Millions of opiate dollars are coming to Mississippi

Hundreds of Mississippians die each year from opioid overdoses, an epidemic that has claimed tens of thousands of lives nationwide. In a series of historic settlement agreements, drug companies have agreed to pay about $50 billion over 18 years for their role in fueling the crisis — and Mississippi has signed on to be part of the settlements.

How state and local governments choose to use this cash windfall in the years to come will significantly shape Mississippi’s policies on addiction treatment and prevention — as well as health care in general.

We’ve broken down the key things you need to know about settlements.

Where does the money go?

Mississippi has begun receiving parts of the roughly $203 million expected from national settlements with three pharmaceutical distributors and an opioid manufacturer. The state also expects an additional estimated $167 million from national opioid settlements with other companies.

The money is divided into three buckets: 15% goes to the state government; another 15% to counties and cities, which will be distributed according to the population and how strongly the crisis has affected the respective communities; and the remaining 70% to an opioid reduction fund that will be controlled by the state Legislature.

Policymakers and local officials are beginning to develop plans for using those dollars. The opioid accords set guidelines for spending, including nine core opioid reduction strategies — which consist of activities such as expanding access to naloxone and opioid use disorder medications, as well as investing in prevention efforts.

Who controls the money in Mississippi?

Both the state government’s share and the relief fund will be under the direct control of the Legislature, which will ultimately decide how that money will be spent. The Legislature, through an appropriations act, established a special account for all funds it controls.

“We were encouraged that they set up (a fund) because that’s a necessary first step,” said Michelle Williams, chief of staff to state Attorney General Lynn Fitch. Advocates across the nation have recommended that states create special funds for the dollars they receive before making any decisions about how to use them.

To date, however, Mississippi’s state and rebate actions have only been used to cover attorneys’ fees in opioid litigation, according to Williams. Across the country, many jurisdictions have been slow to spend their funds.

The attorney general’s office, which helped negotiate the settlements on Mississippi’s behalf, has already signaled some priorities for the money. One is to establish a Center for Addiction Medicine at the University of Mississippi Medical Center — an idea mentioned in an agreement the office reached with cities and counties. The creation and operation of this center would be supported by the rebate fund – the largest pot of settlement dollars. However, lawmakers have not discussed the proposal at length, and confusion surrounds the specifics of the plan.

According to Williams, the concept came about from conversations with UMMC and members of the Legislature. The attorney general’s office provided a document explaining why this new center should receive millions in settlement funds.

That is where any cohesion in Mississippi planning seems to begin and end. UMMC, for example, declined to confirm any communication with the attorney general’s office about the idea of ​​a new center or to answer any questions about the proposal. The system already operates a center that focuses on addiction research and treatment.

According to Leah Smith, deputy chief of staff to Lt. Gov. Delbert Hosemann, his office plans to meet with Mississippi state leaders and is advocating for “a plan to be adopted by the Legislature next meeting in January,” although the timeline is uncertain.

The Mississippi Supervisors Association, whose purpose is to “advocate and educate county officials and others on topics and issues important to county governments,” reported that it has not developed a plan to support its members as they prepare to spend the money. By contrast, the Arkansas Municipal League and the Arkansas Association of Counties have created a joint fund that helps local governments coordinate opioid reduction efforts.

Mike Moore — the former Mississippi attorney general who led the national tobacco settlement agreement and was involved in opioid litigation in several states — is concerned about the divisive approach in Mississippi.

“If you’re going to send checks to every city and county, I don’t know what encourages collaboration there,” he said.

How has the money been spent so far?

Each eligible Mississippi county will receive a share of the approximately $54 million allocated for localities. Choctaw, Montgomery, Sharkey, Webster and Wilkinson counties were not eligible.

Dozens of cities and towns across the state will also receive funds, though the amount varies drastically. Gulfport is projected to receive nearly $4.5 million through 2038, the most of any locality in the state. At the same time, Diamondhead will receive about $92.

These payments may increase as the state finalizes settlements with additional companies.

Gulfport is the state’s second largest city with a population of approximately 73,000. The coastal city has received at least $430,000 so far. Decisions about how the money is spent will be made by the City Council.

Gulfport Councilwoman Ella Holmes-Hines would like the money to go to community organizations that serve people struggling with addiction and training for law enforcement officers.

“The problem is how and why you got the money, so you have to solve the problem,” she said.

So far, the city has used just $4,000 to fund a local meal delivery program for Thanksgiving and Christmas last year.

Few counties reported having concrete plans.

Harrison County Board of Supervisors Chairman Marlin Ladner, for example, said spending decisions can be made this budget season. Harrison County, where Gulfport is located, led the state in suspected overdose deaths and naloxone administrations in 2022. Similarly, Jackson County — which had the highest number of suspected overdose deaths in the state at 100,000 inhabitants in 2023 – has not yet budgeted the funds, according to the County Administration office.

At the other end of the state, the DeSoto County Board of Supervisors committed the $116,000 it has received so far to fund a crisis center.

“It’s for an immediate crisis — if someone has an addiction problem or a mental illness or needs to come in for counseling,” said Lee Caldwell, chairman of the Board of Supervisors. “DeSoto County likes to be first, but we don’t want to be first in opioid deaths. We don’t want to be the first in the challenges that addiction brings to families.”

What do the lawyers say?

As policymakers grapple with next steps, people who see the opioid crisis in Mississippi say the need continues to be very real.

“My friends are dying in the streets. We have overdoses every day,” said Jason McCarty, executive director of the Mississippi Harm Reduction Initiative, a community organization that supports people struggling with and recovering from opioid addiction.

Part of the challenge he and other advocates face is keeping the state’s issue front and center.

Provisional data from the Mississippi Opioid and Heroin Data Collaborative indicates that at least 1,257 people died from suspected opioid-related causes between 2020 and 2023 — an average of 314 people per year. That’s lower than the number of deaths in many other places, he said, but it doesn’t reflect what’s going on.

“Mississippi doesn’t really seem to have a problem compared to other states. But I know we do,” McCarty said.

Some parts of the state were hit harder than others. The coastal region stands out, accounting for a huge share of Mississippi’s suspected overdose deaths, EMS naloxone administrations and drug-related arrests in recent years.

Grassroots organizations, McCarty said, should be first in line to receive settlement resources. The Harm Reduction Initiative distributes naloxone, operates a community recovery center in Jackson, and does educational programs with young people in Mississippi.

But in his experience, that’s not how resource distribution works.

“I feel like money keeps going to these big organizations that really don’t do grassroots work,” McCarty said.

McCarty and other attorneys said it’s difficult to find out what happens to the settlement funds. He said no one has contacted his organization for information on how the state should spend the money.

Jody Couch founded Inside Out Outreach, which works to provide faith-based support to Gulfport’s homeless population, many of whom have addictions. She believes the money could be best spent addressing the lack of housing and other resources in her area.

“This funding could help with the cost of treatment and to make it local,” she said.

Couch has been approached for input by at least one local Gulfport official as the city prepares to decide how to spend its share of the opioid settlement funds.

She believes what the opioid settlement funds need most is oversight to ensure accountability for how the money is spent in her community.

But the state has not implemented public reporting requirements. Localities do not have to say how much money they received or how it was spent. There are also no requirements dictating how localities must use the money — they could use it to fill potholes.

Similar concerns about misuse are playing out nationally, but at the same time, there is hope that money can do good.

“History will be written. We’ll find out how well they do,” said Moore, the former Mississippi attorney general. “But my gut tells me they’re going to be pretty serious about the money being spent fairly.”

KFF Health News Senior Correspondent Aneri Pattani contributed to this report.

This report was produced in collaboration between KFF Health News and Mississippi Today.

KFF Health News is a national newsroom that produces in-depth journalism on health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling and journalism.