The Suffolk County Opioid Settlement Fund is a reserve of money awarded to the County through lawsuits initiated by the County. These lawsuits were against opioid manufacturers, distributors, and pharmacies. In August 2016, Suffolk County filed one of the first county-led lawsuits in the country against opioid manufacturers, distributors, and pharmacies (The County of Suffolk, New York v. Purdue Pharma L.P.). This lawsuit aimed to hold these groups accountable for their role in creating and continuing the opioid epidemic. Nassau County and other counties in New York State then filed similar lawsuits, as they were also heavily affected by the opioid epidemic. These cases were consolidated in 2017, to make a stronger and more streamlined case. The State of New York then joined this lawsuit in 2018. The proceedings mark the first opioid case to move forward with a jury trial in state and federal court. In 2021, the first settlment was reached in this case.

From 2021-2022, the Suffolk Counrt Legislature passed a series of bills to accepted funds from Rite Aid, CVS, Walgreens, Walmart, Johnson & Johnson, Endo, Allergan, and TEVA. As part of the settlement terms, conditions have been placed on how the money from the settlement can be used. The funds from these settlments must only be used for opioid use:

• prevention
• harm reduction
• treatment
• recovery

The document which lists these approved uses for the Suffolk County Opioid Settlement Fund is called the "Schedule C". The money in this fund will be paid to the County over a period of 18 years. The Fund is managed and distributed by the Suffolk County Government.

Federal lawsuits against opioid manufacturers, distributers, and pharmacies was brought by states and local government units like counties, cities, townships, and villages. In 2021, national settlements were reached to resolve all opioid lawsuits against the largest three opioid distributors (McKesson, Cardinal Health, and AmerisourceBergen) and against opioid manufacturer Janssen Pharmaceuticals, Inc., and its parent company, Johnson & Johnson (J&J). In 2022, agreements were announced with two more manufacturers (Allergan and Teva), as well as three pharmacy chains (CVS, Walgreens, and Walmart). Under both the 2021 and 2022 National Settlements, at least 85% of the funds going directly to participating states and local governments must be used for abatement of the opioid epidemic. This means prevention, harm reduction, treatment, and recovery services. Opioid manufacturers, distributors, and pharmacies will pay billions of dollars for abatement. The settlements also created changes in the way the companies in the lawsuits can run their businesses. For example:

• The Distributors will create a clearinghouse to account for their own shipments, and shipments of the other distributors. This is required to detect, stop, and report suspicious opioids orders.
• J&J will not market or sell any opioid products in the next ten years and has agreed to stop lobbying about prescription opioids for ten years. J&J stopped marketing Opioids in 2015 and stopped selling Opioids in 2020.
• Teva and Allergan have agreed to strict limits on their marketing, promotion, sale, and distribution of opioids. This includes a ban on: (1) promotion and lobbying; (2) rewarding or disciplining employees based on volume of opioid sales; and (3) funding or grants to third parties
• Walmart, CVS, and Walgreens are required to make changes in how they handle opioids. This includes requirements addressing their compliance structures, pharmacist judgment, diversion prevention, auspicious order monitoring. It also includes reporting on red-flag processes and blocked and potentially problematic prescribers

In New York, funds gained from settlements will be divided among state agencies and localities. The funds are divided to ensure that each part of the State gets an appropriate share.

In 2021, New York passed legislation to create a dedicated opioid settlement fund. This dedicated fund makes sure that these settlements are used for abatement (Senate Bill S7194). This means they can only be used for prevention, harm reduction, treatment, and recovery services. The legislation establishes the New York State Opioid Settlement Fund Advisory Board, appointed by the state and localities. The Board will guide the legislature in approving the spending of the funds by state agencies, counties, and city governments.

The New York State Office of Addiction Services and Supports (NYS OASAS) maintains an Opioid Settlement Fund Tracker for the use of settlement funds within New York State. For information on opioid settlement funding initiatives in New York State, please visit https://oasas.ny.gov/opioid-settlement-funding-initiatives.

The purpose of these funds is to invest in local prevention, harm reduction, treatment, and recovery programs. This investment will reduce the harmful impacts of the opioid crisis, and help people to lead healthier and more fulfilling lives. These program goals include:

• Educating youth and the wider community, and empowering them to make healthier choices to prevent drug use
• Expanding evidence based strategies to prevent overdose deaths of people who use drugs
• Strengthening pathways to treatment and support services
• Providing more opportunities to engage people using drugs in effective treatment programs
• Supporting families and social networks to heal together
• Meaningfully reintegrate people back into community life through a focus on education, job attainment, and housing

In 2021-2022, a Task Force was created to develop a guidance document for the use of the Suffolk County Opioid Settlement Fund. The Task Force worked to gather information from experts and stakeholders about the opioid crisis in the County. The Task Force met eight times, hearing testimony from experts on the opioid epidemic, including:

• mental health and substance use disorder providers
• treatment service providers
• prevention and recovery agencies
• the court system
• the County Department of Health Services
• other County agencies

Presenters spoke of the devastating impact of loss from the high number of opioid related deaths.  Challenges brought to the Task Force covered accessing appropriate levels of care, concerns with a shrinking behavioral health care workforce, and limited funding.  Presenters also highlighted new initiatives and ideas about how the County can move forward. The overwhelming consensus from the Task Force process was the need to focus these limited opioid dollars in the areas currently with the most significant gaps, and where there is the greatest potential for a positive change. These areas are prevention, harm reduction, treatment and recovery. Click here to read the 2022 Suffolk County Opioid task Force Report.

To prepare for the County for using these funds, the Suffolk County Legislature passed a resolution to create the Opioid Settlement Funding Selection Committee. The purpose of this committee is to review program proposals submitted by local agencies, and select initiatives to fund. The Legislation specified the 5 members of this committee: (1) The County Executive or designee, (2) The Presiding Officer of the Suffolk County Legislature or designee, (3) The Minority Leader of the Suffolk County Legislature or designee, (4) The Commissioner of the Department of Health Services or designee, (5) and a victim’s advocate.

On July 25, 2022, Suffolk County announced the opening of an application portal to accept proposals from local agencies to use a part of the opioid settlement fund. The portal was developed to ensure equal access to all agencies to apply for this funding. It was also a chance and for the County to hear directly from local agencies about their ideas to create meaningful change in the community. The portal included a link to Schedule C (approved uses of funds), a frequently asked questions, and a guidance document. Agencies could call 311 and be connected with the Suffolk County Department of Health Services if they had questions. To apply, agencies submitted descriptions of their proposed programs and budgets. They also provided information on current County contracts, licensures, and any active monitoring plans.  A team from Suffolk County Department of Health Services reviewed all proposals to check that they aligned with the approved uses in the Schedule C.

The Opioid Settlement Funding Selection Committee met to review the portal submissions, and select programs to fund. These decisions were based on:

1. The proposed value of the programs to people who use drugs and their social network, and
2. The observed gaps in care and program suggestions documented by the Task Force.

In August 2023, the portal opened again to accept a second round of applications. The same review and selection process was repeated in this second round.

After two rounds of applications, 76 programs have been awarded across 50 agencies. The agency types that have received awards include:

• Community Based Organizations (CBO)
• New York State Office of Addiction Services and Supports (NYS OASAS) and New York State Office of Mental Health (NYS OMH) Licensed Programs
• Community Coalitions
• Townships
• Hospitals
• School-Based Programs
• Federally Qualified Health Centers (FQHC)
• New York State Department of Health Designated Drug User Health Hub

The Opioid Settlement Funding Selection Committee did not fund any proposals from County departments. The only agency types funded were those mentioned above. This was not a reflection of the quality of the proposals received by County departments. Rather it was an intentional decision to first support proposals from the community.

To fund these programs, the Suffolk County Legislature has allocated almost $58,000,000 of the Suffolk County Opioid Settlement Fund. This was done through the resolution process. This funding amount may appear to be small in comparison to the reserves in the entire Fund. However, these funds are meant to bring lasting change to the County. Spreading the spending of this Fund over a period of many years better ensures that there will be a sustainable source of money to continue combatting this long-standing public health issue. This is especially important as new challenges arise. This time will also allow the County to analyze the effectiveness of the many program approaches taken; what is working, and what is not working. With this data, the County can adjust future funding and focus on activities that bring the most value to the community.

Most programs are funded for a three-year period. This gives agencies time to build/expand and become sustainable. When the County is prepared to offer further rounds of funding, these opportunities will be widely announced.

The intent of these opioid settlement funds is to support prevention, harm reduction, treatment, and recovery programs that will positively change lives, and work to heal from the immense and irreversible loss of life. The County has a duty and responsibility to ensure that these funds are effectively being used to further this goal.

One way the County monitors and evaluates this efficacy is through the collection and analysis of data from each of the awarded programs. The Division of Community Mental Hygiene Services (Division) and the funded agencies worked together to create data metrics for each program. These different metrics were based on individual goals and activities of each program.

These metrics include both process measures and outcome measures. Process measures look at the steps taken to launch and run the program. Outcome measures look at the results of the program. The Division and Agencies also set goals for these outcome measures, known as “units of service”. The Division uses the units of service as an achievement benchmark. They are also used as a tool explore what is effective, and where there are opportunities for improvement within each program. The Division is equipped to provide technical assistance to the agencies if needed.

Each agency completes and submits a detailed data report to the Division on a monthly basis. This is part of their contractual responsibilities. Many agencies include narratives to expand on the data provided, and share impact stories.