First came the payout from opioid settlement. Now, how will millions be used in South Florida?

Palm Beach County Commissioner Michael Barnett said he lost his brother.

Through tears, Commissioner Sara Baxter revealed she has lost not one, but two sisters.

Commissioner Gregg Weiss divulged that he, too, lost a brother. All had been victims of the opioid crisis.

“It’s an insidious disease,” Weiss said at a meeting.

Palm Beach County commissioners recently shared stories about their own loved ones — a strong reminder of the impact of addiction — as they looked ahead toward helping others. The candid conversations came after an advisory committee in Palm Beach County brought forth recommendations on how to spend about $122 million in opioid lawsuit settlement funds rolling into the county over the next 18 years.

Palm Beach and Broward counties are among the many local governments across the U.S. now determining how exactly their shares of millions of dollars should be used. Broward is set to receive about $120 million. They must weigh what would be the most effective use of the money, “a critical moment,” given research already exists on what is and isn’t helpful.

Austin Wright, program director for Resilience Against Drug Deaths at the nonprofit Rebel Recovery, spoke during a meeting on May 21, calling attention to how opioids have been devastating.

“It’s great that these dollars are making their way to the communities that were affected by this issue finally, but we can’t forget that there was just an unbelievable amount of bloodshed,” he said. “We’ve all lost friends, family members, sons and daughters.”

How the funds will work

Palm Beach County has so far received $25 million, said James Green, the county’s community services department director. Green said he did not know exactly when the county received that money, but none of it has been spent yet.

Payments in Broward County were first made in April, June and August of 2023 for a total of about $16.3 million. More payments were made in January, April and May of 2024 for a total of about $9.3 million. The county does not know when the next batch of payments will come in, according to county spokesperson Gregory Meyer.

Neither county plans to craft a plan that accounts for the full 18 years; rather, spending plans will remain fluid to ensure the funds are being spent wherever the greatest needs are at the time.

“In 18 years, we could be talking about ‘Bugs Bunny’ drugs,” said Maureen Kielian, chair of the Behavioral Health, Substance Abuse and Co-Occurring Disorders advisory committee in Palm Beach County and leader of Southeast Recovery Advocates.

“Bugs Bunny drugs” aren’t real, but Kielian’s point is that the Palm Beach County plan may need to be updated and renewed every year to account for any potential introduction of a new, currently nonexistent drug, which could mean recommendations for how to use the funds could change.

Recommendations are at different stages in Palm Beach and Broward counties. In Palm Beach County, the responsible advisory committee proposed a variety of ideas, including providing essential services, creating campaigns, expanding syringe services — which facilitate the safe disposal of syringes and prevent disease outbreaks — and expanding data collection to also include data on mental health.

One of the goals is to end so-called “treat and street,” which is when people seek addiction recovery but then once they resettle into the community, begin using substances again. So, parts of the funds are suggested to go toward resources that keep people from being tempted back into addiction.

During the May 21 meeting, commissioners Weiss and Baxter both emphasized the importance of providing support to the families of those struggling, too.

“It isn’t just the person with the addiction,” Baxter said. The surrounding families “are the people who suffer, too.”

“If we forget that part of this, the rest fails.”

Green said the recommendations will go back to Palm Beach County later this summer for approval.

In the future, when the money starts to be spent, the county will develop a way to monitor the processes and then provide reports detailing how dollars are being spent and what the outcomes are, Green said.

In Broward County, the settlement money, at least for right now, is going toward “more beds to help more people,” Gerard John, the director of the Broward Addiction Recovery Center, said.

BARC Central in Fort Lauderdale intends to expand, bringing in 25 more “detox beds” to the 50 existing beds within the next two to four years. These are places where people seeking treatment can stay, and the detox treatment may last one to two weeks.

“There’s a higher need for medical care,” John said. People seen by BARC now are “more medically compromised,” and have “more mental health issues.”

“They are different from the clients we saw six, seven, eight years ago,” he said.

A residential facility in Coral Springs, which currently has 92 beds, also will get funds for its pharmacy. This is the facility people go to after the detox program, and they can stay for up to two months.

Without the residential program, “it could start the whole cycle again” if they don’t have a place to go, John said. And the program works to help patients not just addicted to opioids — anyone struggling with a substance is welcome to seek treatment.

‘Critical moment of opportunity’

Opioid settlements across the U.S., which include deals with drugmakers, wholesalers and pharmacies, require that most of the funds be used to combat the opioid crisis, according to The Associated Press. Opioids have been linked to about 800,000 deaths in the U.S. since 1999, including more than 80,000 annually in recent years, with most of those involving illicitly produced fentanyl, the AP reported.

Opioid addictions and overdoses saw significant increases around the 2010s, killing more than 1,000 people every year during that time in South Florida alone.

The primary concern pertaining to opioid settlement fund usage — not only in Palm Beach and Broward counties, but across the nation — is if and how the money will be spent solely on mending the loss from the opioid crisis and preventing future addiction.

Advocates and researchers, such as Sara Whaley, a senior practice associate at the Johns Hopkins Bloomberg School of Public Health, are working to avoid what happened when states received money after litigation was pursued against tobacco companies. Only a small percentage of those dollars were used to actually fund tobacco prevention and control efforts.

That’s why Whaley said she and other researchers have put together guiding principles to make sure what happened with big tobacco doesn’t happen with settlement funds tied to the opioid crisis.

“We’re in this kind of critical moment of opportunity, and there is a plethora of research showing kind of what works and what doesn’t work,” she said.

Those principles, according to the Johns Hopkins Bloomberg School of Public Health, include:

— Spending the money to directly impact those suffering from the effects of addiction, rather than being tempted to use the money to fill budget holes or spending all of it right away.

— Using evidence to guide spending, to ensure money is being directed toward programs and resources that work rather than ones that don’t.

— Investing in youth prevention.

— Focusing on racial equity by directing “significant funds to communities affected by years of discriminatory policies and now experiencing substantial increases in overdoses.”

— Developing a fair and transparent process for deciding where to spend funding.

So what works and what doesn’t?

When it comes to youth prevention, Whaley said fear-based programs generally don’t work long term, but building resilience and relationships between adults and children does.

Another example of a resource that works well is the overdose reversal medication naloxone, which Whaley said is “really effective in saving someone’s life if they are having an overdose.”

Every community is different, though. What Broward County needs most may differ from what Palm Beach County needs, which is why Whaley said conducting a needs-assessment in each municipality could be one good way to determine what recovery support services are most lacking. She also said municipalities should have some sort of an oversight committee filled with diverse voices to advise on spending.

“We know that this isn’t enough money that this is going to end the opioid crisis,” she said. “But I think what this does offer is an opportunity for us to break down some of those communication silos and to work together more.”

Ideally, with the funding at state and local levels, communication will be more open about efforts in place and efforts that are still needed, which will help in preventing duplicative or contradictory services, Whaley said.

Lissa Franklin agrees.

Franklin, who has been sober since Feb. 1, 2012, wears many different hats as a substance abuse recovery advocate: member of the Palm Beach County advisory committee making funding recommendations, vice president of Southeast Recovery Advocates and executive director of the Delray Beach Drug Task Force.

Franklin said the way the settlement money is talked about makes it seem like it will bring in a substantial number of funds each year when that’s not necessarily the case, especially when “spread across 18 years” for the county, one of the largest in the state.

“It’s important for people to realize that this doesn’t mean this is the end,” she said. “This is only the beginning. It’s just the start, and it’s going to take continual effort and continual community engagement, a teamwork makes the dream work kind of approach.”