How did Cuyahoga and Summit counties spend their litigation money?

Counties now receiving dollars from the opioid litigation can look to two Ohio counties–Summit County and Cuyahoga County–to see how they handled their funds. In 2019, these two counties settled with many of the companies involved with the opioid litigation for over $325 million (a figure that includes donated product and attorney fees).

More than 1.2 million people live in Cuyahoga County, anchored by Cleveland (population 370,000). Summit County is home to approximately 540,000 people with Akron (population 190,000) serving as the county seat.

Summit County established a seventeen-member Opioid Abatement Advisory Council to assist with the process of distributing litigation funds. The Council first synthesized existing data to determine areas of need and then provided recommendations on how the dollars should be used. Members of the Council were drawn from different fields that touch upon the epidemic, such as education, child welfare and treatment, and also included people with lived experience.

Recommendations from the Council are approved by a group of county leaders and then the County Council; the first grants were made in 2021. Summit County so far has provided funding to:

Healthcare organizations to improve the care provided in emergency settings;
Small nonprofits that provide direct services to families in need;
Harm reduction strategies, including needle exchange programs, fentanyl test strips, and naloxone; and
Improve pregnancy care for people with an opioid use disorder.

According to Greta Johnson, Summit County Director of Communications and Assistant Chief of Staff, the County intends to use the remaining dollars to set up a fund that can provide an ongoing revenue source to help the county address substance use. The County also plans to launch a website that will include a community dashboard so that the public can see how the dollars are being used.

In Cuyahoga County, county leaders prioritized distributing money quickly to treatment, prevention, diversion, and education services. County officials made initial recommendations about how to spend the new money based in part on the Phase I Cuyahoga County Opioid Crisis Mitigation Plan and proposals received from community organizations. The county council then approved those recommendations.

Cuyahoga County chose to focus most of its money on a single, large, new initiative rather than funding many smaller projects. Cuyahoga allotted between $60 and $70 million of $117 million in available money to start a diversion program that provides treatment for people with substance use disorder or mental illness instead of sending them to jail. The Diversion Center opened on May 4, 2021. The allocations include capital expenses for a new building and 4 to 5 years of operating expenses for the program. The Diversion Center is run by a formal Diversion Board which includes representation from several agencies, including Alcohol, Drug Addiction, and Mental Health Services (ADAMHS) Board of Cuyahoga County, which takes recommendations from a Community Input Committee.

Currently, the Diversion Program includes contracts with three entities:

The local ADAMHS Board which provides the Crisis Intervention Training for all police and dispatchers,
The Oriana House which operates the Diversion Center along with a subcontract to University Hospitals for psychiatrists and other medical positions staffed at the Diversion Center, and
Frontline Services which answers the 24/7/365 Diversion Center hotline.

All referrals to the Diversion Center, including those from police, go through the hotline. During the call, staff triage the situation and recommend the Diversion Center for those appropriate. For others they can recommend options such as a hospital ED or activation of the County Mobile Crisis Team instead.

Other programs funded by Cuyahoga County include inpatient and outpatient treatment programs (including treatment in emergency rooms and jails), school-based prevention programs, and support for mothers with opioid use disorder. The County Innovation Office identifies goals and metrics and tracks progress for the funded projects, though detailed reports are not available to the public.