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How Kansas and Colorado Use Opioid Settlement Funds to Promote Evidence-Based Practices in Prevention, Treatment, and Recovery
With decades of experience in implementing interventions across the substance use disorder continuum of care,…
The post How Kansas and Colorado Use Opioid…
With decades of experience in implementing interventions across the substance use disorder continuum of care, there has been a substantial body of evidence developed for “what works” when it comes to policies and programs to address the opioid crisis. As states continue to make decisions on where to allocate funding awarded through ongoing opioid-related lawsuits, maximizing the impact of this funding will require strategies to ensure that resources are directed toward programs and practices demonstrated to be effective in abating the harms of the opioid crisis.
While states have varying administrative formations for allocating settlement funding, state leaders overseeing these funds have several options for encouraging the use of evidence-based and evidence-informed strategies. The strategies that a state agency or advisory council may adopt vary depending on the level of spending authority or oversight granted through existing settlement legal legislation or agreements. For example, a state may be able to set strict requirements that programs be evidence-based within a request for applications process at the state level but may lack authority to institute requirements for spending at the local level — necessitating a more collaborative approach focused on sharing best practices or offering technical assistance. Across different settlement structures, common strategies that states have adopted to encourage adoption of evidence-based practices include:
- Ensuring subject matter expertise and lived experience are included on advisory councils and decision-making bodies
- Prioritizing evidence-based practices within grant-making processes
- Implementing approval, oversight, and/or reporting processes for awarded funds
- Sharing best practices, resources, and technical assistance
Each of the key strategies to effectively using settlement dollars are highlighted below, alongside corresponding examples of each state’s approach.
Opioid Settlement Advisory Councils — Who Needs To Be at the Table?
In 38 states and Washington, DC, funds awarded through abatement funds are overseen by advisory groups that either advise state-level agencies on priorities or have direct decision-making authority. Constituencies represented on these councils often include state agency leadership, state and local elected officials, law enforcement, clinicians or treatment providers, community-based organizations, and people with lived experience. As states continue to establish councils, interagency coordination structures, and grant-making processes, requiring that subject matter experts and communities affected by the substance use crisis be included in these processes can help ensure that these perspectives shape decision-making.
In Kansas, the Kansas Fights Addiction Act Grant Review Board holds 75 percent of all settlement dollars, with the authority to award grants from the Kansas Fights Addiction Fund. HB2079 requires each board member to have expertise in prevention, reduction, treatment, or mitigation of the effects of substance use and addiction, which can include people with lived experience, law enforcement, and policymakers. The remaining 25 percent of settlement funds are administered by localities.
In Colorado, the Colorado Opioid Abatement Council controls 60 percent regional and 10 percent infrastructure funding shares. The council is comprised of licensed professionals with significant experience in substance use treatment, professionals with experience with substance use policy, and people with lived experience with substance use and services. The Opioid Crisis Recovery Funds Advisory Committee advises the Colorado attorney general on the 10 percent state share, and it is comprised of treatment providers, provider associations, people with lived experience with opioids, and representative from a substance use research organization. The remaining 20 percent of funding is directly allocated to the local government.
Funding Evidence-Based Strategies — What Tools Are Available through the Grant-Making Process?
For states that opt to award settlement funds through a grant award process, many factors come into consideration during proposal reviews. One of the highest priorities when evaluating proposed initiatives is whether the initiative is based on data and science-driven evidence. States have a high degree of control over requirements included within grant application processes and how proposals are scored and awarded, and they can use these processes to reward programs and practices with a high degree of evidence.
Kansas has both required and recommended considerations for the board when awarding grants. Required considerations include “science and data-driven substance use prevention reduction, treatment, or mitigation strategies;” consultation with Kansas prescription drug and opioid advisory committee, Kansas Department of Health and Environment, insurance department, other public and private entities; and attention to sustainability, including qualitative and quantitative measures to encourage grantees’ progress toward their proposals’ goals. Recommended considerations include a preference for applicants not otherwise receiving money — which helps fund innovative approaches — and a preference for applicants that expand availability of certified drug treatment programs, which provides more opportunities for those seeking treatment as a form of diversion from criminal justice settings.
Colorado’s review process includes an evaluation rubric that prioritizes applications based on the evidence-base they are proposing. Additionally, the state intentionally highlights aligning of funds and building on past successes by requiring a review of past state assessments to identify both strategies that worked well and those that failed to deliver anticipated outcomes. Grantees must agree to share information about received American Rescue Plan Act funds to minimize duplication of efforts.
Finally, applications must present a process for implementing programs that includes needs assessment, diverse input, strategic prioritization (for example, identifying that medications for opioid use disorder in correctional settings would have the strongest impact on preventing deaths), transparent reporting, and tracking outcomes.
Award Oversight — How Do States Ensure Funded Initiatives Are Fulfilling their Proposed Mission?
After settlement funding is awarded, states monitor their awardees’ spending plans. While oversight approaches may differ, having protocols for award oversight ensures that dollars are used efficiently and effectively. When states require funding reporting or monitoring, they hold their awardees accountable to fulfill proposed initiatives and provide opportunities to demonstrate the impact and effectiveness of their programs. As a part of this process, states may also have policies or procedures for responding when funds are misspent and supporting grantees with corrective action.
In Kansas, awardees of the Kansas Fights Addiction Fund are encouraged to partner with the Sunflower Foundation, a nonprofit that supports capacity building, leadership development, and learning opportunities for nonprofits. The Sunflower Foundation offers applicants grant-making expertise and grant program management resources. After the initial awards, grantees must fulfill reporting requirements to receive final payments. For funds administered by municipalities, the Kansas Attorney General’s office works closely with subdivisions and partners to provide guidance on potential uses for settlement funds. Local entities’ spending is tracked through annual reports on all receipts and expenditures, and the Attorney General’s office is working to develop more detailed guidance to make it easier for subdivisions to implement science- and data-driven approaches in their individual communities.
Colorado has administrative oversight of grant awardees and requires remedial action if funding is misspent. The state will soon offer a non-compliance use form, which will allow individuals to report misspending. Colorado also has formal oversight of local spending and must approve local entities’ two-year plan for spending before funds can be released. All state, regional, local governments, and recipients of state infrastructure funding are required to submit expenditure data showing how funds have been used for approved purposes, which is published on a public dashboard.
Sharing Best Practices and Technical Assistance — What Resources Are Available for Awardees?
Even states with limited oversight or authority over local settlement funding decisions can still take a leadership role in prioritizing the use of evidence-based practices in settlement-funded projects across the state by sharing best practices and other support for local officials and grantees. Offering centralized, easily accessible resources helps to connect grant applicants and awardees with examples and best practices for spending settlement dollars. Multiple access points for these resources and having a wide variety of information available offers more of an opportunity to reach people looking for guidance. Technical assistance could include facilitating collaborations, offering example applications and policies, or outlining local resources, among many other examples.
Kansas offers educational resources available through both the Sunflower Foundation and the attorney general’s office. The state has long-term goals for building out technical assistance, such as the development of “off-the-shelf” tested strategies that smaller cities and counties can deploy. The state also aims to help cities and counties coordinate to pool their resources and use a consensus approach. Finally, state officials work to develop personal relationships with local decision-makers with the goal of increased coordination and potentially preventing problematic expenditures.
Colorado offers an array of professional development and other educational opportunities with the goal of equipping awardees with evidence-based practices. These approaches include regional in-state learning forums, an annual opioid conference with both in-person and virtual attendance options, an up-to-date website with resources and national reports, and a newsletter. Additionally, state officials provide a shared team email to maximize response and engagement.
Key Points
Maximizing the impact of opioid settlement funding will require investing in programs proven to work, and states have many opportunities to encourage the use of evidence-based practices. Formal administrative structures and less formal technical assistance can provide settlement grantees at all levels tools to best save lives, develop effective prevention and treatment initiatives, and further expand evidence-based recovery work.
There are a variety of resources available to guide states through implementing evidence-based practices:
- The Centers for Disease Control and Prevention’s Understanding Evidence guide provides suggestions for navigating emerging evidence
- The Substance Abuse and Mental Health Services Administration’s Evidence-Based Practices Resource Center provides policymakers and others in the addiction field with tools for incorporating evidence-based practices into their communities
- The Results First Clearinghouse Database provides a list of example initiatives with rates of their effectiveness
- Johns Hopkins Bloomberg School of Public Health offers a resource hub of implementation tools for evidence-based practices.
Acknowledgements
The National Academy for State Health Policy provides this information with the ongoing support of the Foundation for Opioid Response Efforts (FORE) and thanks FORE Project Officer Ken Shatzkes and FORE President Karen Scott for their continued guidance and direction. The authors would also like to thank Chris Teters with the Kansas Attorney General’s office and Jamie Feld and Heidi Williams with the Colorado Office of the Attorney General for sharing their expertise and state experiences.
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