Nearly a year after Montana began receiving millions of dollars to invest in efforts to combat the opioid crisis, much of that money remains untouched. Meanwhile, the state’s opioid overdose and death counts continue to rise.
The money is part of the approximately $50 billion that states and local governments will receive nationwide in opioid settlement funds over nearly two decades. The payments come from more than a dozen companies that made, distributed, or sold prescription opioid painkillers that were sued for their role in fueling the overdose epidemic.
Many places have begun deciding where that money will go and making payments to schools, public health departments, and local governments. South Carolina, for example, has awarded more than $7 million to 21 grantees. Wisconsin has posted two years’ worth of spending plans that total nearly $40 million.
Montana, West Virginia, and Hawaii are among the states moving slower.
Montana began receiving its first settlement payments in January, and, by fall, payments totaled roughly $13 million. As of early December, the Montana Opioid Abatement Trust — a private nonprofit created to oversee 70% of the state’s share — had met once to agree to its rules of operation, and its money remained locked behind an inactive grant portal. The remainder, divided among the state and local governments, either hadn’t been spent or wasn’t publicly recorded.
Those charged with distributing the money say they’re building a framework to spend it in ways that last. Meanwhile, some addiction treatment providers are eager to use the funds to plug gaps in services.
The tension in Montana reflects a nationwide push-pull. Those handling settlement dollars say governments should take their time planning how to use the enormous windfall. Others argue for urgency as the drug supply has become increasingly deadly. More than 100,000 Americans died of overdoses in 2022, surpassing the previous year’s record-setting death toll.
Nearly 200 Montanans died of a drug overdose in 2021, the latest year state data is available. That number, likely an undercount, is roughly 40 more deaths than the year before. Emergency medical responders have continued to record an increasing number of opioid-related emergencies this year.
In Billings, the Rimrock Foundation, one of the state’s largest behavioral health providers, has seen its number of clients with opioid use dependency more than triple since 2021. Like other treatment facilities, Rimrock has a waitlist, and addiction treatment providers worry about the limited community resources that exist for patients once they are discharged. “The result of not addressing this is a lot of deaths,” said Jennifer Verhasselt, Rimrock Foundation’s chief clinical officer.
Debbie Knutson, Rimrock’s medical unit and nursing supervisor, said there is widespread confusion about how and when the state’s settlement dollars can be used.
“It’s very concerning if we have money available that we could use to help people that is just kind of sitting, waiting for somebody to decide where it should go,” Knutson said.
Rusty Gackle, the Montana Opioid Abatement Trust executive director, said a lot of work has happened behind the scenes to get local governments ready to accept their initial payments and for regional leaders to form systems to request money from the trust. That included hosting a series of town hall-style meetings to share information about the process. He said many of those local regions are still finalizing their governance structures.
“I would love to progress a little bit faster,” Gackle said. “But I’d rather do it right so that we’re not having to go backwards.”
Montana officials got a late start too, he added. Some states began receiving settlement dollars last year,…
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