WILLIAMSON — On a Thursday afternoon, Justin Ford smoked a cigarette underneath the overhang of a Williamson Health and Wellness Center clinic, avoiding a steady barrage of raindrops on the sidewalk. Ford, a 34-year-old man from nearby Matewan, was waiting to receive his prescription for suboxone, a medication that reduces his cravings for opioid drugs and protects him from overdosing.
Since his teenage years, Ford has struggled with drug use. But, for the past few years, counseling services and suboxone have stabilized his life. Utilizing these treatment options, he says he’s been able to work a construction job with his uncle and become a better father.
“Ever since coming to the suboxone clinic, I’ve been able to get my life together,” Ford said. “I’ve been there for my daughter…I haven’t been making the same mistakes I’ve made in the past.”
Ford is one of tens of thousands of West Virginians whose lives have been shaped by the opioid epidemic. For a decade, multi-billion dollar companies increased their bottom lines at the expense of West Virginians by pumping opioids into the state: here, people fatally overdosed at rates higher than anywhere else in the country. The fallout has persisted into the 2020s; recent data estimates that, between June 2021 and 2022, drugs caused the death of nearly four West Virginians every day.
Many of those companies have paid settlements to West Virginia over the past year and a half for their role in catalyzing the crisis. Those funds, eventually estimated to total upwards of a billion dollars, are intended to benefit West Virginians — like to connect more people like Ford to counseling and medication-assisted treatment programs, or to prevent children in schools from initiating opioid use.
But while the funds could be used that way, there’s no guarantee they will be. The contract agreed to by Attorney General Patrick Morrisey and the state’s local governments allows counties to use their shares, expected to be around $150 million, to pay regional jail fees instead.
These rising jail costs — exacerbated in part by people jailed on charges related to substance use disorder — are a problem in many West Virginia counties, and many county commissioners have said they feel stifled by the $48.25 daily cost to keep someone behind bars.
But for public health experts, allowing settlement funds to be spent on incarcerating those with substance use disorders would further the epidemic.
“If someone wanted to increase overdose rates, what they would do is simply round people up and arrest them,” said Dr. Dan Ciccarone, a professor at the University of California San Francisco who specializes in treating opioid addiction. “Because the number one predictor of overdose…is recent release from incarceration.”
“Every dollar that comes out of the settlements needs to be interrogated.”
A plan to spending $1 billion in opioid settlements
The state’s opioid settlement distribution plan, titled the West Virginia First Memorandum of Understanding, splits the funds into two main chunks. Just under three quarters of the money, 72.5%, is set to fund a foundation tasked with addressing the opioid crisis through a long-term lens. Another quarter of the funds will be paid directly to local governments for communities’ immediate needs.
The document lists approved uses for the counties’ share of the money, which include activities meant to either halt the supply of illicit opiates, care for West Virginians with opiate addiction or prevent other West Virginians from developing substance-use disorders. But paying for past and future regional jail fees are options, too.
Morrisey did not respond to questions about why he and the other authors listed regional jail fees as an approved activity, only writing in an email that the terms of the contract were agreed upon by himself, nearly all the state’s local governments and the settlement courts after negotiations.
Even in a somewhat novel situation like the opioid settlements, experts warn against diverting funds away from abatement efforts. A Johns Hopkins School of Public Health website that guides states on how to spend their opioid settlements cites the American Medical Association and American Bar Association in its call for all “funds to address the substance use epidemic”.
Ciccarone agrees and thinks using the money for jails would be a missed opportunity.
“This has to be an opportunity for redress, for amelioration of the problem,” he said. “Is West Virginia going to be happy five or 10 years from now with how it spent its money?”
Some county officials eye paying down jail bills with settlement funds
Already, some local officials are concerned that their county commissioners will divert settlement shares away from public health efforts.
At times over the past two decades, drug distributors sent more opioid painkillers per person to Mingo County than anywhere else in America. As the county health department’s administrator, Keith Blankenship oversees the agency’s four major projects aimed at controlling the crisis caused by those actions.
Some of the efforts do double duty, helping divert people arrested on drug charges into rehabilitation and lower jail bills at the same time.
“When we first started the program…Mingo County’s jail bill was around the $125,000 a month range,” Blankenship said. “Now it’s down to $80,000. So we feel that we can at least argue that we’ve had some financial impact on the county’s jail bill, which is taxpayers’ money.”
But Blankenship said there is still so much more that’s needed to address substance abuse, and he’s concerned about how county commissioners will spend the new opioid settlement money, now at over $5.7 million and projected to total around $6.8 million.
“I think they have so much already to do between the sheriff’s department and the jail system,” he said. “Their obligations or liabilities are so high already that we won’t be very high on the list.”
Some, like Kanawha County Commission President Kent Carper, said they would not support using settlement money to pay regional jail fees.
“It should be used for the purpose for which it was paid,” Carper said.
But others say they might use the opioid settlement to pay the jail bills. Greg Duckworth, one of Raleigh County’s commissioners, said he and the other commissioners have considered using some of their shares on jail fees, which he said often total between $115,000 and $170,000 a month.
Duckworth touted a Raleigh County program that reduces the number of non-violent offenders in jail but said the fees have continued to burden his commission.
“Spending it on the jail bill would certainly free up some of our monthly bills,” he said.
For West Virginians closest to the opioid crisis’s devastating health impacts, diverting money from treatment and prevention to regional jails would be ignoring people who need the most support.
Tina Richard is the executive director of Williamson Memorial Hospital’s newly-operational Kathy Ireland Recovery Center. As she walked through the third floor of the building on a recent weekday, her head swiveled and she did an about-face to greet a newly admitted patient of the residential detox facility.
Richard walked over to the new patient and embraced her.
“It’s gonna be okay,” Richard said as the woman’s eyes began to well. “We’re going to take care of you.”
Richard, who worked as a nurse across West Virginia for decades, is proud of her detox center’s rehabilitation program. But she sees a need for more care after people leave.
“We need more long term [options], whether that be sober living or apartments that are regulated by outpatient clinics,” she said. “We have to be able to provide the services continuously after [patients] leave.”
Ways to divert people from West Virginia’s over-crowded prisons
It isn’t clear why Morrisey and the contract’s framers added so much leeway for counties to spend their share of the money on regional jail fees. But there are other approved options for the money that would both reduce counties’ jail bills and encourage treatment for those who need it. One section outlines how local governments can transition people away from the criminal justice system and connect people with the best resources available.
These strategies, ones akin to the prison diversion program Blankenship implements in Mingo County, are methods that experts believe will help the West Virginians who bear the opioid crisis’ highest burden.
“More holistic teams that really work with folks with drug violations…on accessing treatment, on housing, on work issues…helping to make life more stable…[these are] mechanisms that really help folks stay out of prison,” said Cathy Slemp, the former state health officer and a member of the Hope in Action Alliance, a statewide coalition that has offered educational opportunities on settlement funding.
Slemp is hopeful that even though counties can divert their settlement shares for jail fees, commissioners will recognize that there are better ways to serve their constituents.
“[It’s important] to prioritize ones that can change the trajectory going forward,” she said. “[Strategies] that decrease the jail bill, that decrease initiation, that decrease overdoses currently…there’s lots of stuff that’s proven it works in all these areas.”
For Justin Ford, who has been sober for the past 10 months, more reliable transportation options would help him address his substance use disorder; epilepsy prevents him from driving, and he often has to hitchhike to get suboxone.
Whatever options county commissioners choose, Ford hopes they think critically before spending settlement funds to pay to incarcerate people like himself. He said jail was the treatment method law enforcement chose for him in the past; each time, it left him worse off than when he entered.
“It hurts a person continuously just to put someone that’s struggling in jail,” he said. “It doesn’t help people; it hurts them more. It truly does.”