Allegheny County is bringing in millions from lawsuits against major opioid distributors and manufacturers — money designated as another weapon in the county's arsenal to abate the opioid epidemic.

So how is it being spent?

Allegheny County is expected to receive at least $82 million over the next 15 years from nationwide settlements against various opioid distributors and manufacturers, including Johnson & Johnson, alleging they fueled the opioid crisis. The county so far received and allocated $8.42 million of the payouts on harm reduction, rehabilitation, prevention and wraparound services, according to members of receiving departments within the county.

Pennsylvania will route 70% of the over $1.08 billion in settlement funds to counties through the PA Opioid Misuse and Addiction Abatement Trust. The trust recommends several spending strategies and approved uses of the funds targeting treatment and prevention initiatives. 

Once in county hands, the funds are overseen by the county manager and county executive, but spending initiatives are heavily influenced by members within the receiving departments, which include the Department of Human Services, the Allegheny County Health Department and the Department of Children Initiatives, according to the Department Human Services Director Erin Dalton.

Pennsylvania Gov. Josh Shapiro said in a release in December of last year, “These funds will be earmarked to offer and expand life-saving treatment options,” yet several counties pushed for allocating their funds to police enforcement.

Spotlight PA and WESA reported in April that a handful of officials and working groups within Lancaster, Butler and Luzerne counties suggested or fielded requests to route portions of the settlement money either directly or indirectly to law enforcement bodies.

Dalton said in Allegheny County, the county manager and county executive “set the tone” that these funds would be exclusively used for treatment and prevention. She said of the money Allegheny County received, “I can't think of a dime of this that's going towards enforcement.”

“Obviously the county manager's office, the county executive, doesn't try to formulate all this work on their own,” Dalton said. “In this particular case, it's primarily a partnership between three agencies at this point within the county.”

Having received close to $7 million, the Department of Human Services is the largest recipient of the opioid settlement funds in the county and has allocated $3.39 million as of Oct. 16, according to Lou Takacs, the communications director for the Allegheny County Controller. Dalton said via email that the money went to existing partners with the county that work in the opioid misuse space.

An email from the Department of Human Services communications team noted the information provided by Takacs only includes expenditures to receiving organizations that filed payment invoices. 

Dalton said the Department of Human Services chose organizations that would reduce the harms of drug use, reduce first-time drug use through outreach and public education and support people with opioid misuse disorder through wraparound services. She said a "really important" facet of the department's current spending strategy is expanding access to evidence-based treatment.

Jessica Merlin, a professor of medicine at the University of Pittsburgh with a research focus on the intersection between addiction and vulnerable populations, said common treatments such as methadone and buprenorphine can slash overdose mortality rates in half, but the difficulty is getting them in the hands of the people. 

“Integrating it into treatment systems where people can access it when they're getting care for all the other things that they get care for not only provides easier access but also normalizes it and destigmatizes it,” Merlin said. 

According to contracts available online and information provided by Takacs, so far the Department of Human Services paid out $172,095.61 of over $800,000 in contracts funded by the settlement to the AHN Center for Recovery Medicine, a branch of the health care giant that increases access to low-to-no-cost treatment plans, which may include prescribing evidence-based medication.

Elizabeth Cuevas, the division chief of the AHN Center for Recovery Medicine, said the center works within five hospitals and out of mobile vans to make treatment as seamless as possible for people with substance misuse disorder. She said the center does not charge out-of-pocket costs and will only bill a patient in traditional health care settings, but their mobile van services are free of charge.

Cuevas said back-to-back, she will treat “rough sleepers,” — people who live outside in a tent — and then someone fully employed living out in the suburbs. By talking to patients, she said she realized substance abuse may have started as a choice for them, “but it quickly devolves into a disease.”

“When you talk to people, and you hear their stories and you start to understand what they go through on a day-to-day basis, they tell you directly, ‘I don't want to do this anymore. I want to stop, but I just don't know how to stop,’” Cuevas said.

Michael Mallon, the center’s program manager, said so far, they’ve used the opioid settlement fund to bolster their presence in Forbes Hospital in Monroeville with the hopes of establishing a full-sized clinical team to serve more patients. 

Beyond treatment programs like AHN, the county also directed the opioid settlement fund toward harm reduction initiatives, including the purchase of Naloxone, a medicine that can rapidly reverse an opioid overdose, according to Takacs.

The county Health Department received $213,750 to purchase 4,500 kits of Naloxone, commonly referred to as Narcan, from the company Emergent Devices Inc., according to Otis Pitts, deputy director of food, housing and public policy for the Health Department.

A total of 689 people died of an overdose in Allegheny County in 2022 — a 125% increase from 10 years ago, according to the county's overdose dashboard. Fentanyl, a highly potent synthetic opioid, was present in 85% of those cases.

Pitts said the purchased Narcan sits on top of a larger supply that is given to police and EMS and to “nontraditional” first responders, which includes everyone who may witness an overdose — like those who use opioids themselves. He noted this is an expanded definition of first responders meant to include everyone “on the frontlines.” 

“A lot of people can find themselves on the frontlines,” Pitts said. “And people that use themselves will commonly find themselves witnessing overdoses. So we're also trying to get Narcan into the hands directly of people that use themselves.”

In March, the FDA approved Narcan for over-the-counter use and several pharmacies have since begun selling it nationally. But with a price tag of over $40 and a proven reluctance people have to buy the medicine in person out of the perceived stigma, Merlin asked, “How are we actually getting Narcan into people's hands?”

Pitts said the purchased Narcan will be available to anyone for free at county-sponsored pop-up events the Health Department advertises online. The county also disperses free fentanyl and xylazine test kits.

The Department of Children Initiatives received $1.25 million in opioid settlement funds, according to Rebecca Mercatoris, the director of the department. She said so far the money is being used to expand access to Early Head Start-Child Care Partnership services in neighborhoods heavily impacted by the opioid crisis.

The Department of Children Initiatives paid out $226,467 of over $900,000 in contracts funded by the settlement fund to the Council of Three Rivers American Indian Center to expand Early Head Start-Child Care Partnership programming. That programming provides child development and family support services to low-income pregnant women, as well as to families with children up to 3 years old.

Mercatoris said the Council of Three Rivers American Indian Center is using the funds to open 40 slots of free, year-round child care services for infants and young toddlers. She said the funds will foster new partnerships with child care providers in neighborhoods heavily impacted by the opioid crisis.

The Department of Children Initiatives was founded in 2021 to ensure young children’s access to high-quality early learning services. Mercatoris said as the “opioid crisis has really unfolded,” the county administration and the department started thinking about how to support the young children at the brunt of it.

“It's become clear that very young children are deeply impacted by opioid misuse disorder, whether that's from adults in their family or extended community impacts,” Mercatoris said. “We have an opportunity to think really thoughtfully about what types of services can really support those families, and thinking about the youngest children and what they might need there.”

For the remaining $344,132 of the received funding, and with further funding to come, Mercatoris said the Department of Children Initiatives is still deciding what organizations and programs to support.

“This administration is really committed to supporting young children and thinking about how can we take some innovative approaches around the prevention space, particularly for the very youngest children who are being impacted,” Mercatoris said.

Each payment of the opioid settlement fund must be spent within 18 months, according to the trust's website, so Dalton said the Department of Human Services has been moving “to get the money out the door.” This meant funding projects with large contractors that were either tentative or ongoing, she said. 

But with only $8.42 million allocated so far, one local nonprofit head said she hopes the county will expand its scope to include smaller organizations in its spending strategy and overarching plans to combat the opioid epidemic.

Sherry Jo Matt, the founder and president of Stop the Judgment Project, an Allegheny County nonprofit organization aimed at stripping away the stigma surrounding opioid misuse and treatment, said the county is so far “doing amazing things,” with the money, but she wants smaller organizations like her own to be included in the conversation going forward.

“I think they need to sit down with the little tiny foundations and get all of us that are doing the same work so that we can divide and conquer because if we're all doing the same work, and we're all doing the same method, then we can all help each other,” Matt said.

Matt founded Stop the Judgment Project in the months after her daughter took a fake Percocet pill laced with fentanyl and died. Her name was Siena Bott and she was 21 years old.

Bott struggled with co-concurrent bipolar, borderline personality and opioid misuse disorder for years but refused treatment out of fear of being branded an addict and judged by her family and friends. Matt said the stigma forced her daughter to withdraw alone in her room instead of going to rehabilitation. She said it was the stigma that killed her. 

Merlin said despite what harm-reductive, rehabilitative and wraparound services are made available to people with opioid misuse disorder — unless the stigma surrounding them is addressed, “nothing moves forward.”