Brewster Discusses Next Steps With Regional Opioid Settlement Funds

BREWSTER – Eight years after Massachusetts’ governor and attorney general joined nationwide class-action lawsuits against pharmaceutical manufacturers accused of creating the opioid epidemic, communities are now confronting a new question: How to use the settlement funds meant to repair the damage?

A regional needs assessment marks the first step toward understanding where those resources can make the greatest impact.

Jo Morrissey of Crescendo Consulting went before the select board last Monday to present findings from the assessment conducted last fall. 

After the settlements were awarded, area towns decided to pool their resources to make an even greater impact across the region. Brewster, Chatham, Harwich, Orleans and Dennis were awarded a total of $1.85 million, which is expected to grow as the final settlements for Purdue Pharma and the Sackler family conclude. These funds are set to be dispersed over 16 years, beginning in 2022. Final payments are scheduled to be distributed in 2038.  

Each town has received a different amount which was determined at a national level. Town Manager Peter Lombardi said for Cape Cod, it was partially based on the schools population at a snapshot in time, but students that were part of a regional school were not counted. Some towns have already expended some of the funding, while Brewster has not spent any. 

“Massachusetts is expected to receive $1 billion over 18 years as part of sweeping nationwide settlements with pharmaceutical companies relating to allegations brought against them in connection with the opioid overdose crisis,” according to a press release from the Healey-Driscoll Administration. “The Opioid Recovery and Remediation Fund (ORRF) was established in 2020 to receive and administer the state’s share of settlement funds.”

The distribution of the funds was contingent on the Massachusetts municipal settlement agreement which developed a list of shared commitments that must be followed when using the money. These included community input, addressing mental health and substance use, supplementing existing programs and services without replacing them and encouraging innovation to fill the gaps. 

The agreement also came with a list of seven strategies that municipalities could use to help heal communities and find some sort of resolution. Each strategy included a list of activities that could help facilitate the action.  

The health departments in each of the four towns across the Lower Cape and Dennis decided a needs assessment was necessary to look at the epidemic’s impact holistically.  

This past fall, Crescendo Consulting conducted five community outreach listening sessions and sent a virtual survey to residents. The listening sessions resulted in 63 residents attending in-person and 209 survey responses. 

The first topic discussed was treatment. Many of the responses alluded to a lack of 30-day inpatient programs accessible to Cape residents; a lack of followup upon release from incarceration, treatment or detox; cost of insurance; a stigma by healthcare professionals for those on medicated-assisted treatment; the difficult task of getting a dual diagnosis for mental health and substance use; and the quality and experience of primary care providers on Cape Cod. 

Key findings also addressed recovery efforts, or the lack thereof. Morrissey discussed how many responses included the lack of sober housing and transportation as a hindrance to recovery. She also said that many residents mentioned similar topics when discussing treatment, such as the lack of follow up for persons incarcerated, in treatment or detox and the cost of insurance. Other pain points included the lack of self-care training for individuals struggling with substance use and support for needed services like employment, housing, counseling and job training. 

Other topics that jumped out at Morrissey as she was conducting the assessment included law enforcement and family. 

A common theme was the need for social workers in local law enforcement and added support for those leaving incarceration, she said. She also heard that many residents felt that the judicial response to drug dealers was too lenient. 

The family bucket included topics like support services for family members, prevention tactics, education and the availability of Narcan, the lifesaving drug for overdoses. 

After concluding the fact-finding efforts, Morrissey hosted a prioritization public meeting on Dec. 19. This included 23 representatives from each municipality that were either key partners to the program or who had lived experiences with opioid abuse. Each participant was asked to rank the 16 identified needs by magnitude, severity and feasibility to create a priority list. 

The top three needs were youth opioid use prevention, providing services and support to address underlying trauma and mental health issues, and understanding the importance of harm reduction services and resources from the continuum of care perspective. 

She then created a timeline of next steps that would enable the municipalities to begin the work. Within the next few months, Morrissey suggested creating an opioid strategic planning charter. By June, she said, a planning committee could be established to help tackle the tasks moving forward. Between June and July, the committee could look into secondary opioid use data. 

In August, a draft strategic plan would help the committee align and create an allocation plan to support the activities identified. By September, the committee would present a final draft of the strategic plan to the town select boards and boards of health. Then, they would need to monitor the activities throughout the next year to report back to the state. 

After the presentation, select board member Pete Dahl inquired about the lack of funding for families of individuals that have passed away due to opioid use. 

“In this case, I just see more treatment and I agree with everything in here,” he said. “But I would love to see an additional plan or additional program that would help the families of those impacted in kind of the most severe way.” 

Morrissey said while the terms are relatively broad, those impacted are included in the “families who are living and loving” category. They will likely be included in the strategic planning process where there is room to get more granular about who will receive the funds and in what capacity, she said. 

Lombardi said if all towns decided to move forward with the timeline, an intermunicipal agreement would be drafted and technical assistance would be provided by the state.