Sonia Verdugo, whose husband died of an opioid overdose last year, regularly delivers medical supplies to drug users living and dying on the streets of Los Angeles and advocates for policies to address drug addiction and homelessness at Los Angeles City Hall.

But Verdugo didn't know that hundreds of millions of dollars flow to California communities each year to fight the opioid crisis, and that those payments will begin in 2022 and continue through 2038.

The money comes from pharmaceutical companies that manufactured, distributed and sold prescription opioid painkillers and have agreed to pay roughly $50 billion nationwide to settle lawsuits over their role in the overdose epidemic, despite a recent Supreme Court ruling. Overturned the settlement Many other companies, including Purdue Pharma, the maker of OxyContin, have already started making payments and plan to continue making payments for years to come.

California is the most populous state, Over $4 billion.

“You walk down the street and you see people with drug addictions on every corner. I mean, they're everywhere,” Verdugo said, “and I've never even heard of this foundation. To me, that's insane.”

Nationwide, much of this extra income is shrouded in secrecy, and in many jurisdictions There is little transparency They have not answered how they spend the money, despite repeated questions from recovering addicts and families who have lost loved ones to addiction.

Meanwhile, there's a lot of bargaining going on over how the money should be spent. Companies are lobbying for spending on products ranging from lockable pill bottles to full-body scanners that screen people entering prisons. Local government officials often champion the areas they represent: treatment, prevention and harm reduction. And some governments are directing funds to the public. fill a budget gap.

In California, local governments Must report The company will report how it uses the settlement money to the state Department of Health Services, but it is not required to make the reports public.

KFF Health News obtained copies of the documents through a public records request and is now making public for the first time 265 expenditure reports for fiscal year 2022-23, the most recent reports submitted by local governments.

The report provides a snapshot of early spending priorities and tensions.

Naloxone wins early

According to the report, as of June 2023, the vast majority of the opioid settlement funds administered by California cities and counties remain unspent — more than $200 million. This is a topic It reverberated throughout the country The authorities will take their time in deliberating.

of city and county The city of Los Angeles accounts for about one-fifth of the total unspent, or about $39 million, but officials say since the report was filed, they have begun allocating funds to recovery housing and programs that connect homeless people to residential addiction treatment.

Among local governments that spent money in the first year, the top spending item was naloxone, a drug that reverses opioid overdoses and better known by the brand name Narcan, which accounted for more than $2 million in spending across 19 projects.

One such project took place in Union City, a San Francisco Bay area community of about 72,000 residents. Five suspected fentanyl overdosesIn September, there were two accidents within 24 hours, two of which were fatal.

The opioid settlement money “has been invaluable,” said Corinna Hahn, the city's director of community and recreation services. She stated in her report“The availability of these resources has facilitated education, training and distribution of Narcan kits to parents, youth and school staff.”

Union City purchased 500 kits containing two doses of naloxone, which cost about $13,500, with another $56,000 set aside for similar projects, including backpacks with Narcan kits and training materials for high school students.

Union City also plans to expand outreach to homeless people and fund drug education and recovery services, including addiction counseling.

Verdugo, the Los Angeles activist, said these life-saving services are desperately needed as homeless people continue to die.

She lost her husband, Jesse Baumgartner, then 46, in June 2023 to a drug addiction that began after he was prescribed painkillers to treat a wrestling injury in high school. He tried to kick his addiction using methadone for six years, but cravings would drive him back to illicit drugs every time his prescriber reduced his dosage.

“It was just a horrible rollercoaster ride that he just couldn't get out of,” Verdugo said.

Sonia Verdugo lost her husband, Jesse Baumgartner, 46, in June 2023 due to complications from opioid addiction. She now works as a community organizer for Ground Game LA.

(Courtesy of Arlene Mejorado/KFF Health News)

By that time, the couple had overcome four and a half years of homelessness and had been in stable housing for about two years.

Fentanyl use is “epidemic,” she said, especially among homeless people, who may be unknowingly exposed to the cheap, highly addictive substance because it's often mixed with other things.

“Once you start using it, there's no going back,” said Verdugo, who works as a community organizer. Ground Game LA.

So she left boxes of naloxone at homeless encampments in the hopes of saving lives.

“They will definitely use it because that's what they need at that moment. They can't wait for an ambulance to come,” she said.

Cities withdraw spending on law enforcement

in contrast, Irvine and Riverside Lists plans to prioritize law enforcement through acquisitions Portable Drug AnalyzerNeither city did so in fiscal year 2022-23, the first year they would do so, but their trend mirrors a pattern in other parts of the country where millions of dollars in settlement payments will be paid out. It flows into police stations and prisons.

However, the use of these funds has sparked controversy, and following a decision by the Department of Health Services, both cities withdrew their plans to purchase drug analyzers. Published regulations The rule states that opioid settlement funds cannot be used for certain law enforcement activities. The rule specifically excludes “devices intended to collect evidence for prosecution, such as TruNarc portable narcotics analyzers.”

In Hawthorne, the police department had already purchased 80 Bora Wraps in a first installment of about $25,000 from the settlement. Kevlar tether launching device It is wrapped around a person's limbs or torso.

After the state said Bola Wraps was not an allowable expense, the city said it would find other sources of funding to pay the remaining installments.

In Santa Rosa, California's wine region, Spent about $30,000 About police officer health and support.

With this funding, the police department Contract Wellness Coordinator Spokeswoman Sergeant Patricia Sefens said the department plans to promote staff from part-time to full-time and buy a mobile machine that measures electrical activity in the brain.

The goal is to use the technology with police officers to “assess the traumatic impact of responding to the increasing number of overdose calls,” Sefens said in an email.

In Dublin, east of San Francisco, officials are using part of a $62,000 settlement to fund the DARE program.

DARE is Drug Abuse Prevention Educationis a series of lessons taught by police officers in schools to encourage students to avoid drugs. “Say No” Campaign In the 1980s.

Research suggests Inconsistent results From the program No long-term effects Many researchers on drug use would call thishas no effect.”

However, the DARE website cites research since the program was updated in 2009, stating:Positive Effects” With 5th graders “Statistically significant decreaseApproximately four months after completing the program, I was able to abstain from drinking and smoking.

“The DARE program was much different when it was first implemented than it is today,” Dublin Police Chief Nate Schmidt said.

Schmidt said the additional settlement money will be used to distribute naloxone to residents and stock it in schools and city facilities.

Other California municipalities have spent smaller amounts on a broader range of addiction-related programs. Ukiah, in Mendocino County north of San Francisco, Spent $11,000 To install a new heating and air conditioning system at a local drug treatment center. orange and San Mateo The county spent part of the settlement on drug treatment for people incarcerated in the jail. City of Oceanside Spent $16,000 Displaying drug prevention art and videos created by middle school students in local cinemas, public spaces, buses and taxis.

The Department of Health Services said it plans to release a statewide report on how the money was spent, as well as reports for each city and county, by the end of the year.