Sea of Blues

Local governments weigh how to best spend opioid settlement cash to thwart addiction

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New Mexico’s opioid crisis far outpaces the nation’s and has become a bigger problem over the last decade. The state has one of the worst fatal drug overdose rates in the country—which saw even higher rates during the pandemic.

Gov. Michelle Lujan Grisham has used an executive order to declare substance abuse here as a public health emergency, noting in a renewed order Dec. 12 that the state needs “immediate reinforcement and coordination” to address the crisis.

Some of the help on the way comes in the form of money from settlements with opioid manufacturers and retailers.

Local governments in Santa Fe say they want to throw out a life preserver by helping people with addictions who land in jail. They’re also working on programs to keep people on the right side of the law—and to keep them healthy.

Former Attorney General Hector Balderas joined nationwide cases and filed individual New Mexico lawsuits that argued pharmacies and drug manufacturers failed to adequately monitor suspicious opioid prescriptions written for illegitimate purposes and, therefore, contributed to today’s growing opioid epidemic. Payments to resolve those cases are due to bring more than $1 billion to state coffers.

Under the terms of the settlements, 55% of payments must be distributed to cities and counties. In Santa Fe County and the City of Santa Fe, officials are making plans about what to do next.

Dollars that are moving into local control could have immediate impacts. This year’s distribution to 33 counties and 20 cities and towns amounted to $96 million, according to documents provided by Attorney General Raúl Torrez.

Balderas, now the president at Northern New Mexico College in Española, tells SFR he advocated for local governments to have direct access to the cash.

“I took a much more aggressive position and wanted to democratize these funds so they wouldn’t just sit at the Legislature, and we chose a 55-45% model, which empowered local governments to bypass the politics and immediately begin building out treatment programs through cities and counties. And the Legislature and the governor could reinvest the other 45%,” Balderas says. “From the very beginning, we structured the settlement so that these dollars could immediately get to providers and so that we could deliver on the ground services.”

Plans are also still in development when it comes to the state’s use of the settlements. During this year’s legislative session, state lawmakers appropriated the first $21 million in settlement dollars for its programs. The state Department of Health received $3.5 million for medical-assisted treatment services—$1 million of which is specifically dedicated treatment for tribal members. The state Human Services Department will use $6.5 million to help provide housing assistance for those affected by opioid addiction; the startup and expansion of certified community behavioral health clinics and more. Finally, the state dedicated $1 million to the Corrections Department.

Lauren Rodriguez, director of communications for Torrez, tells SFR $76.8 million in settlement cash also went to the State Investment Council. The state expects settlement distributions until roughly 2041 and will have decisions to make each year about how to use the money. No one from the office was available for comment before press time, she says.

Balderas, however, says he’s concerned about how the state plans to use its share, adding he doesn’t believe the state “has been prepared enough [or] has done enough planning to determine what the best abatement strategies are.”

“They should have been creating enough treatment provider capacity years ago. They should have created governing councils to be ready to deploy. My vision in the litigation was to ensure that, if there’s a Walgreens or a CVS distributing pain pills, there will be proportional treatment in the community, and I’m not confident that they have necessarily hit the ground running,” Balderas says. “My concern is that if they distribute these proceeds the way they distribute capital outlay, we could exacerbate the addiction crisis in New Mexico.”

Local entities first received money from national settlements last year and the state began distributions this month from cases New Mexico fought alone. Proceeds are expected to continue over a period of 18 years, dependent on the individual settlement, as defendants including Walgreens, Albertsons, Kroger and Walmart transfer money to the state. However, Balderas says “most of the funding” is frontloaded, meaning the bulk should be received in the first few years.

The settlement terms also call for the money to only be used for opioid remediation, which consists of several core strategies, including increasing access to naloxone or other FDA-approved opioid overdose reversal drugs; distribution of and education on medication-assisted treatment (MAT); funding for jails to provide treatment for inmates; and implementation of various prevention and service programs.

For the Santa Fe County, putting the money into jail programs seems an obvious destination, but officials are using a grant from the US Department of Justice to plot out how that might work between now and August 2024.

So far, Communications Coordinator Olivia Romo says, the county has received $865,444 and budgeted $232,502 for fiscal year 2024 to create a new position in the Public Safety Department and to provide MAT services at the jail.

Local advocates say expanding MAT programs for inmates would be a significant and meaningful step. The treatment protocol—which prescribes drugs such as methadone and buprenorphine to help people with the physical aspects of dependence alongside other therapy—is already offered both at the jail and to clients at La Sala Center.

The center, which the county opened in 2021 at 2052 Galisteo St., houses medically-monitored residential withdrawal treatment overseen by the Santa Fe Recovery Center.

The “vast majority” of people seeking help at La Sala have a combination of substance use and mental health issues, La Sala Director Kate Field says, noting the center aims to make therapists and other services available immediately.

“We’re really quite comfortable in working with any presentation of individuals that might come in,” Field says. “That really means oftentimes very acute cases, individuals that cannot access outpatient care because of functional impairment or other barriers and are not meeting criteria for inpatient care. So it’s pretty unique to have this touch point.”

Santa Fe Recovery Center CEO Stacy Martin tells SFR of the roughly 5,000 people the recovery center helped this year with treatment and recovery services, about 50% are opioid addicted, and in recent years there’s been “a rapid increase” in clients using fentanyl. Those treated with MAT have the best chance of kicking the drugs, she says.

“It’s the gold standard because it combines medication with counseling and behavioral health therapies, and that helps people manage their cravings, that alleviates the withdrawal symptoms that can sometimes be debilitating and helps to restore to the extent possible normal brain function which is critical for recovery,” Martin says. “That’s the most critical service that our communities need, and it’s a service that we provide and it’s one that we’re trying to expand to help meet the growing need, as evidenced from the increase of opioid deaths and increase of fentanyl use.”

Martin points to statistics that have grown more dire. The US Centers for Disease Prevention and Control reports an overdose death rate of 51.6 per 100,000 people in New Mexico as of 2021, the latest year for which data is available. A decade earlier, the state’s overdose death rate was 26.3 overdose deaths per 100,000. (For comparison, the national average rate for 2021 was 32.4 deaths per 100,000. New Mexico has the fifth-worst rate.)

In the earliest days of the epidemic, overdose deaths were attributed to prescription drugs like oxycodone, morphine and hydrocodone along with heroin, but as the country cracked down on these, fentanyl produced in other countries and brought here illegally replaced those drugs in even greater quantities.

The US Department of Homeland Security recently wrapped its four-month long Operation Artemis, which led to over 900 seizures including more than 270 pounds of fentanyl pills and powder. And the sea of pills stretches all the way to Santa Fe County: In a single bust in May 2022, the county sheriff confiscated 36,000 fentanyl pills.

Emily Kaltenbach, who serves as the senior director of state advocacy and criminal legal reform for the Drug Policy Alliance and chaired the city’s Municipal Drug Strategy Task Force, tells SFR the organization hopes local governments both support existing programs for harm reduction measures and ramp up treatment.

“We strongly recommend that we invest in communities that are most impacted. Specifically, when we’re talking about opioid abuse and fentanyl, that is one way to help reduce overdose deaths: increased access to harm reduction supplies and services in general,” Kaltenbach says. “We also need to be making sure that we expand access to medication assisted treatment, both in the community and when people are incarcerated, so there’s a continuity of care for people who either need MAT or are already on MAT in the detention center.”

County Health and Human Services Department Director Rachel O’Connor says she agrees.

Jail medical staff already provide MAT programs for both alcohol and opioid dependent inmates who agree to treatment at the facility south of the city limits on Hwy. 14. It’s a badly needed service, as more than half of people booked in the facility in 2023 tested positive for fentanyl. Now, county staff are preparing to go one step further by potentially expanding those programs within a new medical unit.

“We plan to use our opioid settlement funds to renovate the facility to accommodate both enhanced options in treatment and increased detox services,” O’Connor tells SFR. “In conjunction with that, the Community Services Department’s job is to try to maximize the community to receive people that are coming out of the jail, so…there are the options to access treatment if you wish to when you leave the detention center.”

The county has had programs in place for decades to respond to acute substance abuse, she notes, including participation in the Law Enforcement Assisted Diversion in-house program, which provides case management and short-term housing opportunities for those accused of nonviolent crime and seeking treatment for addiction. The county budgeted over $5 million this year for behavioral health services, many related to opioid addiction. The county’s CONNECT program offers social determinant support that can include food, housing and utilities through a “closed-loop referral system.”

“Those services were really developed in the midst of the drug overdose crisis, and we’ve seen that change over time,” O’Connor says. “We’ve had some ability to impact that with increasing acuity again, now really related to fentanyl. We see fentanyl on both sides of La Sala: in the people that come into the crisis center, and certainly in the people that are in detox and in our county jail.”

Most recently in 2023, the county partnered with the City of Santa Fe and the New Mexico Department of Health for its fentanyl public awareness campaign to piggyback on national campaigns with the themes “One Pill Can Kill” and “Never Use Alone.”

“The data shows that a lot of overdoses happen when people are alone, and so how can you save someone’s life if you’re not with them? Sometimes it is used recreationally and it is used in groups, and are these people that are using together—armed with Narcan—to be able to save a life should they need to?” Santa Fe County DWI Administrative Program Manager Chanelle Delgado explains. “So that was kind of the data point that really drove that message is we’re wanting to encourage people if you choose to use, do it in a way that’s gonna save your life, right?”

Meanwhile, the City of Santa Fe already received around $1 million in settlement money, and City Attorney Erin McSherry tells SFR officials anticipate a total of $4.8 million in the first two years, with more than $8 million by the end of the 18-year payout schedule. Right now, she says, city staff are developing a proposal of how to spend the money.

Community Health and Safety Department Director Kyra Ochoa tells SFR the proposal will seek to “serve the people hit the hardest by the opioid crisis.”

While opioid addiction affects families all over Santa Fe, she says those who are both unhoused and addicted are the most at-risk.

“They are not getting the services they need, which include appropriate shelter and housing and treatment,” Ochoa says. “We have a focus on serving and ending homelessness, and homeless folks are not entirely 100% opioid addicted, but that is a large section of the population that are unsheltered, so expanding some of the services we’ve done in that regard would be certainly a focus.”

All plans are subject to approval from the City Council and the mayor, she says, but Ochoa’s department is “looking to consolidate and make maximum impact” with a large project.

“Although we have a hefty amount of opioid settlement dollars here in the first year, that we can launch something with, the ongoing operating costs are not going to be fully covered,” Ochoa says. “So we want to think of it in a way like a grant where we’re going to have to watch something and identify how to sustain it over time.”

Ochoa says she anticipates her department will bring the proposal before the governing body in the early part of next year.

Dr. James Besante, chief medical officer at Santa Fe Recovery Center, tells SFR that given ubiquitous access to drugs, the local plans to spend money on evidence-based treatment and other wide-ranging prevention can’t come soon enough.

“There’s more objective data that suggests these medicines really help people on their recovery journey,” says Besante, adding later, “I could walk outside my office right now and I could probably buy fentanyl within 10 minutes. It is a Herculean task to access methadone treatment, and that could be very expensive and take me weeks to access.”