This article is shared with LebTown by content partner Spotlight PA.

By Ed Mahon of Spotlight PA

HARRISBURG — County officials across Pennsylvania are waiting to hear if a state oversight board will approve how they decided to spend tens of millions of dollars from opioid settlements.

Money for county coroners, initiatives connected to district attorney offices, media campaigns, and $7.5 million to support residents of the Kensington area of Philadelphia are among the programs the powerful board declined to approve in May and instead chose to continue evaluating.

The Pennsylvania Opioid Misuse and Addiction Abatement Trust — which has the power to cut funding if it decides counties spent settlement money inappropriately — is expected to reconsider a range of programs at its next public meeting on June 20. Members of the oversight board have done much of their work in secret — over the objections of advocates focused on addiction issues and at least one of its own board members.

But trust officials have publicly raised concerns about some programs, including Philadelphia’s use of $7.5 million for Kensington residents and an additional $3.5 million aimed at overdose prevention and “community healing.”

The chair of the trust, Tom VanKirk, said in May that members of the oversight board needed more information about Philadelphia’s programs.

“It is a significant sum of money, and we just have no details,” VanKirk said.

He said the trust heard money was going to “things that we have problems with,” and cited playgrounds as an example. “We are duty bound to dig much, much, much deeper into it,” VanKirk added.

The city has defended both programs and says it provided the trust with additional information about where the money is going and why it’s appropriate. The city “funded well supported and evidence‐informed prevention strategies that aim to reduce trauma experienced by Kensington residents,” spokesperson Sharon Gallagher told Spotlight PA.

In order to receive the money, counties agreed to spend the funds in ways that are consistent with the settlement document Exhibit E, which includes a range of approved and recommended uses. Philadelphia argued for a broad interpretation of Exhibit E, saying that programs are not prohibited even if they “do not explicitly align” with what is stated as an allowable use.

Decisions the trust makes could have an influence for years to come as counties allocate settlement money. Overall, the state expects settlements and litigation with opioid companies will bring Pennsylvania more than $1 billion, most of which is going to counties.

The trust approved many programs last month, but records released by the group after the May meeting listed about 150 it was still considering. The trust is reviewing money that was either spent or committed by the end of 2023.

It’s possible that once members review additional information from the counties, the full board will approve many of those programs without much public discussion or explanation. The chair of the trust said he expected “the great bulk” of programs will ultimately be recommended for approval, and multiple county officials reached by Spotlight PA expressed confidence in their strategies.

But there could be more contention surrounding some issues, and the scrutiny highlights larger questions about the best way to respond to the epidemic. Here’s what to know and what to watch for ahead of the trust’s next public meeting.

What happens to rejected plans?

The order creating the trust gives it the power to withhold future payments if it decides counties spent the money inappropriately.

Under the order, counties have up to three months “to cure the misspending,” or the trust can reduce or withhold payments going forward. The cut funding would be shifted to an account controlled by the legislature and governor. The order does not define what it means to “cure” misspending.

The trust in May rejected five programs as noncompliant, including nearly $1,900 for a Chester County initiative aimed at combating underage drinking and related problems.

The county had not spent that money yet, doesn’t plan to challenge the trust’s decision, and “will look to use other funding sources for this prevention program,” the county said in a statement provided by spokesperson Rebecca Brain.

The trust also rejected four programs in Lawrence County, including about $140,000 for a project of the district attorney’s office, $25,000 for the coroner’s office, and $17,500 for a local police department. The county reported it already spent the money for the four rejected programs. The trust did not publicly specify its objections to Lawrence County’s programs at the May meeting, although its guidance and some members have expressed general concerns related to policing and law enforcement.

It’s not clear what the trust told Lawrence County to do next regarding the four programs deemed noncompliant. The trust’s chairperson declined to provide details, saying, “Communication or data specific to individual counties will not be disclosed.” A county official provided limited information to Spotlight PA in May, but indicated officials there planned to consider their options.

Media and public education campaigns

Some public education and media campaigns did not receive a final decision from the trust at the May public meeting, such as Northampton County’s use of about $235,000 for its “Fake is Real” fentanyl awareness campaign. Other similar programs still under consideration include: $300,000 in Allegheny County and $150,000 in Bucks County. Mercer County reported dedicating $80,000 to a media campaign project and spending nearly $79,000 on a separate anti-stigma advertisement project.

During a discussion about Allegheny County, VanKirk said members of the trust want to ensure this type of spending doesn’t “really benefit just the PR firm or the advertising firm that might have been engaged.”

Mark Bertolet, an Allegheny County spokesperson, told Spotlight PA the money there is being used for awareness and outreach, “which includes resources, campaign materials, Naloxone distribution information, and more.” Bucks and Mercer County officials also defended their programs in response to questions from Spotlight PA.

Exhibit E specifically lists funding media campaigns to prevent opioid misuse as one of the approved ways to spend the money. The trust has already approved some other counties’ awareness and prevention campaigns.

Philadelphia

Philadelphia is still seeking approval from the trust for the two programs the trust chairperson raised concerns about at the May meeting.

“Residents in the Kensington area live in a state of constant, compounding trauma due to the intense concentration of open‐air drug markets that operate 24/7,” the city wrote to the trust.

Its memo went on to describe their experiences in stark terms, saying they face “daily exposure to intravenous drug use, open air sex work, discarded syringes, human feces, blood and other hazardous materials, and witness both fatal and non‐fatal overdose in public spaces.” The report described the long-term harm this type of exposure to trauma can have on people.

In the Kensington program, the city said funds were allocated for home repairs, rental assistance, and site and security improvements to schools and parks in the area to ensure children and families can safely access them. The city’s report lists multiple playgrounds, parks, and schoolyards as eligible for those types of improvements.

For the $3.5 million for the Overdose Prevention and Community Healing Fund, the city also provided additional details and said Exhibit E includes more than 100 specific allowable uses, as well as opportunities to fund other programs. Philadelphia’s process empowered “the communities most impacted by the overdose crisis to have agency over who and what got funded in their communities,” the city told the trust.

That grant program includes a citywide category, but it gives special consideration to organizations working to improve North Philadelphia and Kensington because they have the highest overdose rates, the city said last year.

A spokesperson told Spotlight PA the city is confident the funding aligns with Exhibit E.

Coroner programs

The trust agreed to continue evaluating $140,000 for a coroner’s office program in Chester County and $30,600 for a coroner’s office program in Lehigh County, as Spotlight PA previously reported.

During a discussion about Chester County, VanKirk described general questions from members regarding whether this type of money is being used to help future treatment by determining the exact cause of death promptly “as opposed to being used for law enforcement purposes in order to prosecute other people.”

State Sen. Greg Rothman (R., Cumberland) expressed support for allowing counties to fund coroners’ work with the money. Through a spokesperson, the senator told Spotlight PA he plans to ask the trust to reconsider its rejection of Lawrence County’s coroner program.

The trust also chose to continue considering $24,000 for “Psychological Autopsies” in Mercer County. Ann Coleman, chair of the county’s Board of Commissioners, told Spotlight PA the program involves examining the circumstances of overdose deaths to look for ways to prevent future ones.

“If you didn’t have transportation to an appointment, can Mercer County fix that?” she said. “If we didn’t have enough providers, what can we do to get new providers?”

In its report, Mercer County listed the program as managed by the district attorney’s office. District Attorney Peter Acker told Spotlight PA that while he is sponsoring the program, the county coroner is leading it. Acker also described the importance of the coroner’s work, saying he and the coroner “investigate every drug overdose death to see if we can identify and prosecute the supplier of the fatal dose.”

Exhibit E does not specifically mention funding for coroners.

District attorneys, courts, and probation offices

An early point of contention and confusion in Pennsylvania was whether opioid settlement money could be used for policing, prosecution, and similar law enforcement programs. The decisions the trust makes later this month could provide clarity going forward.

Several programs related to prosecution and the court system were listed as still under consideration after the May meeting, including about $85,000 for a community prosecutor program connected to the Lancaster County district attorney’s office, which Spotlight PA and LNP have previously reported on.

Lancaster County officials later indicated that they’ve changed their plans. District Attorney Heather Adams on June 10 told Spotlight PA her office did not seek reimbursement for the community prosecutor position and “does not intend to at this time given the needs of other programming.”

Multiple court-related programs in Cameron County are listed as still under consideration: about $15,000 for staff wages at the office of a magisterial district judge; $20,000 for a detective initiative connected to the district attorney’s office; and nearly $46,000 for staff wages for “Children and Youth Services and Probation.”

Other counties reported dedicating money related to probation and parole, including an adult probation case manager in Lebanon County and nearly $323,000 for a Blair County drug court program. Bucks County reported dedicating $200,000 to a program that funds one full-time probation officer assigned to drug court. The officer is part of a team whose goal “is to promote safety, reduce recidivism and decrease the need for incarcerations,” the county said in response to follow-up questions from the trust.

Chester County reported spending or committing $250,000 for an expanded drug testing program managed by its adult probation office. The county said it extended the hours for testing, which will give more options to working people, and that prior to this funding, its treatment courts were not “able to randomly and routinely test for fentanyl/opiates.”

Treatment court programs provide an alternative to incarceration, and Chester County said, “Frequent and random court-ordered drug testing is an essential tool for the participant to remain clean and sober.”

Exhibit E specifically allows funding “treatment and recovery courts that provide evidence-based options” for people with opioid use disorder, as well as pre-arrest or pre-arraignment diversion strategies. That settlement document also allows certain services for people with opioid use disorder who are on probation or parole, including medication-assisted treatment, recovery support, harm reduction, “or other appropriate services.”

Exhibit E does not specifically list funding probation employee salaries or drug testing for people on probation or parole.

Kate Giammarise of WESA contributed to this article.

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