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Helping Communities Use the Opioid Settlement Funds for Effective Prevention

By Lindsey Vuolo

Investing in youth prevention is the third Principle for the Use of Funds from the Opioid Litigation. Between 2022 and 2023, nearly 10% of expended opioid settlement funds (OSF) were invested in Prevention strategies: Yet prevention efforts are often under-utilized, and many prevention strategies that do receive funding are not grounded in evidence.

Partnership to End Addiction’s new resource, Guidance for Investing the Opioid Settlement Funds in Primary Prevention, aims to help those deciding how to spend the OSF make informed funding decisions that prioritize primary prevention by summarizing the research supporting primary prevention, outlining strategies that are aligned with the approved uses outlined in Exhibit E, providing examples from states and communities already using their OSF for primary prevention-aligned strategies, and offering practical steps for assessing community needs and tracking outcomes related to prevention.

This blog highlights information from the guide and offers some quick dos and don’ts for communities investing OSF in prevention.

What is effective prevention?

Effective primary prevention includes approaches that both reduce risk factors that contribute to youth substance use and strengthen the protective factors that help young people live healthy lives. Primary prevention involves building resilience and coping skills; fostering healthy emotional development; empowering youth and promoting their mental wellbeing; strengthening their relationships with their families, schools and communities; and creating environments that help young people grow up healthy and substance-free.Research has found that these approaches are the most effective for preventing substance use and can reduce other negative outcomes including youth mental health challenges, school dropout, and violence.

Where should communities that want to invest in prevention direct their funds?

Drawing on the research and examples outlined in the guide, here are some quick tips for communities to prioritize when investing OSF in prevention:

  • Prioritize evidence-based and evidence-informed programs: Many programs have been rigorously evaluated and show effectiveness in reducing youth substance use. These programs can be found in the following registries: Blueprints for Health Youth Development, SAMHSA’s Evidence-Based Practices Resource Center and Youth.gov Program Directory and the What Works Clearinghouse. Communities should evaluate whether they currently have school and community-based prevention programs and whether such programs are evidence-based or currently subject to monitoring and evaluation.
  • Focus on skills: Evidence-based prevention programs improve life skills, promote wellness, and bolster family, school and peer connections. Communities should fund programs or strategies that help build resilience, teach life skills, empower youth and/or promote their relationships with their family, school and community.
  • Focus on non-use: When educating youth, focus on the norm of non-use but in a way that doesn’t stigmatize those who may already be using substances. This is an important protective factor against youth substance use and can counter misconceptions about the prevalence of youth substance use. If you have community-level data showing rates of non-use, highlight those trends (see below for limitations on education and information).
  • Include families: Provide education for parents via webinars or resources at school or community events. Parents and family members are an underutilized resource and can play a valuable role in prevention. There are many low- and no-cost resources that the community can make available to parents and other caregivers (see Partnership to End Addiction’s resources).
  • Involve the community: Work with community members to understand the most pressing needs. The most pressing needs will be different from one community to the next, and a community’s needs may change over time. Investing in effective strategies that best meet the community’s needs will have the greatest impact.

What should communities not fund?

Now that we’ve shared some specific ways that communities should use their OSF for prevention, what are some things communities should avoid?

  • Ineffective strategies: Unfortunately, ineffective strategies continue to be widely utilized, and many communities have already directed their OSF towards such purposes. Because they are commonly used, it can be difficult for decision-makers to accept that such strategies are ineffective and may even be harmful. But it is important not to waste valuable resources – money, time and trust – on ineffective strategies (e.g., one-time events, stand-alone guest speakers and media campaigns, scare tactics and punishment).
  • One-time events: Prevention is not a one-time event. Single presentations are not likely to result in long-lasting attitude or behavioral changes. Communities should not expect that they will prevent substance use by hosting a once-a-year school assembly or a one-time community event. An event may be used as an entree into a broader, sustained effort.
  • Guest speakers: Especially if used as a one-time event, guest speakers who are celebrities or share stories to illustrate the life-changing dangers of substance use can have the unintended consequence of making risky behavior seem thrilling and survivable. Law enforcement professionals can come off as intimidating, and the criminal and legal aspects of substance use often don’t resonate with young people and can contribute to stigma by implicitly or explicitly linking substance use to crime.
  • Stand-alone media/awareness campaigns: The research does not support stand-alone public awareness campaigns (that are not part of a broader, more comprehensive prevention strategy) for primary prevention. Education and information alone do not lead to the behavior change or target the underlying reasons people use substances. Media campaigns are also expensive and need to be carefully designed, monitored and evaluated to determine they are having their intended effect.
  • Scare tactics: A lot of research has found that scare tactics do not work. These messages don’t lead to lasting attitude and behavior changes necessary for prevention. In some cases, they can be harmful, particularly for those most at risk for substance use.
  • Punitive practices: Approaches that punish individuals for substance use, such as school suspension or punitive approaches around child protective services, can increase the risk for substance use and perpetuate stigma. The research has found a health-based approach to be more effective in addressing substance use. Communities can both discourage substance use and reduce stigma for those who have substance use disorder by taking a health-based approach.

Bottom line

Investing in prevention is difficult: efforts often require sustained investment over time, and the results can be difficult to measure (i.e., people who don’t develop substance use disorder). Prevention strategies (like scare tactics) that haven’t worked in the past are not going to suddenly work now. Investing in ineffective strategies wastes valuable resources including money and time, and it can sow distrust. Nonetheless, prevention is a worthwhile investment. Supporting prevention over the long term will help reduce the physical, social and economic costs to individuals, families, communities and society of the opioid crisis and help to prevent a future crisis.

For more, see additional resources:

Lindsey Vuolo, J.D., M.P.H., performs legal, regulatory, and policy work related to addiction prevention and treatment.  Prior to joining Partnership to End Addiction, Lindsey worked in regulatory affairs for a managed care organization. She earned a J.D. from Northeastern University School of Law, a Master of Public Health from Tufts University School of Medicine, and a Bachelor of Arts degree from Boston College.