Nebraska struggles to use $180M in opioid settlement money
LINCOLN — Opioids are taking a growing toll on Nebraskans while the state struggles over how to use millions in settlement payments from purveyors of the highly addictive drugs.
Payments that are expected to total nearly $180 million began in March 2021. But it could be well into 2024 before the state starts putting its share of the money to use for treatment, prevention or other efforts to address the effects of opioid addiction on Nebraska.
Legal confusion slowed the process, followed by an abrupt change in policy announced this month by the Department of Health and Human Services.
Sara Howard of Omaha called the delay “heartbreaking.” Howard’s sister, Carrie, died of an overdose in 2009 after becoming addicted to prescription opioids. A former state senator, Howard now serves on Nebraska’s Opioid Remediation Advisory Committee.
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“The fact that we’re going to see another long delay before these dollars can start to get out and be used for their highest purpose, to me, that’s really tragic,” she said at the committee’s December meeting. “There’s very much a human toll to the delay in getting these funds out, in meeting the needs of our state.”
Howard
Nebraska has been spared the worst of the nation’s opioid epidemic so far. The state’s drug overdose death rate ranks at or near the lowest among states, whether measuring all drug overdose deaths or only unintended ones, according to the federal Centers for Disease Control and Prevention.
But there are signs that the problem is getting worse. Federal data shows the rate of unintentional and undetermined overdose deaths involving opioids hit 5.8 per 100,000 Nebraskans in 2021, up from 4.4 in 2020.
The rate of nonfatal opioid overdoses seen in emergency rooms doubled over five years, reaching 17.5 per 100,000 Nebraskans in 2022, up from 8.8 in 2018, and the state’s opioid dispensing rate now tops the national average. Nebraska providers wrote 44.5 opioid prescriptions per 100 people in 2022, compared with 39.5 nationally.
Dr. Ann Anderson Berry, a committee member and the executive director of the University of Nebraska Medical Center’s Child Health Research Institute, said those trends fit what she has seen in her practice. She also said she believes the official overdose numbers understate Nebraska’s problem.
“From my perspective, in the last 12 to 18 months, we are seeing significant increases in number of neonates we are treating” for opioid-related concerns, she said. “We have a pretty profound impact here in Nebraska.”
Anderson Berry
With those trends in mind, Anderson Berry said Nebraska’s share of funds from multistate opioid settlements could keep the state’s opioid problems from worsening.
“I think this is a remarkable opportunity for Nebraska,” she said. “It is intended to help the citizens of Nebraska recover.”
Nebraska is part of multistate settlements with 10 opioid manufacturers, distributors, pharmacies and marketers so far, with the state’s share of payments projected to reach $179.7 million over 18 years. State law directs the payments into the Opioid Recovery Fund. Separate payments are going directly to cities and counties.
The opioid agreements set requirements for what states and local governments can do with the money. States must allocate at least half their payments to the regional level and at least 85% of each state’s total must go for a list of approved opioid remediation activities.
The agreements also call for the creation of advisory committees to recommend how states use the money. Nebraska’s advisory committee began work in early 2022, with half the members representing the state and half representing counties and cities.
The Nebraska committee got off to a slow start, then had to stop and regroup last winter after being alerted that, despite having staff from the Attorney General’s Office at their meetings, they had violated the open meetings law. The confusion forced the committee to redo some previous actions.
Still, the committee was on track to disburse $6 million for prevention programs this month and had awarded a $500,000 contract for a comprehensive needs assessment in October. It allocated $10 million to the state’s six behavioral health regions to plan and fund opioid-related programs.
But HHS officials in recent weeks decided to reject the committee’s plans for the prevention programs and needs assessment, although they approved the money for the behavioral health regions.
Tony Green, interim behavioral health director for HHS, announced the decision at the committee’s December meeting. He said that the committee lacked authority to disburse state money or sign contracts and that HHS would have to follow the state’s procurement process to do so, rather than use the bidding process developed by the committee.
Rather than figure out a way to carry out the committee’s ideas, Green said HHS will develop its own recommendations for using the opioid funds. He said he would bring those plans to the committee in February for feedback and pledged to keep it involved.
“I don’t see it as the department’s going to work in isolation,” he said.
But Green said the department will not do a needs assessment because agency officials already have enough information about Nebraska behavioral health needs. He did not clarify whether the recommendations will only address behavioral health concerns and whether they will include prevention.
Committee members expressed frustration about the sudden change.
Amy Reynoldson, a committee member and the executive vice president of the Nebraska Medical Association, said the committee had followed guidance from HHS staff and the Attorney General’s Office in developing their plans.
“We had individuals sitting in the room who never spoke up and said you’re going down the wrong way,” she said.
HHS spokesman Jeff Powell offered little additional insight about what HHS may recommend, although he said the behavioral health regions could potentially support some of the prevention programs that the committee had been considering.
“The department understands the importance of these funds and the need to support communities which suffered as a result of the opioid epidemic and is committed to distributing funds as quickly as the law allows,” he said.
“DHHS recognizes the importance of prevention, spreading awareness and sharing resources for effective treatment,” he said, adding that the agency “will ensure the distribution of funds meets the requirements of each settlement agreement.”
Powell said an independent efficiency review of state government, required by the state budget, sparked the reconsideration of the opioid committee’s powers. The state contracted with Kristen Cox, founder and CEO of Epiphany Associates, to undertake the efficiency review.
The contract requires her to identify “realistic, feasible, hard cost savings” equal to at least 3% of state general fund appropriations in the fiscal year that began July 1 and at least 6% in the following fiscal year. That works out to be more than $160 million in the first year and more than $322 million in the second year.
Powell did not answer whether the opioid settlement money would be used to replace existing state funds. Such a funding switch could save general fund dollars without reducing overall state spending.
But Reynoldson and other committee members said delays in deciding how to use the opioid dollars could make the Opioid Recovery Fund a tempting target.
Nebraska lawmakers already approved two bills in the 2023 session that tapped into those dollars. Neither bill sponsor talked with the advisory committee about how they might fit with state priorities.
State Sen. Tony Vargas of Omaha introduced one that provides staff support for local Overdose Fatality Review Teams at a cost of $379,000 a year. Sen. Mike McDonnell of Omaha introduced the other, which dedicated $1.125 million annually to provide resiliency training and behavioral health support for first responders, who he said are at higher risk of opioid exposure and dependency.
Our best Omaha staff photos & videos of December 2023
Creighton’s Trey Alexander (23) slams into Villanova’s Eric Dixon (43) in the Villanova vs. Creighton men’s basketball game at the CHI Health Center in Omaha on Wednesday, Dec. 20, 2023.
People ice skate near the holiday lights and Christmas tree at RiverFront Park in Omaha. Photographed with a drone on Wednesday, Dec. 13, 2023.
Volunteers unload and carry at Omaha National Cemetery on Thursday, Dec. 14, 2023. They are to be placed on the graves of veterans for a Wreaths Across America event on Saturday.
Celeste Butler and Sherman Wells stand for a photo outside the Spencer Homes public housing apartments at 26th Avenue and Spencer Street in Omaha on Friday, Dec. 8, 2023.
Nebraska’s C.J. Wilcher (0) celebrates a play while on the bench in the Michigan State vs. Nebraska men’s basketball game at Pinnacle Bank Arena in Lincoln on Sunday, Dec. 10, 2023. Nebraska won the game 77-70.
Connie Greger talks about the movie rental business next to her the Rivoli Theater located at the 533 Main St, on Thursday, Dec. 7, 2023. Her family has owned the theater since 1979.
Fans line up outside for the Nebraska and Arkansas match during the NCAA volleyball tournament Elite Eight at the Devaney Center in Lincoln, on Saturday, Dec. 9, 2023.
Nebraska’s Lexi Rodriguez (8), facing hugs Ally Batenhorst (14) after defeating Arkansas during an NCAA volleyball tournament Elite Eight match at the Devaney Center in Lincoln, on Saturday, Dec. 9, 2023.
Nebraska Head Coach John Cook cheers a point late in the fourth set against Arkansas during an NCAA volleyball tournament Elite Eight match at the Devaney Center in Lincoln, on Saturday, Dec. 9, 2023.
Cade Ziola poses for a portrait at Omaha Skutt on Wednesday, Dec. 6, 2023.
Creighton head coach Kirsten Bernthal Booth celebrates with her team following the second round NCAA volleyball tournament match against Minnesota at Sokol Arena in Omaha home on Saturday, Dec. 2, 2023. Creighton won the match in three sets.
Kiro Tureaud, 3, of Bellevue, visits with Santa Claus during the 13th annual Christmas in the Village along North 24th Street in Omaha home on Saturday, Dec. 2, 2023.
Creighton players lift Ellie Bolton (1) to celebrate a Creighton ace serve against Colgate during the first round of the NCAA volleyball tournament at Sokol Arena on Friday, Dec. 1, 2023.
Creighton’s Sky McCune (3) serves against Colgate during the first round of the NCAA volleyball tournament at Sokol Arena on Friday, Dec. 1, 2023.
Colgate’s Abby Shadwick (8) dives for the ball in front of Taylor Cigna (16) and Carlie Rzeszotarski (12) against Creighton during the first round of the NCAA volleyball tournament at Sokol Arena on Friday, Dec. 1, 2023.
From left: Creighton’s Ava Martin (8), Kiara Reinhardt (5), Kendra Wait (15) and Ellie Bichelmeyer (10) celebrate winning the first set over Colgate during the first round of the NCAA volleyball tournament at Sokol Arena on Friday, Dec. 1, 2023.
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