Public health experts warn that future opioid-related settlement dollars could go to waste, following a decision by West Virginia Attorney General JB McCuskey to give lawmakers the power to distribute most of those funds.
Currently, most settlement funds are distributed by the West Virginia First Foundation. Abigail Winiker, a Johns Hopkins scientist who guides states on opioid settlement spending, noted that the nonprofit follows public health guidance to spend funds on purposes like youth prevention, and focuses on initiatives that have been studied and proven to save lives.
She said that similarly, lawmakers should consult the public, professionals and people with lived experiences. She added that they should set up an advisory council and publish regular reports.
“Lawmakers do know their communities and constituents, but they are generally not addiction experts,” she said. “They can be motivated by politicized agendas.”
McCuskey had listed lawmakers knowing their communities and neighbors well as one reason for giving them control of future settlement money.
He added that foundation panelists are accountable to a board, while lawmakers are accountable to constituents.
“And when you give the legislators the opportunity to spend this money on their priorities, you’re also giving all the citizens of the state of West Virginia input into it in a way that’s very different from the foundation, because their input comes at the voting booth,” he said.
The First Foundation awards settlement money for purposes like treatment, recovery, law enforcement, research and prevention, while local governments receive about a quarter of funds, as part of agreements with opioid manufacturers and distributors.
About 50 panelists from fields like prevention, treatment, law enforcement and recovery guide funding the awards.
McCuskey stressed he doesn’t oppose the work of the foundation. But he added that they are well-funded, with millions left to distribute.
“This is not a different approach,” he said. “It’s a dual approach.”
The foundation will continue to allocate funds from those companies that still owe the state, but lawmakers would decide how to allocate the majority of new settlement money. McCuskey is currently suing in another opioid-related lawsuit.
Jonathan Board, executive director of the First Foundation, listed being apolitical as an advantage of the nonprofit. It has the ability to pivot when members observe trends and it has the nimbleness to disperse funds quickly.
“We would encourage them to learn from the good practices that we have shown,” he said.
Del. Anitra Hamilton, D-Monongalia, wishes McCuskey had studied states that are seeing the most impact with their settlement dollars.
Hamilton, minority vice-chair on the House Committee on Health and Human Resources and a nurse, hopes to see lawmakers collect bipartisan input, public health guidance and study other states on their own.
Sen. Minority Leader Joey Garcia, D-Marion, said he’d love to be able to do some good with the money, but other lawmakers seem focused on scoring political points with more tax cuts.
“I don’t think that has anything to do with rehabilitation for opioid use.”
Senate Minority Leader Mike Woelfel, D-Marion, represents some of the local governments who are suing in a combined, simultaneous lawsuit, which McCuskey says will receive their settlement dollars for similar reasons — familiarity with community needs.
As a Democrat in legislative leadership, Woelfel sees no problem with lawmakers in charge.
“I personally trust legislators to make these types of calls because that’s why they were elected,” he said.
McCuskey said dozens of other lawmakers were excited and had serious proposals for the funds, although the plan was driven by himself.
Jacque Bland, Senate spokesperson, didn’t know which lawmakers were in any conversations that McCuskey referenced.
Ann Ali, House of Delegates spokesperson, also said she didn’t know of any discussions regarding opioid settlement spending.
But Deputy Speaker Matthew Rohrbach, R-Cabell, a member of House leadership and a doctor, said since the lawmakers haven’t even formally accepted McCuskey’s plan yet, it’s too early to say how the allocation process would work.
But he is a supporter of the idea. He said that lawmakers might be more likely to spend more money on locality-specific needs the First Foundation hasn’t funded, like county jail bills or other city and county requests.
“Do we just keep piling more money into a non-governmental entity that, frankly, doesn’t have to answer to the voters, or do we start to bring this back into the Legislature and go through the normal budgetary process?” he said.
Tricia Christensen, a public health consultant who advises states on opioid settlement spending, has little faith lawmakers will spend the money in ways that will prevent overdoses.
Christensen, who has closely followed West Virginia’s opioid settlement distribution and political scene, noted that lawmakers have limited the number of methadone clinics — more of which could save lives — and passed into law a bill that shut down harm reduction programs.
She also expects they’ll make decisions behind closed doors.
“I think that it’s a bad decision,” she said.
“I think that it’s still going to be money,” she said. “It’s still going to be dollars that are going to be handled even worse than they are now. So all of it is a tragedy.”
McCuskey agreed that some lawmaker decision-making may happen out of public view. But he added that voting records are public.
“It doesn’t really matter how you came to a decision on what you’re voting on,” he said. “What matters is how you voted.”
And lawmakers are free to spend money on programs like harm reduction or methadone clinics, he added.
“There’s an election on Nov. 3, and if what you want is legislators who support needle exchanges and things like that, then you go out, you campaign and you get legislators who believe like you do,” he said.
