Commentary: Wasted opioid settlements are a new low in the West Virginia exploitation story

West Virginia is a special place, known to outsiders as “Almost Heaven,” as John Denver sings in his song “Take Me Home, Country Roads.” However, West Virginians know there is an eerie emphasis on the word “almost” in our mountain mama’s hymn. The word “almost” speaks to the promise and potential found in West Virginia. Or, as a neighbor back home in Union once put it: “It’s called Almost Heaven, because we’re close to dying every day.”

One of the reasons our health outcomes remain poor in West Virginians is a long history of exploitation in our state. Our coal miners’ bodies were exploited and discarded. Then decades-long opioid crisis further exploited that pain. As a result, West Virginia has secured more than a billion dollars in the opioid settlements which is the highest per capita of any state.

And yet, the cycle of hope and exploitation continues, except this time, in perhaps its most sinister form: government officials using the pain from the opioid crisis to pay off government debt instead of investing in the public health solutions we need to stay healthy and thrive.

This is not the first time West Virginia’s state and local government response to the opioid crisis made it far worse than it should have been. After being too slow to adopt evidence-based syringe service programs, they rolled them back in the middle of the crisis and contributed to a predictable, preventable, and tragic spike in HIV. West Virginia remains the only state with a moratorium on new methadone clinics, despite methadone being a highly effective medication to treat opioid addiction. Combined, these hostile policies have effectively denied thousands of people access to life-saving approaches. 

Yes, outside companies started the fire, but it is difficult to look at the West Virginia government response and see anything other than throwing more gas on it. And now those same governments that led our inadequate response to the opioid crisis over the past three decades, are fumbling the response again. This time with the money won on behalf of people impacted by the opioid crisis: the opioid settlement money.

In the years one and two of local government opioid settlement spending, more $7.5 million went to law enforcement. Basically no money is going to harm reduction approaches like syringe service programs and relatively little, approximately $900,000 going increasing access for opioid addiction treatment medications. In contrast, more than $4.3 million was spent on jail bills.

Since this money started flowing in 2022, approximately 4,244 people died from an overdose death in West Virginia. Deaths that could have been prevented if we invested in public health approaches like evidence-based prevention, harm reduction, treatment and recovery supports like this money was supposed to be. Yet just like for the past 30 years, we’ve not seen those investments. Does anyone seriously think that buying a shooting range, drones, K9s and a Batman impersonator is going to turn around West Virginia’s failed approach to the crisis? Instead, it looks more like the government equivalent of buying a jet ski with lottery winnings. And it’s a deep betrayal of all the lives lost and impacted by this crisis.

Now you might be wondering why this is happening and what can be done to stop it?

One of the clearest reasons for this spending is that the West Virginia Attorney General, now governor, allowed for spending on jail bills and police equipment in the West Virginia settlement agreement. Those two unique insertions into the standard agreement language accepted by the other 49 states gave decisionmakers in West Virginia the opportunity to ignore the other almost 100 public health examples for how to spend the money on harm reduction, treatment and recovery support. It gave decision makers the opening to invest in the same things that haven’t worked for our state, further diverting these finite resources away from what does work.

And yes, West Virginia’s approach is an outlier. In fact, just across the border, Virginia explicitly says opioid settlement money is not allowed to be spent on jail bills and law enforcement equipment. Yet in West Virginia, it was added to the agreement as explicitly allowable. Turns out, the plan in West Virginia was always to exploit our pain and turn it into a government handout.

As a West Virginian and a public health expert, this is outrageous. Decision makers have a responsibility to act as stewards of this once-in-a-lifetime opportunity to make amends with a community that has been so damaged. This means investing in evidence-based addiction treatment, harm reduction and recovery support. Money spent on off-target things like jail bills must be clawed back and spent on actual solutions. The state must revisit their agreement that allows for this wasteful spending and develop an unallowable spending list like Virginia and six other states have created. 

Our government pursued these lawsuits to hold the companies accountable for what they did to our communities. But that accountability flows both ways. If you use the deaths of our neighbors and the pain of children who lost parents to get this money, you can’t just turn around and use it to buy a drone and act like that is helping. Decision makers must fix the broken addiction ecosystem by investing in public health approaches, or they too must be held accountable.