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The Promise of Litigation Funds to Sustain and Expand Programming

November 30, 2022

The post below is by Lane Davis, a Senior Program Analyst with the National Association of City and County Health Officials’ (NACCHO’s) Overdose, Injury and Violence Prevention team. NACCHO is a non-profit membership association representing local health departments across the country. Lane previously worked as an analyst on state lawsuits against opioid manufacturers and distributors. You can contact her at ldavis@naccho.org.

Local health departments are critical to the public health response to the overdose crisis, often providing overdose prevention programming and services to their communities at low or no cost. Local efforts to bolster these programs are often constrained by available funds, but money from the opioid litigations could help with this problem.

In Milwaukee, Wisconsin, Courtney Geiger, the Public Health Strategist for Substance Misuse and Overdose Prevention at the City of Milwaukee Health Department (MHD), explained that Milwaukee officials immediately saw the litigation funds as an opportunity to sustain and expand its flagship post-overdose outreach program.

Through the Milwaukee Overdose Response Initiative (MORI), a fire department paramedic captain, community paramedic, and a peer support specialist work together as a team to engage overdose survivors within 24 hours after the overdose to offer harm reduction services, treatment, and other resources. MHD and the City of Milwaukee Fire Department started MORI together in 2019.

Grant funding is the main source of financial support for MHD’s overdose prevention programming. But grants are unpredictable, time-limited, and often have restrictions on the specific use of funds. MORI was started in 2019 with grants from the National Association of City and County Health Officials (NACCHO). During this first pilot period, MORI provided resources to 683 overdose survivors. After the NACCHO grant funding ended in September 2021, Geiger says that MHD “really struggled” to sustain MORI through tax dollars. At the end of 2021, MHD won additional funding through NACCHO and the Fire Department won a Bureau of Justice Assistance grant to support MORI. These grant funds total $3 million dollars over about five years.

Additional sources of funds for the MHD’s overdose prevention programming include Wisconsin Narcan Direct and budget allocations from taxes.

Funding Source Restrictions
  • Grant funding
  • Time limited. Unallowable costs vary by grant (e.g., naloxone, equipment purchases)
  • Wisconsin Narcan Direct
  • Provides naloxone at no cost to recipients
  • Budget allocation from taxes
  • Small amount – $25,000 annually

With payments over the next 18 years for some settlements, Geiger sees the opioid litigation money as a consistent, long-term source of funds (MHD’s longest grant for overdose prevention, from the Bureau of Justice Assistance, is just three years). But Geiger says that the uncertain timing and amount of the litigation funds’ availability to MHD complicates efforts to plan service expansions. Once expected in April of 2022, MHD has now been told they will receive around $600,000 sometime at the end of 2022 or early 2023.

When asked to provide preliminary input on how the litigation funds should be spent, Milwaukee officials agreed they wanted to provide sustained funding for MORI, but also to offer new overdose prevention services and programs, especially in the area of harm reduction. To prioritize and tailor these new services, MHD is:

  • Partnering with organizations experienced in needs and policy assessments to identify priority neighborhoods. MHD is working with the Medical College of Wisconsin to identify neighborhoods with high need through geospatial analysis of fatal and non-fatal overdose data and existing harm reduction, treatment, and social services providers.
  • Seeking input from the community, especially harm reduction, treatment, and social service providers and people with lived experience in priority neighborhoods. For example, the day of the interview for this blog post, Geiger had spoken with a local service provider who also has lived experience: “I just asked her – what do you guys need? What do you think the community needs?” Geiger reports that through conversations like these, community members have emphasized the importance of harm reduction resources and education as well as partnerships with trusted community partners.
  • Learning from other jurisdictions. For example, Geiger hopes to emulate and build upon Dane County’s (nearby Madison, WI’s county) fentanyl test strip program and the AIDS-focused health care provider Vivent Health’s long history of providing harm reduction to the community.

MHD has already begun translating some of this information into action. For example, Geiger is working with a culturally specific graphic designer to develop media campaigns tailored to neighborhoods with a high burden of overdoses. With MORI funded through 2023, the first round of litigation funds promises to expand the reach of harm reduction for the highest need communities in the City of Milwaukee.