In Touch with Tennessee
Navigating Opioid Settlements: The SMART Initiative's Role in Tennessee
Are you ready to navigate the complex waters of opioid settlements with us? We look into Tennessee's opioid crisis and the SMART initiative's role in guiding counties and cities on the use of funds from the lawsuits against pharmaceutical companies. SMART Executive Director Jennifer Tourville and CTAS County Government Consultant Heather Duncan discuss their meetings with counties across Southeast Tennessee.
Are you ready to navigate the complex waters of opioid settlements with us? We look into Tennessee's opioid crisis and the SMART initiative's role in guiding counties and cities on the use of funds from the lawsuits against pharmaceutical companies. SMART Executive Director Jennifer Tourville and CTAS County Government Consultant Heather Duncan discuss their meetings with counties across Southeast Tennessee.
Hi and welcome to In Touch with Tennessee, a podcast of the University of Tennessee Institute for Public Service. Tennessee is among the hardest-hit states when it comes to the opioid epidemic. In 2021, there were 3,038 opioid overdose deaths in Tennessee, which accounted for 80% of all drug overdose deaths in the state. Most states, tennessee included, filed lawsuits against pharmaceutical companies and pharmacies that are blamed for creating and fueling this epidemic. Funds from those lawsuits were starting to be dispersed to states to help them fight the crisis. Our substance misuse and addiction resource for Tennessee, or SMART initiative, is providing guidance to account community leaders on how to use these funds. Through our sister agencies, the County Technical Assistance Service and the Municipal Technical Advisory Service, smart is meeting directly with county and city officials to help them address the epidemic. Joining us today are Dr Jennifer Torville, executive Director of the SMART Initiative, and Heather Duncan, a county government consultant with CTAS. Welcome both of you.
Jennifer Tourville:Thank you, thanks, susan, thanks for having us.
Susan Robertson:Jennifer, can you explain to us the settlements and how counties and cities are expected to use the funds?
Jennifer Tourville:Sure, so we could be here for days discussing the settlements, but there are several companies that have settled. The funds are coming in on different timelines, some of the money is split differently and they have different rules for spending. So it's very confusing. It's very. It changes all the time and it's a lot to keep up with. So counties and cities they have specific rules they have to follow for spending.
Jennifer Tourville:The goal of the money is to abate the opioid crisis right, so to use these monies for programs such as, you know, saving lives, narcan, medication out in the communities, programs for incarcerated individuals, treatment programs, prevention programs, programs for mothers, data and research. So there's a lot of different uses. There's a comprehensive list of about 147 programs that these funds can be used for, and so it's taken the counties and cities a while to figure out what to do with these funds. How do they decide what the priorities are in their communities? So it's a process and we're encouraging them not to jump into spending these quickly to take a step back, set up a process, figure out what those priorities are and then allocate those funds accordingly.
Susan Robertson:So what about the work with CTAS? What else about the work you're doing with CTAS specifically?
Jennifer Tourville:So CTAS works directly with counties on different aspects of county government and they have relationships with all of the county executives, all the county leaders. They know the dynamics within the counties, they look at their budgets and they're trusted. They've had long-term relationships with them. So we've partnered with CTAS to have some of those conversations with county executives. They don't know who we are smart as a new initiative within the Institute for Public Service, we don't have those relationships, we haven't built that trust yet and this is a very confusing situation for a lot of them. So partnering with CTAS, going together with CTAS to visit some of these counties, it just adds a layer of trust and comfort with us walking in and having some of these conversations. So we've been trying to do county visits together.
Susan Robertson:And how do you hear from the counties in real territory about the opioid crisis in their communities? Let's try toрон interdependence.
Heather Duncan:Well, I think county leaders, specifically mayors, you know, judges, district attorneys, they are all concerned, as the citizens in every county are concerned about the opioid crisis. You know this isn't your normal. You know drug problem this isn't street street drugs that we have dealt with in the past. You know these are medical necessity drugs that are affecting just common everyday people and when you know you look out in counties, there are very few families left who haven't been touched by some degree by the opioid crisis. So I think, for that reason and because it is, you know, starting to hit our everyday families, county leaders are responding to, you know the need to address this terrible problem.
Susan Robertson:Right, so I know you two have visited with many of the counties in Heather's territory, which is Southeast Tennessee. I believe yes.
Heather Duncan:Southeast Tennessee.
Susan Robertson:What advice have you given them about resettlements? And you both can speak through this.
Heather Duncan:Well, I think I'll chime in first because you know, like Jennifer said, as county government consultants you know we typically help counties with. You know things like budgeting or you know new laws, anything that counties need. You know we're kind of a general consultant and so you know they have looked to us in the past for you know financial assistance and guidance as far as you know how can we spend this money. But, as Jennifer said, you know this opioid money comes up. One portion of it is not so restricted but another portion of it is very restricted. So you know it's kind of been nice from my standpoint to be able to walk into a county with Jennifer and you know I can offer guidance. As far as you know the financial, how do you receive the money, what do you do when you receive it? You know what, what kind of, what pot is restricted, what pot is not restricted, and then from there you know she can talk about what can you do with the various pots of money.
Jennifer Tourville:Yeah, and I would to add to that you know, just the process for deciding how it's spent is something we've been trying to provide some guidance on. So I mean, county mayors don't have the time to oversee the spending of this money coming in for the next 18 years to make sure it's going to the approved uses and to future remediation. So we've been encouraging them To assemble whatever they want to call it Some are calling it an opioid task force, some a committee, some a board, some a council but putting together a group of multidisciplinary people within the community that have some kind of expertise or knowledge about addiction and drug use, to kind of make recommendations to the mayor and to the county commission on this is what we think is needed in our community. These are the people that are asking for some of this money to use within the community. These are the expected outcomes that we should see and to make those recommendations and it takes a lot of work and pressure off of the mayor and the county commission. We've also been encouraging them, if they are going to give some money outside of the county, you know, to community organizations, to have some kind of paper trail, so an application process, and we've developed kind of toolkit, you know, with a request for proposals and application and a budget template and scoring template so that they can use those modifying for their county, make it as easy as possible for them. But then those community organizations can put on paper. This is what we're going to do, these are the outcomes we expect, so that when that committee is making that recommendation to the mayor and the county commission, everything's there, they have all the information, everything's documented and they have everything they need to make a good decision. So we're kind of providing some guidance in that regard to.
Jennifer Tourville:18 years is a long time. So if you can set a process up on the front end that can guide the spending, it'll make it a lot easier moving forward. So we have been providing some some advice on that. And then, like Heather said, to how to spend the money. So some programs produce better outcomes than others.
Jennifer Tourville:Some of these counties are not getting a lot of money. You know if you want to start a treatment program and you're getting $45,000 a year, it's probably not going to work out. So, looking at how much money are they getting out of that 147. Activities programs they can start. What will be the most cost effective. Is there funding outside of the county that we can help secure for them that they can use for a bigger program? Can they partner with a neighboring county? So just looking for alternatives to just that small bucket of money but to use it in the most impactful way to keep people alive. So and it, and it changes moving forward. So you know. Another piece of advice is just to Make sure you're kind of staying current on what settlements are in progress. We just had a new 1 settle last week and there's another 1 pending, so it keeps changing. So making sure that they're aware of what funds are available for them to sign on to the settlements and then what will come into the county.
Heather Duncan:You know I think I've been pretty impressed and Jennifer may not want to comment to this, but you know it's it's the mayor's office who is receiving the money. But you know the many times you know mayors are ill equipped to decide how do we spend opioid money because you know they're just not, they're not opioid experts. None of us are door Jennifer is, but you know we don't have the knowledge to know what is the best way to use this money to help alleviate this problem. And I Would say, and Jennifer, hopefully, will agree that you know the counties that we've been in, I mean they have been pretty impressive so far. They've, the mayors have, you know, assembled a Diversity of, like she said, teams or councils or whatever you want to call it, to try to sit down.
Heather Duncan:And you know, look at where do we stand with the problem right now. You know, do we want to do treatment? Do we want to do, you know, like outreach to our Jail system? Do we want to do like a drug court program? So you know they they have really, I think the counties, the mayors in the counties, have put good minds at the table to try to look at what is the best way to spend this money to help with the problem and, like she said, to look at. You know 18 years going forward and you know, at the end of that 18 years, hopefully be able to look back and reflect. You know, did we do this Well and are we seeing progress?
Jennifer Tourville:Yeah, I completely agree, heather, you're you're very correct. It's been very impressive to see that some of these, especially some of the smaller communities you know, pulling Experts together, especially in rural areas, can be quite difficult, and they've they've done it very well. A lot of, a lot of the counties that we visited have you know people that are very passionate about this. Like Heather said, a lot of people have been directly impacted this themselves, or a family member or a friend, and you have an opportunity in these communities to make a difference. You can use this money to truly, you know, start programs are going to mitigate some of these issues and they're very passionate about it and they're working together and they're, you know, looking at what resources do we have? What are our priorities? Where are gaps? What can we fill with this money? Can we use it to leverage additional funds? And they're having those conversations and they're making really good decisions. So it has been very encouraging to see.
Susan Robertson:Great, that's very good to hear. Um, jennifer, you mentioned there were, there are a number of programs Available that you all, you know, suggest to counties or that you appear on this. This resource lives. We have a couple of types of programs.
Jennifer Tourville:Yeah, so the programs were actually included in the original settlement agreements. Exhibit E to very comprehensive, there's 9 core strategies and I won't read them to you, but just the basics, right? So when we talk about overcoming the opioid crisis, we talk about prevention. A lot which prevention? I guess we could call it the continuum of care, right? So prevention is we stop it before it starts. We're targeting typically its youth, whether it be youth at large or high risk youth. But you're intervening prior to drug use starting or in the very early stages so that it won't progress and get worse. So prevention programs and all different kinds again it's in the exhibit either the very long 16 page document of approved uses.
Jennifer Tourville:And then we talk about harm reduction. And harm reduction is people are, they have substance use disorder, they're currently using drugs, they aren't ready to enter into treatment and recovery. But how do we reduce the harm associated with drug use, Right? So whether that be Having the lock zone available to prevent overdose or I guess not prevent overdose, reverse overdose, you know HIV and hep C testing and treatment, so the harms associated with it is what we're trying to reduce there. So those uses are all approved and there's different, different types of those Treatment.
Jennifer Tourville:Of course treatment is an approved use. It is the most expensive. Treatment can be extremely costly, especially inpatient, outpatient too. We have a lot of people that use drugs that don't have health insurance and so treatment can be very costly. And that can be through jail programs, that can be through intensive outpatient programs All different kinds of programs are approved to use these funds. And then you have recovery services, and recovery services Are kind of the wraparound services and then direct recovery support. So Peer navigators in our emergency departments and jails, um workforce development programs. You have faith based Recovery programs, collegiate recovery programs, recovery community centers, housing, transportation all of those services that are needed after you go through treatment and you're trying to sustain recovery.
Jennifer Tourville:And then data and research. So how you determine how to spend the money usually is going to involve some kind of data analysis and review. Right, you have to look at what do we need, what do we have, what do we not have? What do our numbers look like? Are prescriptions increasing or decreasing, or overdoses increasing or decreasing? Where are they? Do we have hotspot? So Looking at that data will really inform how you can use this money most impassively in your community, because it's going to look different in every community, and that's what makes it hard. You can't say, oh, go, put all your money in prevention or in harm reduction. It has to be based on the actual needs of your community.
Jennifer Tourville:And then there's uses for support for people who are impacted by this. Think about law enforcement, ems. I mean the people, the 1st responders, who are constantly interacting with people that are overdosing or, um, you know, public safety issues. We have crimes committed. There can be trauma related, you know, caregiver trauma and so there's programs to support them. There's also programs to support families that have been impacted. So there's very comprehensive list that covers the entire continuum of care and then also the people that have been affected On the outside. So very comprehensive.
Heather Duncan:And we've heard those discussions in the meetings that we've gone to. I mean, I know one county we were in. They were very Adam and I guess that they wanted to spend it in prevention and I talked about school programs, extensively talked about school programs, even starting in the middle school and elementary school age education, drug education. But then we've had somewhere they talked about release from jail and how to get these people back into the normal society and normal lives and taking people to and from their counseling. So I think it's been. I have learned a lot myself just sitting in those meetings with Jennifer and hearing these committees debate and discuss how best can they impact their community and their county. You know with which type program.
Susan Robertson:Right Now the funds, were they dispersed to counties based on size, based on overdose figures.
Jennifer Tourville:So both so they were the score criteria. They looked at population, opioid prescriptions written, fatal and non-fatal overdoses, so they took. It's a little different with the different buckets of money, but essentially that's what they looked at the opioid abatement council part of the money, which is the bulk of how it's being fed through Tennessee to the counties that data they collected from the Tennessee Department of Health over the past three years that was available, calculated it all out, came up with an allocation percentage, and then that percentage is the percentage of the money that they get and that will actually be recalculated every four years. So every four years everybody's allocation percentage will change, which means their payment amounts will change. So that does add a layer of difficulty for planning down the road on how to spend these funds, because there's a lot of unknowns about how much money they're getting for various reasons. That's one of them being, though, they'll recalculate those data points and that allocation percentage will change.
Susan Robertson:Right. How many counties have you two visited together so far?
Heather Duncan:Right, at least six or seven right, we lost count. We did a road tour one day. We did about three counties, and one day I took Jennifer over the hills and through the woods.
Jennifer Tourville:He did and I'd say that's probably about accurate. And one thing I learned is we have some. Some of our rural counties are absolutely beautiful. I mean they're gorgeous. If you're going to have to drive on a road trip, you know, just down the road and around the corner it's a beautiful place to go.
Heather Duncan:And you have to get off the bait and pass a little bit right.
Jennifer Tourville:Absolutely. Yeah, my dad looked on. You know he can track my phone. He looked one day and he texted me. He's like where are you? I was like I don't know what is sure as beautiful. So it's been very enjoyable, not only to, you know, go on a tour with Heather, but to get to talk to our counties and also see our counties. I've been to several that I've never been to before. So, it's been very enjoyable.
Heather Duncan:I've enjoyed it as well Getting to. Like I said, I've learned a lot and I think it. You know my job is to help counties, but I think it. The more knowledge you have, in whatever area, it's easier to help and you feel like you're giving better help. So, um, spending this time with Jennifer and learning this about you know the opioid money that it's not just about money, it's about making communities better and stronger for the future. So I've thoroughly enjoyed it.
Susan Robertson:Well, great. And, jennifer, I don't know if it's you or one of your staff members who visited other counties around the state as well. Is that correct?
Jennifer Tourville:Yeah, so I've been doing quite a bit of driving around. Yeah, so we have been going, and some with other CTAS consultants and some on our own. We have hired consultants of our own and we'll be. They're assigned to each grand division of the state. They just started, so they're brand new. They're still learning Again. Like we said, this is Very confusing. So it's I want to make sure that they have All of the information correct before we send them out alone. So I've been going with them and we've been going and Heather's met them. We've. We've went on a couple Me and the others with Heather. So we've kind of been traveling around together, getting them trained, getting them used to talking to the communities, and then they will continue on Without me at some point. But yeah, so outside of Heather's District region I'm not sure what you call them Heather so outside of Heather's region, we have been doing mostly in East Tennessee. We've done some in the West, mostly in East and middle, though, but we've we've been to quite a few.
Susan Robertson:Well, thank you both for joining us today and talking about this. It's not a very valuable service, in addition to the other services that you have provides to Tennessee counties.
Jennifer Tourville:Thanks for having us. Thanks for having us, susan.
Susan Robertson:We appreciate it and thank you for tuning in to think that's with Tennessee. Make sure to subscribe to us and, wherever you listen, to your favorite podcast.