over that period was around $65 million.
Meanwhile, a second settlement against the Oxycontin manufacturer Purdue Pharma and its former owners, the Sackler family, is being paid out through a longstanding Chapter 11 bankruptcy proceeding.
All participants in the former lawsuit were required to send at least 70% of the settlement to an “opioid remediation fund” and create a committee, the makeup of which was left to state law, to direct its use. Some states, including Vermont, made the committee advisory to state government, while in other states, the committees directly disburse the funds.
When the Legislature created the Opioid Settlement Advisory Committee last year, the bill specifically called for the “inclusion of individuals with lived experience of opioid use disorder and their family members whenever possible.”
The department, which coordinates and staffs the committee, did include multiple people meeting that description. But the format of meetings and their limited number made it challenging to offer feedback, said Jessica Kirby, another committee member who runs the syringe service program at the Howard Center in Burlington.
Whitman noted that the Legislature deserves some of the blame for that problem since statute currently limits the number of meetings the committee can hold annually to six.
Human Services Chair Rep. Theresa Wood, D-Waterbury, said “allowing sufficient time for all people to be heard” was important. The department is listening to their testimony, and the legislature could change the limitation on the number of meetings, even this year, she said.
“Next year the process will be more refined,” Wood said, while also noting that the programs funded now would need continued funding year after year.
Kirby, who is also in recovery from opioid addiction, urged creative efforts to reach the people actively using who she works with every day. For a variety of reasons — lack of clean clothes, secure housing, internet access, they are generally unable to attend virtual meetings, she said.
“We’re missing out from hearing from people who are struggling the most,” Kirby said. “There are a lot of people who really do want to share their experiences.”
Pavek said he was frustrated that he was not given an opportunity to provide the committee with information on alternative programs, including overdose prevention sites. These are supervised locations where people can go to take drugs, be monitored for overdoses and receive first aid and other services.
Levine’s memo outlining the recommendations said the committee wanted to further study such sites “and their potential feasibility in a rural state like Vermont.”
But that wasn’t the only sort of programming that got overlooked in a highly scheduled set of meetings, Pavek said.
Committee members were able to rank the health department’s projects. Yet “it ultimately felt like we were giving our consent to a set of recommendations that was developed internally,” he said. That hit him hard because of what opioids have taken from him, including a family member who died from an overdose very recently.
He said he does feel proud of several of the funded projects. However, “I do feel the weight of my dead friends and family,” Pavek said. “In light of that, it’s really hard to count this as a win when it feels like we were just a few tweaks away from creating an allocation that would have been the most innovative in the nation, even without overdose prevention sites.”
Correction: An earlier version of this story misstated the legislative committee that heard testimony on the opioid settlement money Thursday.