Despite receiving millions of dollars to combat the opioid crisis, Montana has yet to utilize much of the allocated funds. This comes as the state continues to witness a rise in opioid overdose and death counts.

The funds are part of the approximately $50 billion nationwide settlement that states and local governments will receive over a period of nearly two decades. These settlements stem from lawsuits against more than a dozen companies involved in the production, distribution, or sale of prescription opioid painkillers, which have contributed to the overdose epidemic.

While many states have already begun allocating the funds to various initiatives such as schools, public health departments, and local governments, Montana, along with West Virginia and Hawaii, has been slower in its decision-making process.

For example, South Carolina has awarded over $7 million to 21 grantees, while Wisconsin has already outlined two years' worth of spending plans totaling nearly $40 million.

Montana Faces Challenges in Distributing Opioid Settlement Funds

Montana began receiving its first settlement payments in January, and, by fall, payments totaled roughly $13 million. As of early December, the Montana Opioid Abatement Trust — a private nonprofit created to oversee 70% of the state's share — had met once to agree to its rules of operation, and its money remained locked behind an inactive grant portal. The remainder, divided among the state and local governments, either hadn't been spent or wasn't publicly recorded.

Those charged with distributing the money say they're building a framework to spend it in ways that last. Meanwhile, some addiction treatment providers are eager to use the funds to plug gaps in services.

The tension in Montana reflects a nationwide push-pull. Those handling settlement dollars say governments should take their time planning how to use the enormous windfall. Others argue for urgency as the drug supply has become increasingly deadly. More than 100,000 Americans died of overdoses in 2022, surpassing the previous year's record-setting death toll.

Nearly 200 Montanans died of a drug overdose in 2021, the latest year state data is available. That number, likely an undercount, is roughly 40 more deaths than the year before. Emergency medical responders have continued to record an increasing number of opioid-related emergencies this year.

In Billings, the Rimrock Foundation, one of the state's largest behavioral health providers, has seen its number of clients with opioid use dependency more than triple since 2021. Like other treatment facilities, Rimrock has a waitlist, and addiction treatment providers worry about the limited community resources that exist for patients once they are discharged. "The result of not addressing this is a lot of deaths," said Jennifer Verhasselt, Rimrock Foundation's chief clinical officer.

According to Debbie Knutson, the medical unit and nursing supervisor at Rimrock, there is a lot of confusion surrounding the use of Montana's settlement dollars. Many are concerned that the money is just sitting there, waiting for someone to decide how to allocate it and help those in need.

Rusty Gackle, the executive director of the Montana Opioid Abatement Trust, explained that a significant amount of work has been done behind the scenes to prepare local governments for receiving their initial payments and to establish systems for requesting funds from the trust. This process has involved town hall-style meetings to share information and finalize governance structures.

Gackle expressed a desire to move forward more quickly but emphasized the importance of doing things right to avoid setbacks. He also noted that Montana got a late start compared to other states, with some states receiving settlement dollars as early as last year.

Montana plans to divide its money into three parts: 15% for the state, 15% for local governments, and the remainder for the Montana Opioid Abatement Trust, with a portion set aside for attorneys' fees.

As of late November, the state hadn't begun spending the $2.4 million it had in hand for state agencies. Officials also aren't tracking how and when local governments spend their direct payments.

Similarly, West Virginia and Hawaii hadn't — by late November — begun spending the largest shares of their funding. In West Virginia, the makeup of the foundation board that will oversee roughly 70% of the state's settlement dollars was announced only in August, six weeks after the state's deadline, and the board is now sitting on more than $217 million.

Nationwide, state and local governments have received more than $4.3 billion as of Nov. 9. How much of that has been used remains uncertain due to states' . But from what is known, it varies.

Colorado, whose spending plan is similar to Montana's but received its settlement money earlier, has allocated millions toward school and community-based programs, recovery housing services, and expanded treatment services.

Sara Whaley, a Johns Hopkins researcher who tracks states' uses of opioid settlement funds, said a slower start isn't inherently wrong. She prefers governments take time to spend the money well rather than fund outdated or untested practices. In some cases, governments are building entirely new systems to dole out the money. Several waited until the courts finalized the settlement amounts and details.

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