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The Principles Coalition Announces Quarter 2 Award Winners

June 27, 2023

The Principles coalition is excited to announce the recipients of the Award for Excellence in the Application of the Opioid Litigation Principles for Quarter 2 are the states of North Carolina and Rhode Island. These awards are designated by a coalition, led by faculty at the Johns Hopkins Bloomberg School of Public Health, that developed a set of evidence-based guidelines, known as the Principles, to help policymakers use opioid settlement funds effectively and equitably.

More than 670,000 people in the U.S. fatally overdosed from prescription and illicit opioids between 1999-2021. As the crisis deepened, states and localities filed lawsuits against drug manufacturers, pharmaceutical distributors, and pharmacies for their role in these deaths and other harms. Funds from litigation settlements are directing billions of dollars to states and localities to combat the opioid overdose crisis. 

To guide states and localities in spending the money from these settlements, faculty at the Johns Hopkins Bloomberg School of Public Health worked with collaborators across the country to create the Principles for the Use of Funds from the Opioid Litigation. Announced in January 2021, these concepts have been endorsed by more than 60 organizations across the U.S..

The Principles are:

  • Principle 1: Spend the money to save lives
  • Principle 2: Use evidence to guide spending
  • Principle 3: Invest in youth prevention
  • Principle 4: Focus on racial equity
  • Principle 5: Develop a fair and transparent process for deciding where to spend the funding

Details about how to apply the Principles and other resources for effective settlement spending are available at the website:

To recognize jurisdictions and encourage broad use of the Principles, a coalition of endorsing organizations launched the Excellence in the Application of the Opioid Litigation Principles Award. These awards, given quarterly, recognize jurisdictions that have demonstrated rigorous application of the Principles in their decision-making process, including a focus on evidence, equity, and transparency. A committee of the Principles endorsing organizations, including representatives from the Bloomberg School, Shatterproof, Yale Program of Addiction Medicine, SpiritWorks Foundation, the Colorado Consortium for Prescription Drug Abuse Prevention, and Partnership to End Addiction, reviewed the applications.

The first set of winners, the state of Colorado and Rock County, WI, were named earlier this year. 

North Carolina Memorandum of Agreement (MOA) between the state and local governments allocates 85 percent of opioid settlement funds to counties and municipalities and the remaining 15 percent to the state. The MOA is well-aligned with the Principles in several key respects. These include:

  • North Carolina has required that all the money coming to the state be spent on opioid remediation (Principle 1) and that local governments report publicly on how the money is being spent (Principle 5). 
  • North Carolina has built an extensive website – the Community Opioid Resources Engine for North Carolina (CORE-NC) – with evidence-based materials for counties and municipalities to use as they decide how to spend the money (Principle 2).
  • North Carolina’s commitment to equity (Principle 4) is the center of the NC Opioid and Substance Use Action Plan and is the foundation for their approach to the opioid settlements.

Collaboration between state and local governments and across different organizations has been a hallmark of the approach in North Carolina. The resources on the website were developed jointly by the North Carolina Department of Justice, the North Carolina Association of County Commissioners, the University of North Carolina Injury Prevention Research Center, the North Carolina Department of Health and Human Services, and other groups. Additionally, technical assistance for planning, implementing, and evaluating NC opioid settlement funds is available from the North Carolina Association of County Commissioners’ Opioid Settlement Technical Assistance Team.

“The best way to turn the tide on the opioid crisis is to make sure we are delivering help to the people who need it,” said Attorney General Josh Stein. “I’m grateful for all of the hard work of my team, the North Carolina Association of County Commissioners, and the thousands of people across the state who are committed to getting this urgent work right. I’m proud that North Carolina was honored in this way, and I look forward to our continuing to set a standard for the rest of the nation.”

Recognizing the immediacy of need in their state, Rhode Island seated its advisory committee in the spring of 2022 and approved the first round of expenditures in August 2022. Several additional areas stood out in Rhode Island’s application: 

  • The state is following the evidence in its support for the interventions it is funding, including the first state-funded harm reduction center in the country (Principle 2).
  • The largest pot of money, more than $4 million, has been allocated to youth prevention programs (Principle 3).
  • The state has woven a focus on racial equity throughout its work, including an explicit requirement that grantees’ projects support equity-funded work (Principle 4).

“Every death is a tragedy,” said Governor Dan McKee. “Our administration is committed to countering this crisis – helped greatly by our ability to distribute the opioid settlement funds to community agencies doing critical lifesaving work every day. Recent data show that the number of fatal overdoses in Rhode Island did not increase from 2021 to 2022. Our Non-Hispanic Black Rhode Islanders continue to be most impacted and there was a notable 50% increase in the rate of fatal overdoses among Latino Rhode Islanders. Now that we have been investing settlement funds, we want to see these numbers decrease.” 

In addition to making immediate decisions, Rhode Island has already begun planning for the long term (Principle 1). For the fiscal year 2024 and beyond, the committee made recommendations that were approved by the Executive Office of Health and Human Services Acting Secretary Ana Novais in the Fall and were recently approved by the General Assembly in its annual budget approval process.

“As dollars begin to flow to states and local governments from the opioid litigation, a clear foundation will help inform effective spending decisions, ” said Sara Whaley, MPH, MSW, research associate at Johns Hopkins Bloomberg School of Public Health and one of the coordinators of the Principles. “We commend North Carolina and Rhode Island for their creation of a state-wide framework, informed by the Principles, that will help to ensure that their respective settlement funds are used to save lives.”

For additional details on North Carolina and Rhode Island, please see their respective press announcements here and here.

Nominations are currently being accepted from or on behalf of state or local governments that demonstrate robust application of the Principles.The deadline for the next quarter is Monday, July 31, 2023. Submit nominations here.