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The marketing pitches are bold and arriving fast: Invest opioid settlement dollars in a lasso-like device to help police detain people without Tasers or pepper spray. Pour money into psychedelics, electrical stimulation devices, and other experimental treatments for addiction. Fund research into new, supposedly abuse-deterrent opioids and splurge on expensive, brand-name naloxone.

This story also ran on Fortune. It can be republished for free. More from This InvestigationPayback: Tracking the Opioid Settlement Cash

Opioid manufacturers and distributors are paying more than $54 billion in restitution to settle lawsuits about their role in the overdose epidemic, with little oversight on how the money is spent. Were tracking how state and local governments use or misuse the cash.Read More

These pitches land daily in the inboxes of state and local officials in charge of distributing more than $50 billion from settlements in opioid lawsuits.

The money is coming from an array of companies that made, sold, or distributed prescription painkillers, including Johnson & Johnson, AmerisourceBergen, and Walgreens. Thousands of state and local governments sued the companies for aggressively promoting and distributing opioid medications, fueling an epidemic that progressed to heroin and fentanyl and has killed more than half a million Americans. The settlement money, arriving over nearly two decades, is meant to remediate the effects of that corporate behavior.

But as the dollars land in government coffers more than $4.3 billion as of early November a swarm of private, public, nonprofit, and for-profit entities are eyeing the gold rush. Some people fear that corporations, in particular with their flashy products, robust marketing budgets, and hunger for profits will now gobble up the windfall meant to rectify it.

They see a cash cow, said JK Costello, director of behavioral health consulting for the Steadman Group, a firm that is being paid to help local governments administer the settlements in Colorado, Kansas, Oregon, and Virginia. Everyone is interested.

Costello receives multiple emails a week from businesses and nonprofits seeking guidance on how to apply for the funds. To keep up with the influx, he has developed a standard response: Thanks, but we cant respond to individual requests, so heres a link to your localitys website, public meeting schedule, or application portal. Email Sign-Up

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KFF Health News obtained email records in eight states that show health departments, sheriffs offices, and councils overseeing settlement funds are receiving a similar deluge of messages. In the emails, marketing specialists offer phone calls, informational presentations, and meetings with their companies.

Alabama Attorney General Steve Marshall recently sent a letter reminding local officials to vet organizations that reach out. I am sure that many of you have already been approached by a variety of vendors seeking funding for opioid initiatives, he wrote. Please proceed with caution.

Of course, not all marketing efforts should prompt concern. Emails and calls are one way people in power learn about innovative products and services. The countrys addiction crisis is too large for the public sector to tame alone, and many stakeholders agree that partnering with industry is crucial. After all, pharmaceutical companies manufacture medications to treat opioid addiction. Corporations run treatment facilities and telehealth services.

Its unrealistic and even harmful to say we dont want any money going to any private companies, said Kristen Pendergrass, vice president of state policy at Shatterproof, a national nonprofit focused on addiction.

The key, agree public health and policy experts, is to critically evaluate products or services to see if they are necessary, evidence-based, and sustainable instead of flocking to companies with the best marketing.

Otherwise, you end up with lots of shiny objects, Costello said. Carolyn Williams lost her 47-year-old son, Haison Akiem Williams, to an overdose in February. She wants settlement funds to support services she thinks could have kept him alive: mental health treatment, case management, and housing. In June, she spoke at a protest outside a Drug Enforcement Administration building in Arlington, Virginia, where people called for an end to a criminal justice approach to addiction.(Aneri Pattani/KFF Health News)

And, ultimately, failure to do due diligence could leave some jurisdictions holding an empty bag.

Take North Carolina. In 2022, state lawmakers allotted $1.85 million of settlement funds for a pilot project using the first FDA-approved app for opioid use disorder, developed by Pear Therapeutics. There were high hopes the app would help people stay in treatment longer.

But less than a year later, Pear Therapeutics filed for bankruptcy.

The state hadnt paid the company yet, so the money isn’t lost, according to the North Carolina Department of Health and Human Services. But the department and lawmakers have not decided what to do with those dollars next.

$1 Million for Drug Disposal Pouches

Jason Sundby, CEO of Verde Environmental Technologies, said the Deterra pouches his company sells are a low-cost way to prevent expensive addictions.

Customers place their unused medications in a Deterra pouch and add water, deactivating the drugs before tossing them, ensuring they cannot be used even if fished out of the trash. A medium Deterra pouch costs $3.89 and holds 45 pills.

The goal is to get these drugs out of people’s homes before they can be misused, diverted, and people start down the path of needing treatment or naloxone or emergency room visits, Sundby said.

Sundbys company ran an ad about spending settlement dollars on its product in a National Association of Counties newsletter and featured similar information online. The Deterra website prominently features opioid settlement funds as a potential funding stream to purchase drug disposal pouches. Several other companies have taken similar approaches, urging consumers to consider applying opioid settlement funds to their products. (KFF Health News screenshot of https://deterrasystem.com/resources/funding/ on Nov. 21, 2023)

It may be paying off, as Deterra is set to receive $1 million in settlement funds from the health department in Delaware County, Pennsylvania, and $12,000 from the sheriffs office in Henry County, Iowa. The company also has partnerships with St. Croix and Milwaukee counties in Wisconsin, and is working on a deal in Connecticut.

Several other companies with similar products have also used their product sites to urge jurisdictions to consider the settlements as a funding stream and theyre seeing early success.

DisposeRx makes a drug deactivation product its version costs about a dollar each and received $144,000 in South Carolina for mailing 134,000 disposal packets to a program that educated high school football players, coaches, and parents about addiction.

SafeRx makes $3 pill bottles with a locking code to store medications and was awarded $189,000 by South Carolinas opioid settlement council to work with the Greenville County Sheriffs Office and local prevention groups. It also won smaller awards from Weld and Custer counties in Colorado.

None of the companies said they are dependent on opioid settlements to sustain their business long-term. But the funds provide a temporary boost. In a 2022 presentation to prospective investors, SafeRx called the opioid settlements a growth catalyst.

Critics of such investments say the products are not worthwhile. Todays crisis of fatal overdoses is largely driven by illicit fentanyl. Even if studies suggest the companies products make people more likely to safely store and dispose of medications, thats unlikely to stem the record levels of deaths seen in recent years.

The plausible mechanism by which they would even be able to reduce overdoseis a mystery because prescription medications are not driving overdose, said Tricia Christensen, policy director with the nonprofit Community Education Group, which is tracking settlement spending across Appalachia.

Safe storage and disposal can be accomplished with a locking cabinet and toilet, she said. The FDA lists opioids on its flush list for disposal and says there is no evidence that low levels of the medicines that end up in rivers harm human health.

But Milton Cohen, CEO of SafeRxs parent company, Caring Closures International, said keeping prescription medicines secure addresses the root of the epidemic. Fentanyl kills, but often where people start, where water is coming into the boat still, is the medicine cabinet, he said. We can bail all we want, but the right thing to do is to plug the hole first. SafeRx has been awarded $189,000 in opioid settlement funds in South Carolina to work with the Greenville County Sheriffs Office and local prevention groups.(Caring Closures International)

Products to secure and dispose of drugs also provide an opportunity for education and destigmatization, said Melissa Lyon, director of the Delaware County Health Department in Pennsylvania. The county will be mailing Deterra pouches and postcards about preventing addiction to three-quarters of its residents.

The Deterra pouch is to me a direct correlation to the overprescribing that came from pharmaceutical companies aggressive marketing, she added. Since the settlement money is to compensate for that, this is a good use of the funds.

Tools for Law Enforcement That Superheroes Would Envy

Other businesses making pitches for settlement funds have a less clear relationship to opioids.

Wrap Technologies creates tools for law enforcement to reduce lethal uses of force. Its chief product, the BolaWrap, shoots a 7-foot Kevlar tether more than a dozen feet through the air until it wraps around a persons limbs or torso almost like Wonder Womans Lasso of Truth. Brownwood, Texas, has spent about $15,000 of opioid settlement funds to buy nine BolaWrap devices.(Wrap Technologies)

Terry Nichols, director of business development for the company, said the BolaWrap can be used as an alternative to Tasers or pepper spray when officers need to detain someone experiencing a mental health crisis or committing crimes related to their addiction, like burglary.

If you want to be more humane in the way you treat people in substance use disorder and crisis, this is an option, he said.

The company posts body camera footage of officers using BolaWrap on YouTube and says that out of 192 field reports of its use, about 75% of situations were resolved without additional use of force.

When officers de-escalate situations, people are less likely to end up in jail, Nichols said. And diverting people from the criminal justice system is among the suggested investments in opioid settlement agreements.

That argument convinced the city of Brownwood, Texas, where Nichols was police chief until 2019. It has spent about $15,000 of opioid settlement funds to buy nine BolaWrap devices.

Our goal is to avoid using force when a citizen is in need, said James Fuller, assistant police chief in Brownwood. If were going to take someone to get help, the last thing we want to do is poke holes in them with a Taser.

After Brownwoods purchase, Wrap Technologies issued a press release in which CEO Kevin Mullins encouraged more law enforcement agencies to take the opportunity afforded by the opioid settlement funds to empower their officers. The company has also sent a two-page document to police departments explaining how settlement funds can be used to buy BolaWraps.

Language from that document appeared nearly word-for-word in a briefing sheet given to Brownwood City Council before the BolaWrap purchase. The council voted unanimously in favor.

But the process hasnt been as smooth elsewhere. In Hawthorne, California, the police department planned to buy 80 BolaWrap devices using opioid settlement funds. It paid its first installment of about $25,000 in June. However, it was later informed by the state Department of Health Care Services that the BolaWrap is not an allowable use of these dollars.

Bola Wraps will not be purchased with the Settlement Funds in the future, Hawthorne City Clerk Dayna Williams-Hunter wrote in an email.

Carolyn Williams, a member of the advocacy group Vocal-TX, said she doesnt see how the devices will address the overdose crisis in Texas or elsewhere.

Her son Haison Akiem Williams dealt with mental health and addiction issues for years. Without insurance, he couldnt afford rehab. When he sought case management services, there was a three-month wait, she said. Police charged him with misdemeanors but never connected him to care, she said. Share Your Story

Do you have concerns about how your state or locality is using the opioid settlement funds? Are they doing something effective that other places should replicate? Tell us here.Share Your Story

In February, he died of an overdose at age 47. His mother misses how he used to make her laugh by calling her Ms. Carol.

She wants settlement funds to support services she thinks could have kept him alive: mental health treatment, case management, and housing. BolaWrap doesnt make that list.

Its heartbreaking to see what the government is doing with this money, she said. Putting it in places they really don’t need it.

Aneri Pattani: apattani@kff.org, @aneripattani Related Topics Multimedia Public Health States Alabama California Colorado Connecticut Investigation Iowa North Carolina Opioid Settlements Opioids Pennsylvania South Carolina Texas Wisconsin Contact Us Submit a Story Tip

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How Prevent is tackling young extremism 20 years after the 7/7 bombings

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How Prevent is tackling young extremism 20 years after the 7/7 bombings

Radicalised nine-year-olds, teenagers mixing incel culture with extreme right ideologies and a Muslim who idolises Hitler – this is just some of the casework of those tasked with deradicalising young extremists in the UK.

Monday will mark 20 years since the 7/7 attacks on the London transport network when four suicide bombers killed 52 people and injured 770 others.

A year later the government set up its deradicalisation programme Prevent as part of its counter-terrorism strategy.

Sky News has spoken to two leading intervention providers (IPs) at Prevent who both say their work is getting ever more complex and the referrals younger.

The Metropolitan Police’s Prevent co-ordinator, Detective Superintendent Jane Corrigan, has also told Sky News it is “tragic” that when it comes to terrorism, “one in five of all our arrests is a child under 17”.

She believes parents should talk to their children about what they are reading and seeing online.

“Parents instinctively know when something doesn’t feel right when their child is becoming withdrawn or isolated – not wanting to engage,” she says.

More on Prevent

People worried that someone they know has thoughts that could lead to terrorism can refer them to Prevent.

File pic: iStock
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File pic: iStock

‘A pic-n-mix of ideologies’

Home Office figures show 11-year-olds are the largest age group to get referred.

Concerning cases are passed on to IPs such as Nigel Bromage who told Sky News: “Often there will be a pic-n-mix of ideologies.

“From my own examples and experience, we are aware of people looking at the incel culture and mixing that with some far-right elements.”

Jason Farrell with Nigel Bromage
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Sky’s Jason Farrell with intervention provider Nigel Bromage, who was exposed to extremism when he was a child

Incels, meaning “involuntary celibates” are men who have been unable to have a relationship with women despite wanting one and become misogynistic and hateful as a result.

Like many IPs, Mr Bromage from Birmingham comes from an extremist background himself, having once been a regional organiser for the proscribed Neo-Nazi group Combat 18.

For him too, it began as a child.

“It all started with someone giving me a leaflet outside my school gates,” Mr Bromage says.

“It told me a horrific story about a mum getting killed by an IRA bomb explosion – and at the end of the leaflet there was a call to action which said: ‘If you think it’s wrong then do something about it’.”

He developed a hatred for Irish republican terrorism which morphed into general racism and national socialism.

“At the very end I thought I was going to go to prison, or I would end up being hurt or even killed because of my political beliefs,” he says.

Nigel Bromage
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Mr Bromage says his youngest case involved a nine-year-old

Boy, 9, groomed by his brother

Mr Bromage reveals his youngest case was a nine-year-old who had been groomed by his brother.

“He was being shown pro-Nazi video games, and his older brother was saying ‘when I go to prison or I get in trouble – they you’re the next generation – you’re the one who needs to continue the fight’,” he says.

“Really, he had no interest in the racist games – he just wanted to impress his brother and be loved by his brother.”

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Every year, nearly 300 children who are 10 or younger are referred to Prevent.

Home Office figures show that over the last six years 50% of referrals were children under the age of 18.

Eleven-year-olds alone make up a third of total referrals, averaging just over 2,000 a year, with the figure rising even higher in the most recent stats.

Another IP, Abdul Ahad, specialises in Islamic extremism.

He says the catalyst for radicalisation often comes from events aboard.

Ten years ago, it was Syria, more recently Gaza.

“It is often a misplaced desire to do something effective – to matter, to make a difference. It gives them purpose, camaraderie and belonging as well – you feel part of something bigger than you,” he says.

The wreckage of a double-decker bus after the blast at Tavistock Square. Pic: PA
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Fifty-two people were killed on 7 July 2005 when four suicide bombers blew up three London Underground trains and a bus. Pic: PA

Clients want someone to ‘hear them’

Some of his clients “don’t fit into any particular box”.

“I’m working with a guy at the minute, he’s a young Muslim but he idolises Hitler and he’s written a manifesto,” he says.

“When you break it down, some people don’t know where they fit in, but they want to fit in somewhere.”

Mr Ahad says the young individual mostly admires Hitler’s “strength” rather than his ideologies and that he was drawn to darker characters in history.

Often his clients are very isolated and just want someone to “hear them”, he adds.

Read more:
What is Prevent – and why is it controversial?
PM warns of new kind of terror threat

Abdul Ahad
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Intervention provider Abdul Ahad specialises in Islamic extremism

Mr Ahad is also an imam who preaches at the Al-Azar Mosque in South Shields, a well-regarded centre for community cohesion and outreach.

He uses his understanding of the Islamic faith in his Prevent sessions to help guide his referrals away from extreme interpretations of the Koran by offering “understanding and context”.

He says: “We quote the correct religious texts – we explain their responsibility as a Muslim living in the UK and we re-direct their energies into something more constructive.”

Common theme of mental health issues

Mental health problems are a common theme among those referred to Prevent including depression and autism.

A recent inquest into the death of autistic teenager Rhianan Rudd found she took her own life after being radicalised by two white supremacists.

Her mother was critical of Prevent, as well as the police and MI5 after she had referred her daughter to the deradicalisation programme and Rhianan was subsequently charged with terrorism offences.

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Last month a coroner found some failings in the processes around protecting Rhianan, but none of them attributable to Rhianan taking her own life.

Det Supt Corrigan says a referral doesn’t mean individuals end up being arrested or on an MI5 watchlist.

She says: “You’re not reporting a crime, but you are seeking support. I would say the earlier you can come in and talk to us about the concerns you have the better. Prevent is just that – it is a pre-criminal space.

“It’s tragic when you see the number of young people being arrested for very serious charges. Just look at terrorism – one in five of all our arrests is a child under the age of 17. We need to think about how we respond to that.”

Prevent has been criticised for failures such as when Southport killer Axel Rudakabana failed to be recognised as needing intervention despite three referrals, or when MP David Amiss’ killer Ali Harbi Ali went through the programme and killed anyway.

Axel Rudakubana. Pic: Merseyside police
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Axel Rudakubana failed to be recognised as needing intervention despite three referrals. Pic: Merseyside police

It’s harder to quantify its successes.

Mr Ahad says he understands why the failures hit the headlines, but he believes the programme is saving lives.

He says: “I think the vast majority of people get radicalised online because they are sitting in their room reading all this content without any context or scholarly input. They see one version of events and they get so far down the rabbit hole they can’t pull themselves out.

“I really wish Prevent was around when I was a young, lost 15-year-old because there was nothing around then. It’s about listening to people engaging with them and offering them a way of getting out of that extremism.”

File pic: iStock
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File pic: iStock

‘Radicalisation can happen in days to weeks’

Det Supt Corrigan says: “I’ve sat with parents whose children have gone on to commit the most horrendous crimes and they all spotted something.

“Now, with hindsight, they wished they had done something or acted early. That’s why we created this programme, because radicalisation can happen in days to weeks.”

Twenty years on from 7/7 the shape of the terrorist threat has shifted, the thoughts behind it harder to categorise, but it is no less dangerous.

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Volpe toss hits Judge as sloppy Yanks fall again

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Volpe toss hits Judge as sloppy Yanks fall again

NEW YORK — A blunder that typifies the current state of the New York Yankees, who find themselves in the midst of their second six-game losing streak in three weeks, happened in front of 41,401 fans at Citi Field on Saturday, and almost nobody noticed.

The Yankees were jogging off the field after securing the third out of the fourth inning of their 12-6 loss to the Mets when shortstop Anthony Volpe, as is standard for teams across baseball at the end of innings, threw the ball to right fielder Aaron Judge as he crossed into the infield from right field.

Only Judge wasn’t looking, and the ball nailed him in the head, knocking his sunglasses off and leaving a small cut near his right eye. The wound required a bandage to stop the bleeding, but Judge stayed in the game.

“Confusion,” Yankees manager Aaron Boone said. “I didn’t know what happened initially. [It just] felt like something happened. Of course I was a little concerned.”

Avoiding an injury to the best player in baseball was on the Yankees’ very short list of positives in another sloppy, draining defeat to their crosstown rivals. With the loss, the Yankees, who held a three-game lead over the Toronto Blue Jays in the American League East standings entering June 30, find themselves tied with the Tampa Bay Rays for second place three games behind the Blue Jays heading into Sunday’s Subway Series finale.

The nosedive has been fueled by messy defense and a depleted pitching staff that has encountered a wall.

“It’s been a terrible week,” said Boone, who before the game announced starter Clarke Schmidt will likely undergo season-ending Tommy John surgery.

For the second straight day, the Mets capitalized on mistakes and cracked timely home runs. After slugging three homers in Friday’s series opener, the Mets hit three more Saturday — a grand slam in the first inning from Brandon Nimmo to take a 4-0 lead and two home runs from Pete Alonso to widen the gap.

Nimmo’s blast — his second grand slam in four days — came after Yankees left fielder Jasson Dominguez misplayed a ball hit by the Mets’ leadoff hitter in the first inning. On Friday, he misread Nimmo’s line drive and watched it sail over his head for a double. On Saturday, he was slow to react to Starling Marte’s flyball in the left-center field gap and braked without catching or stopping it, allowing Marte to advance to second for a double. Yankees starter Carlos Rodon then walked two batters to load the bases for Nimmo, who yanked a mistake, a 1-2 slider over the wall.

“That slider probably needs to be down,” said Rodon, who allowed seven runs (six earned) over five innings. “A lot of misses today and they punished them.”

Jazz Chisholm Jr.’s throwing woes at third base — a position the Yankees have asked him to play to accommodate DJ LeMahieu at second base — continued in the second inning when he fielded Tyrone Taylor’s groundball and sailed a toss over first baseman Cody Bellinger’s head. Taylor was given second base and scored moments later on Marte’s RBI single.

The Yankees were charged with their second error in the Mets’ four-run seventh inning when center fielder Trent Grisham charged Francisco Lindor’s single up the middle and had it bounce off the heel of his glove.

The mistake allowed a run to score from second base without a throw, extending the Mets lead back to three runs after the Yankees had chipped their deficit, and allowed a heads-up Lindor to advance to second base. Lindor later scored on Alonso’s second home run, a three-run blast off left-hander Jayvien Sandridge in the pitcher’s major league debut.

“Just got to play better,” Judge said. “That’s what it comes down to. It’s fundamentals. Making a routine play, routine. It’s just the little things. That’s what it kind of comes down to. But every good team goes through a couple bumps in the road.”

This six-game losing skid has looked very different from the Yankees’ first. That rough patch, consisting of losses to the Boston Red Sox and Los Angeles Angels, was propelled by offensive troubles. The Yankees scored six runs in the six games and gave up just 16. This time, run prevention is the issue; the Yankees have scored 34 runs and surrendered 54 in four games against the Blue Jays in Toronto and two in Queens.

“The offense is starting to swing the bat, put some runs on the board,” Boone said. “The pitching, which has kind of carried us a lot this season, has really, really struggled this week. We haven’t caught the ball as well as I think we should.

“So, look, when you live it and you’re going through it, it sucks, it hurts. But you got to be able to handle it. You got to be able to deal with it. You got to be able to weather it and come out of this and grow.”

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Former White Sox pitcher, world champ Jenks dies

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Former White Sox pitcher, world champ Jenks dies

Bobby Jenks, a two-time All-Star pitcher for the Chicago White Sox who was on the roster when the franchise won the 2005 World Series, died Friday in Sintra, Portugal, the team announced.

Jenks, 44, who had been diagnosed with adenocarcinoma, a form of stomach cancer, this year, spent six seasons with the White Sox from 2005 to 2010 and also played for the Boston Red Sox in 2011. The reliever finished his major league career with a 16-20 record, 3.53 ERA and 173 saves.

“We have lost an iconic member of the White Sox family today,” White Sox chairman Jerry Reinsdorf said in a statement. “None of us will ever forget that ninth inning of Game 4 in Houston, all that Bobby did for the 2005 World Series champions and for the entire Sox organization during his time in Chicago. He and his family knew cancer would be his toughest battle, and he will be missed as a husband, father, friend and teammate. He will forever hold a special place in all our hearts.”

After Jenks moved to Portugal last year, he was diagnosed with a deep vein thrombosis in his right calf. That eventually spread into blood clots in his lungs, prompting further testing. He was later diagnosed with adenocarcinoma and began undergoing radiation.

In February, as Jenks was being treated for the illness, the White Sox posted “We stand with you, Bobby” on Instagram, adding in the post that the club was “thinking of Bobby as he is being treated.”

In 2005, as the White Sox ended an 88-year drought en route to the World Series title, Jenks appeared in six postseason games. Chicago went 11-1 in the playoffs, and he earned saves in series-clinching wins in Game 3 of the ALDS at Boston, and Game 4 of the World Series against the Houston Astros.

In 2006, Jenks saved 41 games, and the following year, he posted 40 saves. He also retired 41 consecutive batters in 2007, matching a record for a reliever.

“You play for the love of the game, the joy of it,” Jenks said in his last interview with SoxTV last year. “It’s what I love to do. I [was] playing to be a world champion, and that’s what I wanted to do from the time I picked up a baseball.”

A native of Mission Hills, California, Jenks appeared in 19 games for the Red Sox and was originally drafted by the then-Anaheim Angels in the fifth round of the 2000 draft.

Jenks is survived by his wife, Eleni Tzitzivacos, their two children, Zeno and Kate, and his four children from a prior marriage, Cuma, Nolan, Rylan and Jackson.

The Associated Press contributed to this report.

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