7/16/21

By: Jaqueline Blanco

The Opioid Crisis. Since the late 1990s, the United States has been facing an opioid crisis that impacts thousands of Americans every day, causing them to become addicted or die from drug misuse. In 2017, more than 47,000 Americans died of opioid overdose and in 2019, nearly 50,000 more Americans died of the same result. So what are Opioids and why is this a crisis? Opioids are a type of drug that can help relieve pain and are oftentimes found in prescription medications such as pain killers. They can also be found in street drugs such as heroin. Opioids have become a major concern because nearly 20% of patients prescribed opioids misuse them or develop an addiction, sometimes leading to patients using heroin.

Recently, many states, such as New York, California, Virginia, North Carolina, Illinois, and many more throughout the country have begun to sue pharmaceutical companies for the damage opioids have caused. These include big pharmaceutical companies like Purdue Pharma, Johnson & Johnson, Mckesson Corporation, Cardinal Health, and more. Essentially, the lawsuits put forth and against these companies are due to governments wanting money and accountability for misleading marketing or pharmaceutical companies playing alleged key roles in the opioid crisis. Many of these lawsuits are reaching settlements consisting of large payouts to governments over a period of time, enough so that some big pharmaceutical companies, like Purdue Pharma, are filing for bankruptcy.

Take for example the North Carolina Opioid lawsuit against big pharmaceutical companies such as Cardinal Health, Mckesson, AmerisourceBergen, Teva, and Johnson & Johnson. Like several other states, North Carolina sued these pharmaceutical companies in their alleged roles in the opioid crisis. In 2019, North Carolina, along with four other states, agreed on a deal that included $22 billion in cash and $26 billion in medication-assisted treatment for drugs over a 10 year period. And now that the state of North Carolina has reached an agreement with these companies, many are beginning to ask and wonder, how will the state distribute their new funds?

Steve Mange, a Senior Policy & Strategy counsel to the North Carolina Attorney General,  emphasized that the money coming from the settlement will go towards fighting the opioid epidemic and other public health efforts, and he does not want a repeat of the tobacco settlement agreement. In a recent press release, North Carolina and its counties came to an agreement that 80 percent of the settlement money would go to the counties and local governments, 15 percent will be given to the General Assembly to address the opioid epidemic, and 5 percent will go towards incentive funding for other counties to join this agreement.

Yet, while the state of North Carolina and its counties have agreed on how to distribute the settlement funds as a whole, many are still asking how the counties and local government are going to distribute their share? The goal is to continue fighting the opioid epidemic and putting public safety first. This is why all opioid settlement funds local governments receive are to be used on high-impact strategies and collaborative strategic planning that is used to fight against the epidemic.

The agreement between the state of North Carolina and the payout to its counties will offer “a high level of transparency into how local governments use the funds, including special revenue funds subject to audit” and “annual financial and impact reports.” Additionally, to ensure further transparency and accountability, local governments receiving these funds will need to create finance and compliance audits, special budget items or resolutions, annual financial reports, annual impact information, and public performance dashboards. These accountability requirements could also help local governments create more equity in their communities and an even distribution of  settlement funds.

For some local governments, these accountability requirements may be a bit overwhelming or novel. Some may be questioning where to start. Well, a potential solution for local governments to meet the requirements while simultaneously adviancing equity is “results-based budgeting”. Result-based budgeting is a strategy focused on structure, data-driven planning, and using evidence as a guide to budgeting. The current government budgeting is oftentimes ineffective as revenues may fall short, low-performance programs continue to be funded, and distribution of funding does not take equity into account.

Using evidence as a way to guide budgeting not only limits governments to invest in what is known to be effective or proven to work, but also allocates funding towards goals and future achievements instead of departments. Budgeting for equity could also be a potential goal for governments and with result-based budgeting could also be made possible. For North Carolina and its local governments, who will soon acquire newly found funds, result-based budgeting is a great strategy for them to look at. Results-Based Accountability (RBA) is a framework for social change that many communities and governments are using to create their results-based budgets. If North Carolina governments choose a results-based approach to budgeting and impact, there are also public dashboard systems available that are being used to support these frameworks. These are a potential solution for meeting accountability and transparency requirements, while building a basis for long-term, equitable, sustainable impact.

North Carolina’s counties and local governments should evaluate what resources, programs, and services they are already using that have yielded results towards helping fight the ongoing opioid crisis. By implementing goals or future achievements and using result-based budgeting or accountability approaches, North Carolina’s local governments can not only make great efforts towards fighting the opioid crisis, but possibly in other public issues that could use a reallocation of funding.

About the Author:

Jaqueline Blanco is a rising senior Public Policy student at the University of Maryland and a Content Marketing Intern with Clear Impact. She enjoys writing and learning more about ways to help solve or address public issues in her community while hoping to one day work in a position where she can make a positive impact.