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State and local governments are receiving billions of dollars in opioid settlements to address the drug crisis that has ravaged America for decades. But instead of spending the money on new addiction treatment and prevention services they couldnt afford before, some jurisdictions are using it to replace existing funding and stretch tight budgets.

This story also ran on USA Today. 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

Scott County, Indiana, for example, has spent more than $250,000 of opioid settlement dollars on salaries for its health director and emergency medical services staff. The money usually budgeted for those salaries was freed to buy an ambulance and create a financial cushion for the health department.

In Blair County, Pennsylvania, about $320,000 went to a drug court the county has been operating with other sources of money for more than two decades.

And in New York, some lawmakers and treatment advocates say the governors proposed budget substitutes millions of opioid settlement dollars for a portion of the state addiction agencys normal funding.

The national opioid settlements dont prohibit the use of money for initiatives already supported by other means. But families affected by addiction, recovery advocates, and legal and public health experts say doing so squanders a rare opportunity to direct additional resources toward saving lives.

To think that replacing what youre already spending with settlement funds is going to make things better its not, said Robert Kent, former general counsel for the Office of National Drug Control Policy. Certainly, the spirit of the settlements wasnt to keep doing what you’re doing. It was to do more.

Settlement money is a new funding stream, separate from tax dollars. It comes from more than a dozen companies that were accused of aggressively marketing and distributing prescription painkillers. States are required to spend at least 85% of the funds on addressing the opioid crisis. Now, with illicit fentanyl flooding the drug market and killing tens of thousands of Americans annually, the need for treatment and social services is more urgent.

Thirteen states and Washington, D.C., have restricted the practice of substituting opioid settlement funds for existing dollars, according to state guides created by OpioidSettlementTracker.com and the public health organization Vital Strategies. A national set of principles created by Johns Hopkins University also advises against the practice, known as supplantation.

Paying Staff Salaries

Scott County, Indiana a small, rural place known nationally as the site of an HIV outbreak in 2015 sparked by intravenous drug use received more than $570,000 in opioid settlement funds in 2022.

From August 2022 to July 2023, the county reported using roughly $191,000 for the salaries of its EMS director, deputy director, and training officer/clinical coordinator, as well as about $60,000 for its health administrator. The county also awarded about $151,000 total to three community organizations that address addiction and related issues.

In a public meeting discussing the settlement dollars, county attorney Zachary Stewart voiced concerns. I dont know whether or not were supposed to be using that money to add, rather than supplement, already existing resources, he said. Susan Ousterman, of Bucks County, Pennsylvania, lost her 24-year-old son, Tyler Cordeiro, to a drug overdose in 2020. She has been fighting to ensure the opioid settlement funds are used effectively since.(Steven Ousterman)

But a couple of months later, the county council approved the allocations.

Council President Lyndi Hughbanks did not respond to repeated requests to explain this decision. But council members and county commissioners said in public meetings that they hoped to compensate county departments for resources expended during the HIV outbreak.

Their conversations echoed the struggles of many rural counties nationwide, which have tight budgets, in part because they poured money into addressing the opioid crisis for years. Now as they receive settlement funds, they want to recoup some of those expenses.

The Scott County Health Department did not respond to questions about how the funds typically allocated for salary were used instead. But at the public meeting, it was suggested they could be used at the departments discretion.

EMS Chief Nick Oleck told KFF Health News the money saved on salaries was put toward loan payments for a new ambulance, purchased in spring 2023.

Unlike other departments, which are funded from local tax dollars and start each year with a full budget, the county EMS is mostly funded through insurance reimbursements for transporting patients, Oleck said. The opioid settlement funds provided enough cash flow to make payments on the new ambulance while his department waited for reimbursements.

Oleck said this use of settlement dollars will save lives. His staff needs vehicles to respond to overdose calls, and his department regularly trains area emergency responders on overdose response. 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

It can be played that it was just money used to buy an ambulance, but theres a lot more behind the scenes, Oleck said.

Still, Jonathan White the only council member to vote against using settlement funds for EMS salaries said he felt the expense did not fit the moneys intended purpose.

The settlement was written to pay for certain things: helping people get off drugs, White told KFF Health News. We got drug rehab facilities and stuff like that that I believe could have used that money more.

Phil Stucky, executive director of a local nonprofit called Thrive, said his organization could have used the money too. Founded in the wake of the HIV outbreak, Thrive employs people in recovery to provide support to peers with mental health and substance use disorders. Phil Stucky is executive director of a nonprofit called Thrive, which began in Scott County, Indiana, in the wake of a large HIV outbreak in 2015. Thrive employs people in recovery to provide peer support to others with mental health and substance use disorders.(Jake Zaepfel)

Stucky, who is in recovery himself, asked Scott County for $300,000 in opioid settlement funds to hire three peer specialists and purchase a vehicle to transport people to treatment. He ultimately received one-sixth of that amount enough to hire one person.

In Blair County, Pennsylvania, Marianne Sinisi was frustrated to learn her county used about $322,000 of opioid settlement funds to pay for a drug court that has existed for decades.

This is an opioid epidemic, which is not being treated enough as it is now, said Sinisi, who lost her 26-year-old son to an overdose in 2018. The county received extra money to help people, but instead it pulled back its own money, she said. How do you expect that to change? Isnt that the definition of insanity?

Blair County Commissioner Laura Burke told KFF Health News that salaries for drug court probation officers and aides were previously covered by a state grant and parole fees. But in recent years that funding has been inadequate, and the county general fund has picked up the slack. Using opioid settlement funds provides a small reprieve since the general fund is overburdened, she said. The countys most recent budget faces a $2 million deficit.

Forfeited Federal Dollars

Supplantation can take many forms, said Shelly Weizman, project director of the addiction and public policy initiative at Georgetown Universitys ONeill Institute. Replacinggeneral funds with opioid settlement dollars is an obvious one, but there are subtler approaches.

The federal government pours billions of dollars into addiction-related initiatives annually. But some states forfeit federal grants or decline to expand Medicaid, which is the largest payer of mental health and addiction treatment.

If those jurisdictions then use opioid settlement funds for activities that could have been covered with federal money, Weizman considers it supplantation.

Its really letting down the citizens of their state, she said.

Officials in Bucks County, Pennsylvania, forfeited more than $1 million in federal funds from September 2022 to September 2023, the bulk of which was meant to support the construction of a behavioral health crisis stabilization center. Email Sign-Up

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We were probably overly optimistic about spending the money by the grant deadline, said Diane Rosati, executive director of the Bucks County Drug and Alcohol Commission.

Now the county plans to use $3.9 million in local and state opioid settlement funds to support the center.

Susan Ousterman finds these developments difficult to stomach. Her 24-year-old son died of an overdose in 2020, and she later joined the Bucks County Opioid Settlement Advisory Committee, which developed a plan to spend the funds.

In a September 2022 email to other committee members, she expressed disappointment in the suggested uses: Please keep in mind, the settlement funds are not meant to fund existing programs or programs that can be funded by other sources, such as federal grants.

But Rosati said the county is maximizing its resources. Settlement funds will create a host of services, including grief groups for families and transportation to treatment facilities.

Were determined to utilize every bit of funding thats available to Bucks County, using every funding source, every stream, and frankly every grant opportunity that comes our way, Rosati said.

The countys guiding principles for settlement funds demand as much. They say, Whenever possible, use existing resources in order that Opioid Settlement funds can be directed to addressing gaps in services.

Ed Mahon of Spotlight PA contributed to this report.

Aneri Pattani: apattani@kff.org, @aneripattani Related Topics Courts Rural Health States Indiana Investigation New York Opioid Settlements Opioids Pennsylvania Contact Us Submit a Story Tip

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College football Luck Index 2025: Who needs luck on their side next season?

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College football Luck Index 2025: Who needs luck on their side next season?

Almost no word in the English language makes a college football fan more defensive than the L-word: luck.

We weren’t lucky to have a great turnover margin — our coaches are just really good at emphasizing ball security! We’re tougher than everyone else — that’s why we recovered all those fumbles!

We weren’t lucky to win all those close games — we’re clutch! Our coaches know how to press all the right buttons! Our quarterback is a cool customer!

We weren’t lucky to have fewer injuries than everyone else — our strength-and-conditioning coach is the best in America! And again: We’re just tougher!

As loath as we may be to admit it, a large percentage of a given college football season — with its small overall sample of games — is determined by the bounce of a pointy ball, the bend of a ligament and the whims of fate. Certain teams will end up with an unsustainably good turnover margin that turns on them the next year. Certain teams (often the same ones) will enjoy a great run of close-game fortune based on some combination of great coaching, sturdy quarterback play, timely special teams contributions … and massive amounts of unsustainable randomness. Certain teams will keep their starting lineups mostly intact for 12 or more games while another is watching its depth chart change dramatically on a week-to-week basis.

As we prepare for the 2025 college football season, it’s worth stepping back and looking at who did, and didn’t, get the bounces in 2024. Just because Lady Luck was (or wasn’t) on your side one year, doesn’t automatically mean your fortunes will flip the next, but that’s often how these things go. Be it turnovers, close-game fortune or injuries, let’s talk about the teams that were dealt the best and worst hands last fall.

Jump to a section:
Turnover luck | Close games luck
Injuries and general shuffling | Turnaround candidates

Turnover luck

In last year’s ACC championship game, Clemson bolted to a 24-7 halftime lead, then white-knuckled it to the finish. SMU came back to tie the score at 31 with only 16 seconds left, but Nolan Hauser‘s 56-yard field goal at the buzzer gave the Tigers a 34-31 victory and a spot in 2024’s College Football Playoff at Alabama’s expense.

In the first series of the game, Clemson’s T.J. Parker pulled a perfect sack-and-strip of SMU QB Kevin Jennings, forcing and falling on a loose ball at the SMU 33-yard line. Clemson scored two plays later to take a 7-0 lead. Late in the first quarter, Khalil Barnes picked off a Jennings pass near midfield, ending what could have become a scoring threat with one more first down. A few minutes later, Clemson’s Cade Klubnik fumbled at the end of a 14-yard gain, but tight end Jake Briningstool recovered it at midfield, preventing another potential scoring threat from developing. (Klubnik fumbled seven times in the 2024 season but lost only one of them.)

Early in the third quarter, after SMU cut Clemson’s lead to 24-14, David Eziomume fumbled the ensuing kickoff at the Clemson 6, but teammate Keith Adams Jr. recovered it right before two SMU players pounced.

Over 60 minutes, both teams fumbled twice, and Clemson defended (intercepted or broke up) eight passes to SMU’s seven. On average, 50% of fumbles are lost and about 21% of passes defended become INTs, so Clemson’s expected turnover margin in this game was plus-0.2 (because of the extra pass defended). The Tigers’ actual turnover margin was plus-2, a difference of 1.8 turnovers in a game they barely won.

Clemson was obviously a solid team in 2024, but the Tigers probably wouldn’t have reached the CFP without turnovers luck. For the season, they fumbled 16 times but lost only three, and comparing their expected (based on the averages above) and actual turnover margins, almost no one benefited more from the randomness of a bouncing ball.

It probably isn’t a surprise to see that, of last year’s 12 playoff teams, eight benefited from positive turnovers luck, and six were at plus-3.3 or higher. You’ve got to be lucky and good to win, right?

You aren’t often lucky for two straight years, though. It might be noteworthy to point out that, of the teams in Mark Schlabach’s Way-Too-Early 2025 rankings, five were in the top 20 in terms of turnovers luck: No. 5 Georgia, No. 7 Clemson, No. 9 BYU, No. 11 Iowa State and No. 17 Indiana (plus two others from his Teams Also Considered list: Army and Baylor).

It’s also noteworthy to point out that three teams on Schlabach’s list — No. 6 Oregon, No. 8 LSU and No. 15 SMU — ranked in the triple-digits in terms of turnovers luck. Oregon started the season 13-0 without the benefit of bounces. For that matter, Auburn, a team on the Also Considered list, ranked 125th in turnovers luck in a season that saw the Tigers go just 1-3 in one-score finishes. There might not have been a more what-could-have-been team in the country than Hugh Freeze’s Tigers.


Close games

One of my favorite tools in my statistical toolbox is what I call postgame win expectancy. The idea is to take all of a game’s key, predictive stats — all the things that end up feeding into my SP+ rankings — and basically toss them into the air and say, “With these stats, you could have expected to win this game X% of the time.”

Alabama‘s 40-35 loss to Vanderbilt on Oct. 5 was one of the most impactful results of the CFP race. It was also one of the least likely results of the season in terms of postgame win expectancy. Bama averaged 8.8 yards per play to Vandy’s 5.6, generated a 56% success rate* to Vandy’s 43% and scored touchdowns on all four of its trips into the red zone. It’s really hard to lose when you do all of that — in fact, the Crimson Tide’s postgame win expectancy was a whopping 98.5%. (You can see all postgame win expectancy data here)

(* Success rate: how frequently an offense is gaining at least 50% of necessary yardage on first down, 70% on second and 100% on third and fourth. It is one of the more reliable and predictive stats you’ll find, and it’s a big part of SP+.)

Vandy managed to overcome these stats in part because of two of the most perfect bounces you’ll ever see. In the first, Jalen Milroe had a pass batted at the line, and it deflected high into the air and, eventually, into the arms of Randon Fontenette, who caught it on the run and raced 29 yards for a touchdown and an early 13-0 lead.

In the second half, with Bama driving to potentially take the lead, Miles Capers sacked Milroe and forced a fumble; the ball sat on the ground for what felt like an eternity before Yilanan Ouattara outwrestled a Bama lineman for it. Instead of trailing, Vandy took over near midfield and scored seven plays later. It took turnovers luck and unlikely key-play execution — despite a 43% success rate, Diego Pavia and the Commodores went 12-for-18 on third down and 1-for-1 on fourth — for Vandy to turn a 1.5% postgame win expectancy into a victory. It also wasn’t Alabama’s only incredibly unlikely loss: The Tide were at 87.8% to beat Michigan in the ReliaQuest Bowl but fell 19-13.

(Ole Miss can feel the Tide’s pain: The Rebels were at 76.0% postgame win expectancy against Kentucky and 73.7% against Florida. There was only a 6% chance that they would lose both games, and even going 1-1 would have likely landed them a CFP bid. They lost both.)

Adding up each game’s postgame win expectancy is a nice way of seeing how many games a team should have won on average. I call this a team’s second-order win total. Alabama was at 10.7 second-order wins but went 9-4. That was one of the biggest differences of the season. Somehow, however, Iron Bowl rival Auburn was even more unfortunate.

Based solely on stats, Arkansas State should have won about four games, and Auburn should have won about eight. Instead, the Red Wolves went 8-5 and the Tigers went 5-7.

Comparing win totals to these second-order wins is one of the surest ways of identifying potential turnaround stories for the following season. In 2023, 15 teams had second-order win totals at least one game higher than their actual win totals — meaning they suffered from poor close-game fortune. Ten of those 15 teams saw their win totals increase by at least two games in 2024, including East Carolina (from 2-10 to 8-5), TCU (5-7 to 9-4), Pitt (3-9 to 7-6), Boise State (8-6 to 12-2) and Louisiana (6-7 to 10-4). On average, these 15 teams improved by 1.9 wins.

On the flip side, 19 teams overachieved their second-order win totals by at least 1.0 wins in 2023. This list includes both of 2023’s national title game participants, Washington and Michigan. The Huskies and Wolverines sank from a combined 29-1 in 2023 to 14-12 in 2024, and it could have been even worse. Michigan overachieved again, going 8-5 despite a second-order win total of 6.0. Other 2023 overachievers weren’t so lucky. Oklahoma State (from 10-4 to 3-9), Wyoming (from 9-4 to 3-9), Northwestern (from 8-5 to 4-8) and NC State (from 9-4 to 6-7) all won more games than the stats expected in 2023, and all of them crumpled to some degree in 2024. On average, the 19 overachieving teams regressed by 1.9 wins last fall.

It’s worth keeping in mind that several teams in Schlabach’s Way-Too-Early Top 25 — including No. 6 Oregon, No. 8 LSU, No. 11 Iowa State, No. 13 Illinois and, yes, No. 21 Michigan — all exceeded statistical expectations in wins last season, as did Also Considered teams like Army, Duke, Missouri and Texas Tech. The fact that Oregon and LSU overachieved while suffering from poor turnovers luck is (admittedly) rather unlikely and paints a conflicting picture.

Meanwhile, one should note that three Way-Too-Early teams — No. 12 Alabama, No. 23 Miami and No. 25 Ole Miss (plus Washington and, of course, Auburn from the Also Considered list) — all lost more games than expected last season. With just a little bit of good fortune, they could prove to be awfully underrated.


Injuries and general shuffling

Injuries are hard to define in college football — coaches are frequently canny in the information they do and do not provide, and with so many teams in FBS, it’s impossible to derive accurate data regarding how many games were missed due to injury.

We can glean quite a bit from starting lineups, however. Teams with lineups that barely changed throughout the season were probably pretty happy with their overall results, while teams with ever-changing lineups likely succumbed to lots of losses. Below, I’ve ranked teams using a simple ratio: I compared (a) the number of players who either started every game or started all but one for a given team to (b) the number of players who started only one or two games, likely as a stopgap. If you had far more of the former, your team likely avoided major injury issues and, with a couple of major exceptions, thrived. If you had more of the latter, the negative effects were probably pretty obvious.

Despite the presence of 1-11 Purdue and 2-10 Kennesaw State near the top of the list — Purdue fielded one of the worst power conference teams in recent memory and barely could blame injury for its issues — you can still see a decent correlation between a positive ratio and positive results. The six teams with a ratio of at least 2.8 or above went a combined 62-22 in 2024, while the teams with a 0.5 ratio or worse went 31-56.

Seven of nine conference champions had a ratio of at least 1.3, and 11 of the 12 CFP teams were at 1.44 or higher (five were at 2.6 or higher). Indiana, the most shocking of CFP teams, was second on the list above; epic disappointments like Oklahoma and, especially, Florida State were near the bottom. (The fact that Georgia won the SEC and reached the CFP despite a pretty terrible injury ratio speaks volumes about the depth Kirby Smart has built in Athens. Of course, the Dawgs also enjoyed solid turnovers luck.)


Major turnaround candidates

It’s fair to use this information as a reason for skepticism about teams like Indiana (turnovers luck and injuries luck), Clemson (turnovers luck), Iowa State (close-games luck), Penn State (injuries luck) or Sam Houston (all of the above, plus a coaching change), but let’s end on an optimistic note instead. Here are five teams that could pretty easily enjoy a big turnaround if Lady Luck is a little kinder.

Auburn Tigers: Auburn enjoyed a better success rate than its opponents (44.7% to 38.5%) and made more big plays as well (8.9% of plays gained 20-plus yards versus 5.7% for opponents). That makes it awfully hard to lose! But the Tigers made exactly the mistake they couldn’t make and managed to lose games with 94%, 76% and 61% postgame win expectancy. There’s nothing saying this was all bad luck, but even with a modest turnaround in fortune, the Tigers will have a very high ceiling in 2025.

Florida Gators: The Gators improved from 41st to 20th in SP+ and from 5-7 to 8-5 overall despite starting three quarterbacks and 12 different DBs and ranking 132nd on the list above. That says pretty spectacular things about their overall upside, especially considering their improved experience levels on the O-line, in the secondary and the general optimism about sophomore quarterback DJ Lagway.

Florida Atlantic Owls: Only one team ranked 111th or worse in all three of the tables above — turnovers luck (111th), second-order win difference (121st) and injury ratio (131st). You could use this information to make the case that the Owls shouldn’t have fired head coach Tom Herman, or you could simply say that new head coach Zach Kittley is pretty well-positioned to get some bounces and hit the ground running.

Florida State Seminoles: There was evidently plenty of poor fortune to go around in the Sunshine State last season, and while Mike Norvell’s Seminoles suffered an epic hangover on the field, they also didn’t get a single bounce: They were 129th in turnovers luck, 99th in second-order win difference and 110th in injury ratio. Norvell has brought in new coordinators and plenty of new players, and the Noles are almost guaranteed to jump up from 2-10. With a little luck, that jump could be a pretty big one.

Utah Utes: Along with UCF, Utah was one of only two teams to start four different quarterbacks in 2024. The Utes were also among only four teams to start at least 11 different receivers or tight ends and among five teams to start at least nine defensive linemen. If you’re looking for an easy explanation for how they fell from 65th to 96th in offensive SP+ and from 8-5 to 5-7 overall, that’s pretty succinct and telling.

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Good Cheer rallies in slop to win Kentucky Oaks

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Good Cheer rallies in slop to win Kentucky Oaks

LOUISVILLE, Ky. — Unbeaten filly Good Cheer rallied on the outside through the slop to overtake Tenma by the final furlong and win the 151st Kentucky Oaks on Friday at Churchill Downs.

Louisville-born trainer Brad Cox watched the heavy 6-5 favorite cover 1 1/8 miles in 1:50.15 with Luis Saez aboard. Good Cheer paid $4.78, $3.62 and $3.02 for her seventh dominant victory.

The bay daughter of Megdalia d’Oro and Wedding Toast by Street entered the Oaks with a combined victory margin of more than 42 lengths, and on Friday, she added more distance to her resume with a stunning surge over a mushy track.

Cox, who grew up blocks from Churchill Downs, earned his third Oaks win and Saez his second.

Drexel Hill paid $21.02 and $11.76 for second while Bless the Broken was third and returned $4.78.

A thunderstorm that roared through about two hours before the scheduled post left the track soggy and sent many of the 100,910 fans seeking shelter at the track’s urging. The $1.5 million showcase for 3-year-old fillies was delayed by 10 minutes, and the conditions proved to be a minor nuisance for Good Cheer.

She was off the pace after starting from the No. 11 post but well within range of the leaders before charging forward through the final turns. Good Cheer was fourth entering the stretch and closed inside and into the lead, pulling away for her fourth win at Churchill Downs and second in the mud.

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ID. Buzz recall: VW’s third-row bench is too big for its own good

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ID. Buzz recall: VW’s third-row bench is too big for its own good

Volkswagen of America is recalling nearly 5,700 2025 VW ID. Buzz vans because the NHTSA says the third-row bench seat is too spacious. (For real.)

According to the National Highway Traffic Safety Administration (NHTSA), the third-row bench is physically wide enough for three people, but it’s only designed to hold two, so it’s only equipped with two seat belts. That mismatch violates Federal Motor Vehicle Safety Standard number 208, which covers occupant crash protection. A bench that invites three passengers but only protects two isn’t just awkward – it’s a safety risk. It simply makes it too easy to squeeze that third person in the back “just that once” without a seatbelt, and that’s inviting trouble.

Volkswagen will fix the ID. Buzz issue by having dealers install “fixed unpadded trim parts” that adjust the seat’s usable width, and they’ll do it for free, because recall repairs are always free. It’ll probably be hard plastic on the seat to ensure a third person can’t squeeze in. Owner notification letters are expected to go out starting June 20, 2025.

Volkswagen has reported that, to date, there have been “no field claims known” of safety issues caused by the extra-wide third row bench seat. 

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Read more: This is the 2025 VW ID. Buzz’s Electrify America charging package


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