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Colorado could soon get a lot of money from opioid settlements. But where should those dollars go?

In a new Colorado Health Institute survey, experts weighed between spending money on treatment, prevention and other priorities

Empty pill bottles cover the Opioid Memorial Wall, part of a Colorado campaign called Lift the Label aiming to reduce the stigma around addiction in order to encourage treatment and recovery. (John Ingold, The Colorado Sun)
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Colorado could soon be in line for tens of millions — maybe even hundreds of millions — of dollars from legal settlements related to the opioid epidemic.

That kind of windfall would represent a major leap forward in the state’s effort to combat the crisis, which has claimed more than 5,000 Coloradans’ lives since 2000. But it would also present a significant challenge.

“With those dollars will come fights over how to spend them,” Alex Caldwell, a director of the Colorado Health Institute, said last week at the institute’s annual conference.

Those fights wouldn’t just be at the state Capitol. While the Attorney General’s office is involved in discussions over multi-state, multibillion-dollar settlements with several drug companies, local governments that filed lawsuits separately could also be in line for dollars coming directly into their budgets.

To help clarify the funding choices, a new report from Caldwell and her colleagues provides insight into where people who are working every day to end the opioid epidemic think the dollars should go. And, collectively, they favor putting the biggest chunk into treatment for those addicted to the drugs.

The institute, working with the Colorado Consortium for Prescription Drug Abuse Prevention, polled two dozen experts in the state and asked them how they would allocate a hypothetical $100 million in settlement money.

The group’s consensus was to put about 41% of the money into treatment programs. Prevention efforts and funding to address the consequences of the epidemic in the criminal justice system — by, for instance, expanding treatment services in jails — were next on the priorities list, each receiving about 22% of the money. Efforts that come under the category of “harm reduction” — things like syringe exchanges, or programs to distribute overdose-reversal drugs — received about 14% of the funding, with the final 1% going to other, miscellaneous programs.

Needles from heroin-users are collected in bins at the Harm Reduction Action Center in Capitol Hill. The center counts more than 900 lives saved by training clients to use naloxone, the antidote to an opioid overdose. (Marvin Anani, Special to The Colorado Sun)

Robert Valuck, the consortium’s executive director, said the focus on treatment makes sense.

“We must meet the unmet need that we have,” he said during a panel discussion of the report at the health institute’s conference last week. “Colorado is making more progress than virtually every other state, but we’re still at 70% unmet need.”

That means 70% of the people in the state who need treatment for opioid addiction aren’t getting it.

The state has worked feverishly in recent years to expand treatment capacity, especially for so-called medication-assisted treatment, using a drug like buprenorphine to help a person break the bonds of addiction. Research shows that medication-assisted treatment may be the best way of combatting opioid addiction.

So, for instance, Colorado has used federal grant money to create mobile treatment clinics that can bring services to rural parts of the state where there are no brick-and-mortar treatment centers. A bill passed in the legislature earlier this year and another proposed for the coming session aim to expand treatment to people in jails and prisons.

The Outpatient Behavioral Health Services building at Denver Health, part of the hospital’s new Center for Addiction Medicine, provides medications such as methadone and buprenorphine to treat opioid addiction. (John Ingold, The Colorado Sun)

Hospitals have also worked to streamline the process for getting treatment and more quickly connect patients with the help they need. One such effort is at Denver Health, where staffers with the hospital’s new Center for Addiction Medicine are helping patients work through housing and transportation challenges to ensure they can receive treatment and stick with it.

That last part is key — and part of why treatment for such a gripping disease as opioid addiction requires steady funding. When the center launched this summer, Dr. Josh Blum, a Denver Health addiction specialist, said patients of his have a risk of relapse even years after starting on medication-assisted treatment and that patients may have plenty of starts and stops on the road to recovery.

“It’s nearly impossible to do on your own,” he said. “People can always buck the odds. But the odds are against you.”

But Valuck said, as much as he believes more funding needs to go toward treatment, he hopes not all of the money from likely settlements ends up there. He likened the opioid epidemic to a running faucet — if the state doesn’t shut off the flow, the treatment need will just keep growing.

“So we must,” he said, “no matter how hard it is, we must make some meaningful investment in prevention.”


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