Schools, Sheriffs, and Syringes: State Plans Vary for Spending $26B in Opioid Settlement Funds

The cash represents an unprecedented opportunity to derail the opioid epidemic, but with countless groups advocating for their share of the pie, the impact could depend heavily on geography and politics.

With more than 200 Americans still dying of drug overdoses each day, states are beginning the high-stakes task of deciding how to spend billions of dollars in settlement funds from opioid manufacturers and distributors. Their decisions will have real-world implications for families and communities across the country that have borne the brunt of the opioid crisis.

Will that massive tranche of money be used to help the people who suffered the most and for programs shown to be effective in curbing the epidemic? Or will elected officials use the money for politically infused projects that will do little to offer restitution or help those harmed?

Jacqueline Lewis, of Columbus, Ohio, is wondering exactly that. She lost her son this fall after his 20-year struggle with addiction.

After emptying her retirement account and losing her house to pay for his rehab, court fees, and debts to dealers, she’s now raising her 7-year-old granddaughter while also caring for her 95-year-old mother with dementia, on nothing more than Social Security payments.

When Lewis heard Ohio would receive $808 million in opioid settlement funds, she thought there’d finally be relief for thousands of families like hers.

She was eager to speak with members of the OneOhio Recovery Foundation, which was created to oversee the distribution of most of Ohio’s funds. As they determined priorities for funding, she wanted them to consider perspectives like hers, a mother and grandmother who’d faced addiction up close and saw the need for more treatment centers, addiction education in the workplace, and funding for grandparents raising grandkids as a result of the opioid epidemic.

But she couldn’t find anyone to listen. At an August foundation meeting she attended, board members excused themselves to go into a private session, she said. “They just left the room and left us sitting there.” When she attended another meeting virtually, audience members weren’t allowed to “voice anything or ask questions.”

A local group that advocates for people affected by the opioid epidemic has expressed similar concerns and is now suing the foundation for a lack of transparency, even though few decisions about funding priorities have been made yet.

The strife in Ohio highlights the tensions emerging nationwide as settlement funds start flowing. The funds come from a multitude of lawsuits, most notably a $26 billion settlement resulting from more than 3,000 cities, counties, and states suing manufacturer Johnson & Johnson and distributors McKesson, AmerisourceBergen, and Cardinal Health for their roles in the opioid crisis. Payments from that case began this summer and will continue for 18 years, setting up what public health experts and advocates are calling an unprecedented opportunity to make progress against an epidemic that has ravaged America for three decades.

But, they caution, each state seems to have its own approach to these funds, including different distributions between local and state governments and various processes for spending the money. With countless individuals and groups advocating for their share of the pie — from those dealing with addiction and their families to government agencies, nonprofits, health care systems, and more — the money’s impact could depend heavily on geography and politics.

“It sounds like a lot of money, but it’s going to a lot of places and going to be spread out over time,” said Sara Whaley, a researcher at Johns Hopkins Bloomberg School of Public Health who tracks state use of opioid funds. “It’s not going to magically end this crisis. But if it’s used well and used thoughtfully, there is an opportunity to make a real difference.”

And if not, it could be just another political boondoggle.

Avoiding the ‘Tobacco Nightmare’

The worst-case scenario, many say, is for the opioid settlement to end up like the tobacco master settlement of 1998.

States won $246 billion over 25 years, but less than 3% of the annual payouts are used for smoking prevention or cessation, according to the Campaign for Tobacco-Free Kids. Most has gone toward filling budget gaps, building roads, and subsidizing tobacco farmers.

But there are stronger protections in place for the opioid settlement dollars, said Christine Minhee, founder of a website that tracks the funds.

The arrangement specifies that states must spend at least 70% of the money for opioid-related expenses in the coming years and includes a list of qualifying expenses, like expanding access to treatment and buying the overdose reversal medication naloxone. Fifteen percent of the funds can be used for administrative expenses or for governments to reimburse past opioid-related expenses. Only the remaining 15% is a free-for-all.

If states don’t meet those thresholds, they could face legal consequences and even see their future payouts reduced, Minhee said.

“The kind of tobacco nightmare stuff where only 3% of funds were spent on what they were meant for is legally and technically impossible,” she said. Though, she added, “a different nightmare is still possible.”

Experts tracking the funds say transparency around who receives the money and how those decisions are made is key to a successful and useful distribution of resources.

In Rhode Island, for instance, public comment is a regular part of opioid advisory committee hearings. In North Carolina and Colorado, online dashboards show how much money each locality is receiving and will track how it is spent.

But other states are struggling.

In Ohio, the document that creates a private foundation to oversee most of the state’s funds says that “the Foundation shall operate in a transparent manner” and that meetings and documents will be public. Yet the OneOhio Recovery Foundation has since said it is not subject to open-meetings law. It has adopted a policy that meetings can be closed if the board decides the content is “sensitive or confidential material that is not appropriate for the general public.”

The contradiction between the board’s actions and how it was conceived led Dennis Cauchon, president of Harm Reduction Ohio, which distributes naloxone across the state, to sue the foundation. He said he wants the public to have more say in how the funding is spent.

“The board members are in a closed loop, and they’re having a hard time learning what the needs are,” Cauchon said.

The 29-member board includes representatives of local regions, as well as appointees from the governor, state attorney general, and legislative leaders. Many are city- and county-level politicians, and one is the wife of a U.S. senator. They are not paid for this role.

Nathaniel Jordan, executive director of the nonprofit Columbus Kappa Foundation, which distributes naloxone to Black communities in Ohio, has raised concerns about the board’s lack of racial diversity. Since 2017, Black men have had the highest rate of drug overdose deaths in the state, he said, but only one board member is Black. “What gives?”

Kathryn Whittington, chair of the OneOhio Recovery Foundation, said the board is being “very transparent in what we are doing.” The public can attend meetings in person or online. Recordings of past meetings are posted online, along with the agenda, board packet, and policies discussed — including a draft of the diversity and inclusion policy the board is considering.

People who want to provide input “can always reach out to me as the chair or any other board member,” said Whittington, who added that two of her children have struggled with addiction too. But the best option is to contact one of Ohio’s 19 regional boards, she said. Those groups can elevate local concerns to the foundation board.

“We are still at the very beginning,” Whittington emphasized. No money from the 18-year settlement has been spent yet. The board’s operational expenses — including a $10,000-per-month contract with a public relations firm — is being paid from $1 million from a previous opioid-related settlement.

But Lewis, the woman raising her granddaughter in Columbus, worries that the day for families to speak may never come.

“They keep saying it’s not ready, and before you know it, they’ll be handing out money and it’ll be too late,” she said.

Following the Money

Rhode Island is one of the states working fastest to distribute settlement dollars. Its Executive Office of Health and Human Services, which controls 80% of the funds and works with an opioid advisory committee, released a plan to use $20 million by July 2023.

Although the plan doesn’t specify funding for people raising grandchildren, it does allocate $900,000 to recovery supports, which will include community agencies that serve family members, the department said. The single largest allocation, $4 million, will go to school- and community-based mental health programs.

The investment that has sparked the most interest is $2 million for a supervised drug consumption site. Its location and opening date will be determined by organizations that respond to the state’s request for proposals, said Carrie Bridges Feliz, chair of the opioid settlement advisory committee. At a time when fentanyl, a synthetic opioid 50 times stronger than heroin, is infiltrating most street drugs and overdose rates are high, “we were anxious to make use of these funds.”

In contrast, the process of distributing settlement dollars in Louisiana has barely begun. State Attorney General Jeff Landry announced in July 2021 that Louisiana was expected to receive $325 million from the 18-year settlement but has not released any additional information. His office did not respond to repeated inquiries about the status of the funds.

The governor’s office and state health department said they could not answer specific questions about the funds and had not yet been contacted by the attorney general’s office, which negotiated the state’s settlement agreement. Multiple clinicians who treat substance use disorder and advocates who work with people who use drugs were similarly in the dark.

The state’s written plan says it will create a five-person task force to recommend how to spend the money. Kevin Cobb, president of the Louisiana Sheriffs’ Association, said the group had appointed its representative to the task force, but he didn’t know if other members had been selected or when they would meet.

One decision Louisiana has made so far is to give 20% of the settlement funds directly to sheriffs — a move that has made some people nervous.

“This plays into an increase in support for an authoritarian response to what are public health issues,” said Nadia Eskildsen, who has worked for syringe service programs and other such groups in New Orleans.

She worries that money will be funneled toward increasing arrests, rather than helping people find housing, work, or health care. Meanwhile, almost 1,400 Louisiana residents died of opioid-related causes last year.

K.P. Gibson, the Acadia Parish sheriff who will represent the sheriffs association on the state task force, said his focus is not on punishment, but on getting people into treatment. “My jail problem will resolve itself if we resolve the problem of opioid addiction,” he said.

Many health and policy experts say using settlement funds to pair mental health professionals with police officers or provide medications for opioid use disorder in prisons could reduce deaths.

States’ choices generally reflect a range of local priorities: While Louisiana has carved out funds for law enforcement, Maine is dedicating 3% of its statewide share for special education programs in schools, and Colorado has allocated 10% to addiction infrastructure, like workforce training, telehealth expansion, and transportation to treatment.

Maine requires that some funds be used for special education because school districts also sued the opioid companies, said state Attorney General Aaron Frey.

Patricia Hopkins said she signed on to the lawsuit because she’s seen the impact of the opioid crisis on students over the past decade as superintendent of school district 11, a rural part of central Maine’s Kennebec County with 1,950 students.

A report compiled by her staff in 2019 showed nearly 4% of students have a parent dealing with addiction.

Sixty miles north, in rural Penobscot County, school district 19 social worker Meghan Baker said she knows two siblings who were home when first responders arrived to revive their parents with naloxone, and another set of siblings who lost their mother to an overdose.

Students who experience this trauma often become angry, act out at school, and find it difficult to trust adults. When Baker refers them to counseling services in the community, they encounter waitlists that run six months to a year.

“If we could hire more guidance counselors and social workers, at least we can help some of those kids during the school day,” she said.

It’s clear that many have high hopes for the billions of dollars in opioid settlement funds arriving over the next two decades. But they have questions too, because effectively using this large pot of money requires planning and forethought.

For people like Jacqueline Lewis in Ohio, whose family has lost so much to an epidemic too long ignored, progress feels slow.

As she tries to make do on Social Security, Lewis focuses on the positives: Her granddaughter is a happy child, and her older brother lives with them to help out. But the financial worries gnaw at her. And what if her own health falters before her granddaughter is an adult?

“I might be OK right now, but tomorrow, I never know,” she said.

KHN correspondent Rae Ellen Bichell contributed to this report.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

USE OUR CONTENT

This story can be republished for free (details).

Los mentores trabajan, sin límites, en la recuperación de adicciones

Los especialistas en apoyo a pares están ellos mismos en recuperación y se los contrata para ayudar a otros. Pueden vincularse con los pacientes de una manera distinta que los profesionales de salud.

CENTENNIAL, Colorado.— Sarah Wright visita a su mentora varias veces al día, en la habitación de hotel transformada en oficina en este suburbio de Denver.

Pero su visita de un miércoles por la mañana a mediados de octubre fue una de las primeras con dientes.

La especialista en ayuda a pares, Donna Norton, había impulsado a Wright a ir al dentista años después de que la falta de vivienda y la adicción afectaran su salud, literalmente hasta la mandíbula.

Wright todavía se estaba acostumbrando a su dentadura postiza. “No he tenido dientes en 12, 13 años”, dijo, y agregó que la hacían sentir como un caballo.

Una nueva sonrisa fue el hito más reciente de Wright mientras trabaja para reconstruir su vida, y Norton ha estado allí en cada paso: al abrir una cuenta bancaria, conseguir un trabajo, desarrollar un sentido de autoestima.

La voz de Wright comenzó a temblar cuando habló sobre el papel de Norton en su vida durante los últimos meses. Norton envolvió a Wright en sus brazos, adornados con tatuajes de llamas, telarañas y un zombi Johnny Cash.

“Oh, muffin”, le dijo. “Estoy tan orgullosa de ti”.

Norton, de 54 años, es una abuela que maneja una Harley, ama a los bulldogs, lleva ocho años sobria y, profesionalmente, “es una persona que anima a los que se ven mal en papel”.

La gente la quiere. “Si me buscaras en un papel, no estarías en esta habitación conmigo”, dijo Norton. “No me dejarías acercarme a tu casa”.

Si fuera terapeuta o trabajadora social, abrazar y compartir sus experiencias con las drogas y la ley podría considerarse cruzar la línea de los límites profesionales. Pero como especialista en apoyo de pares, a menudo eso es parte del trabajo.

“No tengo límites”, dijo Norton. “A la m…”, dijo, “aquí es un término cariñoso”.

Norton trabaja para la Fundación Hornbuckle, que brinda apoyo entre pares a los participantes en la SAFER Opportunities Initiative, que ofrece refugio a corto plazo en el hotel para personas del condado de Arapahoe que no tienen hogar y tienen trastornos de salud mental o adicciones.

Los especialistas en apoyo a pares están ellos mismos en recuperación y se los contrata para ayudar a otros. A medida que se distribuyen miles de millones de dólares en fondos para acuerdos por opioides a los estados y localidades, los líderes locales deciden qué hacer con el dinero.

Entre las opciones están apoyar y capacitar a estos especialistas, cuyos requisitos de certificación varían según el estado.

Los estados, condados, municipios y naciones indígenas presentaron miles de demandas contra las compañías farmacéuticas y los mayoristas acusados ​​de alimentar la crisis de los opioides. Muchos de esos casos se convirtieron en grandes demandas colectivas.

Este año, cuatro empresas llegaron a un acuerdo extrajudicial y acordaron pagar $26,000 millones durante 18 años. Los estados participantes deben seguir las pautas sobre cómo se puede gastar el dinero.

En Colorado, cientos de millones de dólares de ese acuerdo (y algunos otros) se destinarán a gobiernos locales y grupos regionales, varios de los cuales presentaron planes para utilizar parte del dinero en servicios de apoyo a pares.

David Eddie, psicólogo clínico y científico investigador del Recovery Research Institute del Hospital General de Massachusetts, dijo que los servicios de apoyo de recuperación entre pares han “ganado mucha fuerza en los últimos años”.

De acuerdo con la Administración de Servicios de Salud Mental y Abuso de Sustancias, la “evidencia creciente” muestra que trabajar con un par especialista puede generar mejores resultados de recuperación, desde una mayor estabilidad en la vivienda hasta tasas más bajas de recaídas y hospitalizaciones.

Un informe de la Oficina de Responsabilidad del Gobierno de EE.UU. identificó los servicios de apoyo entre pares como una práctica prometedora en el tratamiento de adultos con adicciones. En muchos estados, estos especialistas reciben un reembolso a través de Medicaid.

“Pueden llenar un vacío realmente importante”, dijo Eddie. “Pueden hacer cosas que nosotros, como médicos, no podemos hacer”.

Pueden, por ejemplo, ayudar a navegar la burocracia del sistema de servicios de protección infantil, sobre el cual los médicos pueden tener poco conocimiento, o invitar a alguien a tomar un café para construir una relación. Si una persona deja de asistir a la terapia, dijo Eddie, un especialista en apoyo de pares “puede ir físicamente a buscar a alguien y traerlo de vuelta al tratamiento, ayudarlo a volver a participar, reducir su vergüenza, eliminar el estigma de la adicción”.

Norton, por ejemplo, recogió a un cliente que la llamó desde un callejón después de ser dado de alta de un hospital por una sobredosis.

“Algunas personas te dirán: ‘Decidí que me iba a recuperar y nunca más iba a beber, drogarme o consumir’. Esa no es mi experiencia. Me tomó 20 años lograr mi primer año limpia y sobria. Y significó intentarlo todos los días”, dijo Norton desde su oficina. En una canasta debajo de su escritorio tiene tres kits de reversión de sobredosis de opioides surtidos con Narcan.

Su oficina, tibia por la luz del sol que entra por una ventana orientada al sur y la rotación casi constante de personas que se dejan caer en el sofá, tiene un estante con artículos esenciales. Hay tampones, para quien los necesite —Norton “nunca olvidará” la vez que recibió una multa por robar tampones en una tienda de comestibles mientras no tenía hogar— y kits de análisis de orina, para determinar si alguien está drogado o experimentando psicosis.

Norton enseña a “parar, tirarse al piso y rodar” como un mecanismo de afrontamiento cuando las personas se sienten perdidas y piensan en volver a consumir. “Si estás en crisis, ¿qué haces?”, dijo Norton. “Te detienes de inmediato, te recuestas en el suelo, ruedas y sales. Así que digo ‘Vete a la cama. Solo ve a dormir’. La gente dice: ‘Esa no es una herramienta de bienestar’”.

“Lo es”, intervino Audrey Salazar. Una vez, cuando Salazar estaba a punto de recaer, se quedó con Norton un fin de semana. “Literalmente me dormí”, dijo Salazar. Las dos descansaron y comieron Cocoa Puffs y Cheez-Its de la caja.

“Fue tan malo”, dijo Norton sobre el atracón de comida chatarra. Pero el fin de semana volvió a encarrilar a Salazar. Trabajar con un especialista en apoyo de pares que ha “recorrido el mismo camino”, dijo Salazar, “te vuelve responsable de una manera muy amorosa”.

Ese día de octubre, Norton pasó de regañar a una persona para que hiciera una cita con el médico, a conseguir que otra persona creara una despensa de alimentos, a descubrir cómo responder al banco que le dijo a un tercer cliente que no se podía abrir una cuenta sin una dirección residencial. También trabajó en bajar las defensas de un recién llegado, un hombre elegantemente vestido que parecía escéptico del programa.

Algunas personas llegan a Norton después de haber sido liberadas de la cárcel del condado, otras por el boca en boca. Y Norton ha reclutado gente en los parques y en la calle. El recién llegado aplicó después de enterarse del programa en un refugio para personas sin hogar.

Norton decidió que compartir un poco sobre ella misma era el camino a seguir con él.

“‘Mi experiencia son las cárceles, los hospitales y las instituciones. Tengo un número antiguo, es decir, un número de convicto. ‘Y tengo ocho años sin drogas’”, recordó haberle dicho. “‘Mi oficina está al final del pasillo. Hagamos algunos trámites. Hagámoslo'”.

Norton es uno de los siete pares en el personal de la Fundación Hornbuckle, que estima que cuesta alrededor de $24,000 por mes para brindar servicios de pares a este grupo de residentes, y los especialistas que trabajan a tiempo completo ganan alrededor de $3,000 por mes más $25 por hora por cliente.

La oficina de Norton es el centro de actividad de un piso en un hotel donde viven unas 25 personas que participan en la Iniciativa SAFER mientras se recuperan de los trastornos adicciones hasta que se “gradúan” en otro hotel, ubicado al lado. A partir de ahí, se mudarán a su propia vivienda, que los empleados a menudo les ayudan a encontrar.

Mientras están en el programa, los residentes se reúnen al menos una vez a la semana con un administrador de casos, un terapeuta y un especialista en apoyo de pares, además de asistir a reuniones grupales, que se llevan a cabo todos los días excepto los domingos y están dirigidas por compañeros.

Kyle Brewer, con sede en Arkansas, es el administrador del programa de especialistas en pares de NAADAC, la Asociación de Profesionales en Adicción (anteriormente, la Asociación Nacional de Consejeros sobre Alcoholismo y Abuso de Drogas). Brewer, quien dijo que su vida se descarriló después de que comenzó a usar opioides recetados para controlar el dolor de la extracción de una muela de juicio, dijo que los fondos de acuerdos por opioides presentan una oportunidad para apoyar a las personas que trabajan con las personas necesitadas.

“Cuando estamos trabajando y hablando y resolviendo problemas de diferentes enfoques para resolver la crisis de los opioides, deberíamos tener a las personas que se han visto directamente afectadas por esos problemas en la sala, guiando esas conversaciones”, dijo.

Hacia el final del día, Norton volvió a encontrarse con el muchacho nuevo en el pasillo, esta vez cuando regresaba de la máquina de hielo.

“Ocho años limpio. Me quito el sombrero ante ti”, dijo.

“Empecé con un día”, dijo Norton.

“Bueno, comenzaré con una hora”, dijo el muchacho.

Dijo que necesitaba limpiar su auto, donde había estado viviendo. Dijo que tiene problemas para ponerse los jeans por la mañana después de perder un pulgar por haber estado expuesto a temperaturas congelantes. Quería encontrar un trabajo de medio tiempo. Tiene que resolver un trauma con terapia. Su madre murió hace aproximadamente un año y medio.

“El viernes por la noche, iremos al cine”, dijo Norton.

“Oh, genial”, dijo. “Quiero ver la nueva de Top Gun”.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

USE OUR CONTENT

This story can be republished for free (details).

The Player-Coaches of Addiction Recovery Work Without Boundaries

States, tribes, and local governments are figuring out how best to spend billions of dollars from an opioid lawsuit settlement. One option they’re considering is funding peer support specialists, who guide people recovering from addiction as they do it themselves.

CENTENNIAL, Colo. — Sarah Wright stops by her peer support specialist’s hotel room-turned-office in this Denver suburb several times a day.

But her visit on a Wednesday morning in mid-October was one of her first with teeth.

The specialist, Donna Norton, had pushed Wright to go to the dentist years after homelessness and addiction had taken a toll on her health, down to the jawbone.

Wright was still getting used to her dentures. “I haven’t had teeth in 12½, 13 years,” she said, adding that they made her feel like a horse.

A new smile was Wright’s latest milestone as she works to rebuild her life, and Norton has been there for each step: opening a bank account, getting a job, developing a sense of her own worth.

Wright’s voice started to waver when she talked about Norton’s role in her life during the past few months. Norton wrapped her arms, adorned with tattoos of flames, spiderwebs, and a zombie Johnny Cash, around Wright.

“Oh, muffin,” she said. “I’m so proud of you.”

Norton, 54, is a Harley-riding, bulldog-loving, eight-years-sober grandmother and, professionally, “a cheerleader for the people that look bad on paper.”

People like her. “If you were to look me up on paper, you wouldn’t be in this room with me,” Norton said. “You would not let me near your house.”

If she were a therapist or social worker, hugging and sharing her experiences with drugs and the law might be considered a breach of professional boundaries. But as a peer support specialist, that’s often part of the job.

“I have no boundaries,” Norton said. “F— off,” she said, “is a term of endearment here.”

Norton works for the Hornbuckle Foundation, which provides peer support to participants in the SAFER Opportunities Initiative. SAFER provides short-term shelter in the hotel for people in Arapahoe County who are homeless and have mental health or substance use disorders.

Peer support specialists are themselves in recovery and are employed to help others. As billions of dollars in opioid settlement funds roll out to states and localities, local leaders are deciding what to do with the money. Supporting and training peer specialists, whose certification requirements vary by state, are among the options.

States, counties, municipalities, and tribes filed thousands of lawsuits against drug companies and wholesalers that are accused of fueling the opioid crisis. Many of those cases were lumped together into one mega-lawsuit. This year, four companies settled out of court, agreeing to pay $26 billion over 18 years. Participating states must follow guidelines for how the money can be spent.

In Colorado, hundreds of millions of dollars from that settlement (and a few others) will go to local governments and regional groups, several of which submitted plans to use some of the money for peer support services.

David Eddie, a clinical psychologist and a research scientist at the Recovery Research Institute at Massachusetts General Hospital, said peer recovery support services have “been gaining a lot of traction in recent years.”

According to the Substance Abuse and Mental Health Services Administration, “mounting evidence” shows that working with a peer specialist can result in better recovery outcomes, from greater housing stability to reduced rates of relapse and hospitalization. A report by the U.S. Government Accountability Office identified peer support services as a promising practice in treating adults with substance use disorders. In many states, peer specialists are reimbursed through Medicaid.

“They can plug a really important gap,” Eddie said. “They can do things that we as clinicians can’t do.”

They can, for example, help navigate the bureaucracy of the child protective services system, about which clinicians might have little knowledge, or take someone out to coffee to build a relationship. If a person stops showing up to therapy, Eddie said, a peer support specialist “can physically go and look for somebody and bring them back to treatment — help them reengage, reduce their shame, destigmatize addiction.”

Norton has, for instance, picked up a client who called her from an alley after being discharged from a hospital stay for an overdose.

“Some people will tell you, ‘I decided I was going to get in recovery, and I never had to drink, drug, or use again.’ That’s not my experience. It took me 20 years to get my first year clean and sober. And that was trying every day,” said Norton from her office, her Vans planted just inches from a basket that lives under her desk: It contains three opioid overdose reversal kits stocked with Narcan.

Her office, warmed by the sunlight coming through a south-facing window and the nearly constant rotation of people plopping onto the couch, contains a shelf of essential items. There are tampons, for whoever needs them — Norton will “never forget” the time she got a ticket for stealing tampons from a grocery store while she was homeless — and urine analysis kits, for determining whether someone is high versus experiencing psychosis.

She teaches “stop, drop, and roll” as a coping mechanism for when people are feeling lost and thinking about using substances again. “If you’re on fire, what do you do?” Norton said. “You stop immediately, you lay on the ground, you roll and get yourself out. So I’m like, ‘Go to bed. Just go to sleep.’ People are like, ‘That’s not a wellness tool.’”

“It is,” Audrey Salazar chimed in. Once, when Salazar was close to relapsing, she stayed with Norton for a weekend. “I literally just slept,” Salazar said. The two rested and ate Cocoa Puffs and Cheez-Its by the box.

“It was so bad,” Norton said of the junk food binge. But the weekend got Salazar back on track. Working with a peer support specialist who has “walked the same walk,” Salazar said, “holds you accountable in a very loving way.”

That October day, Norton pivoted from nagging one person to make a doctor’s appointment, to getting someone else set up with a food pantry, to figuring out how to respond to the bank that told a third client that an account couldn’t be opened without a residential address. She also worked on lowering the defenses of a newcomer, a sharply dressed man who seemed skeptical of the program.

Some people come to Norton after being released from the county jail, others by word of mouth. And Norton has recruited people in parks and the street. The newcomer applied after hearing about the program in a homeless shelter.

Norton decided that sharing a little about herself was the way to go with him.

“‘My experience is jails and hospitals and institutions. I’ve got an old number,’ meaning a convict number. ‘And I have eight years drug-free,’” she recalled telling him. “‘My office is down the hall. Let’s get some paperwork done. Let’s do this.’”

Norton is one of seven peers on staff with the Hornbuckle Foundation, which estimates that it costs about $24,000 a month to provide peer services to this group of residents, with peer specialists working full time make about $3,000 a month plus $25 an hour per client. Norton’s office is the hub of activity for a floor in one hotel where about 25 people participating in the SAFER Opportunities Initiative live while recovering from substance use disorders until they “graduate” to another hotel, located next door. From there, they’ll move on to their own housing, which staffers often help them find.

While in the program, residents meet at least once a week with a case manager, a therapist, and a peer support specialist, in addition to attending group meetings, which take place every day except Sundays and are all run by peers.

Kyle Brewer, based in Arkansas, is the peer specialist program manager for NAADAC, the Association for Addiction Professionals (formerly the National Association for Alcoholism and Drug Abuse Counselors). Brewer, who said his life derailed after he started using prescription opioids to manage the pain from a wisdom tooth removal, said opioid settlement funds present an opportunity to support the people who work on the ground.

“When we’re working and talking and troubleshooting different approaches to solve the opioid crisis, we should have the people that have been directly affected by those issues in the room, guiding those conversations,” he said.

Toward the end of the day, Norton ran into the new guy in the hallway again, this time on his way back from the ice machine.

“Eight years clean. My hat goes off to you,” he said.

“I started with one day,” said Norton.

“Well, I’ll start with one hour,” said the new guy.

He said he needed to clean out his car, where he’d been living. He said he has trouble putting his jeans on in the morning after losing a thumb to frostbite. He wanted to find a part-time job. He has trauma to work through in therapy. His mother died about a year and a half ago.

“Friday night, we’re going to the movies,” said Norton.

“Oh, cool,” he said. “I want to see ‘Top Gun,’ the new one.”

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

USE OUR CONTENT

This story can be republished for free (details).

Fentanilo en la escuela secundaria: una comunidad de Texas se enfrenta al mortal opioide

Desde julio, cuatro estudiantes del Distrito Escolar Independiente Consolidado de Hays, al sur de Austin, han muerto por sobredosis de fentanilo.

KYLE, Texas – Los pasillos de la escuela secundaria Lehman lucían como cualquier otro en un día reciente de otoño. Sus 2,100 estudiantes hablaban y reían mientras se apresuraban a ir a sus clases en medio de paredes cubiertas de afiches que anunciaban eventos del baile de bienvenida, clubes y partidos de fútbol americano. Sin embargo, junto a esos afiches había algunos con un sombrío mensaje que advertía a los estudiantes de que el fentanilo es extremadamente mortal.

Esos carteles no estaban allí el año pasado.

Justo antes de que comenzara el año escolar, el Distrito Escolar Independiente Consolidado de Hays, que incluye a Lehman, anunció que dos estudiantes habían muerto después de tomar pastillas con fentanilo. Fueron las primeras muertes de estudiantes relacionadas con el opioide sintético en este distrito escolar del centro de Texas, que tiene campus de secundaria en Kyle y Buda, una ciudad cercana.

En el primer mes de clases, se confirmaron otras dos muertes.

La reacción de las autoridades escolares, empleados, estudiantes y padres ha sido intensa, una mezcla de angustia y terror con ira y ganas de actuar. La comunidad, al parecer, está dispuesta a contraatacar. El sistema escolar ha dado prioridad a su actual campaña educativa contra las drogas. Los estudiantes hacen frente a sus conductas de riesgo y a la presión de sus compañeros. Y los padres intentan iniciar conversaciones difíciles sobre las drogas con sus hijos.

Están “cogiendo el toro por los cuernos”, dijo Tim Savoy, jefe de comunicaciones del distrito escolar.

Pero también hay dudas sobre si esos esfuerzos serán suficientes.

El problema de sobredosis que afronta el distrito, que está justo al sur de Austin y a una hora al noreste de San Antonio, imita una tendencia nacional.

Según los Centros para el Control y Prevención de Enfermedades, en 2021 murieron más de 107,000 personas por sobredosis, todo un récord. La mayoría de esas muertes —7,238 de ellas— estuvo relacionada con el fentanilo y otros opioides sintéticos. La Administración para el Control de Drogas ha advertido que el fentanilo se encuentra cada vez más en “píldoras de recetas falsas” que son “fácilmente accesibles y a menudo se venden en las redes sociales y plataformas de comercio electrónico”.

El jefe de policía de Kyle, Jeff Barnett, dijo que eso es un problema que afronta en su comunidad. “Probablemente podrías encontrar una píldora con fentanilo en cinco minutos en las redes sociales y probablemente organizar un encuentro en una hora” con un traficante, dijo Barnett.

La amenaza del fentanilo ha hecho que los estudiantes de secundaria sean más propensos a conseguir las píldoras letales. Pueden creer que están consumiendo drogas para fiestas que, aunque son ilegales, no son -por sí solas- tan mortales como el fentanilo.

Los chicos “no están comprando fentanilo intencionadamente”, indicó Jennifer Sharpe Potter, profesora de psiquiatría y ciencias del comportamiento en UT Health San Antonio, en un testimonio durante una audiencia celebrada en septiembre ante la Cámara de Representantes de Texas. No saben qué hay en las pastillas que compran, añadió, y describió el problema como la “tercera ola de la crisis de sobredosis”.

Kevin McConville, de 17 años, un estudiante de Lehman que murió en agosto, parece ser una de las víctimas de esta ola. En un vídeo producido por el distrito, los padres de Kevin explican con una inmensa tristeza en sus ojos que, tras la muerte de su hijo, se enteraron por sus amigos de que tenía dificultades para dormir. Tras tomar pastillas que creía que eran Percocet y Xanax, no se despertó.

Historias como esta han llevado al distrito escolar a emitir la siguiente advertencia en su página web: “El fentanilo está aquí. Tenemos que hablar del fentanilo. Y el fentanilo es mortal”. Es 100 veces más potente que la morfina y 50 veces más potente que la heroína, según la DEA, y dos miligramos son potencialmente letales.

El distrito ha puesto en marcha la campaña “Lucha contra el fentanilo”, que cuenta con la colaboración de la policía municipal y de los servicios médicos de urgencia. Hay un “HopeLine” al que los alumnos pueden enviar anónimamente información sobre compañeros que puedan estar consumiendo drogas ilícitas. A partir de sexto grado, los alumnos deben ver un vídeo de 13 minutos en el que se recalca lo peligroso y mortal que es el fentanilo y se explica cómo identificar si un compañero puede tener una sobredosis.

“Estamos reclutando a los estudiantes para que nos ayuden a ser los ojos y los oídos si están en una fiesta o en casa de un amigo”, dijo Savoy.

El sistema escolar también espera concienciar a los estudiantes de los riesgos que afrontan. No se puede confiar en ninguna píldora, sea cual sea, que no proceda de una farmacia: “Es como jugar a la ruleta rusa”, dijo Savoy.

El mensaje parece que está llegando. Sara Hutson, alumna del último año del instituto Lehman, dice que compartir pastillas que se venden sin receta, como Tylenol y Motrin, solía ser habitual, pero ya no lo considera seguro. Ya no confía.

Pero otros estudiantes no son tan precavidos. Lisa Peralta compartió en un post de Facebook en septiembre que su hija, que está en séptimo grado, admitió haber comido una “gomita para la ansiedad” que le dio su amiga. “Tengo miedo porque mi hija se deja llevar por sus amigos”, escribió la residente de Kyle. “No confío en que no lo vuelva a hacer si se siente presionada”.

Por muy claros que sean los mensajes del distrito y de los padres, a Savoy le preocupa que nunca sean suficientes porque los estudiantes son muy aventureros. “Es simplemente la mentalidad adolescente”, dijo. “Piensan: ‘Somos invencibles; a mí no me va a pasar’. Pero está pasando en nuestra comunidad”.

Aun así, los sentimientos de descontento y dolor son a veces palpables. Los estudiantes se pelean más en la escuela, dijo Jacob Valdez, un estudiante de décimo grado de Lehman que conocía a dos de los estudiantes que murieron. Eso puede estar pasando, añadió, porque “todo el mundo está angustiado”.

La tensión no se limita a los estudiantes de intermedia y secundaria. También se ha vuelto muy real para los padres de los niños de primaria, desde que la DEA advirtió al público en agosto sobre las píldoras con fentanilo que parecen caramelos de colores brillantes. El distrito escolar de Hays también está colgando carteles de advertencia dirigidos a los estudiantes más jóvenes.

Jillien Brown, de Kyle, dijo que está preocupada por sus hijas, Vivian, de 5 años, y Scarlett, de 7. “Les hemos dicho que están ocurriendo cosas aterradoras, que la gente se está poniendo muy enferma y está muriendo por tomar lo que creen que son caramelos o medicamentos”, indicó Brown. “Utilizamos la palabra ‘veneno’, como cuando Blancanieves mordió la manzana”.

Pero la conversación debe ser continua, dijo Brown, porque al día siguiente de hablar con sus hijas, “un niño pequeño en el autobús les dio un caramelo y se lo comieron”.

Del mismo modo, April Munson, residente en Kyle y antigua profesora de primaria, considera que todo es “desgarrador”. Le mostró a su hijo de 9 años, Ethan, fotos de las píldoras multicolores de “fentanilo arco iris”. “Es una conversación difícil de tener, pero las conversaciones difíciles son a menudo las más importantes”, dijo. “Y, realmente, no puedes permitirte dejar de hablar del tema”.

Y mientras los padres y los funcionarios escolares intentan evitar que el fentanilo vuelva a castigar, llega otro golpe de realidad.

El año pasado, el distrito escolar comenzó a almacenar en cada escuela un suministro de naloxona, el fármaco para revertir sobredosis, también conocido como Narcan. En lo que va de semestre, a pesar de todo lo que ha pasado, lo han tenido que utilizar para salvar a otros cuatro estudiantes, dijo Savoy. En un caso, los socorristas tuvieron que usar tres dosis para reanimar a un estudiante: el fentanilo “era así de fuerte”, agregó.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

USE OUR CONTENT

This story can be republished for free (details).

Fentanyl in High School: A Texas Community Grapples With the Reach of the Deadly Opioid

The first fentanyl-related deaths of students in an area south of Austin, Texas, were reported over the summer. The school district, parents, and students are trying to deal with the aftermath.

KYLE, Texas — The hallways of Lehman High School looked like any other on a recent fall day. Its 2,100 students talked and laughed as they hurried to their next classes, moving past walls covered with flyers that advertised homecoming events, clubs, and football games. Next to those flyers, though, were posters with a grim message warning students that fentanyl is extremely deadly.

Those posters weren’t there last school year.

Right before this school year started, the Hays Consolidated Independent School District, which includes Lehman, announced that two students had died after taking fentanyl-laced pills. They were the first recorded student deaths tied to the synthetic opioid in this Central Texas school district, which has high school campuses in Kyle and Buda, a nearby town. Within the first month of school, two more fatalities were confirmed.

The reaction from school officials, employees, students, and parents has been intense, mixing heartbreak and terror with anger and action. The community, it seems, is ready to fight back. The school system has prioritized its existing anti-drug educational campaign. Students are wrestling with their risky behaviors and peer pressure. And parents are trying to start difficult conversations about drugs with their children.

They are “taking the bull by the horns,” said Tim Savoy, the school district’s chief communications officer.

But there are also questions about whether those efforts will be enough.

The overdose problem facing the district, which is just south of Austin and about an hour northeast of San Antonio, mimics a nationwide trend. More than 107,000 people in the U.S. died of drug overdoses in 2021, according to the Centers for Disease Control and Prevention, a record. Most of those deaths — 71,238 of them — involved fentanyl and other synthetic opioids. The Drug Enforcement Administration has warned that fentanyl is increasingly finding its way into “fake prescription pills” that are “easily accessible and often sold on social media and e-commerce platforms.”

The police chief in Kyle, Jeff Barnett, said that’s a problem in his area. “You could probably find a fentanyl-laced pill within five minutes on social media and probably arrange a meeting within the hour” with a dealer, Barnett said.

The fentanyl threat has made high schoolers more susceptible to getting ahold of the lethal pills. They might believe they are using party drugs that, though illegal, are not — on their own — nearly as deadly as fentanyl.

The kids are “not intentionally buying fentanyl,” Jennifer Sharpe Potter, a professor of psychiatry and behavioral sciences at UT Health San Antonio, said in testimony during a September hearing before the Texas House of Representatives. They don’t know that it’s in the pills they buy, she added, describing the problem as the “third wave of the overdose crisis.”

Seventeen-year-old Kevin McConville, a Lehman student who died in August, appears to be one of this wave’s victims. In a video the district produced, Kevin’s parents explain with grief heavy in their eyes that after their son’s death, they learned from his friends that he was struggling to sleep. After taking pills he thought were Percocet and Xanax, he didn’t wake up, his parents said.

Stories like that have led the school district to issue the following warning on its website: “Fentanyl is here. We need to talk about fentanyl. And fentanyl is deadly.” It’s 100 times as potent as morphine and 50 times as potent as heroin, according to the DEA, and 2 milligrams is potentially lethal.

The district launched a “Fighting Fentanyl” campaign — which enlists city police and emergency medical services personnel. There’s a “HopeLine” to which students can anonymously send information about classmates who may be taking illicit drugs. Starting in sixth grade, students are required to watch a 13-minute video that underscores how dangerous and deadly fentanyl is and explains how to identify when a classmate may be overdosing.

“We’re recruiting students to help us be the eyes and ears if they’re at a party or at a friend’s house,” Savoy said.

The school system also hopes to raise students’ awareness of the risks they face. Any pill — no matter what it is — that didn’t come from a pharmacy cannot be trusted: “It’s like playing Russian roulette,” Savoy said.

The message may be resonating. Sara Hutson, a Lehman High senior, said sharing over-the-counter pills such as Tylenol and Motrin used to be common, but she no longer considers it safe. Her trust is gone.

But other students aren’t as cautious. Lisa Peralta shared in a Facebook post in September that her daughter, who is in seventh grade, admitted to eating an “anxiety gummy” her friend gave her. “I’m scared because my daughter is a follower,” the Kyle resident wrote. “I just don’t trust that she won’t do it again if she feels pressured.”

No matter how clear the district and parents make their messages, Savoy worries they may never be enough because students are so adventurous. “It’s just the teenage mindset,” he said. “They think, ‘We’re invincible; it’s not going to happen to me.’ But it is happening to us in our community.”

Still, the feelings of unease and grief are sometimes palpable. Students have been fighting more at school, said Jacob Valdez, a Lehman sophomore who knew two of the students who died. That might be happening, he added, because “everyone is just angsty.”

The tension is not limited to middle and high school students. It’s also become very real for parents of elementary school kids, since the DEA warned the public in August about fentanyl-laced pills that look like brightly colored candies. The Hays school district is also hanging warning posters geared toward younger students.

Jillien Brown of Kyle said she is worried about her daughters, 5-year-old Vivian and 7-year-old Scarlett. “We told them that there’s some scary things going on, that people are getting very sick and they’re dying from taking what they think is candy or medicine,” Brown said. “We use the word ‘poison,’ so like when Snow White bit the apple.”

But the conversation must be ongoing, Brown said, because the day after she talked to her daughters, “some little kid on the bus gave them a candy and they ate it.”

Similarly, Kyle resident April Munson, a former elementary school teacher, considers it all “gut-wrenching.” She showed her 9-year-old son, Ethan, pictures of the multicolored “rainbow fentanyl” pills. “It’s a hard conversation to have, but hard conversations are often the most important ones,” she said. “And, really, you can’t afford to have elephants in the room.”

And even as parents and the school officials attempt to prevent fentanyl from striking again, another reality check comes.

Last year, the school district started stocking in every school a supply of the overdose reversal drug naloxone, also known as Narcan. So far this semester, despite all the community has gone through, it has been used to save four more students, Savoy said. In one case, Savoy said, first responders had to use three doses to revive a student — the fentanyl “was that strong,” he said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

USE OUR CONTENT

This story can be republished for free (details).

Fentanyl in High School: A Texas Community Grapples With the Reach of the Deadly Opioid

The first fentanyl-related deaths of students in an area south of Austin, Texas, were reported over the summer. The school district, parents, and students are trying to deal with the aftermath.

KYLE, Texas — The hallways of Lehman High School looked like any other on a recent fall day. Its 2,100 students talked and laughed as they hurried to their next classes, moving past walls covered with flyers that advertised homecoming events, clubs, and football games. Next to those flyers, though, were posters with a grim message warning students that fentanyl is extremely deadly.

Those posters weren’t there last school year.

Right before this school year started, the Hays Consolidated Independent School District, which includes Lehman, announced that two students had died after taking fentanyl-laced pills. They were the first recorded student deaths tied to the synthetic opioid in this Central Texas school district, which has high school campuses in Kyle and Buda, a nearby town. Within the first month of school, two more fatalities were confirmed.

The reaction from school officials, employees, students, and parents has been intense, mixing heartbreak and terror with anger and action. The community, it seems, is ready to fight back. The school system has prioritized its existing anti-drug educational campaign. Students are wrestling with their risky behaviors and peer pressure. And parents are trying to start difficult conversations about drugs with their children.

They are “taking the bull by the horns,” said Tim Savoy, the school district’s chief communications officer.

But there are also questions about whether those efforts will be enough.

The overdose problem facing the district, which is just south of Austin and about an hour northeast of San Antonio, mimics a nationwide trend. More than 107,000 people in the U.S. died of drug overdoses in 2021, according to the Centers for Disease Control and Prevention, a record. Most of those deaths — 71,238 of them — involved fentanyl and other synthetic opioids. The Drug Enforcement Administration has warned that fentanyl is increasingly finding its way into “fake prescription pills” that are “easily accessible and often sold on social media and e-commerce platforms.”

The police chief in Kyle, Jeff Barnett, said that’s a problem in his area. “You could probably find a fentanyl-laced pill within five minutes on social media and probably arrange a meeting within the hour” with a dealer, Barnett said.

The fentanyl threat has made high schoolers more susceptible to getting ahold of the lethal pills. They might believe they are using party drugs that, though illegal, are not — on their own — nearly as deadly as fentanyl.

The kids are “not intentionally buying fentanyl,” Jennifer Sharpe Potter, a professor of psychiatry and behavioral sciences at UT Health San Antonio, said in testimony during a September hearing before the Texas House of Representatives. They don’t know that it’s in the pills they buy, she added, describing the problem as the “third wave of the overdose crisis.”

Seventeen-year-old Kevin McConville, a Lehman student who died in August, appears to be one of this wave’s victims. In a video the district produced, Kevin’s parents explain with grief heavy in their eyes that after their son’s death, they learned from his friends that he was struggling to sleep. After taking pills he thought were Percocet and Xanax, he didn’t wake up, his parents said.

Stories like that have led the school district to issue the following warning on its website: “Fentanyl is here. We need to talk about fentanyl. And fentanyl is deadly.” It’s 100 times as potent as morphine and 50 times as potent as heroin, according to the DEA, and 2 milligrams is potentially lethal.

The district launched a “Fighting Fentanyl” campaign — which enlists city police and emergency medical services personnel. There’s a “HopeLine” to which students can anonymously send information about classmates who may be taking illicit drugs. Starting in sixth grade, students are required to watch a 13-minute video that underscores how dangerous and deadly fentanyl is and explains how to identify when a classmate may be overdosing.

“We’re recruiting students to help us be the eyes and ears if they’re at a party or at a friend’s house,” Savoy said.

The school system also hopes to raise students’ awareness of the risks they face. Any pill — no matter what it is — that didn’t come from a pharmacy cannot be trusted: “It’s like playing Russian roulette,” Savoy said.

The message may be resonating. Sara Hutson, a Lehman High senior, said sharing over-the-counter pills such as Tylenol and Motrin used to be common, but she no longer considers it safe. Her trust is gone.

But other students aren’t as cautious. Lisa Peralta shared in a Facebook post in September that her daughter, who is in seventh grade, admitted to eating an “anxiety gummy” her friend gave her. “I’m scared because my daughter is a follower,” the Kyle resident wrote. “I just don’t trust that she won’t do it again if she feels pressured.”

No matter how clear the district and parents make their messages, Savoy worries they may never be enough because students are so adventurous. “It’s just the teenage mindset,” he said. “They think, ‘We’re invincible; it’s not going to happen to me.’ But it is happening to us in our community.”

Still, the feelings of unease and grief are sometimes palpable. Students have been fighting more at school, said Jacob Valdez, a Lehman sophomore who knew two of the students who died. That might be happening, he added, because “everyone is just angsty.”

The tension is not limited to middle and high school students. It’s also become very real for parents of elementary school kids, since the DEA warned the public in August about fentanyl-laced pills that look like brightly colored candies. The Hays school district is also hanging warning posters geared toward younger students.

Jillien Brown of Kyle said she is worried about her daughters, 5-year-old Vivian and 7-year-old Scarlett. “We told them that there’s some scary things going on, that people are getting very sick and they’re dying from taking what they think is candy or medicine,” Brown said. “We use the word ‘poison,’ so like when Snow White bit the apple.”

But the conversation must be ongoing, Brown said, because the day after she talked to her daughters, “some little kid on the bus gave them a candy and they ate it.”

Similarly, Kyle resident April Munson, a former elementary school teacher, considers it all “gut-wrenching.” She showed her 9-year-old son, Ethan, pictures of the multicolored “rainbow fentanyl” pills. “It’s a hard conversation to have, but hard conversations are often the most important ones,” she said. “And, really, you can’t afford to have elephants in the room.”

And even as parents and the school officials attempt to prevent fentanyl from striking again, another reality check comes.

Last year, the school district started stocking in every school a supply of the overdose reversal drug naloxone, also known as Narcan. So far this semester, despite all the community has gone through, it has been used to save four more students, Savoy said. In one case, Savoy said, first responders had to use three doses to revive a student — the fentanyl “was that strong,” he said.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.

USE OUR CONTENT

This story can be republished for free (details).