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Injury and Violence Prevention Section
health.injuryprevention@state.mn.us

Contact Info

Injury and Violence Prevention Section
health.injuryprevention@state.mn.us

Local Public Health Guide to Spending Opioid Settlement Funds

This webpage was developed to be a resource for local public health as they convene stakeholders around settlement fund decisions and implement strategies to abate the harms of the overdose epidemic.

MDH plans on updating this webpage continually with new resources and content. Please send your feedback or content ideas to Thomas.lyden@state.mn.us or Will.Beaton@state.mn.us.

Framework for spending funds

Minnesota has the chance to use settlement funds to save lives and mitigate lifelong harms from drug misuse. To do this, settlement funds should be spent on effective interventions that are based on evidence. Settlement funds present a critical opportunity to work in synergy with other available resources. Maximizing the impact of the settlement funds will require coordination and thoughtful utilization. Below are resources to guide your community in deciding how best to allocate the dollars your community receives in order to maximize its impact.

Johns Hopkins Principles for the Use of Funds from the Opioid Litigation provides five overarching principles that should be adopted to make sure that funds are spent most effectively:

  1. Spend the money to save lives
  2. Use evidence to guide spending
  3. Invest in youth prevention
  4. Focus on racial equity
  5. Develop a fair and transparent process for deciding where to spend funds

Consider the RAND Helpful Hints for Avoiding Pitfalls and their four takeaways for effectively spending funds in order to maximize impact and avoid ineffective spending of settlement dollars.

The Colorado Opioid Crisis Response Blueprint (PDF) provides a guide for prioritizing needs and getting buy-in from stakeholders. The blueprint can be adapted for use in local communities.

The Association of Minnesota Counties Opioid Settlement Toolkit (PDF) provides Minnesota-specific information about the settlement agreement.;

The Strategic Prevention Framework developed by SAMHSA, provides steps that communities may find helpful as they make decisions about how to spend settlement funds. Decision-making groups should go through the framework’s five steps and ask themselves the corresponding questions. The five steps are:

  1. Assessment: Identify local needs based on data. What is the problem?
  2. Capacity: Build off local resources and readiness to address needs. What do we have to work with?
  3. Planning: Find out what works to address the identified needs and how to do it well. What should we do and how should we do it?
  4. Implementation: Deliver evidence-based programs and practices as intended. How can we put our plan into action?
  5. Evaluation: Examine the process and outcomes of programs and practices. Is our plan succeeding?

The framework is guided by two cross-cutting principles that should be integrated into each step: cultural competence and sustainability. When deciding what strategies to fund with settlement dollars, communities should also consider the strategy’s evidence of effectiveness, conceptual fit, and practical fit.

  • Evidence of effectiveness is the proof that a strategy will address the factors it is meant to address.
  • Conceptual fit is the degree to which a strategy addresses the priority factors driving substance use or overdose and has been shown to have positive outcomes for the focus population.
  • Practical fit is the degree to which a strategy is culturally relevant for the focus population, the community has the capacity to support it, and it enhances existing prevention activities.

Data sources

There are several data sources that can inform your decisions on how to spend your community’s settlement funds. Below is a list of data sources to consider using to assess your community’s needs. Try to use as many data sources as possible to get a more comprehensive picture of overdose and substance use in your community.

  • Death certificates
  • State Unintentional Drug Overdose Reporting System (SUDORS)
  • Hospital discharge data (I.e., emergency department visits and inpatient hospitalizations)
  • Ambulance runs
  • Treatment admissions
  • Law enforcement Record Management System (RMS)
  • Drug seizures
  • Minnesota Student Survey

Data resources

Below is a list of data reports and resources that can help you obtain data for your community.

Resources for implementing strategies

This section is meant to be used alongside Exhibit A of the Minnesota Opioid Memorandum of Agreement (PDF). The agreement provides 13 categories of strategies (A through M) that communities can implement using opioid settlement funds as well as a list of specific examples of strategies that fall under the category. Below you will find the same list of categories (A through M) with resources that can assist with implementation of strategies that fall under that category.

Strategy categories

What is this strategy?

Support treatment of Opioid Use Disorder (OUD) and any co-occurring substance use disorder (SUD) or mental health conditions through evidence-based or evidence-informed programs. This includes Medications for Opioid Use Disorder (MOUD). The Food and Drug Administration has approved three medications for MOUD: buprenorphine, methadone, and naltrexone. These medications are safe to use for months, years, or a lifetime.

Why evidence-based addiction treatment?

MOUD is a highly effective treatment for OUD. The use of FDA-approved medications for OUD works to normalize brain chemistry, block the euphoric effects of opioids, relieve cravings, and normalize body functions. According to SAMHSA, MOUD has been shown to reduce overdose deaths, HIV and hepatitis C, illicit opioid use, and criminal activity among people with SUD and to increase retention in treatment and ability to gain and maintain employment.

Resources to help understand and implement this strategy

What is this strategy?

Support people in recovery from SUD and any co-occurring mental health conditions through evidence-based or evidence-informed programs or strategies. SAMHSA defines recovery as a process of change through which people improve their health and wellness, live self-directed lives, and strive to reach their full potential. This strategy includes funding support services such as peer recovery specialists or care navigators and supporting Recovery Community Organizations and Recovery Oriented Systems of Care. This strategy includes ensuring robust support is available by providing a full continuum of care for SUD and funding wrap-around services such as housing, transportation, education, job placement and training, and childcare. Recovery supports should be responsive to the health beliefs, and language needs of diverse people groups. It should also address diversity in how services are delivered and seek to reduce health disparities in access and outcomes.

Why treatment and recovery support services?

Recovery support services empower people who use drugs to make choices that reduce the harm of using drugs and improve their overall well-being. Anyone with SUD or co-occurring mental health conditions can recover and manage their conditions successfully. Providing services and supports that address the basic needs of people who use drugs can help make this possible. Holistic recovery support services have a strong evidence base and help individuals build the four pillars of recovery: health, home, purpose, and community. These findings can be found in John Hopkin's Primer on Spending Funds from the Opioid Litigation (PDF).

Resources to help understand and implement this strategy

What is this strategy?

Provide connections to care for people who have—or are at risk of developing—SUD and any co-occurring mental health conditions. This includes identifying SUD and other risk factors, supporting MOUD in the emergency department, and connecting individuals to services following an overdose. Peer recovery specialists are often an effective way to connect individuals to the help they need.

Why connections to care?

According to the CDC's SUDORS Dashboard, in 2021, 82% of overdose deaths in Minnesota had at least one opportunity for intervention prior to death. For example, 16% of decedents had a previous overdose, 10% had witnessed another person’s fatal drug use, 47% had a mental health diagnosis, and 14 % had recently been released from an institutional setting (e.g. prison/jail, psychiatric hospital, residential treatment). Connecting people to care such as harm reduction, treatment, and wrap-around services at these intervention points has the potential to save lives. Transferring care happens frequently and can be challenging for people with SUD. Building systems that ensure a seamless transition of care improves the chances of recovery. For example, this might mean a warm handoff from emergency medical care to a SUD treatment provider or harm reduction resources in the community following a non-fatal overdose.

Resources to help understand and implement this strategy;

What is this strategy?

Address the needs of persons with SUD and any co-occurring mental health conditions who are involved in, are at risk of becoming involved in, or are transitioning out of the criminal justice system. This includes supporting diversion and deflection programs that reroute people out of the criminal justice system and into treatment, providing MOUD to individuals with OUD in jail, and connecting individuals leaving jail to MOUD, harm reduction, and wrap-around services in the community.

Why address the needs of criminal justice-involved persons?

Diversion and deflection programs provide people with mental health conditions and SUD with an alternative that addresses the health and wellbeing of the individual rather than punishing them for the symptoms of their disease. These programs also benefit corrections staff by directing individuals with complex needs to providers that can better address their mental and chemical health needs.

Meeting the needs of individuals with SUD in jails is also critical to reducing overdose deaths. The risk of overdose in the first two weeks following release is nearly 40 times higher among formerly incarcerated individuals compared to the general public. Providing MOUD in jail is highly effective. Research shows it reduces the risk of death following incarceration by 75% and reduces the risk of death from overdose by 85% in the first month following release (Opioid Overdose Mortality Among Former North Carolina Inmates: 2000-2015). Furthermore, treatment with methadone or buprenorphine is shown to lower rates of re-arrest and reincarceration - these findings can be found in the Evidence Based Strategies for Opioid Abatement of Harms Report (PDF).

Resources to help understand and implement this strategy

What is this strategy? 

Address the needs of the perinatal population and caregivers with SUD and any co-occurring mental health conditions, and the needs of their families, including babies with neonatal opioid withdrawal syndrome (NOWS). This includes providing MOUD and recovery services and supports to the perinatal population, education and support to families affected by NOWs, and trauma-informed services to reduce the negative impact of Adverse Childhood Experiences (ACEs).

Why address the needs of the perinatal population, caregivers, and families? 

The use of buprenorphine or methadone is the evidence-based standard of care for treatment of pregnant and post-partum women with OUD. While infants may develop NOWs from buprenorphine and methadone, providing MOUD for pregnant women improves outcomes for both the mother and the baby by mitigating the risk of relapse, overdose, and other severe impacts associated with OUD. A diagnosis of NOWs does not imply harm and should not be used to assess child social welfare risk or to punish the mother. Many children with in-utero opioid exposure have normal development. Evidence-based care and supportive services help these children, and their families reach their potential.

Resources to help understand and implement this strategy 

What is this strategy?

Support efforts to prevent over-prescribing and ensure appropriate prescribing and dispensing of opioids. This includes efforts to educate and train healthcare providers, support non-opioid treatment alternatives, and improve the use of the Prescription Drug Monitoring Program (PDMP).

Why promote appropriate prescribing of opioids?

The current overdose epidemic is thought to have begun with excessive prescribing of opioids. Progress has been made in reducing the inappropriate prescribing of opioids. For example, research has found that in Minnesota, the number of opioids reported as dispensed has steadily decreased every year since 2015. However, the reduction in excessive opioid prescribing has coincided with an increase in people turning to the illicit market for opioids. Appropriate prescribing and dispensing of opioids help to ensure that people are tapered safely and get the care they need.  

Resources to help understand and implement this strategy

What is this strategy? 

Support efforts to prevent substance misuse through public education campaigns and evidence-based youth primary prevention programs. Jurisdictions should be cautious of funding prevention programs that do not have evidence supporting their effectiveness. Several resources are available to help jurisdictions select evidence-based programs that are likely to be effective.

Why primary prevention?

Preventing future drug use and misuse is critical to curbing the overdose epidemic. Effective prevention strategies promote positive youth development and resilience while mitigating risk factors. Such programs help protect against a range of negative outcomes in addition to substance use, such as mental health problems, school drop-out, and involvement with the juvenile justice system. Primary prevention is cost-effective. For example, CADCA states that Investing in effective prevention strategies is estimated to save between $2-$20 for every $1 spent.

Resources to help understand and implement this strategy

What is this strategy?

Support efforts to prevent or reduce overdose deaths or other substance use-related harms. This includes increasing the availability of naloxone and fentanyl test strips, supporting and expanding syringe service programs, infectious disease testing, and increasing awareness of the Good Samaritan Law.

Why harm reduction? 

Harm reduction is a critical component of addressing the overdose epidemic. Syringe Service Programs, sometimes referred to as SSPs, are an integral component of harm reduction strategies. Decades of research show that SSPs are safe, effective, cost-saving, and do not increase illegal drug use or crime. According to the CDC, SSPs are shown to be associated with a reduction in HIV and hepatitis C incidence and an increase in entry to drug treatment and likelihood of stopping drug use. Other evidence-based harm reduction services include providing supplies for safer consumption of drugs, providing naloxone and fentanyl test strips, and overdose prevention sites. Harm reduction approaches empower people who use drugs to make positive changes that can improve their health and reduce the risks of drug use.

Resources to help understand and implement this strategy

What is this strategy?

In addition to items in section C, D and H relating to first responders, support first responders in response to the overdose epidemic. Strategies should be selected that will have the best chances of preventing overdoses and harms related to substance use.

Why support for first responders?

First responders are on the front lines of the overdose epidemic. As such, they have the opportunity to save more lives by providing naloxone and connections to care following an overdose. On the front lines, first responders may also experience compassion fatigue. Compassion fatigue is an extreme mental state characterized by burnout and secondary trauma. First responder wellness and work-life balance should be promoted in order to mitigate the impacts of compassion fatigue.;

Resources to help understand and implement this strategy

What is this strategy? 

Support efforts to provide leadership, planning, coordination, facilitations, training, and technical assistance to abate the opioid epidemic. Opioid settlement funds provide the opportunity to build off existing overdose prevention efforts and collaborate across sectors in order to have maximum impact. 

Why leadership, planning, and coordination? 

Planning and coordination allows people in the community, including those with lived experience, to provide input on the development of overdose abatement plans which helps to ensure that plans are well suited to meet the needs of the community. By understanding community needs and coordinating with key partners, jurisdictions can help ensure that limited resources are maximized, and services are not duplicated.

Resources to help understand and implement this strategy

What is this strategy? 

In addition to the training referred to throughout Exhibit A, support training to abate the opioid epidemic. This includes staff training or networking programs that improve the capability of organizations to abate the overdose epidemic and supporting infrastructure for cross-systems coordination to prevent overdoses and related harms.

Why training? 

Increasing collaboration and coordination among different sectors is crucial to reducing overdose deaths and preventing substance use-related harms.

Resources to help understand and implement this strategy

What is this strategy? 

This strategy includes data collection, epidemiological monitoring and surveillance, and evaluation of opioid abatement strategies. It also includes research on non-opioid treatment of chronic pain and novel harm reduction efforts such as fentanyl test strips.

Why research?

Quality data is crucial to understanding and intervening in the overdose epidemic. As abatement strategies are implemented using settlement funds, it is important that they are evaluated to ensure that funds are achieving their intended impact.

Resources to help understand and implement this strategy

What is this strategy?

Support strategies related to the post-mortem period such as toxicology testing, autopsies, death investigations, and overdose fatality reviews. This strategy also includes connecting individuals who may have SUD that interact with the medical examiner’s office to care and services.

Why post-mortem strategies?

Toxicology testing, autopsies, and death investigations are important for accurately tracking and identifying overdose cases and emerging substances in the drug supply. Overdose fatality review teams are made up of professionals from various sectors. Teams do a “social autopsy” of the decedent in order to identify system gaps and missed opportunities for intervention. Teams then come up with and implement recommendations that prevent future fatal overdoses.

Resources to help understand and implement this strategy

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Last Updated: 11/14/2023