Jeremy Alford and David Jacobs: Lawmakers seek clarity in fight over opioid settlements

Louisiana is a participating state in 15 legal settlements with corporate entities deemed responsible for the national opioid epidemic that claimed more than 5,000 lives in the state over five years. 
About $600 million is expected to flow into the state over the next 18 years. Under current rules, that money goes not to state government but to the locals: 20 percent for sheriffs, the rest for parishes and municipalities.
While there is a statewide advisory board, no entity has been tasked with enforcing the settlement terms the courts have established about how the money should be spent. During the session that ended last week, lawmakers launched an effort to find out exactly where those dollars are going, one of several ways they’re hoping to get a better handle on the problem. 
“This is really not about politics,” Sen. Brach Myers told the Senate Health and Welfare Committee. “It’s about wanting to know exactly where that money is being secured and how it’s being used to save lives.”
Myers, along with Rep. Annie Spell, carried SCR 22, which asks the legislative auditor to for a wide-ranging report on the program detailing the total amount received to date, amounts distributed to each parish and sheriff, an itemized account of expenditures, the purpose and classification of those expenditures, the legal basis for classifying spending as treatment or abatement, the outcome or performance metrics tied to each expenditure, each recipient’s reporting compliance status, unspent balances, future allocations, administrative costs and any barriers to reporting and oversight. 
The report would follow up on one the LLA completed last year, which was far less comprehensive. Through a survey, the auditor could only tally $8.6 million in local spending by 20 parishes and 24 sheriffs out of $98.5 million distributed. Some respondents hadn’t spent any, and 35 parishes and 21 sheriffs didn’t respond to the survey. 
Rep. Tehmi Chassion’s HCR 50 also seeks more information, specifically regarding the opioid abatement and treatment programs in correctional facilities. He explained to the House Criminal Justice Committee that the issue was personal for him.
“If these programs were available back in the day, I think my dad would still be here,” he said.
Kevin Cobb, executive director of the Louisiana Sheriffs Association, said there was some initial hesitation among sheriffs to spend the settlement money because they weren’t certain what it could be used for, though the state’s Louisiana Opioid Abatement Task Force has since been able to provide more clarity. He said uses include detection, enforcement and education. 
“It’s not something that’s going to go away,” Cobb said of the “war on drugs.”
“It’s just something we’re going to continue to have to fight.”
Cobb said he welcomes a review of how the money is being used and recognizes the court-ordered parameters, but he hopes recipients don’t lose all flexibility to craft solutions that fit their areas. 
“The auditor’s expertise is doing the auditing and gathering information,” he said. “And then your community has the expertise of knowing what is good for them.”
Senate Health Chair Patrick McMath’s SB 26, which Gov. Jeff Landry has signed, addresses regulatory hurdles that may be limiting the number of opioid treatment providers in the state. Such facilities have been required to undergo a lengthy facility needs review, which is not required in most states and helps explain why only one new OTP has opened in Louisiana since 2015, even as the epidemic has raged, McMath said in committee. 
Louisiana has the 10th-highest rate of overdoses in the country, yet trails other states in the ability to provide treatment, said Andrew Whitacre, who works on substance abuse prevention and treatment with The Pew Charitable Trusts. For example, Kentucky has 45 OTPs, Oklahoma and South Carolina have 30, but Louisiana only has 11, he said. 
McMath’s SB 43, which was still awaiting the governor’s possible signature as of Wednesday evening, would establish the Psychedelic-Assisted Therapy Initiative for opioid addiction and mental health conditions. The bill would not legalize psychedelic substances, but it would support clinical research at academic centers in the state. 
Researchers at LSU’s Health Sciences Center in Shreveport have studied the psychedelic drug ibogaine as part of an FDA-approved trial. Glenn Curtis, the former head of the Louisiana National Guard, testified in committee that he has seen soldiers suffering from PTSD and brain injuries benefit from psychedelics, including his son. 
McMath suggested unspent opioid settlement money could help to pay for the program. He said the drugs only would be used in a supervised in-patient setting, unlike the state’s medical marijuana program where patients take the cannabis home with them. 
The governor has signed HB 907 by House Health and Welfare Chair Dustin Miller, which provides civil and criminal immunity, and prevents disciplinary actions by professional licensing boards, for the distribution or use of opioid antagonists (medications that block the effects of opioids)
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