³Ô¹Ï²»´òìÈ worked with three Louisiana news outlets — , , and — to ask all 64 sheriffs in the state how they’ve spent their opioid settlement funds. The responses were shared and presented in a data table for all four newsrooms to use. Reporters then conducted individual reporting for separate articles.

Every state is from companies accused of flooding the nation with prescription painkillers and fueling overdose deaths. But only one state is directing 20% of those payouts to sheriffs — the largest carve-out for law enforcement nationwide.

In Louisiana, sheriffs are elected, do not serve at the pleasure of another local official, and have independent budgets. They’re also not required to proactively report to the public or another authority how they spend billions in opioid settlement cash.

Short of filing public records requests or waiting for official audits, that has made it difficult for the average person to track the windfall. Many consider the dollars to be “blood money” and believe the spirit of the settlements is to spend it all on abating the addiction crisis.

³Ô¹Ï²»´òìÈ worked with three Louisiana news outlets — , , and — to track those dollars. The newsrooms contacted all 64 Louisiana sheriffs over five months, often filing public records requests, to produce the first detailed accounting of millions spent.

The findings include:

• Thirty-eight sheriffs reported spending more than $8.1 million total. Much of it went to crime-fighting equipment, such as surveillance cameras and drug detection products, though smaller amounts funded mobile apps, addiction treatment in jails, and educational programs for youth.
• $5.4 million, about 66% of reported spending, was deemed inappropriate by a three-person review panel. The panel, assembled by ³Ô¹Ï²»´òìÈ and its partners, included a Louisiana resident in recovery who lost his son to a fentanyl overdose, an addiction medicine doctor, and a public health policy analyst who has been tracking settlement dollars since 2022. They judged the expenditures using their professional and personal expertise. Expenditures the panel disapproved of included salaries and overtime pay for homicide detectives and officers conducting jail shakedowns to find contraband.
• $4.7 million, nearly 60% of reported spending, went to items or services that other states say should not be purchased with opioid cash. Six states have , such as technology to extract data from cellphones and automated external defibrillators, which are . Although Louisiana does not have its own “unallowable” list, the state’s — a five-member body that advises sheriffs and parishes but does not control the money — said it has shared the guidance from other states.
• Nine sheriffs stood out for promising uses: All of their expenditures, totaling nearly $1.8 million, were deemed appropriate by the review panel and allowable in other states. These included providing addiction treatment in jail, training officers to respond to overdoses, and increasing public awareness of addiction resources.
• Twenty sheriffs did not provide their expenditures, leaving roughly $10.7 million that hidden from public view. The Jefferson Parish Sheriff’s Office, which covers an area just outside New Orleans and was allotted the highest amount — nearly $4 million through 2025 — did not respond to more than a dozen calls and emails.

Nationwide, debates over law enforcement’s role with opioid settlement money have been underway since the funds began flowing significantly in 2022 and have continued as the pool of money has grown. Purdue Pharma, , finalized its this year, and various settlements are set to pay out for an additional decade-plus.

Since the earliest days, these dollars have been viewed across government agencies and the private sector as a pot of gold for which many are vying.

Law enforcement agencies are part of this scrum. They say seizing drugs and arresting dealers save lives, but that costs money and the addiction crisis has burdened their budgets. However, many recovery advocates staunchly oppose any opioid cash flowing to what they see as the .

Since there are few guardrails on how the money is spent, decisions often come down to how local politicians and residents see addiction and what type of approach they believe will be effective in combating it.

Louisiana provides a natural experiment to see which priorities prevail when money is handed directly to sheriffs.

First Public Look at How Louisiana Sheriffs Have Spent Over $8M in Opioid Settlement Cash

In Louisiana, sheriffs receive 20% of the state's opioid settlement cash — the largest carve-out for law enforcement nationwide. But since sheriffs are not required to proactively report how they spend the money, it's hard to track. Reporters from ³Ô¹Ï²»´òìÈ, The Current, Gulf States Newsroom, and Verite News contacted all 64 sheriffs to uncover spending details. <br><br> Click column headings to sort the table.

Note: In some cases, the amount of money spent exceeds the amount allocated because sheriffs may have reported spending that included their 2026 allocations or because sheriffs combined their opioid settlement dollars with the share received by parish governments or other funding sources. Descriptions of spending are based on emails or phone calls with the sheriffs' offices and have been lightly edited. <br> Source: The money allocated to sheriffs was obtained by summing values for years 1-5, representing 2021-2025, from the Louisiana Opioid Abatement Task Force’s <a href="; target="_blank" style="color:#0071ce">public spreadsheet</a>. Data on money spent was collected by ³Ô¹Ï²»´òìÈ, The Current, Gulf States Newsroom, and Verite News. • <a href="/download-the-data-louisiana-sheriffs-opioid-settlement-expenditures/&quot; target="_blank" style="color:#0071ce">Download the data.</a> <br> Credit: ³Ô¹Ï²»´òìÈ' Lydia Zuraw and Aneri Pattani, The Current’s Alena Maschke, Gulf States Newsroom’s Drew Hawkins, and Verite News’ Katie Jane Fernelius

The state’s agreement with parishes and sheriffs receiving settlement cash contains broad categories for , including “law enforcement expenditures relating to the opioid epidemic.”

But even if the sheriffs’ spending is legal, that doesn’t mean it’s appropriate or effective, addiction and public health experts say.

“What’s happening here is they have a lot of money and they want to distribute it to all the wrong places,” said Danny Bolner Jr., a Jefferson Parish resident who has been in recovery from addiction for more than two decades and lost his 28-year-old son to a fentanyl overdose in 2016. On the panel that reviewed expenditures, Bolner represented the view of families who have lost loved ones to the crisis.

The purchase of drones and vehicles struck a nerve for him. He’d prefer for opioid cash to support programs that educate youth about healthy ways to process emotions, provide job training to people in recovery, and distribute overdose reversal medications.

“This money is what we have to save lives,” he said. If sheriffs use it in other ways, the finite pot “is going to be gone and then they won’t have nothing to help.”

A Safe, a Scanner, and Surveillance Cameras

For , a public health policy analyst and national opioid settlement expert who was a member of the review panel, determining if expenditures fit the spirit of the settlements often centered on whether they facilitated arrests or prevented overdoses.

“The impetus of this opioid settlement money is to spend on innovative ways to not let this happen again,” she said, referring to the overdose crisis that has claimed since 2000. She said sheriffs should be asking, “How could we use this to reinvest in the community, not just build up our office?”

Many of the sheriffs’ equipment purchases didn’t meet her bar.

For example, the East Baton Rouge Sheriff’s Office bought a safe to store evidence from opioid investigations and a scanner for their traffic division to identify narcotics in hidden compartments. The Terrebonne Parish Sheriff’s Office spent $465,000 on , which are automated license plate readers that capture data about passing vehicles and share them with law enforcement agencies nationwide. The Bossier Parish Sheriff’s Office purchased 130 body cameras and 50 dash cameras.

Sheriffs already receive taxpayer dollars and federal grants to buy law enforcement tools, Christensen said. Opioid cash, which is finite and has a specific purpose, should not be used for that, she and the other reviewers said. In fact, some states don’t allow it.

13 Louisiana Sheriffs Spent 100% of Opioid Settlement Money Inappropriately, per an Expert Panel

The expenditures were reviewed by Tricia Christensen, a public health policy analyst who has been tracking opioid settlement spending since 2022; Stephen Loyd, an addiction medicine doctor and a person in recovery who serves as West Virginia's drug czar; and Danny Bolner Jr., a person in recovery who lost his son to a fentanyl overdose and is raising his son’s daughter in Jefferson Parish, Louisiana. A majority vote determined which expenditures were appropriate. <br><br> The map depicts the percentage of money each sheriff spent on expenditures disapproved by the reviewers.

Note: The reviewers voted on the propriety of each expenditure based on their own views of the purpose of opioid settlement money. The rates of opioid-involved deaths are age-adjusted. Rates based on counts <5 were suppressed by the Louisiana Department of Health to protect privacy. "Opioid-involved deaths" include deaths in which opioids were present in the body and/or contributed to death, even if they were not the sole cause of death. <br> Sources: Settlement spending and reviewer opinions collected by ³Ô¹Ï²»´òìÈ, The Current, Gulf States Newsroom, and Verite News; opioid-involved death rates from the Louisiana Department of Health <br> Credit: ³Ô¹Ï²»´òìÈ' Lydia Zuraw and Aneri Pattani, The Current’s Alena Maschke, Gulf States Newsroom’s Drew Hawkins, and Verite News’ Katie Jane Fernelius

But taxpayer money may not cover everything sheriffs need, said , executive director of the Louisiana Sheriffs’ Association. “Our budgets are overloaded,” he said.

Complex investigations to dismantle drug trafficking syndicates can require advanced equipment, , a spokesperson for the East Baton Rouge Sheriff’s Office, wrote in a statement.

“While treatment and recovery services are indispensable components of addressing opioid addiction, they address the consequences of addiction after these drugs have already reached our community,” she wrote. “Law enforcement has a different, but equally essential, responsibility: preventing those deadly drugs from reaching potential victims in the first place.”

First Lt. Blake Tabor, a spokesperson for the Terrebonne sheriff’s office, similarly wrote, “Our role as a law enforcement agency is primarily focused on disrupting the criminal activity that fuels addiction in our community.” That effort complements other entities’ work in prevention, treatment, and recovery, he added.

The Bossier Parish Sheriff’s Office declined to comment.

Where Public Health Meets Public Safety

Not all sheriffs spent the money on enforcement.

Acadia Parish Sheriff directed all his settlement cash to provide treatment in jail. He said he hopes to break cycles of addiction and crime.

“I want people back into society, being productive,” he said.

Research shows for opioid use disorder behind bars and .

In St. Martin Parish, settlement funds helped launch a of officers that connects people with substance use disorders or related mental illness to treatment, said Chester Cedars, chief legal counsel for its sheriff’s office. Officers also try to coordinate support services for family members and assist with questions around paying for care.

“We’re not clinicians,” Cedars said, but we “serve as a broker” between people who need services and those who provide them.

, an addiction medicine doctor and the West Virginia drug czar, who was the third member of the review panel, said he loved the comprehensive nature of the program. Addiction “is a family issue,” he said. “Every time that phone rings, it’s a potential family crisis.”

It’s not a coincidence that these parishes earned top marks from the reviewers. Cedars is the former chair of the , and Gibson is the current chair. That’s the body meant to guide others on priority uses of settlement cash.

Cedars was clear that the St. Martin sheriff’s office was not using “one penny for any enforcement activity,” because that’s not what the settlement “intended to accomplish.”

Gibson was more hesitant, saying the legal guidelines are broad and “I’m not here to criticize anybody.”

He has advised about a dozen sheriffs who have reached out with questions, but he knows they’re not required to heed his guidance.

A from the Louisiana Legislative Auditor found that the task force has no teeth to enforce its recommendations.

If people want stronger guardrails on the opioid cash, state lawmakers need to enact new rules, Gibson said.

Stepping Up Oversight

The Louisiana state legislature in May calling for the legislative auditor to review how all parishes and sheriffs are handling their opioid settlement money and report to lawmakers prior to the 2027 legislative session.

State Sen. , a Republican who co-authored the resolution, said the goal is to shed light on where dollars are flowing, if jurisdictions are spending them at all, and which funded programs are effective.

With that information, Myers said, he and others could “absolutely” introduce bills “to tighten up how funding is spent.”

Louisiana Sheriffs Spent $4.7M in Opioid Settlement Cash on Items, Activities Deemed Unallowable in Other States

Six states — <a href="; target="_blank" style="color:#0071ce">California</a>, <a href="; target="_blank" style="color:#0071ce">Indiana</a>, <a href="; target="_blank" style="color:#0071ce">Kansas</a>, <a href="; target="_blank" style="color:#0071ce">Michigan</a>, <a href="; target="_blank" style="color:#0071ce">South Carolina</a>, and <a href="; target="_blank" style="color:#0071ce">Virginia</a> — have created lists of items and services that they say opioid settlement funds should not be spent on, including surveillance cameras and vehicles. Although Louisiana does not have its own "unallowable" list, the state's Opioid Abatement Task Force said it has shared other states' guidance with some sheriffs. Yet nearly 60% of the sheriffs' spending involves items found on such lists.

Note: Unallowable lists may not be legally binding in each state but are considered strong guidance. <br> Source: Data collection by ³Ô¹Ï²»´òìÈ, The Current, Gulf States Newsroom, and Verite News <br> Credit: ³Ô¹Ï²»´òìÈ' Lydia Zuraw and Aneri Pattani

Meanwhile, the Louisiana Opioid Abatement Task Force is trying to strengthen its oversight.

Curtis Nelson is executive counsel for the Louisiana Opioid Abatement Administration Corporation, a nonprofit that supports the task force. He said the body is seeking quotes from accountants to conduct ongoing forensic audits of parishes and sheriffs. The goal is to audit 10 to 15 entities annually, starting with those receiving the most money. If the audits turn up misuse, the task force could withhold future payments from those parishes or sheriffs, Nelson said.

The task force is also exploring creating its own unallowable list, like those in other states, Nelson said.

Louisiana Gov. Jeff Landry and Attorney General Liz Murrill did not respond to questions about whether they’d support an unallowable list or take other actions to address opioid settlement spending.

But many advocates are hopeful that an unallowable list could curb spending they found concerning.

“You’re keeping them on the track when you tell them what they can’t use it for,” said Bolner, the Jefferson Parish resident who lost his son to overdose and is raising his son’s daughter.

While he awaits greater oversight for sheriffs, Bolner plans to continue the work he’s been doing for years: distributing overdose reversal medications at schools, hospitals, and bars; participating in grief support groups with other families; and showing up at community events to raise awareness about addiction. He said he’ll keep speaking with sheriffs and parishes about what he considers the best use of settlement money.

“If I save one life, it’s accomplished,” he said.

Methodology

The Current’s Alena Maschke, Gulf States Newsroom’s Drew Hawkins, and Verite News’ Katie Jane Fernelius contributed to the database featured in this article.

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

Work Requirements Unfairly Burden Medicaid Applicants

Great story (“A Deloitte-Run System Denied Medicaid Benefits for Michigan’s Disabled. Now Trump’s Law Piles On,” July 21). However, a key point was missed. The wrongly denied recipients have the burden of proving their entitlement. This can cost thousands. They have no money with which to finance the carrying of that burden of proof. Additionally, how does one prove that they cannot do any work? Doctors generally say: I will just provide their work restrictions (e.g., 10-pound lifting restrictions), but I’m not a vocational expert, so I’m not going to opine on “employability” or “non-employability.” Moreover, it takes many months to go through reconsiderations and appeals, so even if the worker wins, they will have lost everything by then. Finally, under the doctrine of “exhaustion of remedies,” the recipient must suffer through the administrative steps before asking a court to help. And even then, the court will defer to the administrative agencies’ findings of fact (i.e., the department’s hired doctor over the treating doctor).

Bottom line: Once there is an incorrect/wrongful denial, it is an unjust horror show that literally destroys lives — all because far-right politicians have stereotyped Medicaid recipients, painting them all as presumptively people who could work but would rather just unjustly receive benefits — a totally false and ignorant paradigm. A partial solution would include placing the burden of proof on the state to prove the recipient can work and that suitable work is available, and to enact a presumption that when a treating doctor has credibly explained a substantial disability, the department must presume qualification absent clear and convincing proof to the contrary.

— N. Dean Nasser Jr.; Sioux Falls, South Dakota

A Reckless Data Grab?

The Office of Personnel Management has already suffered massive data breaches affecting millions of employees and their families.

I am a retired federal civil servant and one of the many whose data was .

The (“Trump’s Personnel Agency Says It Will Remove Some Identifying Info as It Sweeps Up Medical Records,” July 22) raise the question of how the requested massive dump of health data any better than the personnel records previously affected.

— Kathryn Edgecomb; Vancouver, Washington

States Need More Than Money To Fight the Opioid Crisis

New Mexico offers a compelling case study in the national conversation about opioid settlement accountability (“Leadership Vacuum: Agencies in New York and Beyond Pass the Buck on Opioid Cash Oversight,” July 21). While much of the public attention has focused on whether settlement dollars are being misspent, the New Mexico Office of the State Auditor’s review of local governments found a different problem: Large amounts of opioid remediation funding remain unspent years after settlements were reached and funds were distributed. The state auditor’s transparency review identified more than $100 million in opioid settlement funds held by local governments, with many entities reporting little or no expenditures as of fiscal year 2025.

That outcome does not point to widespread misuse. Instead, some local officials repeatedly cited workforce shortages, provider capacity constraints, procurement hurdles, and long-term sustainability concerns as barriers to moving dollars into prevention, treatment, and recovery programs.

While these barriers are significant, New Mexico has built structures that may be worth watching. A state law established dedicated opioid settlement funds and a framework intended to ensure resources are used for opioid remediation purposes. State agencies, local governments, behavioral health providers, and policymakers are now working through how best to coordinate spending, measure outcomes, and communicate progress to the public. The New Mexico Office of the State Auditor will continue to provide transparency, reporting on who is spending, what is producing results, and where bottlenecks exist.

The lesson for other states is clear: Securing settlement dollars creates an unprecedented opportunity to remediate harms resulting from the opioid crisis, but it is only the first step. States also need the workforce, infrastructure, and coordination to turn that money into treatment, recovery services, prevention programs, and fewer overdose deaths.

The core question is no longer just where the money is. It is whether states have built the systems to translate settlement dollars into measurable public health gains.

— New Mexico State Auditor Joseph Maestas; Santa Fe, New Mexico

Progress on the Prior Authorization Front

Health plans continue to make steady progress implementing the to simplify prior authorization. The article “Insurers Hedge on Trump-Backed Pledge To Improve Denials Process” (July 17) paints an incomplete picture of this ongoing work, particularly related to supporting for patients and for prior authorization requests.

Participating health plans committed to implementing aimed at reducing administrative burden and accelerating access to care on a transparent timeline, and that work is on track. In April 2026, participating health plans announced and a for submitting electronic prior authorization requests for most medical services starting in 2027.

Health plans will continue adopting common data standards on a rolling basis as the standardization commitment is fully implemented, starting in 2027. As more providers move away from manual, error-prone processes and adopt electronic prior authorization, this standardized approach will mean faster answers, a more consistent experience, and less friction for everyone.

in place to support member transitions between insurers during an active course of treatment. Under the voluntary commitments, when a patient with an approved authorization for in-network care switches health plans, the previous plan’s authorization is honored for 90 days. Health plans can implement several data exchange options to support patient transitions, and plans are not required to use a specific method to meet the commitment.

The series of voluntary commitments made by the industry requires substantial work, meaningful investment, and strong partnerships. Health plans are making steady progress in meeting these commitments and will continue to do so until they are fulfilled.

— Mike Tuffin; AHIP president and CEO; Washington, D.C.

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

Last year, Baltimore had three in the span of three months in its Penn North neighborhood.

In one incident, more than two dozen people were hospitalized after many were , lying in the streets or on sidewalks. No one died, but some came close.

Follow-up that the street drugs of N-methylclonazepam, a benzodiazepine that operates similarly to Xanax or Valium. Like opioids, benzodiazepines suppress breathing. When they’re combined, the goes up. And benzodiazepines don’t respond to opioid overdose reversal drugs.

Afterward, the created test strips specifically for benzodiazepines. The group distributed them — along with test strips that identify other harmful adulterants, such as fentanyl, , and medetomidine — at clinics and neighborhood events. The strips, available at no cost, can also be found in bars and spread out on street corners. People testing drugs mix a small amount with water and then dip a test strip into the liquid. The strip will change color if it identifies an adulterant.

“Nobody really knows what they’re getting whenever they’re getting stuff off of the street,” said Candy Kerr, a spokesperson for the coalition. “Having the test strips available for the general public gives them the option to move slower if they’re going to use whatever they’re going to use.”

But a new federal policy could make it harder for organizations such as Kerr’s to give out the test strips, and they’re worried that overdoses could increase. In late April, the Substance Abuse and Mental Health Services Administration banned the use of federal grants for distributing strips to the public and for some other harm reduction practices that have been credited with saving lives. Test strips have been used for to identify adulterants.

sent to local health departments and nonprofits that provide addiction services explained that the Trump administration believes those harm reduction practices “facilitate illicit drug use and are incompatible with Federal laws.”

According to the letter, grants from the Department of Health and Human Services also cannot be used for programs that support the use of clean needles or drug paraphernalia such as pipes, or to fund a type of that people can , so someone is aware and can call for help if they overdose. 

The Trump administration wants to focus more on other techniques, such as giving out naloxone, an overdose reversal drug available as a nasal spray, according to Emily Hilliard, an HHS spokesperson.

“It is critical that federal funding provided by the American taxpayer goes to effective, common-sense solutions that have been proven to save lives and keep people out of an endless cycle of addiction and moves them into a life of recovery,” she said.

The new policy does not prohibit federal funds from being used to purchase test strips for use by law enforcement officers, public health officials, EMTs, or other medical professionals.

That creates an important exception for government agencies that test drugs and send out on what adulterants are saturating the drug supply in certain locations.

Still, , who oversaw SAMHSA’s in the Biden and Trump administrations, says there is a substantial body of evidence giving test strips to people who use drugs can change behavior.

“There’s some people deciding not to use the substances, some people deciding to reduce, to use less, or take other types of precautions, including naloxone, and making sure that there are people around that can actually then help in the case of an overdose,” Olsen said.

Kerr said the best approach would be to continue to promote the use of test strips while also continuing to give out lifesaving medications like naloxone. She believes that working on all fronts has helped lead to Baltimore’s decline in overdose deaths, which more than 40% since 2023.

Under the new policy, nonprofits will still be able to hand out test strips, but they will have to find other funding for that work, which Kerr finds worrisome.

“We’ve been making these strides forward because we’ve had these things, because we’ve been funded,” she said. “We’re going to have to pull money from other places.”

To pay for the test strips, Kerr said, the Baltimore Harm Reduction Coalition will have to cut back on services such as giving out hygiene and wound care kits. But she said that option is better than risking another mass overdose in Baltimore — or allowing even just one preventable fatality.

This article is from a partnership that includes , , and ³Ô¹Ï²»´òìÈ.

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

Can’t see the audio player? Visit kffhealthnews.org to listen.

For years, Washington, D.C., has paid for Medicaid — the state-federal health insurance program for low-income people — out of its general budget. But next year, the city is shifting part of that recurring multimillion-dollar cost to a new funding source: opioid settlement dollars.

That’s raising red flags for addiction recovery advocates, people directly affected by the crisis, and the commission in charge of recommending how the city uses its share of the settlement money.

The come from a host of companies that made or distributed prescription painkillers and were accused of fueling the overdose crisis. State and local governments nationwide are set to receive more than $50 billion over almost two decades. Washington, D.C.’s cut is expected to .

The money is meant to remediate the addiction crisis, often by increasing services or funding new programs.

But many states are facing increasing fiscal pressures as they are squeezed by inflation, federal funding cuts, and rising costs. Some officials have been tempted to turn to opioid settlement cash as a budget stopgap — an idea that can trigger opposition and outrage from recovery advocates and people who have struggled with opioid addiction and their family members.

“These funds were awarded to D.C. for very specific reasons and with a specific mandate, which are to remediate issues related to the opioid crisis in new and innovative ways,” said Queen Adesuyi, a partner at , a consulting group for community-based organizations, who is crying foul over the proposed fiscal year 2027 budget.

A document provided to ³Ô¹Ï²»´òìÈ shows line items in the district’s fiscal 2027 budget that would direct about $2.3 million in opioid settlement funds to help pay for the city’s Medicaid contribution and at least $5.5 million to support addiction treatment centers previously funded through the general budget. Substituting opioid settlement dollars for general funding keeps overall spending on treatment flat instead of increasing.

“Opioid settlement dollars are not meant to be a rainy-day fund for existing government obligations,” said , associate director of the Center on Addiction and Public Policy at Georgetown Law’s O’Neill Institute.

More than 80 individuals and 30 city organizations protesting this use of settlement dollars, saying the district’s planned to spend opioid cash to “pay off its own debts.” The letter was sent to DBH Director Barbara Bazron; the chair of the D.C. Council’s Committee on Health, ; and Attorney General .

Chad Jackson, himself in recovery, chairs the district’s , which was created to advise the city on how to spend its settlement dollars. Jackson called the latest move supplantation, a budgeting tactic that shifts money from one fund to another to free up dollars.

“If the opioid settlement funds were not there, I feel pretty confident that these things would have been funded, because they have to be funded,” Jackson said.

What’s happening now is against the district’s opioid litigation law, he said.

The that money from the district’s opioid abatement fund “shall supplement, and not supplant.”

“It’s a pretty tightly written law where the intent is very clear: Do not supplant,” Weizman said.

Adesuyi, an advocate for programs that help people who use drugs, said the council is flouting that law and that it’s a “slap in the face.”

Councilmember Henderson and Attorney General Schwalb weighed in too.

“We are also concerned that DBH may be using the settlement monies for other unauthorized purposes,” they wrote in a to the department. They highlighted the $2.3 million used to cover the city’s Medicaid contribution and asked the department to explain by July 31 how it determined that was legal.

It’s unclear whether the Department of Behavioral Health met that deadline. DBH, Henderson’s office, and the attorney general’s office did not respond to that specific question.

However, DBH spokesperson said in a statement that the department is “committed to compliance with all statutory requirements governing opioid settlement funds.” The department’s general position has been that its budget was approved by the council, and that the funding supports efforts that counter opioid addiction.

The council “passed a legally-certified budget for the next fiscal year that makes the best use of all local resources, including the opioid settlement fund, to award grants to 17 community-based providers who last year served nearly 9,800 residents including 3,500 in medication-assisted treatment for opioid addiction,” Reed told ³Ô¹Ï²»´òìÈ.

The district’s budget is pending a 30-day “congressional review,” which is the last step in its .

Still, some residents like Adesuyi want more accountability for how the opioid money is spent.

“The drug supply is getting a lot more unpredictable, which calls for some nimbleness, and it calls for interventions that are more courageous. Unfortunately, DBH is not meeting the mark when it comes to that,” Adesuyi said, adding, “It’s frustrating, it’s disappointing, and it’s enraging because people are dying unnecessarily in the district to overdose.”

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

Céline Gounder, ³Ô¹Ï²»´òìÈ’ editor-at-large for public health, discussed the health risks of consuming raw milk and an outbreak of infant botulism linked to recalled formula on CBS News’ CBS Mornings and CBS News 24/7’s The Daily Report on July 7. Gounder also discussed allegations about Health and Human Services Secretary Robert F. Kennedy Jr.’s oversight of the Centers for Disease Control and Prevention on CBS Mornings on July 6.

• .
• .
• .

³Ô¹Ï²»´òìÈ Georgia correspondent Briah Lumpkins discussed extreme heat in Georgia on WUGA’s The Georgia Health Report on July 3.

• .

³Ô¹Ï²»´òìÈ senior correspondent Aneri Pattani discussed strategically directing opioid settlement money to support long-term impact during the National League of Cities’ June 25 webinar “Sustaining the Work: Strategically Leveraging Opioid Settlement Funds.”

• .
• Read ³Ô¹Ï²»´òìÈ’ ongoing series “Payback: Tracking the Opioid Settlement Cash.”

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

Her earliest memory is of standing on the passenger seat of her dad’s car as a toddler, wearing a peach-colored blouse, while he drove from their Kentucky home to Florida to pick up drugs. On a stop for a burger, she met Ronald McDonald.

“I grew up with the impression that that’s how you paid your bills,” Madden said. “That’s how your kids got things.”

By 16, she was addicted to pain pills. By 30, methamphetamine. She lost custody of two children and gave up two more for adoption at birth. She served time in the county jail and state prison.

Pregnant again at 40, Madden resolved to stop using. It was then that she learned of The Hub in Whitesburg, a town of 1,575 residents, her hometown.

Over the past two years, the state of Kentucky has sent hundreds of thousands of opioid settlement dollars to the rural eastern region of the state to help minimize the ramifications of drug misuse. The Hub, a program that oversees a network of community centers offering a range of services from recovery peer support to canned food to sterile syringes, is part of that effort.

In April, Kentucky Attorney General Russell Coleman announced $320,000 would be awarded to the Kentucky River District Health Department’s . There are now Hubs in four rural eastern Kentucky counties — Knott, Lee, Letcher, and Owsley, all of which are among the nation’s — addressing substance use disorders, housing, hunger, employment, and other challenges. The program also operates The Hub on Wheels, which provides services throughout the district.

In 2025, The Hub received $545,000 from the same source, facilitating expansion from two to five counties. (The fifth Hub will be in Perry County.) The new $320,000 is a two-year grant to develop a program to help women who’ve been incarcerated reintegrate into society.

Both grants are from Kentucky’s approximately $1 billion share of the $57.8 billion for state and local governments from the to resolve litigation for their role in fueling the opioid overdose crisis.

Madden believes investment in harm reduction services is money well spent. She’s witnessed them work in her own life. She’s found solid footing for recovery at The Hub.

But the Trump administration is cutting federal funding for such efforts, disputing their benefits. A told programs across the country that they could no longer expect federal funding. The order stipulated that discretionary grants issued by the Substance Abuse and Mental Health Services Administration should not be spent on “so-called ‘harm reduction’” efforts, claiming they “only facilitate illegal drug use and its attendant harm.”

Advocates for these services in this rural region, which cast its ballots for President Donald Trump in all three elections, beg to differ.

Meeting Folks Where They Live

Whitesburg — home to a lively cultural scene, including — is a town residents are fiercely proud to call home. The Hub is housed in a storefront on Main Street, neighboring City Hall, Hazard Coffee Company, Cut-Away Barber & Beauty Shop, and the fire station. Like the other Hubs, it provides a range of services targeted to the needs of the community.

The inaugural Hub, launched in 2022 in Beattyville, the Lee County seat, two hours northwest of Whitesburg, offers breakfast and lunch, a food pantry, a clothing closet, a laundry room, and a computer lab. Also: , a medication that can quickly reverse an opioid overdose; drug test strips; hepatitis C treatment; sterile syringes; and wound care.

The program’s motto is “Meeting you where you are but not leaving you there!” It’s founded on the principles of . Harm reduction services are designed to minimize the effects of drug use, keep people safe, and treat them with respect, until they might be ready to enter recovery. The support includes housing, food, healthcare, and overdose prevention tools.

JoAnn Fraley is Kentucky River’s harm reduction program coordinator and its Hub initiative director. “In order for anybody to sustain recovery, they have to have financial stability, they have to have transportation, and they have to have a home,” she said. “We try to fill those gaps.”

While critics suggest that exchanging clean syringes for used ones abets drug use, research published in the Journal of Substance Use and Addiction Treatment indicates that people who participate in syringe services programs are more likely than those who don’t to or stop using drugs altogether, and that they are more likely to enter and remain in treatment. According to the Centers for Disease Control and Prevention, syringe services programs also by about half.

In 2025, Kentucky River’s Hub model was named one of 19 award winners by the National Association of County and City Health Officials.

“What jazzes me about it is it’s a community approach to harm reduction,” said Lauren Carr, who advises the Kentucky Association of Counties on how best to utilize opioid settlement funds. “Whether that’s feeding a hungry stomach, or putting clothes on somebody’s back, or giving them clean [syringes], you’re meeting that person’s needs.”

“It can be that lifeline,” Carr said.

Paying Back for Good

Becky Todd, who leads the Beattyville Hub’s team, is a community health worker and peer support specialist. In April 2024, she was released from jail, having served multiple sentences on drug-related charges. She walked 3 miles from jail to The Hub with nowhere else to go. She’s working toward her bachelor’s degree in social work at Eastern Kentucky University.

“I could not have done it without this place,” Todd said. “It’s my saving grace.”

Amber McDaniel recalls the first time she entered The Hub, after more than a decade of addiction, having lost her home, her kids, and her family’s support. “I didn’t know where to turn, didn’t know what to do,” she said. “I mean, I was about to lose my mind.” She’s now a Hub staff member .

Hannah Stamper was placed in foster care and began using meth at 14. She was drawn to dealing drugs because “I loved for people to need me.” She’s now on staff as a member of , a program that trains AmeriCorps members to work in the recovery field. “People today need me in a good way, and I love that.”

Fraley has witnessed a transition in Lee County. A half-dozen years ago, conversations in public meetings about addiction and homelessness were strained “because nobody wanted to talk about it or acknowledge it.”

The community sees The Hub’s impact, she said, “and now they’re, like, ‘Whoa. We love you.’”

Scott Lockard, the district’s public health director, said a combination of data and anecdotal observations substantiates the initiative’s success, including an increase in the number of people entering treatment and a decline in reported communicable diseases.

“I’ve been in public health for 36 years, and it’s one of the most effective interventions I’ve seen,” Lockard said.

The Kentucky River team worked to educate the community about the potential outcomes of the Hub model, and Fraley said there was little resistance, just concern that the money be well spent. She said the planning has always included people who have lived with addiction.

“Their voice needs to be at every table,” she said.

Lockard agrees. To ensure the community is investing this money wisely, he said, “we’ll talk to those people who are experiencing the problem, find out what they think would help them best, and then look for those evidence-based interventions.”

Jannie Gatlin and Mandy Parker, who both are in recovery, attended a recent crafting class at the Whitesburg Hub. Gatlin, who started taking fentanyl in Colorado after her first son died at 2 months old of a digestive disorder, comes almost every day with her toddler, Hunter.

Parker was prescribed opioids for pain from a kidney disorder. When those pills became less available, she turned to street drugs. “That’s just the nature of the beast,” she said.

She believes The Hub is helping break the stigma of substance use disorder in her community. When people see “real change happening,” she said, there’s a ripple effect. “It makes a difference.”

She appreciates that The Hub is here on Main Street — right, she firmly believes, where it should be.

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

The sweeping 195-page , published May 4, advocates for making access to treatment easier than getting drugs, preventing young people from developing addictions in the first place, increasing support for people in recovery, and reducing overdose deaths.

Those broad goals are widely supported by public health researchers, addiction treatment clinicians, and recovery advocates.

But accomplishing such goals will be difficult in the face of the administration’s , and community grants, that serve people who use drugs, and , the state-federal health insurance program for low-income people that is the largest payer for addiction and mental health care nationwide.

Many components of the National Drug Control Strategy are “things that we would agree with and that we fully support,” said , who leads overdose prevention efforts at the Global Health Advocacy Incubator, a public health advocacy group.

But there are “disconnects in what the strategy says is important and then what they’re actually going to fund,” she said of the Trump administration. “Those inconsistencies feel particularly loud in this strategy.”

The White House’s National Drug Control Strategy, released , is a touchstone document meant to lay out the federal government’s coordinated approach to what in recent decades has been one of the country’s defining problems.

Since 2000, have died of drug overdoses. Although deaths have , the numbers remain elevated compared with earlier decades, and overdose death rates among Black Americans and Native Americans are disproportionately high.

The strategy document published this week is the first of President Donald Trump’s current term. In keeping with the administration’s approach to addiction issues, it places heavy emphasis on law enforcement efforts to reduce the supply of illicit drugs. The document repeatedly refers to the ongoing “war” against “foreign terrorist organizations” — the Trump administration’s term for drug cartels — and touts increased enforcement at U.S. borders.

It also to implement artificial intelligence technologies to screen for illicit drugs brought into the country and wastewater testing to detect illegal drug use nationwide.

The second half of the strategy focuses on reducing the demand for drugs through public health prevention efforts, addiction treatment, and support for people in recovery. It promotes the role of religion in recovery and calls for the widespread use of overdose reversal medications, such as naloxone.

In a news release, the White House’s Office of National Drug Control Policy called the document a “roadmap” that will “continue dismantling the drug supply and defeating the scourge of illicit drugs in our country.”

The Trump administration did not respond to requests for comment about how the strategy aligns with its other actions.

In December, Trump signed a , which continues several grants related to treatment and recovery and the requirement for Medicaid to cover all FDA-approved medications for opioid use disorder. In January, he announced the , including a to address homelessness, opioid addiction, and public safety.

However, few details have been provided about the initiative, and in January, about a month after the SUPPORT Act passed, billions of dollars in addiction-related grants were abruptly within a frantic 24-hour period.

That “whiplash” left “a sense of instability and uncertainty in the field,” said , a national adviser with the Manatt Health consultancy. She led substance use treatment policy at the Substance Abuse and Mental Health Services Administration, or SAMHSA, under the Biden administration and left about six months into Trump’s second term.

That insecurity was exacerbated by the , which proposes cuts to several addiction and mental health programs and the consolidation of key federal agencies working on those matters. Jones’ group and nearly 100 others in the field have asking Congress to reject the proposals, as it did with similar requests last year.

The national drug strategy adds new, potentially contradictory information to this confusing landscape.

Increasing Access to Treatment

One of the most significant public health goals in the strategy, mentioned at least half a dozen times, is to make it easier to get treatment than it is to buy illegal drugs.

National data underscores the necessity: More than who need substance use treatment don’t receive it.

The administration’s actions on health insurance may make it difficult to improve that statistic.

Medicaid is the for adults with opioid use disorder. When implemented, the Medicaid work requirements in Trump’s One Big Beautiful Bill Act are projected to strip that coverage from with substance use disorders.

The last time Medicaid rolls were purged — after — many people who had been receiving medication treatment for opioid addiction stopped it and fewer people started treatment, according to a .

Olsen, who is also an addiction medicine doctor, said she loves the strategy’s emphasis on making treatment readily available to anyone who wants it. But she said that’s “hard to really imagine when now people may have to pay for it themselves because they may be losing their Medicaid insurance coverage.”

the upcoming Medicaid changes could lead 156,000 people to lose access to medications for opioid use disorder and result in more than 1,000 additional fatal overdoses per year.

People with private insurance may be affected, too.

The Trump administration has Biden-era regulations aimed at bolstering mental health parity, the idea that insurers must cover mental illness and addiction treatment comparably to physical treatments. And recently, the administration said it would altogether, raising fears that addiction treatment could become increasingly unaffordable.

The administration did not respond to specific questions about how it reconciles its actions on Medicaid and parity with the goal of increasing treatment.

Prioritizing Prevention

The strategy highlights preventing addictions before they begin as one of the keys to reducing demand for drugs. It calls for “promoting a drug-free America as the social norm” and implementing school and community-based programs that are backed by science.

“Investing in primary prevention, before drug use starts, saves lives and resources,” it says, citing about of such programs.

Yet, the president’s budget proposes cuts to these types of programs, and federal layoffs have decimated the agencies that would implement such work.

The White House’s proposes cutting roughly $220 million from SAMHSA’s and nearly $40 million from the program.

Since the new administration started, SAMHSA has , and the Centers for Disease Control and Prevention is . 

“It’s not clear to me that they’re really going to be able to have the funds or the people to be able to carry that out,” Olsen said of the strategy’s prevention goals.

Another wrinkle appears in the strategy’s discussion of marijuana. The document points to marijuana use as one of the drivers of increasing drug use disorders and reports that “convergent evidence from multiple sources” suggests cannabis use increases the risk of psychosis. It calls for developing new tools to treat marijuana withdrawal and addiction.

However, just two weeks ago, the White House medical marijuana to a lower tier of scheduled substances and is moving to to do the same for marijuana broadly.

“The administration, on the one hand, is moving in a direction of liberalizing access to cannabis,” Jones said, “but at the same time, in the strategy, it talks about the dangers of doing so.”

“There’s a disconnect there that just makes you question: Which one do you believe?” she added.

The administration did not respond to specific questions about its marijuana policies.

Stopping Overdose Deaths

One of the more surprising elements of the National Drug Control Strategy comes in the last paragraph of the final chapter. It focuses on public drug-checking programs, which often involve using test strips to help people who use drugs determine whether there are more-dangerous substances, such as fentanyl or xylazine, in the batch they bought. That helps them determine whether or how to safely use those drugs.

“Rapid test strips and similar technologies that detect fentanyl and other drugs are an important tool that should be legal,” the strategy document says.

However, SAMHSA announced in that it would no longer pay for test strips, as part of the Trump administration’s “clear shift away from harm reduction and practices that facilitate illicit drug use.”

The administration has similarly attacked harm reduction programs in an and its budget . It did not respond to specific questions about how this position interacts with the drug control strategy.

, a Georgetown University professor who served as acting director of the Office of National Drug Control Policy during the Biden administration, wrote about the contradiction in : “It is the height of rhetoric over reality to champion a tool while simultaneously cutting off the funding used to acquire it.”

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

Who Really Collects in the Wage Garnishment Game?

I was a consumer bankruptcy attorney for years during the global financial crisis of 2008 (pre-Affordable Care Act). Around 40% of the bankruptcies were caused by medical debts uncovered by insurance. With the effectiveness of the ACA, the number of bankruptcies in Colorado plummeted.

My comment on “State Lawmakers Seek Restraints on Wage Garnishment for Medical Debt” (Feb. 20)? BC Services acts as if it is garnishing these wages to keep rural hospitals, medical providers, etc. in business. The likely reality is that BC Services (and other collection operations) takes “90-day-overdue” bills — which may or may not have ever been delivered to the patient; usually disregards whether the hospital has offered the patient a reasonable repayment schedule; and then keeps 50% or more of the debt, along with its attorneys’ fees and costs. The medical provider receives very little of the money sent to collections.

— Bill Myers, Denver

On Work Requirements: Working Out Solutions

Eighty hours a month works out to about 20 hours a week, and I think if people can work or study from home, they should be able to meet the requirements (“New Medicaid Work Rules Likely To Hit Middle-Aged Adults Hard,” Feb. 11). More importantly, though, “navigators” will help people get exemptions if they qualify. I wonder why there is so much moaning about the law and nothing about the means to fix the problems it creates. It seems like a lot of hot air. We know it’s a problem. So how about exploring solutions?

— Therese Shellabarger, North Hollywood, California

The Flip Side of a Drug’s Benefits

I read Phillip Reese’s report on anti-anxiety medications, adults who take them, and their concerns about this administration’s policies regarding them (“As More Americans Embrace Anxiety Treatment, MAHA Derides Medications,” Feb. 23). If the anti-anxiety medications provide solace to adults such as Sadia Zapp — a 40-year-old woman who survived cancer — then she should be able to continue them. Unfortunately, the same is not true for many other people, particularly patients such as myself.

When I was 16, I went through an unnecessarily painful and traumatic year. I was sent away from home three times, sent to a wilderness therapy “troubled teen industry” camp that has now been shut down, sent to a new boarding school that I hated, and was away from my family for many months. Of course, I felt depressed and anxious, so my psychiatrist at Kaiser prescribed citalopram. At first, it caused extreme agitation and violent ideation, stuff that is commonly reported to the point it has an . Thankfully, it calmed down. And when I lowered the dose, my life was calm, stable, and productive.

Unfortunately, that did not last long. Over time, the effects wore out, so I tried to go off. I was not given any safety instructions on how to taper slowly and safely, so I went off multiple times. Each time caused extreme withdrawal symptoms, including self-harm, crying spells, and worse depression than ever before. Also, the sexual “side effects” persisted and even worsened upon cessation to this day. It is a , and it is very rarely covered. While the worst symptoms of withdrawal went away, I still live with a worsened sexuality than a young adult my age is supposed to have.

Back to the article, which seems to focus on adults. Its only named profile is Zapp, and when it cites statistics, it begins at age 18. Solely showing statistics of adults is unethical because it obscures the high and rising prescription rates among minors. Minors are also more likely to suffer permanent developmental damage to their sexualities and experience suicidal ideation. This is a major problem that warrants further conversations.

When covering the downsides of SSRIs, the article mentioned only mild side effects, like upset stomach, decreased libido, and mild discontinuation effects, without covering the major concerns of suicidal ideation, akathisia, PSSD, and severe withdrawal. I believe that framing antidepressants as an unequivocal good is equivalent to framing them as an unequivocal evil; both misguide patients through harm and deception.

Lastly, I want to finish on this by the brilliant psychiatrist Awais Aftab.

— Eli Malakoff, San Francisco

A Rigged System?

Insurers pay these exorbitant amounts because they set them in the first place (Bill of the Month: “Even Patients Are Shocked by the Prices Their Insurers Will Pay — And It Costs All of Us,” March 3). They have been doing this for years. I learned this over 15 years ago, when I dislocated and broke my elbow. I had no insurance and, as a “self-pay” patient, paid the surgeon, hospital, and radiology center myself. They set the prices high enough that people will buy insurance out of fear, ensuring they make a profit.

The first thing I learned was that there is not a set price for all; for the insured, it is a fixed system controlled by contracts and codes. As a self-pay patient, the cost may vary.

It was late in the evening and I tripped over a snow shovel, slammed my arm up against a gate post, and it was hanging like a puppet without a string! I called an ambulance and, at the hospital, they strapped me up and told me that I must see the orthopedic surgeon the next day. He sent me to a radiology facility for an X-ray; I paid for it and took it to the surgeon. When I received a bill from the radiology center, I called to say that I had paid. They said it was for the radiologist (who, as far as I knew, never analyzed it). The contract with the insurance company required that every patient had to be billed, whether or not a radiologist reviewed scans. If not, they would lose their contract.

My elbow was dislocated, with a fracture, and I needed surgery. The surgeon’s office called the hospital for pricing, and he told me it would be about $2,000 for outpatient surgery. I called the hospital to confirm the appointment for outpatient surgery, and they wanted $8,000! When I objected, and told them what the surgeon had quoted, they checked. “Oh, you are a self-pay!” Cost would be $2,000. I gave them my card number and prepaid it before they could change their minds.

I had a friend in New Jersey who had the very same injury and surgery. She had insurance through her employer, and she paid more in copays than I paid when paying directly.

Insurance companies are SHARKS!

— Stephanie Hunt-Crowley, Chamberet, Nouvelle Aquitaine, France (formerly Frederick, Maryland)

US vs. Canada

Re: the article about nurses moving to Canada (“‘You Aren’t Trapped’: Hundreds of US Nurses Choose Canada Over Trump’s America,” Feb. 26). You neglect the “rest of the story” — or maybe you don’t know it? I had my medical office in Los Angeles for about 30 years and had dozens of Canadians come to L.A., where some had to self-pay for care, but chose to because of the superior level of medicine available. One man, a son of a gynecologist in Canada, had a draining abscess from a years-old appendectomy. The reason was, after investigation, that the Canadian practice had used silk suture (organic material), which can harbor microbes and carry a greater risk of infection. The trend has been to discontinue silk in favor of nylon. The Canadians were obliged to “use up” the silk suture they had before switching to nylon. The surgeons at my hospital were astounded.

— Kathryn Sobieski, Jackson, Wyoming

On the NET Recovery Device’s Track Record — And Detractors

I read your piece about the NET Recovery device with interest (Payback: Tracking Opioid Cash: “Maker of Device To Treat Addiction Withdrawal Seeks Counties’ Opioid Settlement Cash,” March 18), and I am grateful to you for pointing to one of our many success stories — the story of Michelle Warfield, whom the NET device helped get off opioids.

I also wanted to note a couple of instances where I see the facts differently than they were portrayed in your piece. Your piece seemed to imply that the NET device is new, and I wanted to note that the device has been around for decades (it helped Eric Clapton and members of The Who and the Rolling Stones get sober back in their heyday), and is based on a proven technology that stimulates both the brain and the vagus nerve to help patients with their cravings and withdrawal. There are countless studies that prove the power of neurostimulation, including that showed significant reductions in opioid and stimulant use without medication for a polysubstance population receiving at least 24 hours of stimulation.

I also noted you quoted detractors of our device, and I’d simply urge anyone looking at the issue of opioid addiction abatement to consider who those detractors are; organizations that now find themselves competing for grant dollars from counties increasingly choosing to fund innovation. It is not surprising that those with the most to lose financially would prefer the status quo. But the counties and jails leading this charge are doing so because they have seen what works, and their constituents, real patients, are the proof.

The success stories of our patients speak for themselves, and our only motivation at NET Recovery is to help as many people as possible get truly clean and sober by helping to break that initial grip the opioids have on them. When the NET device works, and it works an astounding 98% of the time (producing a clinically meaningful reduction in opioid withdrawal symptom severity in one hour), our patients are experiencing the return of choice and true freedom.

Thank you for your interest in our work and for the coverage you provide.

— Joe Winston, NET Recovery CEO, Costa Mesa, California

Education Is the First Step in Lowering Health Care Prices

After reading this article about making hospital prices more transparent, I realized the information alone could help drive medical prices down (“Trump Required Hospitals To Post Their Prices for Patients. Mostly It’s the Industry Using the Data,” Feb. 17). Your publication shows good use of evidence-based research — it’s timeless and informative.

As a student at Thomas Jefferson University on the path to serving in the health care arena, I understand the struggles and complexities of medical decision-making. In the medical setting, the topic of price is always overshadowed by patient care and clear communication on the part of both professionals and patients, and it does not reflect how patients would navigate comparison-shopping for care. Almost every patient relies on the help of a physician or gets help from an insurance network and not from online price matching.

I believe that many people should engage with this article even if they aren’t entering the health profession; it would benefit everyone. Although price transparency may help insurers and care providers more than patients, if their goal is to lower prices, they must look beyond the simple posting or sharing of prices. I appreciate the effort to try to bring awareness to this major issue and encourage thoughtful policy discussion about lowering medical prices.

— Jan Rodriguez, Philadelphia

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

They worked for a bit. But by 2011, Warfield struggled to walk.

And “by that time, I was addicted,” said Warfield, now living in Shelbyville, Kentucky.

After she lost her health insurance, Warfield started buying pills on the street. She tried to quit several times, but the debilitating withdrawal — so bad she couldn’t get out of bed, she said — kept driving her back to drug use.

Until last year.

Through her church, Warfield learned about the NET device. It’s a cellphone-sized pack connected to gel electrodes placed near the ear that deliver low-level electrical pulses to the brain.

“Once I got set up on the device, within 30 minutes, I didn’t have any cravings” for opioids, Warfield said.

After three days on the device in August, she stopped using drugs altogether, she said.

Warfield’s treatment was paid for with her county’s opioid settlement dollars — money from pharmaceutical companies accused of fueling the overdose crisis.

State and local governments nationwide are receiving over nearly two decades and are meant to spend it treating and preventing addiction.

Warfield wants them to allot a good chunk to the NET device, which costs counties about $5,500 a person. The pitch is gaining traction. , which makes the device, said it has signed about $1.2 million in contracts with more than a dozen counties and cities in Kentucky. 

But some researchers and recovery advocates say the company’s rapid consumption of opioid dollars raises red flags. They see the NET device as the latest in a series of products that have been overhyped as the solution to the addiction crisis, preying on people’s desperation and capitalizing on the windfall of opioid settlements. Many of these products — from to body scanners for jails — have little evidence to back their lofty promises. That has not stopped sales representatives from repeatedly pitching elected officials or circulating ready-made templates to request settlement money for the companies’ products.

In fact, a device similar to NET called the Bridge gained popularity several years ago, receiving more than $215,000 in opioid settlement cash nationwide. But about the study backing its effectiveness, and the device is currently off the market.

NET Recovery’s activity “fits the national trends of these industry money grabs,” said , a national expert on opioid settlements based in Tennessee. The device “could be helpful for some,” she said. “But it’s being sold as a silver bullet.”

This year, 237 organizations working to end overdose — including Christensen’s consulting company — to guide officials in charge of opioid settlement money. In it, they called the NET device an example of problematic spending on unproven treatment.

Treating Withdrawal or Addiction

The FDA has for a specific use: reducing drug withdrawal symptoms. It has not approved the device to treat addiction.

That’s a crucial distinction, said , executive director of the Institute for Research, Education and Training in Addictions. He co-authored evaluating the evidence on neuromodulation devices like NET.

“The term ‘treatment’ becomes confusing,” Hulsey said. “These devices were cleared to treat opioid withdrawal symptoms, not to treat an opioid use disorder.”

NET Recovery CEO said the company adheres to FDA rules and advertises the device only for withdrawal management. But “we are finding that physicians are prescribing this to folks for long-term behavior based on the results of our study.”

He’s referring to that he co-authored and the company funded, in which researchers followed two groups of addiction patients in Kentucky for 12 weeks. The first group received the NET device for up to seven days, while the second group received a sham treatment.

The study found no significant difference between the groups’ outcomes. Participants who got the NET device were similarly likely to use illicit drugs after treatment as those who got the fake.

Hulsey, who was not affiliated with the study, said the takeaway is clear: “They didn’t find that was effective.”

A subgroup of participants who chose to use the device for more than 24 hours consecutively, however, went on to use illicit drugs less often than other participants.

As the researchers acknowledged in their paper, that subgroup might simply have been more motivated to engage with any form of treatment. The results don’t necessarily show that the device is making a difference, Hulsey said.

Rapid Growth

Winston had a different take. He said the success of the subgroup is “intriguing and outstanding.”

So outstanding, in fact, that the company this month is opening a brick-and-mortar location in Miami, where the device will be available to anyone who can pay $8,000 out-of-pocket. (The cost is higher for individuals than for county governments.) It has also applied for opioid settlement dollars from the state of Kentucky to conduct a larger research study and aims to bring the NET device into metro areas such as Louisville and Lexington.

Last year, NET Recovery hired a magistrate in Franklin County, Kentucky, to head up its operations in the state. (Magistrates function as county commissioners.) , who is also a mental health clinician, travels to different counties, extolling the benefits of the device and encouraging officials to contract with the company.

Her county to NET Recovery prior to her joining the company. Moving forward, Dycus said, she would recuse herself from any contract votes in her county.

Christensen, the national expert on opioid settlements, called Dycus’ new role “extremely strategic” for the company and “an obvious conflict of interest” for a public official.

Giving People Choice

More options for people to enter recovery is generally good, said Jennifer Twyman, who has a history of opioid addiction and now works with , a nonprofit that advocates to end homelessness and the war on drugs.

But settlement funds are finite, she said, and when counties invest in the NET device, that leaves less money to support options like mental health treatment, housing, and transportation programs — critical for many people who use drugs.

“People slip through these big, huge gaps we have and they die,” Twyman said, pointing to photos of dead friends that line her office wall.

She added that people should have the option of taking medications such as methadone and buprenorphine — for treating opioid addiction. only 1 in 4 people with opioid addiction get them.

Many people can’t afford them, find a doctor willing to prescribe them, or get transportation to appointments, Twyman said. against those who use medications, with detractors saying they’re not truly abstinent or clean.

Companies like NET Recovery sometimes lean into that stigma, Twyman said.

For instance, Scott County, Kentucky, jailer — whom the company considers a key champion for its device — to other county officials that medication treatment is just “swapping one drug for another.” It’s a common refrain from critics that .

Winston told ³Ô¹Ï²»´òìÈ his company is supportive of all types of recovery but that the NET device can help the “underserved population” of people who don’t want medication.

Longtime addiction researcher has led studies for NET Recovery and consults for , one of the leading producers of medications for opioid use disorder. He said he sees value in both approaches. It just depends on whom you’re trying to treat.

For people injecting drugs or accustomed to high doses of fentanyl, who are more likely to return to using drugs after residential treatment, “I would hesitate to recommend the device,” he said. Abstinence-based approaches can . But for people who are “highly motivated to stay abstinent,” the NET device may be a good fit.

“Giving people choices is the right thing to do,” he said.

Community as Part of Recovery

Warfield, who has not used opioids since August, credits not just the NET device with her recovery but her community too.

“It’s not a miracle cure,” she said of the device. “You still have to manage your triggers, but it’s easier.”

She regularly attends individual and group therapy to address childhood trauma. She’s found close friends within her church and has reconnected with her daughter. She installed a car seat in her vehicle so she can drive her grandson to preschool.

Warfield explained her hope for opioid settlement money to reach others in her community simply: “I want people to get as much help as they can.”

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .

NEW ORLEANS — Elyse Stevens had a reputation for taking on complex medical cases. People who’d been battling addiction for decades. Chronic-pain patients on high doses of opioids. Sex workers and people living on the street.

“Many of my patients are messy, the ones that don’t know if they want to stop using drugs or not,” said Stevens, a primary care and addiction medicine doctor.

While other doctors avoided these patients, Stevens — who was familiar with the city from her time in medical school at Tulane University — sought them out. She regularly attended 6 a.m. breakfasts for homeless people, volunteered at a homeless shelter clinic on Saturdays, and, on Monday evenings, visited an abandoned Family Dollar store where advocates distributed supplies to people who use drugs.

One such evening about four years ago, Charmyra Harrell arrived there limping, her right leg swollen and covered in sores. Emergency room doctors had repeatedly dismissed her, so she eased the pain with street drugs, Harrell said.

Stevens cleaned her sores on Mondays for months until finally persuading Harrell to visit the clinic at University Medical Center New Orleans. There, Stevens discovered Harrell had diabetes and cancer.

She agreed to prescribe Harrell pain medication — an option many doctors would automatically dismiss for fear that a patient with a history of addiction would misuse it.

But Stevens was confident Harrell could hold up her end of the deal.

“She told me, ‘You cannot do drugs and do your pain meds,’” Harrell recounted on a Monday evening in October. So, “I’m no longer on cocaine.”

Stevens’ approach to patient care has won her awards and nominations in , , and . Instead of seeing patients in binaries — addicted or sober, with a positive or negative drug test — she measures progress on a spectrum. Are they showering daily, cooking with their families, using less fentanyl than the day before?

But not everyone agrees with this flexible approach that prioritizes working with patients on their goals, even if abstinence isn’t one of them. And it came to a head in the summer of 2024.

“The same things I was high-fived for thousands of times — suddenly that was bad,” Stevens said.

Flexible Care or Slippery Slope?

More than who need substance use treatment don’t receive it, national data shows. Barriers abound: high costs, lack of transportation, clinic hours that are incompatible with jobs, fear of being mistreated.

Some doctors had been trying to ease the process for years. Covid-19 accelerated that trend. Telehealth appointments, fewer urine drug tests, and medication refills that last longer became the norm.

The result?

“Patients did OK and we actually reached more people,” said , immediate past president of the American Society of Addiction Medicine. The organization supports continuing flexible practices, such as helping patients avoid withdrawal symptoms by of addiction medication and focusing on recovery goals .

But some doctors prefer traditional approaches that range from zero tolerance for patients using illegal drugs to setting stiff consequences for those who don’t meet their doctors’ expectations. For example, a patient who tests positive for street drugs while getting outpatient care would be discharged and told to go to residential rehab. Proponents of this method fear loosening restrictions could be a slippery slope that ultimately harms patients. They say continuing to prescribe painkillers, for example, to people using illicit substances long-term could normalize drug use and hamper the goal of getting people off illegal drugs.

Progress should be more than keeping patients in care, said , a Stanford psychologist, who has treated and researched addiction for decades and .

“If you give addicted people lots of drugs, they like it, and they may come back,” he said. “But that doesn’t mean that that is promoting their health over time.”

Flexible practices also tend to align with harm reduction, a divisive approach that proponents say keeps people who use drugs safe and that critics — — say enables illegal drug use.

The debate is not just philosophical. For Stevens and her patients, it came to bear on the streets of New Orleans.

‘Unconventional’ Prescribing

In the summer of 2024, supervisors started questioning Stevens’ approach.

In emails reviewed by ³Ô¹Ï²»´òìÈ, they expressed concerns about her prescribing too many pain pills, a mix of opioids and other controlled substances to the same patients, and high doses of buprenorphine, a medication considered to treat opioid addiction.

Supervisors worried Stevens wasn’t doing enough urine drug tests and kept treating patients who used illicit drugs instead of referring them to higher levels of care.

“Her prescribing pattern appears unconventional compared to the local standard of care,” the hospital’s chief medical officer at the time wrote to Stevens’ supervisor, . “Note that this is the only standard of care which would likely be considered should a legal concern arise.”

Springgate forwarded that email to Stevens and encouraged her to refer more patients to methadone clinics, intensive outpatient care, and inpatient rehab.

Stevens understood the general practice but couldn’t reconcile it with the reality her patients faced. How would someone living in a tent, fearful of losing their possessions, trek to a methadone clinic daily?

Stevens sent her supervisors of and backing her flexible approach. She explained that if she stopped prescribing the medications of concern, patients might leave the health system, but they wouldn’t disappear.

“They just wouldn’t be getting care and perhaps they’d be dead,” she said in an interview with ³Ô¹Ï²»´òìÈ.

Both University Medical Center and LSU Health New Orleans, which employs physicians at the hospital, declined repeated requests for interviews. They did not respond to detailed questions about addiction treatment or Stevens’ practices.

Instead, they provided a joint statement from Richard DiCarlo, dean of the LSU Health New Orleans School of Medicine, and Jeffrey Elder, chief medical officer of University Medical Center New Orleans.

“We are not at liberty to comment publicly on internal personnel issues,” they wrote.

“We recognize that addiction is a serious public health problem, and that addiction treatment is a challenge for the healthcare industry,” they said. “We remain dedicated to expanding access to treatment, while upholding the highest standard of care and safety for all patients.”

Not Black-and-White

³Ô¹Ï²»´òìÈ shared the complaints against Stevens and the responses she’d written for supervisors with two addiction medicine doctors outside of Louisiana, who had no affiliation with Stevens. Both found her practices to be within the bounds of normal addiction care, especially for complex patients.

, an addiction medicine doctor and the , said doctors running pill mills typically have sparse patient notes that list a chief complaint of pain. But Stevens’ notes detailed patients’ life circumstances and the intricate decisions she was making with them.

“To me, that’s the big difference,” Loyd said.

Some people think the “only good answer is no opioids,” such as oxycodone or hydrocodone, for any patients, said , an addiction medicine doctor and associate professor at Michigan State University. But patients may need them — sometimes for things like cancer pain — or require months to lower their doses safely, she said. “It’s not as black-and-white as people outside our field want it to be.”

Humphreys, the Stanford psychologist, had a different take. He did not review Stevens’ case but said, as a general practice, there are risks to prescribing painkillers long-term, especially for patients using today’s lethal street drugs too.

Overprescribing fueled the opioid crisis, he said. “It’s not going to go away if we do that again.”

‘The Thing That Kills People’

After months of tension, Stevens’ supervisors told her on March 10 to stop coming to work. The hospital was conducting a review of her practices, they said in an email viewed by ³Ô¹Ï²»´òìÈ.

Overnight, hundreds of her patients were moved to other providers.

Luka Bair had been seeing Stevens for three years and was stable on daily buprenorphine.

After Stevens’ departure, Bair was left without medication for three days. The withdrawal symptoms were severe — headache, nausea, muscle cramps.

“I was just in physical hell,” said Bair, who works for the National Harm Reduction Coalition and uses they/them pronouns.

Although Bair eventually got a refill, Springgate, Stevens’ supervisor, didn’t want to continue the regimen long-term. Instead, Springgate referred Bair to more intensive and residential programs, citing Bair’s intermittent use of other drugs, including benzodiazepines and cocaine, as markers of high risk. Bair “requires a higher level of care than our clinic reasonably can offer,” Springgate wrote in patient portal notes reviewed by ³Ô¹Ï²»´òìÈ.

But Bair said daily attendance at those programs was incompatible with their full-time job. They left the clinic, with 30 days to find a new doctor or run out of medication again.

“This is the thing that kills people,” said Bair, who eventually found another doctor willing to prescribe.

Springgate did not respond to repeated calls and emails requesting comment.

University Medical Center and LSU Health New Orleans did not answer questions about discharging Stevens’ patients.

‘Reckless Behavior’

About a month after Stevens was told to stay home, Haley Beavers Khoury, a medical student who worked with her, had collected nearly 100 letters from other students, doctors, patients, and homelessness service providers calling for Stevens’ return.

One student wrote, “Make no mistake — some of her patients will die without her.” A nun from the Daughters of Charity, which ran , called Stevens a “lifeline” for vulnerable patients.

Beavers Khoury said she sent the letters to about 10 people in hospital and medical school leadership. Most did not respond.

In May, the hospital’s review committee determined Stevens’ practices fell “outside of the acceptable community standards” and constituted “reckless behavior,” according to a letter sent to Stevens.

The hospital did not answer ³Ô¹Ï²»´òìÈ’ questions about how it reached this conclusion or if it identified any patient harm.

Meanwhile, Stevens had secured a job at another New Orleans hospital. But because her resignation came amid the ongoing investigation, University Medical Center said it was required to inform the state’s medical licensing board.

The medical board began its own investigation — a development that eventually cost Stevens the other job offer.

In presenting her side to the medical board, Stevens repeated many arguments she’d made before. Yes, she was prescribing powerful medications. No, she wasn’t making clinical decisions based on urine drug tests. But national addiction organizations supported such practices and promoted tailoring care to patients’ circumstances, she said. Her response included a 10-page bibliography with 98 citations.

Liability

The board’s investigation into Stevens is ongoing. shows no action taken against her license as of late December.

The board declined to comment on both Stevens’ case and its definition of appropriate addiction treatment.

In October, Stevens moved to the Virgin Islands to work in internal medicine at a local hospital. She said she’s grateful for the welcoming locals and the financial stability to support herself and her parents.

But it hurts to think of her former patients in New Orleans.

Before leaving, Stevens packed away handwritten letters from several of them — one was 15 pages long, written in alternating green and purple marker — in which they shared childhood traumas and small successes they had while in treatment with her.

Stevens doesn’t know what happened to those patients after she left.

She believes the scrutiny of her practices centers on liability more than patient safety.

But, she said, “liability is in abandoning people too.”

This article first appeared on ³Ô¹Ï²»´òìÈ and is republished here under a .