More than 90% of Wyoming’s local opioid settlement money goes unspent while overdose deaths climb

The hold-up is, in part, because local communities are trying to figure out how they can legally spend money and what would benefit their residents most.

Wyoming communities have been slow to spend millions in opioid settlement funds while overdose deaths continue to climb in the state.  

Local governments here received more than $7.5 million in opioid settlement funds last year, according to reports sent to the Wyoming Attorney General’s Office. But leaders only spent or allocated about 5.6% of that.

In fact, 14 counties and seven of the 10 participating towns didn’t spend any of the settlement money last year. That’s following WyoFile reporting in late 2022 that few plans were in place for the funding. 

Local government leaders say they’re proceeding slowly to ensure the funds are spent appropriately and effectively — a process possibly complicated by limited access to opioid overdose data, as WyoFile previously reported.  

Local Wyoming communities must spend the funds to “actively abate and alleviate the impacts of the opioid crisis and co-occurring substance abuse in Wyoming,” according to the state’s agreement. 

Of those who have spent some of the money, the types of expenditures have been wide-ranging, from “fentanyl resistant” gloves, to treatment programs, to a drug detection dog.

These settlement dollars resulted from a lawsuit alleging major opioid manufacturers and distributors like Johnson & Johnson, Allergan and Walmart were responsible for aiding the opioid epidemic. And the funds are expected to keep coming for at least 14 more years (estimated at about $33.7 million in Wyoming by 2038, according to KFF Health News). Future settlements could increase the funding even more.

Wyoming’s agreement determined that 65% of the money coming to the state would go to local governments. Another 35% would go to the Wyoming Department of Health. (There’s a separate agreement for tribes, including the Northern Arapaho and Eastern Shoshone.)

Opioid settlement spending reports for every county and city that received funds are listed at the bottom of the story. 

Why not spend?

Laramie County reported receiving nearly $1.3 million in opioid settlement funds in 2023: the largest allocation of any local government in Wyoming.

It hasn’t spent any yet, but not for lack of ideas, Vice County Commissioner Gunnar Malm said.

“We’ve been kind of taking an approach of making sure that we spend it correctly as we don’t want to run afoul of any part of the settlement,” he said. 

The OneWyo Opioid Settlement Memorandum of Agreement lists more than 70 ways the money can be spent, including expanding the availability of treatment for opioid use disorder, training and scholarships for health care providers combating the crisis, and public education campaigns. 

Malm initially wanted to spend funds on drug courts, which can help people convicted of drug crimes avoid jail time through supervision and mandatory treatment. But the county attorney was concerned it didn’t align close enough with the agreement, he said. 

“After analysis from our grants manager and our county attorney, it seems as if it has to be fairly specific to actual opioids only,” he said.

The county also could’ve funded media campaigns or prevention supplies like naloxone — an opioid overdose reversal drug — but they already receive those kinds of funds and supplies from the state, Malm said.

So, the county is looking into spending money on medically assisted treatment in jails to help people with substance use disorders there, among other things. But Malm welcomes other ideas from the public, too, he said.

Meanwhile, in Sweetwater County, Commissioner Keaton West has been concerned about what to spend the money on, too, saying more specific guidance from the attorney general’s office is warranted. Sweetwater also hasn’t spent any of the settlement money yet. 

“I’ll admit we need to do a better job and start making a plan for [the settlement funds], but some of that is just a lack of communication between the attorney general’s office and our grants writer,” he said.

His county has hired an attorney to make sure they spend the money correctly, West said, and the dollars could go towards an existing mental health center, drug treatment programs or jail-based treatment. But he’s also curious about creating something new and helping the populations most in need.

“We don’t want [the settlement funds] to sit there forever, right?” West said. “I mean, we’re getting it for a reason. And so we want to utilize that to the best of its ability … but we’re still planning.”

According to Wyoming’s agreement, if funds are spent inappropriately, the money will need to be paid back, withheld from future payments or possibly taken back via a lawsuit from the AG’s office. 

In a 2021 press release about the opioid settlement, Attorney General Bridget Hill said, “In a state of our size, we must work together at all levels of state and local government to maximize this and any future settlement funds to abate and alleviate the impacts of the opioid crisis.”

In Laramie, which has yet to spend its settlement, city attorney Bob Southard said he’s less worried about spending the money within the agreement’s constraints than spending it on what the community needs most. 

“Is it housing? Is it basic medical care?” he said. “I’m full of questions. But the answers are taking time.”

Southard plans on creating a working group with public and private sectors to discuss spending options, he said. 

There is no deadline to spend these funds, and more will be coming. But at the same time, more Wyomingites are dying from overdoses. 

Wyoming’s Vital Statistics Services reports that 120 residents died from overdoses last year — double the number from 2017. Opioids were connected to 81 deaths, while fentanyl specifically was linked to 52.

“While in the past we have seen decreases in overdose deaths between some years, this is unfortunately the sixth year in a row with those numbers going up,” Wyoming Department of Health Director Stefan Johansson said in a March press release. 

Southard said he wants to get this funding into the right hands, but balancing timely spending and thoughtful purchases is challenging.

“I can’t give you that answer, where that balance is,” he said. “I can understand the criticism, ‘You’re moving too slowly.’ And if we move too quickly and waste the money, I could understand that criticism, too.”

Follow the money

Local governments did spend about $422,000 of the settlement last year on a variety of programs and items.

For example, two communities — Sheridan County and Rock Springs — bought “drug terminators” to destroy illicit substances when they’re found. 

Sheridan County also used some of its money to buy the sheriff a drug detection dog and kennel (totaling about $11,000). As of early this year, the county still had more than $300,000 to spend.

Meanwhile, Washakie and Big Horn counties teamed up to help fund the Northern Wyoming Treatment Court.

Washakie and Converse counties also sent funds directly to treatment centers, allocating money to Cloud Peak Counseling Center and High Country Behavioral Health, respectively. (Converse is the only county that allocated all of its funding from last year, exclusively sending it to the behavioral health center.)

“We knew we weren’t capable of keeping it internal and managing it and doing the right job,” County Commission Chairman Jim Willox said. “I mean, that’s just not what commissioners are geared up for … And so really, High Country really became the obvious choice in our community.”

The funding at that facility is going towards a person who can prescribe medications in Douglas, High Country Behavioral Health CEO Kipp Dana said. 

“So this helps to offset the cost of having a full-time prescriber just in Douglas alone,” he said. 

The organization, which has locations from Evanston to Thermopolis, is trying to work with local governments to support its operations in other parts of the state. 

Crook County spent $4,851 on the evidence-based Botvin LifeSkills Training Program to reduce substance abuse among school children. 

“I’m full of questions. But the answers are taking time.”

LARAMIE CITY ATTORNEY BOB SHOUTHARD

Meanwhile, Uinta County bought its drug court deputy/coordinator a newer patrol truck to replace one with 240,000 miles on it, the county’s report said. 

The 2022 Dodge Ram with lights and communication devices (price tag $73,241.99) “will allow the Drug Court Deputy to regularly test participants for prohibited opioid usage,” as well as support program operations and tow the trailers for opioid “take-back” programs for residents to dispose of unused prescriptions, according to the county. 

Evanston and Lincoln County purchased the opioid overdose reversal drug naloxone while Rocks Springs spent some of its settlement on “[a]dvanced training for fire department personnel,” bringing some EMTs up to the level of intermediate or advanced. That could help them better intervene in overdoses, city officials wrote.

And finally, Campbell County reportedly spent $5,486.60 on “fentanyl resistant” gloves for first responders and its treatment court. 

Many medical gloves now have this label, but there’s broad scientific agreement that special gloves aren’t necessary when handling opioids, including fentanyl — regular nitrile gloves should do. 

When it comes to fears of overdosing due to touching fentanyl or accidentally inhaling powder in the air, toxicologist, emergency physician and addiction specialist Ryan Marino said there have been zero confirmed cases. 

“There has never been an overdose from [casual/accidental exposure],” the Case Western Reserve University School of Medicine associate professor said. “And for a number of reasons, it doesn’t make sense that there ever would be.”

One, it takes the drug considerable time to get through the skin and two, the powder doesn’t aerosolize on its own or stay in the air long, according to Marino, the American College of Medical Toxicology and American Academy of Clinical Toxicology. 

Even standard fentanyl patches for medical patients can take 13 hours to deliver a therapeutic dose of the drug through the skin, Marino said.

There have been many misleading videos circulating on the internet, but Marino said people’s reactions in those clips don’t line up with a true overdose: while video subjects may hyperventilate, feel anxiety or impending doom, and have an increased heartbeat, genuine fentanyl overdoses generally elicit the opposite response. The user gets sleepy, their heartbeat slows and their breathing slows or stops.

Misconceptions about first responders accidentally overdosing are common, though, and the fear many feel about handling these drugs is real. General practices — like wearing rubber gloves and a face mask — are still broadly encouraged for law enforcement and EMS when encountering unknown substances.

Bigger picture

What does Wyoming’s spending look like compared to other states? Not ideal, according to Dr. Bradley Stein, a physician and senior policy researcher with the RAND Corporation.

While many rural areas don’t have as much expertise and experience funding efforts to combat the opioid crisis, he said, “if the money’s not getting out, it’s not helping people.”

“And so I do think there are ways to try to get it out,” he added. “There’s certainly, probably the ability now to look at what other communities have done.”

States across the country are making decisions about how to spend this money, including rural communities. Of course, each state’s opioid settlement agreement is a bit different, but Stein noted that many are similar. 

Still, how the money is so far being spent in Wyoming seems closely connected to the opioid crisis, he said, unlike what he’s seen elsewhere.

Other places have tried to use money in “gray areas,” like funding a public defender or abstinence-only treatment, he said. 

“[Wyoming’s approach to spending] sounds to me as being . . . a far more conservative interpretation than I’ve heard in other places,” he said. 

Communities could consider banding together for larger projects, he said, or look at the array of efforts going on elsewhere: Supporting access to opioid use disorder treatment, bolstering telehealth options, supporting pregnant women and investing in school programming. 

“I think there are lots of different ways that communities have looked at using these funds, that even if those jurisdictions don’t feel we’ve got the expertise to do this, there are models out there they can turn to,” he said.

Back at the local level, Kota Babcock — a volunteer with the Wyoming Harm Reduction Collective — was disappointed some of the money went to things like naloxone when that can already be obtained for free via the Wyoming Department of Health. 

Still, he’s hopeful because there’s so much funding left, which Babcock said he hopes can continue supporting access to evidence-based medications and support for those who are at higher risk of opioid use disorders, like people with lower incomes, people of color or members of the LQBTQ community.

It could also go toward grants — like for shelters and harm reduction groups — and fund non-judgemental drug education for teens and larger-scale awareness campaigns around the state, he suggested. 

“The more people know about things, the better off they are to make healthy and informed decisions,” he said, noting work the health department is already doing in certain areas. 

At the same time, Babcock believes communities around Wyoming are hamstrung by certain laws on the books, preventing settlement spending on things like clean needles and fentanyl test strips.

Wyoming’s definition of illegal drug paraphernalia includes, “all equipment, products and materials of any kind when used, advertised for use, intended for use or designed for use for manufacturing, converting, preparing, packaging, repackaging, storing, containing, concealing, injecting, ingesting, inhaling or otherwise introducing into the human body a controlled substance in violation of this act.”

Having or delivering drug paraphernalia — including clean needles — can mean up to six months in jail and up to $750 in fines. If it’s provided to minors, the penalties are stiffer. 

Providing clean needles could help prevent the state’s increasing HIV cases and higher-than-national-average hepatitis C cases, Babcock said.

“I think that it’s kind of a similar struggle that we’re having with mental health in the state where it’s really hard to open that dialogue after years and years of treating people who are dealing with these issues like they do not matter or like those issues should be repressed,” he said. “We do treat mental health and substance abuse like bedroom topics in this state.”

This story was published on April 22, 2024.