Over the past two years, rural Greene County in northeastern Tennessee has collected more than $2.7 million from regional and national settlements with opioid manufacturers and distributors. But instead of helping people harmed by addiction, county officials are finding other ways to spend it.<\/p>\n

They have put $2.4 million<\/a> toward paying off the county\u2019s debt and have directed<\/a> another $1 million<\/a> arriving over more than a decade into a capital projects fund. In March, they appropriated $50,000 from that fund to buy a \u201clitter crew vehicle\u201d \u2014 a pickup truck to drive inmates to collect trash along county roads.<\/p>\n

\u201cIt\u2019s astounding,\u201d said Nancy Schneck, a retired nurse who has seen addiction infiltrate the community, where employers avoid drug testing for fear of losing too many employees and mental health crises and homelessness are rampant. She wants to see the money go toward mental health and addiction treatment. Why can\u2019t county leaders \u201csee treating some people and maybe getting them out of this cycle might be advantageous?\u201d she said.<\/p>\n

In 2021, the latest year for which comparable data is available, Greene County\u2019s rate of drug overdose deaths topped state and national figures.<\/p>\n

But Mayor Kevin Morrison<\/a> said the county has borne the costs of the opioid epidemic for years: It has funded a beleaguered sheriff\u2019s office, improved the jail \u2014 which is packed with people who\u2019ve committed addiction-related crimes \u2014 and supported a drug court to divert some people to treatment. It has also suffered indirect costs of the crisis: people dropping out of the workforce due to addiction, schools and welfare services caring for more children who\u2019ve experienced trauma, and some taxpayers leaving the county altogether. Addiction is not the sole reason for Greene County\u2019s economic woes, but it has contributed to more than $30 million<\/a> of debt.<\/p>\n

Greene County, Tenn., is directing some of its opioid settlement money into the county\u2019s capital projects fund. In March, $50,000 from that fund was appropriated to buy a \u201clitter crew vehicle,\u201d a pickup truck used to drive inmates assigned to collect trash by the side of the road. The new truck is not in use yet but looks just like this white truck, the sheriff\u2019s office said. (Greene County Sheriff’s Office)<\/span><\/figcaption><\/figure>\n

\u201cWe\u2019ve been dealing with this crisis for quite some time, but nobody wants to pay the bill as it comes,\u201d Morrison said. \u201cSo when these funds are made available, then we are paying bills that have been due for quite some time.\u201d<\/p>\n

The debate in this Appalachian county is reverberating nationwide as state and local governments receive billions of dollars<\/a> from companies that made, distributed, or sold opioid painkillers, like Johnson & Johnson, Cardinal Health, and CVS. The companies were accused of fueling the overdose epidemic, and the money is meant to remediate that harm. About $3 billion has already landed<\/a> in state, county, and city coffers, and about $50 billion more is expected in the coming decade and beyond.<\/p>\n

States are required to spend at least 85% of the money on opioid-related programs, but KFF Health News\u2019 ongoing investigation<\/a> into how the cash is used \u2014 and misused \u2014 shows there is wide interpretation of that standard and little oversight.<\/p>\n

That restriction didn\u2019t apply to the money Greene County moved to its capital projects fund.<\/p>\n

In many rural communities, which have been struggling to pay addiction-related costs for decades, local officials justify using the settlement funds to reimburse past expenses. Most of Tennessee\u2019s 95 counties are in significant debt, which can present difficult choices about how to use this money, said Robert Pack<\/a>, co-director of East Tennessee State University\u2019s Addiction Science Center.<\/p>\n

Still, he and many advocates hope the settlement funds are spent on tackling the current crisis. After all, more than 200 people<\/a> nationwide are dying of overdoses each day. Investing in treatment and prevention can save lives and protect future generations, they say.<\/p>\n

\u201cThere is no good excuse to sit on the funds or put them into a general fund,\u201d said Tricia Christensen<\/a>, policy director for the nonprofit Community Education Group<\/a>. The organization is tracking settlement spending<\/a> across Appalachia, which Christensen called the epidemic\u2019s ground zero. \u201cThese dollars should be used to support people who have been most impacted by the overdose crisis.\u201d<\/p>\n