WELLFLEET — Money from the settlement of lawsuits against the pharmaceutical industry for its aggressive and deadly marketing of opioids has begun to flow to the towns of the Outer Cape.
As of November, $79.3 million had been deposited in state and town coffers from drug manufacturers Johnson & Johnson and Mallinckrodt and distributors Cardinal, McKesson, and Amerisource Bergen. Eastham, Wellfleet, Truro, and Provincetown will eventually receive a total of $621,000, spread out over 17 years.
The total coming to the four towns for the year 2022 comes to just $63,344 — not enough to hire even one social worker. But it is an opportunity to do something about a thorny problem beset with challenges and lack of resources. There is little insurance reimbursement for most substance abuse services, and many nonprofits, such as Wellfleet-based Live for Lou, hold fundraisers to pay insurance deductibles and the costs of maintaining sober homes.
The settlement money is supposed to mitigate some of the devastating effects of one of the deadliest addiction waves in American history. Since 2020, there have been six opioid overdose deaths on the Outer Cape alone — three in Eastham, two in Provincetown, and one in Wellfleet. The towns’ emergency medical services have had to respond to more than 50 calls related to opioid use in just the last two years.
The money due to the state of Massachusetts and its towns and counties totals $526 million and will be deposited in annual chunks until 2038. Forty percent of that total goes to the towns for prevention and treatment programs and recovery services for people with addiction disorders. The remaining 60 percent, totaling $347 million, will be deposited in a state trust fund for similar uses.
Mass. Health and Human Services Secretary Mary Lou Sudders and her successors will decide how to spend the state money. Residents who want to be involved in or at least observe the decision-making process can attend quarterly virtual meetings of the 21-member Opioid Recovery and Remediation Fund Advisory Council.
For Cape Cod, the settlement means $8,418,798 by 2038 in new money for addiction services. Nearly $1 million has been sent to the 15 towns in Barnstable County this year, according to the state. None of the towns has decided how to spend the money yet, according to Mandi Speakman, deputy director and project manager for the Barnstable County Dept. of Human Services.
Just how the towns use the money will be decided by select boards. Kate Lena, the county’s substance abuse prevention program manager, has been presenting the Barnstable County Regional Substance Abuse Council’s recommendations to the select boards across Cape Cod. She was in Wellfleet on Sept. 27 and in Truro on Oct. 25, and she spoke with Provincetown’s board of health on Oct. 20. A meeting with the Provincetown Select Board will happen soon, but there is no firm date yet, Speakman said.
Lena has advised towns to pool the money and collaborate on its uses. She asked that people affected by substance use disorder be part of decision making; this should include, Speakman said, people in “recovery, people who are actively using substances, and family members.” The projects they support should be evidence-based, she added.
Select boards will be taking directions from health departments, according to Truro and Provincetown officials.
“The money given to the separate towns will not be enough to do anything substantive, so we hope to develop a plan for the Outer Cape as a region,” said Truro Health Director Emily Beebe. “We hope to develop a plan so the funds will be more effectively applied to help the residents they are meant to help.”
The health directors of the four towns are forming a working group with the Outer Cape Community Solutions Network, Beebe said. A rural health network founded in 2019, it received a $100,000 U.S. Health Resources and Services Administration grant in 2021 for the specific purpose of unifying health providers in rural areas to work on systemic or root causes of health disparities — poverty, poor public transportation, and the housing crisis.
With doctors, social workers, police, and firefighters attending to patients in crisis, it is impossible to address these “upstream” problems that affect people’s health, said Alex Nelson, the network coordinator and the first staff member. She has hired Elen Camara as an ambassador to the Latino community. And the network is looking to hire an ambassador to the Jamaican community, Nelson said.
“It is really common, especially in rural communities, for folks in these positions to end up working alone,” said Nelson, a 28-year-old Nauset High School graduate from Orleans.
Town health agents spend most of their time on inspections and on wastewater and conservation issues. But the pandemic has turned their attention to health care, said Nelson. To that end and related to the opioid settlement funds, the network has pulled together a substance use disorder working group that will hold its first meeting next week. It will include the town health directors, public safety personnel, people in recovery, peer support specialists (who are also in recovery), case managers, social workers, and doctors.
They will do “asset mapping” to find what services exist and what is needed. “Then you can be strategic in your planning approach,” Nelson said.
The last time this part of Cape Cod had a rural health network was 1987 to 2010, when it was run by B.L. Hathaway and called the Lower/Outer Cape Community Coalition. The group found gaps in services and helped create the Cape Cod Children’s Place, the Community Development Partnership, and the Ellen Jones Community Dental Center, Nelson said.
Systemic change takes time, but the network “is about breaking down silos to have more efficient solutions,” Nelson said.
The state trust fund money — the $347 million mentioned above — will create and enhance a range of services that should touch Cape Codders. In fact, of the $9.5 million that has been spent so far, $600,000 went to Acadia Healthcare to open a mobile methadone clinic in Wellfleet, according to Matt Davis, Acadia’s regional vice president. (See story on page A8.)
That is part of the trust’s effort to expand medication-assisted treatment statewide. The other priorities are to bolster harm-reduction services to keep active drug users safe, add supportive housing, and engage in community outreach. The state has also allocated another $110 million in American Rescue Plan Act funds to forgive loans for psychiatrists, social workers, and doctors entering the field of mental health and addiction in underserved areas, including the Outer Cape.
