5 Key Issues in 2024 • Spotlight PA

Ed Mahon reported this story while attending the USC Annenberg Center for Health JournalismData Exchange 2024 of.

HARRISBURG – This has been a crucial year for opioid settlement money in Pennsylvania.

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

But even as the Pennsylvania Opioid Misuse and Addiction Abatement Trust has taken on increased oversight, board members have conducted much of their work behind closed doors. The secrecy drew objections from lawyers, local government officials and even one of the council members.

As was the audience blocked from attending some meetings and silencing those they could witness, Spotlight PA worked with other news outlets to bring more transparency and responsibility at trial.

Opioid board members addressed a number of issues, including programs that provide clean needles to drug usersbackground public defender’s officesand support the residents of Kensington. The decisions they made could influence how the settlement money is spent for years to come.

Here are five key takeaways from the year on opioid spending as Pennsylvania responds to an epidemic that continues to kill thousands annually.

1. Debates about distributing clean needles to drug users

There is a contradiction between opioid regulatory documents and Pennsylvania 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 broad support in the medical community and typically connect people to other services, such as overdose reversal medications, wound care, and substance use treatment.

Agreements between drug companies and state attorneys general identify the expansion of these programs as one of the core strategies for the billions of dollars coming into the states.

But in Pennsylvania, these programs are considered illegal — or at least in a gray area. Pennsylvania is one of 12 states that do not implicitly or explicitly authorize syringe service programs by statute or regulation, according to a analysis last year. And the state’s definition of illegal drug paraphernalia includes hypodermic syringes, needles and other items used to inject illegal drugs. That means the people who run these programs are at risk of arrest across much of the state.

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

Following the newsrooms’ reflectiona state House committee for the first time in at least 10 years has approved a bill to authorize these programs all over the state. However, the measure failed to clear the legislature. And those programs have faced separate setbacks in Philadelphia, where Mayor Cherelle Parker opposed their use public money for them.

Allegheny County, where officials took steps years ago to allow these programs locally, has used 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 to the services, despite opposition from a board member.

2. Prosecutors vs. public defenders

While Pennsylvania prosecutors are eligible to receive millions of dollars in opioid settlements, their counterparts on the other side of the courtroom have been excluded.

Guidelines from the opioid trust discouraged counties from spending their funds on public defender positions, Spotlight PA reported in April. A process from ACLU of Pennsylvania cited this reporting as an example of how inappropriate defenses are often excluded from funding.

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

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

Bucks County later reported dedicating $97,000 in opioid settlement funds to 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 Bucks County program description. The trust in November approved that use.

District attorneys’ offices can also expect to face greater scrutiny in 2025. An amended court ruling in October clarifies that those offices must submit spending reports to the trust at least once a year. This addresses a disparity in responsibility which 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.

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

Several counties took the disputes to court.

Somerset County appealed the denial of $30,000 for a youth program. Philadelphia opposes the denial of millions of dollars intended to support the residents of Kensington. And most recently, Northampton County filed an appeal against the trust’s rejection part of a newsletter program.

Whatever the Commonwealth Court decides could have an impact beyond these three counties. Philadelphiafor example, it requires the court to issue guidance that provides a broad interpretation of spending requirements and respects county decisions.

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

4. Involvement of the limited public

Members of the public have been routinely excluded from having a say in how opioid settlement money should be used, a first-of-its-kind national study by KFF Health News and Spotlight PA found earlier this year. People who are excluded include those who have lost loved ones to the opioid crisis or who deal with it on a daily basis.

The story highlighted the problem in Philadelphia’s Kensington neighborhood, which received international attention because of the impact the opioid crisis has had on the community. The trust in June rejected $7.5 million meant to help area residents, with one local leader calling the move “a re-traumatizing moment”.

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

The Pennsylvania trust continues to not allow public comment at its meetings. Advocates have pushed for greater involvement here and in other states.

In Maine, a former member of that state’s opioid board cited one of Spotlight PA and KFF Health News’ findings at a recent public forum. Courtney Gary-Allen, a substance abuse advocate in long-term recovery, urged that state’s board to allow comments at all regular meetings.

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

5. More information, clarity on expenses

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

That was hard to say in many cases, especially in a place like Pennsylvania where so many decisions happen at the local level.

To answer these questions, Spotlight PA and WESA at the beginning of this year filed open records requests with every county in the state to make spending reports available to the public, lawyer, researcherand other journalists. In November, Spotlight PA published a searchable database that tracks the spending decisions of county governments and if the trust has approved them.

The efforts of others have brought greater clarity to spending as well, including in Wyoming, Michigan, Californiaand at the national level.

More money is on the 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 multi-company deals, according to a recent court order.

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