Georgia has the opportunity to tap into millions of dollars to address the drug overdose crisis thanks to settlements of lawsuits against pharmaceutical companies and others involved in distribution and sales of prescription opioids. Most recently, in May 2022, Governor Kemp signed legislation that helps unlock $636 million from the settlement with Cardinal, McKesson, AmerisourceBergen and Johnson & Johnson. With equitable planning and additional legislative action, Georgia can ensure that this influx of funding is spent intentionally and transparently to save lives and build long-term, community-led solutions.
Drug Overdose Is an Urgent, Costly Health Crisis in Georgia
Drug overdoses have been increasing in Georgia over time. According to the Georgia Department of Public Health, all drug overdose deaths in Georgia increased by about 56 percent from 2019 to 2021. Most drug overdose deaths involve opioids—particularly illicitly manufactured fentanyl. From 2019 to 2021, fentanyl-involved overdose deaths increased by a staggering 218 percent. In 2020, drug overdose was the leading cause of premature death for Georgians.
Drug overdose affects every Georgia community, but in different ways. Overall, the drug overdose death rate is highest among whites compared to other racial/ethnic groups in Georgia. However, the Black and Latinx communities have seen sharp increases over the past decade. Between 2010 and 2020, drug overdose has increased by about 244 percent among Black Georgians and 410 percent among Latinx Georgians compared with a 52 percent increase among white Georgians during that same period. Similarly, non-rural Georgia has a higher number of overdose deaths, but rural Georgia has a higher death rate. Only about 1 in 10 Georgians who die of a drug overdose had a history of treatment for substance use disorder, which indicates that there are significant barriers to getting access to the life-saving services that Georgians need. Many Black and Latinx Georgians and Georgians living in rural communities face particularly steep barriers to accessing services and supports for substance use disorder.
Drug overdose also costs the state millions of dollars per year. According to CDC estimates, the combined cost of opioid use disorder and fatal overdose in Georgia is about $21 million per year. However, investing in prevention, treatment, harm reduction and recovery support services can both save lives and save money. For example, a prevention program that helps communities address risk factors for substance use disorder and other problems among youth found that a $603 investment in each child yielded an estimated $7,753 in savings by the time the participants turned 23, which amounts to almost $13 return for each dollar invested.
Opioid Settlements Bring Millions in Funding to Georgia
On January 7, 2022, Georgia’s Attorney General Chris Carr announced that Georgia had joined a multi-state agreement with Cardinal, McKesson, and Johnson & Johnson. On May 2, 2022, Governor Kemp signed Senate Bill 500 into law, which enacts a litigation bar that prevents local governments from pursuing any further legal action against these entities in the future. This ban was required in order to receive 100 percent of the settlement dollars available. With the litigation bar in place, Georgia will receive a total of $636 million and an initial allocation of $66 million within 90 days.
Georgia has previously received and distributed funding from a different settlement. In February 2022, Governor Kemp announced the award of over $13 million from the state’s settlement with McKinsey & Company (see table below for more details).
| Settlement | Total Funding Amount for Georgia | Funding Distribution |
| McKinsey & Company | Over $13 million | Department of Behavioral Health and Developmental Disabilities
Department of Public Health
|
| Cardinal, McKesson, AmerisourceBergen and Johnson & Johnson | $636 million ($66 million available within first 90 days) | No funding announcements have been made. The settlement memorandum of understanding outlines some guidelines.
Overall State Local |
Sources: Office of the Governor; Office of the Attorney General; and NationalOpioidSettlement.Com
Georgia also receives hundreds of millions in Federal funding each year to address substance use disorder and mental health issues from Substance Abuse and Mental Health Services (SAMSHA), the Centers for Disease Control and Prevention (CDC) and the Department of Justice (DOJ). The opioid settlement funding presents an opportunity to bolster existing Federal funding rather than supplanting it. Funding decisions should be made with those other programs in mind in order to avoid duplication of efforts and ensure cohesion in the work.
Georgia Can Save Lives Now While Also Prioritizing Prevention and Building Community Resilience
The new opioid settlement funding presents an opportunity to address the current drug overdose crisis—by expanding access to treatment, harm reduction and recovery services—while also preventing the overdose crisis of tomorrow. Addressing the current overdose crisis might look like using the funding to expand access to naloxone, improve treatment services in jails and prisons, enhance integrated recovery support services, or—thanks to the passage of House Bill 1175—provide access to fentanyl test strips. These types of investments can save lives today and center the urgent and important needs of Georgian’s living with substance use disorder.
It is also critical that we create the conditions where Georgia’s children can thrive in order to prevent future substance use disorder and drug overdose. Substance use disorder and mental health conditions often begin during childhood and adolescence, and in Georgia, they have become increasingly common. According to the Georgia Department of Public Health, suicide was the 3rd and overdose was the 7th leading cause of death for 1 – 19-year-olds in Georgia from 2016- 2020. Across the United States, youth have seen declining rates of mental health over time, and these mental health concerns were further exacerbated by the health impacts of the pandemic as well as its effect on social connectedness, economic stability and more. According to CDC data, in 2021, 37 percent of high school students reported they experienced poor mental health during the COVID-19 pandemic. Some youth are more severely impacted than others. For example, in 2021, female youth and lesbian, gay and bisexual youth reported more acute levels of poor mental health; elevated emotional abuse by a parent or caregiver; and were more likely to have attempted suicide. Moreover, a growing body of research tells us that societal issues like economic insecurity, social isolation and generational trauma are some of the underlying drivers contributing to increases in not only drug overdose, but also the interrelated increases in suicide and mental health concerns. As House Speaker David Ralston stated in remarks regarding mental health legislation during the 2022 legislative session, “we are losing the battle for the future to hopelessness and despair.”
In order to meet the moment and truly address drug overdose at its roots, Georgia should use also opioid settlement funds to expand evidence-based prevention programs for children and youth and initiate community-level initiatives that build community resilience. For example, Georgia could use funding to build upon the successes of the Department of Behavioral Health and Developmental Disabilities’ Apex program and increase funding for school-based mental health services that meet children where they are. Georgia could also fund new evidence-based programs for children, youth, and their families—like nurse home visiting programs, family training programs, or school-based group interventions—that promote positive development and address risk factors for both substance use disorder and mental health conditions. Lastly, Georgia could also use the funding to support innovative, community-led efforts to help children, families and communities heal from trauma. Childhood trauma, known as adverse childhood experiences (ACEs), increases the risk of overdose. As the number of ACEs someone has experienced increases, so does their risk of opioid misuse. Programs that address individual- and community-level trauma can help decrease the risk of overdose along with other poor health and life outcomes. For example, in West Virginia, Ohio and Tennessee, multi-sector community coalitions have come together to address the root causes of the overdose epidemic and build community resilience.
Legislative Action Can Ensure Accountability and Community-Led Decision-Making
State-level legislative solutions exist that can establish a system of accountability for how settlement money is spent and ensure decision-making is led by communities and those most impacted by the overdose epidemic. Specifically, policymakers should pass legislation that establishes the infrastructure needed to implement the terms of the current settlement (and any future opioid settlements) in a way that is equitable, evidence-based and transparent. Such legislation might include:
- Creation of an opioid fund to manage payments received by the state from opioid-related settlements
- Establishment of an oversight body that oversees management of the fund
- Membership should reflect both professional expertise and lived experience related to the overdose crisis (including, people living with substance use disorder and their family; public health experts; youth; healthcare providers; faith leaders; recovery experts; law enforcement; returning Georgians impacted by the War on Drugs; etc.)
- Development of a public reporting system that tracks how funds are spent and what impact they are having (such as North Carolina’s data dashboard)
During the 2022 Legislative Session, House Bill 1321 proposed the creation of the Georgia Opioid Crisis Abatement Trust and the Opioid Recovery and Remediation Fund Advisory Council and established a public reporting process. However, that bill never made it out of the House. In addition, House Bill 911, which passed both the House and Senate, included over $260,000 to support the administrative infrastructure necessary to implement the terms of the opioid settlement as well as the proposed Georgia Opioid Abatement Trust Funds and the Opioid Recovery and Remediation Fund Advisory Council. Ultimately, that line was vetoed from the fiscal year 2023 budget by Governor Kemp. From Texas to Tennessee to Kentucky, many other states have passed and begun to implement similar legislation. In addition to looking to other states, policymakers, state agencies, and others can also borrow from resources like the Georgia Prevention Project’s ‘Recommendations for Effective Use of Georgia Opioid Settlement Resources’ and Johns Hopkins University’s ‘Principles for the Use of Funds from the Opioid Litigation’ as they think through future legislative and administrative action.
The Chairman of Georgia’s Behavioral Health Reform and Innovation Commission, former State Representative Kevin Tanner, declared this the decade of mental health reform. Georgia should leverage this forward momentum and all the funding at our disposal, including opioid settlement dollars, to ensure we put an end to the drug overdose epidemic and build a brighter future for Georgia’s children.
