State, county and municipal officials are considering how to spend millions in opioid lawsuit settlement funds.

Once touted as a miracle pain treatment, opioid-based prescriptions have created a nightmare for millions of Americans directly or indirectly affected by an epidemic of addiction.

Fentanyl, a synthetic opioid that can be 50 times stronger than heroin, has become a leading cause of fatal and nonfatal overdoses in the U.S.

In Michigan, overdose deaths peaked at 3,096 in 2021, but 2022 was close: 2,998. Last year’s figures are incomplete but appear to be close to the 3,000 mark.

In 2021, Oakland County documented 180 drug overdose deaths involving synthetic opioids — a 119.5% increase in such deaths over 2020.

This crisis also includes lives disrupted by near-deaths, an estimated 650 each year. It includes chaos and heartbreak for families and businesses responding to deaths, near-deaths and an estimated 635 drug-related arrests, based on the state’s most-recent figures available.

After a series of lawsuits — some of which are ongoing — by states against drug makers and distributors, Michigan will receive an estimated $1.6 billion over the next 18 years from legal settlements related to the opioid crisis. Half the money, $800 million, will be divided among county, city, and township governments. The other half goes to the state’s Opioid Healing and Recovery Fund.

Oakland County will get at least $36 million by 2040. Now county officials and those at 39 of its municipalities are figuring out how to best spend it.

Opioid settlement money can only be used to address the crisis.

The state’s opioid task force priorities are prevention, treatment, recovery, harm reduction, prioritizing needs of vulnerable people — which includes support for people who are pregnant or parenting and addressing racial disparities, collecting and analyzing data, and providing technical assistance to local governments.

Madiha Tariq, the county’s deputy executive in charge of health and human services and public services, said the amount the county receives could change, depending on the outcome of remaining lawsuits.

This year’s payment is just over $5.2 million, she said. The county is hiring an epidemiologist to gather data. The commission approved spending $541,000 on the jail’s medication and treatment program, which had been limited to county residents only.

“We don’t want to discriminate (and say) ‘you can’t get medication or treatment because you’re from Wayne County or Macomb County.’ We learned that at one point, 60% of the people in jail who needed the program were from outside the county,” she said. “We want to make sure anyone under our supervision or in custody can receive this program.”

The county also hosted a series of listening sessions to get as close as possible to individuals’ experiences.

“We chose the locations based on the highest levels of overdoses. We wanted to be in areas where communities felt the most impact,” she said. Nearly 500 people, including 200 teenagers, participated.

Tariq said 46% of adults who responded had a loved one affected by the crisis and 26% of those who responded were personally affected by substance use disorder.

As part of the sessions, participants were asked to rank the spending priorities, using the state’s priorities.

“And if someone had a personal experience to share, they could write about it anonymously on-site,” she said. “What was really interesting was that their priorities aligned with our overall strategies: Treatment in jail and prisons, expanding the warm handoff and recovery services, harm reduction and expanding staff and infrastructure.”

People recovering from an opioid addiction also emphasized the need for treatment centers, something Tariq called “a big elephant in the room.”

Before large amounts of money are committed, the county is hiring an epidemiologist and creating an advisory board. Tariq said the board members’ names will be announced in the near future. They’ll be experts, Tariq said, but “we’re not just focused on people with PhDs. We’re looking for people with lived experiences, people in different trades. Opioids affect everyone.”

The group will analyze information from the listening sessions and data collected by the epidemiologist. After identifying priorities, they’ll develop a funding mechanism for specific programs, with a goal of being as inclusive as possible, she said.

“We have to make sure whatever we support with these funds is transformative and sustainable,” Tariq said. “We also want to be absolutely transparent about how we’re using this money.”

Steve Norris, who directs Alliance of Coalitions for Healthy Communities’ harm reduction and recovery support office, attended some of the listening sessions. His impression was that many who attended weren’t sure how to appropriately spend the money or which organizations should be funded and what work needs to be done.

He would like to see money to support changes recommended by the county’s overdose fatality review board, which meets monthly to review cases and find ways to correct systemic failures or improve key interactions with a person in crisis, and education on Naloxone, a medication that may reverse an overdose.

“Based on what I’ve seen, they’ve done a pretty good job of dispersing the money so far, including hiring staff and creating the board,” Norris said. “That alone takes a good chunk of one year’s disbursements.”

Sheriff Michael Bouchard said his office works with the Alliance of Coalitions for Healthy Communities and Oakland Community Health Network to address some needs of people in the jail.

Once out of jail, people with substance use disorders have a greater risk of overdosing and dying, he said. That’s why follow-up care is so critical — which could mean anything from home visits or other types of support.

A holistic approach to people struggling with addiction would include expanding support for mental health co-responders, he said, adding that deputies are called to help people in a mental health crisis on a daily basis.

Many of those people are self-medicating, Bouchard said. The Ride to Recovery program, started in 2017, allows deputies to drive a person to a drug-treatment center. State records show that every county resident is within a 30-minute ride to those facilities but the centers often do not have the capacity to provide treatment to all who arrive.

More than half the jail’s inmates need support for significant mental health issues, Bouchard said.

“People that are struggling with addiction — for example, many people in our jail are there for crimes sometimes not related to actual drug crimes. They’ve committed crimes to be able to pay for drugs,” he said.

Bouchard believes the focus of spending should be on resources to support recovery efforts, “not arresting people.”

He said education is another key to help people, especially those buying and using street drugs.

“Someone may think they’re getting Adderall or Valium but they’re getting something with fentanyl-laced counterfeit pills,” he said.

At least 100 dispensers are scattered around the county with free Naloxone doses along with fentanyl test strips and pamphlets explaining how people can get help. The county maintains an online map: https://www.arcgis.com/apps/instant/sidebar/index.html?appid=96df1b2b41d84d1b8f6a7523e7eda677

Oakland County’s top five communities for opioid settlement money:

• Pontiac City, $1,977,290.71. For the current budget year, records show the city received $194,282. City council amended the budget on April 30 to accept an unanticipated $49,300.

• Southfield, $1,362,085.51. “At this time we have not determined how these monies will be spent. We are investigating allowable uses, said Mayor Ken Siver. He said a decision is not imminent, because the city is busy with other issues. The city council’s May 6 agenda is full of infrastructure items.

• Farmington Hills, $956,706.39: Assistant City Manager Karen Mondora said a substantial portion of the money so far received was used to offset past opioid-related work by the city’s emergency responders.

“These funds have been instrumental in enhancing the capabilities of our police, fire and EMS, who are specially trained and equipped to assist individuals affected by this crisis,” she said, adding that the city will use future money for special training and equipment needed to respond to the opioid epidemic.

Mondora said even before the opioid settlements, the city was actively responding to those affected by the drug epidemic. The infusion of settlement funds, she said, will enhance what the city can do to combat “the far-reaching effects of this crisis in our community.”

• West Bloomfield Charter Township, $908,024.90: The township received $112,935 in 2023 and expects to receive $133,251 this year. Township Supervisor Steve Kaplan said the 2023 funds were divided among three agencies.

The Jamie Daniels Foundation, which has a partnership with Children’s Hospital, received $3,000 for 2000 fentanyl test strips.

The fire department received $11,325 to stock 10 Narcan dispensers around the community, which hold free doses of Naloxone/Narcan, educational pamphlets and fentanyl test strips. The boxes, including the one at the township hall, are restocked weekly.

The township gave $22,500 to the Greater West Bloomfield Coalition for Youth, which is dedicated to substance abuse prevention and has partnerships with close to a dozen health-related organizations. The money will be used to support health coping classes for children and for related supplies and equipment for their teachers.

The township’s designated opioid fund has $29,228, which will be disbursed next year, Kaplan said.

“If one life is saved as the result of a relative or passerby having Narcan, it’s all worth it. How do you place a value on a life? It’s incalculable,” Kaplan said.

• Royal Oak, $898,808.83: The city commission approved five disbursements in 2023, including $74,836 for an emergency medical dispatch software upgrade; $20,000.00 to ease the financial burden of drug test costs for people enrolled in the 44th District Court’s sobriety court program; $2,500 to the Royal Oak Community Coalition to develop educational programming for students; $2,500 to the coalition to create programs for pregnant and postpartum women and $2,500 to expand the police department’s quick response team. The city hosts a webpage dedicated to information for adults and children at https://www.romi.gov/1348/Opioids.

The five Oakland County communities getting the smallest payouts:

• Southfield Township, $376.03: Township Supervisor James O’Reilly said his community, nestled between Southfield and Birmingham, contains three villages: Franklin, Bingham Farms and Beverly Hills. Villages are not eligible for settlement money, because while they are specific communities with their own governments, they are also part of the township. The township’s overall population of 15,000 is largely within the villages. Only 39 people are true township residents, O’Reilly said.

“Essentially the township’s property covers a strip mall, a cemetery and a few homes, some of which are partly covered by the City of Southfield. If we had $15,000 or $150,000 in settlement money, we might parcel it out to two or three organizations,” he said, adding that the township board will likely send its $376 to a treatment program. “You can get more out of the investment with more immediate results.”

• Holly Township, $14,193.42: In February, the township board accepted $1,700 from the McKinsey Opioid Settlement and made plans to invite the Holly Area Youth Assistance Center to apply for the funds.

• Springfield Charter Township, $15,477.89: Township Supervisor Laura Moreau said in 2023, five distributions totaling $1,929 arrived. That money was used by the fire department to buy Narcan and train personnel on responding to suspected or confirmed opioid overdoses. The township’s fire department is working with McLaren Oakland to implement a state-funded Narcan leave-behind program, which includes training and literature. Fire Chief Matt Covey said he expects the program to be running by the end of June, adding that this proactive approach raises the chances that Narcan will be available should a friend or family member experience an overdose, “potentially saving lives in our community.”

• Lyon Charter Township, $20,872.66: The board of trustees has voted to accept settlement agreements.

• Milford Charter Township, $22,253.48: Milford Township has so far received $2,774.00. The money was transferred to the Milford Fire Department “where it will be used for Naloxone and Narcan,” said Township Supervisor Don Green. It may also be used for Lucas devices and automated external defibrillators (AEDs), equipment needed for patients in cardiac arrest.