The upcoming $50 billion influx of funds for state and local governments is a cause for concern for former Mississippi Attorney General Mike Moore, who fears they will misuse it.

Moore took legal action against Big Tobacco and observed as states used the billions of dollars from settlements to cover budget deficits, repair roads, and compensate tobacco farmers. He now believes that they may repeat these same errors as they receive a significant influx of money from the companies responsible for the nation’s opioid crisis.

The number of deaths from drug overdose has increased five times in the past 20 years, initially due to the use of prescription opioids, then heroin, and currently illicit fentanyl.

Moore, a member of the Democratic party, played a crucial role in brokering the $246 billion tobacco settlement during the 1990s. He also acted as a representative for multiple states and local governments who brought forth legal action against drug companies, distributors, pharmacies, and other involved parties for their role in the addiction crisis.

For this time, there are additional safety measures in position, created based on knowledge gained from the tobacco settlement.

However, Moore cautions that these actions lack significant impact.

According to Moore, there is a lack of responsibility and consequences for not properly using settlement funds. In an interview earlier this month, he stated, “There is no punishment for not using the settlement money correctly. You will not be imprisoned for misusing the funds.”

Making things more difficult is the large amount of people who will receive money from settlements related to opioid use. 4,000 claims were submitted by state and local governments, which could complicate efforts to create a unified response to the opioid crisis. In addition to victims and their families, hospitals and insurance companies have also sued drug companies. This means the funds will be distributed among a wider range of recipients compared to the tobacco settlement, where only states were plaintiffs.

Certain states, such as Ohio, have created a plan that applies to the entire state. However, other states are adopting a less all-encompassing strategy or delegating the responsibility to local government officials. There have been instances where certain areas have utilized their initial opioid settlement funds to purchase new police vehicles, equipment for hacking phones, and restraints for law enforcement.

Moore expressed concern that money may be distributed to cities and counties in certain states without proper infrastructure in place. He acknowledges the limited funds available and emphasizes the need for prioritization in addressing the opioid crisis.

This interview has been modified to make it shorter and easier to understand.

Governments at the state and local level will be granted over $50 billion in financial compensation for opioid settlements within the next 20 years. While this may seem like a significant amount, considering the numerous plaintiffs involved in the cases, it raises concerns about the adequacy of the funds and the challenges of developing a comprehensive and successful strategy to combat the issue.

At the outset, I made it clear to everyone that the initial step in obtaining a settlement is determining what your course of action will be in the event of a victory. In simpler terms, what is the ultimate goal of this case? If it is to combat the opioid crisis, a well-structured and coordinated plan is necessary, rather than simply dividing the funds among a large number of individuals.

We put in a lot of effort to encourage people to participate. However, we were unable to reach everyone due to the large number of states (50), cities and counties (4,000), and various other parties involved, such as individuals, hospitals, and insurance companies. This made the task much more complex compared to our previous experience with tobacco, where we only had to deal with states.

The issue is that every municipality, regardless of whether they had a legitimate case or any history of opioid overdoses, was seeking compensation. While it makes sense for large cities like Los Angeles, New York, or Cleveland to file, smaller cities like Lucedale, Mississippi may not have significant expenses related to the opioid crisis. Yet, they could still receive a portion of the funds. In such cases, with only $10,000, there may not be much that can be done.

Can the measures in place for spending the opioid settlement dollars guarantee they will be used appropriately, unlike the lack of guardrails in the tobacco settlement?

One positive accomplishment we have made regarding opioids is that we have mandated that 85 percent of the funds must be used for opioid abatement. Additionally, the settlement agreement contains a standardized framework that includes the measures agreed upon by experts to effectively decrease and deter opioid use.

Is that referred to as Exhibit E?

Yes, now everyone is obligated to do that.

The issue is, for example, in the state of Ohio, Governor [Mike] DeWine has proposed that everyone collaborate. He established a program called OneOhio, which is a written agreement. He obtained the cooperation of all the cities, counties, and the state. Together, they determined that when Ohio obtains $100, the funds will be distributed according to a predetermined plan. This is a significant step towards ensuring that the money is used for addressing the opioid crisis.

My main concern is that certain states may allocate funds to cities and counties without proper infrastructure in place, as I have described in Ohio. I am worried that the allocated amount would not be enough to make a significant impact unless it is combined with efforts from multiple regions, where they collectively decide to provide access to Narcan in all public areas, establish treatment options, and ensure accessibility to these treatments. However, this cannot be achieved if the funds are divided among 4,000 different parties.

We have mandated that 85% of the funds must be used for abatement efforts, which is positive. However, there is uncertainty about whether or not this will actually be followed through on in an effective and timely manner, ultimately leading to improved public health outcomes.

What is the extent to which states can flex the guardrails?

The way each state organizes itself determines its dependency. Florida and Ohio have established strong entities with a governing board overseen by the attorney general. This implies that they will closely monitor the proper use of funds.

The most important aspect is having someone in charge of overseeing it. Without this, there is a risk of a $50,000 or $100,000 payment being sent to a small town and them using it for their own expenses, such as purchasing a patrol car.

What influence did your experience with tobacco have on this approach?

I wish it were possible to require individuals to use their funds towards the issue at hand.

I traveled to all 50 states and delivered speeches about the tobacco settlement to lawmakers. I would speak in both the Senate and House in Tennessee, receiving enthusiastic applause. However, upon leaving, it was disheartening to see that no action was taken.

In my state, a tobacco trust fund was established. All funds were required to be deposited into the trust, and only the interest could be used for tobacco prevention and cessation efforts. During my tenure as attorney general, the trust remained intact. However, when I did not run for re-election, the new governor, Haley Barbour, and his administration emptied the trust fund. Currently, the trust fund has no funds as the money was consistently used in the annual budget. This situation highlights the importance of having a solid plan in place to prevent such actions.

There are numerous resources available to tackle the opioid crisis. However, it appears that state and local authorities may struggle with implementing them effectively. Are they knowledgeable on how to utilize these funds efficiently?

Why not prioritize and excel at the top five or three tasks on Exhibit E instead of trying to do everything?

If it were up to me, I would prioritize a strong prevention and education program to discourage people from engaging in abusive behavior. It is clear that there needs to be more education and warnings about fentanyl. Sadly, there are still many young individuals who are losing their lives.

Ensure that individuals do not die by ensuring access to Narcan. Next, prioritize treatment by finding a means to deliver it to those in need. Focus on actions that have the greatest potential to save lives.

There is a debate over the allocation of settlement funds between public health and law enforcement. Certain portions of the opioid settlement have already been allocated towards items such as police vehicles, phone surveillance tools, and restraint devices. Do you believe this is a suitable way to use the funds?

I am aware of the limited funds available for this situation. This is why I believe it is crucial to prioritize how it is spent. The budget is simply not sufficient to fully address the opioid crisis. It is impossible to allocate resources for law enforcement equipment and activities while neglecting treatment, prevention, and life-saving measures such as Narcan.

There is a significant amount of focus on enforcement, but what we truly need is treatment. Treatment is the missing component.

Certain states have pledged to fully disclose all of their expenses related to opioids, while others have not made any guarantees. How challenging will it be to ensure that governments are responsible for their actions?

The issue is the lack of responsibility. There are no consequences for not following through. You won’t face legal consequences if you don’t use the settlement funds properly. While there is an agreement in place, those in positions of power often change roles and forget their obligations. They may think, “That was the previous person’s problem.”

This is the reason for creating these groups. Establishing a statewide opioid task force or commission allows for autonomy and accountability.

These lawsuits focused on holding opioid manufacturers and distributors accountable. However, the majority of drug overdose fatalities are caused by illegal fentanyl and synthetic opioids. This presents challenges in responding to the overdose crisis, unlike situations involving tobacco where regulation was possible due to its legal status.

The situation is intricate and constantly evolving. With the emergence of fentanyl, new substances and chemicals like tranq are emerging. It is important to stay informed about these developments. The focus should be on addressing substance use disorder, regardless of the specific substance. The priority is getting assistance to those who require it.

I have been involved in the public sphere for numerous years, and as a result, people recognize me and approach me to share their personal experiences. They often begin with, “I’m not sure if you’re aware, but I lost my son to opioid addiction. I saw you on television.” They proceed to tell me their unique story, which could involve a 17-year-old.

Can we take away any lessons from tobacco regarding preventing opioid use?

Cigarettes do not result in immediate death, but instead cause harm over time. However, significant strides have been made in addressing this issue.

Public education has successfully implemented measures to address the issue. Approximately $100 million is allocated annually towards advertisements aimed at reaching teenagers through platforms such as Instagram and Snapchat. These efforts aim to deter them from using vaping devices or other substances. Using similar tactics, we can also target the opioid crisis. However, it seems that prevention strategies were not given enough attention.

The issue of drug use is influenced by both the demand and supply sides. Law enforcement focuses on the supply side and has been quite successful in their efforts. However, we have not been as successful on the demand side. A highly effective solution is to implement a comprehensive public education campaign, which has shown to be effective in reducing demand. This campaign must consistently communicate the appropriate messages to the target audience, spanning multiple generations. Unfortunately, this approach has not been utilized for addressing drug use in our nation.

Our “just say no” initiative was a complete failure. However, when it came to tackling tobacco use, we brainstormed creative and unconventional methods that ultimately proved successful. It may take time, but the same approach can be effective in this situation.