Can $395 million break the cycle of opioid addiction in Maryland?

Article by Rick Hutzell

Six people working to keep others alive discuss how the massive opioid lawsuit settlement could be a game-changer – or a historic lost opportunity

Drinking afternoon coffee from a cracked brown cup, Jessie Dunleavy laughs when she describes herself as a radical.

She’s just explained how millions of dollars coming to Maryland from opioid lawsuit settlements should be spent. Reducing the deadly danger of using addictive painkillers and their street equivalents is at the core of her ideas, a strategy called harm reduction.

But over the course of about an hour, she arrives at what she sees as an undeniable truth: Just make it all legal. Worry more about saving lives and keeping people healthy than the morality of using heroin or Oxycotin to get through the day.

People recover from addiction if given a chance and a safe path, she said. That path includes easier access to opioid medications, a treatment that currently comes with its own stigma of addiction.

People who aren’t ready to stop should be given safe places to get high and shouldn’t have to give up their right to health care because of an illness.

“We treat these people like animals,” Dunleavy said.

Then, as if it were a surprise that she’s saying it, she launches her most radical idea of all.

“We can’t put more money into the things we’re already doing,” she said. “We need bold action.”

Dunleavy has come to this idea through heartbreak and hard work. Her 34-year-old son, Paul, died of an overdose in 2017. She believes it was preventable. Since then, she’s become an advocate for change, writing “Cover My Dreams in Ink,” a book about Paul’s life and death. She lectures, serves on numerous advisory boards and talks to anyone who will listen.

“I want it to be legalized. I think it’s the only way to save lives.”

Our conversation in a posh West Street coffee shop was one of a dozen I’ve had over the past six weeks with recovery professionals and advocates, outreach experts, crisis response leaders and government lawyers.

All of them have started with a simple question. How should we spend this money?

Not everyone agrees with what Dunleavy says, but there is wide agreement in the desire for a game-changing moment through bold action on opioid abuse. The ideas focus on more recovery housing, more crisis response and more harm reduction efforts.

What Dunleavy and many of the others I interviewed are most worried about is that the money will be wasted. That politics will defeat science. That it won’t be spent wisely. That nothing will truly change.

“Typically what happens with big pots of money like that, it seems is that it goes into our government and it doesn’t really hit the grassroots … right?” said Angel Traynor, founder and director of the recovery center Serenity Sistas near Annapolis.

As soon as next month, Maryland will start receiving an estimated $395 million out of the $26 billion global settlement stemming from thousands of lawsuits against Johnson & Johnson and three major distribution companies. They put up the money to address the harm caused by powerful painkillers blamed for the death of more than half a million people in the United States through addiction and overdose.

Over the next 18 years, much of the money will flow to government agencies, cities and counties, which will use it to address the problem in their communities. Money from additional likely settlements will add funding, creating an opportunity to make a difference in the lives of millions of people.

The terms of the Johnson & Johnson settlements require 85% of the money go to recovery programs. But beyond that, how it will be spent is being sorted out now.

It won’t be an overnight decision. No one is going to wake up July 1 and say, we’ll put all the money here. Early state priorities include treatment and recovery programs in jails and prisons.

The money also won’t come in the form of a single truckload of cash, but steadily over the term of the settlement. That means decisions made today on how the money should be spent can be modified, changed or reversed based on an understanding of what works in reducing the number of people dealing with opioid use disorder and overdose.

Politics also will play a role as a succession of elected state and county officials seek to put their imprint on spending priorities through appointments and oversight. Powerful healthcare institutions, such as hospitals and providers of inpatient clinical care, seem likely to be part of the equation, too.

Right now, Robin Rickard is leading the effort to figure out how the money should be spent. She was appointed by Gov. Larry Hogan last summer as the second executive director of the Maryland Opioid Operational Command Center.

While there are lots of decisions yet to be made, Rickard believes Maryland is ahead of many states because it established the Opioid Restitution Fund in 2019.

“That legislation was enacted to help guide how we use all of the settlement funds that we receive at the state level,” she said. “So it’s really specific in what we can and cannot use to help the opioid crisis. These are treatment … and recovery peer programs.”

They already are set up around the state and follow, in theory, a path defined by the acronym SBIRT – screening, brief intervention, referral to treatment. Each jurisdiction is supposed to be increasing access to medical treatment for opioid use disorder, have a heroin coordinator who works to both get drugs off the street and offer overdose and crisis services, education and other evidence-based programs.

“So it’s specific so that we don’t… get all this money and then it goes to roads or bridges or something like that,” Rickard said. “It’s specific for us to help with our response.”

The plan has goals for reducing addictions and deaths in each of Maryland’s 24 counties plus Baltimore City. They’re based on conversations with local health officers, emergency managers, police departments and education officials as well as people working in treatment and addiction. There have been 10 town halls around the state.

“A lot of people keep hearing in the news, yeah, everybody’s getting all this money and you know, just like you, they are inquiring what are we going to spend this money on. Before we get to that, we want to just get everyone’s feedback and just be as transparent as possible,” Rickard said.

Traynor is part of that feedback, a highly respected figure in the recovery community of Maryland. Once suffering from addiction herself, she runs Serenity Sistas as a sober home for women that offers peer counseling from people who have been through their own recovery.

She is involved with the command center planning on how to spend the money and has a longtime working relationship with Rickard. She’s worried the money will get tied up in bureaucracy; with too many rules on how it can be used and how it is distributed.

Traynor believes money should go first to overdose and crisis response agencies, part of the county Health Department in Anne Arundel County. They get people into treatment before they die. Then she wants it to go directly to nonprofits like hers that are on the back end of SBIRT, providing months or years of housing and counseling for people after they leave treatment.

“I’m not saying that the county Health Department shouldn’t get any money,” she said. “I’m not saying that at all. But my experience is that the county will give you grants and then they place these expectations on you and they have their own agenda … Right? That’s it, they have an agenda with where and how they think it should go.”

Serenity Sistas offers a place for women coming out of a medical treatment program. It comes after the T in SBIRT and follows the widely used model of treating opioid use disorder with personal support for rebuilding lives shattered by addiction.

Other nonprofits offer programs exclusively for women or men, or with some defining population. Some are certified by the state; some are not. But everyone in the field I spoke with said there’s a demand for more.

In the Annapolis area, Samaritan House, which offers recovery services for men along with limited medical treatment, recently added a new home. Chrysalis House, which serves young mothers, is expanding as well. Traynor’s Serenity Sistas is expanding as well.

“I mean, we’re the ones that are out there doing the work,” Traynor said. “And it’s not just me. I mean, there’s so many… I think that that’s where a good portion of the money should go. And I think that that we need to sit down at a table and, and get that 18-year plan because this money is coming in….”

The command center is crucial to how this will work. It’s the holder of all statewide data on addictions and recovery. Created by Hogan and initially headed by former Anne Arundel County Executive Steve Schuh, the center has vast say over which resources go where and to whom.

If there is an effort to track the success of the roughly 146 programs around the state, it’s here.

“They have to provide us performance measures on what and how they’re doing with their brands so that we can keep track of everything that’s going on with the grants that we have provided,” Rickard said.

Local numbers for overdoses are improving. There were 157 fatalities in the county last year, out of more than 800 reported opioid overdoses, according to county statistics. That was down 20% from 2020. Through May of this year, the numbers continued to decline.

Local governments have a shot at controlling some of the funding. Annapolis and Anne Arundel County each have their own share of the settlement. But they don’t always work well together, and that worries Traynor. She sees a deep need for more resources in the city.

“I have not talked to the county so I just don’t know,” said. “I don’t know what the plan is. I think my biggest fear … is that there is such a huge disconnect between Annapolis city and Anne Arundel County.”

Changes in administration can also mean changes in priorities, how local grants are administered or how much attention is paid to accountability. Traynor doesn’t believe County Executive Steuart Pittman puts enough focus on addictions.

A new governor will take Hogan’s place in December. He or she can be expected to get involved in allocating the settlement money, at least through appointments to key positions. There’s also a discussion in the Maryland General Assembly about creating an advisory board to oversee the settlement money, giving state lawmakers input.

“Robin assured me that people in recovery would be at that advisory board. Now, we also know that Robin’s not the be-all-and-end-all here,” Traynor said. “You know, she has her recommendations. But recommendations don’t always get followed in the government.”

Anne Arundel County will get $31 million over the life of the settlement and has its own opioid restitution fund set up, according to a spokesman for the county. A spokesperson for county health officer Nilesh Kalyanaraman would only say that the money should be used to “expand access to treatment, early intervention, recovery, and harm reduction services.”

City officials declined to talk about how much money they expect to receive, saying it was inappropriate to comment until the other companies involved in the lawsuits settle.

Adetola Ajay has some ideas on where it should go. As part of his job as a community services specialist in Mayor Gavin Buckley’s office, he works on addiction prevention efforts for the city – like the Naptown Anti Dope Movement. He also tries to improve equitable access to treatment.

While there are sober living homes and transitional housing in the Annapolis area, there are few if any resources in the city itself. For people coming out of clinical programs, access can be crucial.

“If you have transportation issues, those become more barriers to treatment,” Ajay said.

And when they do find a place and a way to get there, Black city residents respond better when working with peer counselors who look like them and come from the same community. Black men and women suffer disproportionately from overdoses.

“I would like to advocate for funding for workforce development programming, specifically for people in recovery,” Ajay said.

He wants the people making the decisions on how to use the settlement money to look like the communities hardest hit by opioid addictions.

That means making sure everyone affected by the crisis of addictions has an opportunity to direct how the settlement money will be used.

He knows of no sober living homes or treatment facilities owned and run by African Americans, another gap in having an inclusive leadership.

“That would also be something that would be like a game-changer,” he said.

Jen Corbin shares some of the priorities for the settlement money with Taynor and Ajay, particularly the need for better post-treatment housing and resources.

The county director of Crisis Response, she’s one of the best-known champions of robust government response to the opioid crisis in Maryland. She was talking to parent groups about the dangers of opioids in schools long before it became an issue that most elected officials were eager to discuss.

Her agency runs Safe Stations, which allows anyone with an addiction or mental health crisis to seek emergency treatment by going to a fire station. Roughly 70% of people who have done this find treatment, and 55% to 60% are still sober 90 days later, according to data Corbin provides the state.

Plenty of money has been pumped into SBIRT, but not as much on recovery programs.

“I want to make sure we’re not missing on the back end and that we’re helping people who are heading towards long-term recovery…,” Corbin said “So where I find there’s a lot of effectiveness is in our case managers and our peers who go out and support these individuals.

“That’s a piece Angel and I have talked a lot about. What do we do when people come out of treatment, and they hit those roadblocks?”

Despite her description of the need for backend support, the front end in Anne Arundel County is stretched thin.

Safe Stations, which has been funded largely through grants since its inception a few years ago, has been so successful it now draws people from around the state from communities on the Eastern Shore, Western Maryland or Southern Maryland.

Agencies in those jurisdictions say they don’t have the crisis response and mental health resources that Anne Arundel County has established. Anne Arundel continues to support it, but the grants that made it possible start expiring this summer, Corbin said.

“I’d like to see some of this money going towards maintaining something that is really used by many counties,” Corbin said. “Because we are going to be the only one that can kind of keep it going.”

Corbin also believes expanding requirements for training and standards in recovery homes would help, as would better pay for the people who work in these programs. Local governments also should be compensated for the stress on their resources caused by services for people dealing with addiction and overdose.

“I mean, the whole reason for the Safe Stations was to try to … get people help before they’re overdosing,” Corbin said. “Fire and police respond to so many calls and that takes up a large amount of the day making sure that they’re available… I think there’s an impact to our system here.

“I don’t know what that looks like or how that would be done. But that’s something that always kind of interests me.”

Mike Goldfadden, executive director of Samaritan House, hasn’t been involved in discussions so far on how the settlement money will be spent. He’s sure some of it will be distributed through grants to fund continuing programs.

Samaritan House is different than Serenity Sistas in that it offers a continuum of care, from crisis to outpatient. Residents spend nine to 10 months in the program after release from a clinical treatment center, and some of the programs offer medication.

“Even that is not long enough,” he said. “We try to get our guys two years with our transitional housing. We can get them a year in our housing and a year in transitional housing.

“We think that is successful… We find the longer they’re in some program that is connected … the more successful it is.

What happens next is where Goldfadden thinks the settlement millions need to be spent.

“The gap is chronically relapsing individuals, of which unfortunately there are many…. We see a lot of people who are just chronic relapsers,” Goldfadden said. “They come in, they do well for a period of time. There are a lot of success stories but there are people who, for whatever reason whatever variables don’t succeed at a point in time and then they fall through the cracks.”

Paul Dunleavy was one of those people. He went through treatment and relapsed again and again.

His mother believed the help that would have saved him would have been the medicine that allowed him to treat his addictions, particularly buprenorphine.

Part of Maryland’s response to the opioid epidemic has been to widely distribute suboxone, an overdose recovery medicine that is now handed out in public settings. But it is much harder to get drugs like buprenorphine.

There is resistance to treatment drugs despite ample evidence that they work.

“Abundant evidence shows that methadone, buprenorphine, and naltrexone all reduce opioid use and opioid use disorder-related symptoms, and they reduce the risk of infectious disease transmission as well as criminal behavior associated with drug use,” the National Institute of Health reported in a study released in December. “These medications also increase the likelihood that a person will remain in treatment, which itself is associated with lower risk of overdose mortality, reduced risk of HIV and HCV transmission, reduced criminal justice involvement, and greater likelihood of employment.”

The resistance comes from the fact that they are another form of opioid, so treatment is seen as swapping one addictive drug for another. Dunleavy believes it’s the result of elected officials fearing public reaction rather than listening to the science.

“I started to realize at the end of his life that we couldn’t get buprenorphine,” she said. “He couldn’t get it.

They tried clinical doctors, emergency rooms and primary care physicians, none of whom were willing to write the prescription.

“Then he goes out and gets street drugs and dies,” Dunleavy said.

She thinks it’s the same kind of thinking that creates resistance to harm reduction methods like handing out clean needles and safe smoking kits or overdose reduction spaces – where people can go to use drugs in relative safety. Most of those I talked to support some harm reduction strategies.

It wasn’t that long ago that someone running a program in the Anne Arundel County Health Department tried to hand out safe smoking kits in Eastport. The criticism was immediate from the community, and the employee who led the program no longer works for the county.

Dunleavy is worried that this mindset puts Maryland at risk of missing the opportunity to use the lawsuit settlements to change the narrative of opioid addiction. She points back to 100 years ago when the nation tried to stamp out alcohol use only later to admit defeat and legalize it again.

“It’s absolutely no different,” she said. “It’s the same as prohibition.”