Small bins are lined up to be distributed to users, wherein the user can dispose of their drug needles and paraphernalia safely, and drop them off at the Harm Reduction Action Center. Photo by PHILIP B. POSTON/Sentinel Colorado

AURORA | Thousands of local governments nationwide, including Aurora and Denver, are receiving settlement money from companies that made, sold or distributed opioid painkillers, like Johnson & Johnson, AmerisourceBergen and Walmart.

These companies are shelling out more than $50 billion total in settlements from national lawsuits. Aurora’s take in the settlements is $334,150 for the first year, according to state reporting records. The city is slated to receive about $3 million over 18 years.

An additional $24 million or so is being steered by Arapahoe County’s Regional Opioid Abatement Council, led by elected and appointed officials from Aurora and nearby jurisdictions. Denver, which is a city and a county, is slated to receive close to $1.2 million this year and $10.4 million over 18 years.

Colorado has not been a stranger to the opioid epidemic, which has claimed thousands of lives in the state. In recent years, many people have fallen victim to the powerful synthetic opioid fentanyl, which law enforcement and other monitors warn has tainted the supply of street drugs and can unknowingly poison people who believe they are taking other substances.

In 2021, the most recent year for which data is available, 1,881 people died of a drug overdose in the state, according to the Colorado Department of Public Health and Environment. More than two-thirds of those were from opioids.

Colorado will receive about $270 million in settlement money over the next 15 years from drug makers Teva and Allergan and pharmacies CVS and Walgreens, according to a press release from the Colorado Attorney General’s Office. The majority of the funds will be distributed to local communities through 19 Regional Opioid Abatement Councils, including Arapahoe County’s. The state has received about $400 million from previous settlements as well.

“Holding the companies that created and fueled the opioid crisis responsible continues to be a top priority for me and my team,” Colorado Attorney General Phil Weiser said in a statement. “Just like with previous settlements secured by our department and other attorneys general across the country, this money will go directly towards supporting the people and communities in Colorado who continue to battle the harms of drug addiction and misuse.”

Finding out the precise amount each city or county is receiving on a national scale has been nearly impossible because the firm administering the settlement hasn’t made the information public until recently.

After more than a month of communications with state attorneys general, private lawyers working on the settlement and the settlement administrators, Kaiser Family Foundation Health News obtained documents showing the exact dollar amounts — down to the cent — that local governments were allocated for 2022 and 2023.

More than 200 spreadsheets detail the amounts paid by four of the companies involved in national settlements. (Several other opioid-related companies will start making payments later this year.)

For example, Jefferson County, Kentucky — home to Louisville — received $860,657.73 from three pharmaceutical distributors this year, while Knox County, a rural Kentucky county in Appalachia — the region many consider ground zero of the crisis — received $45,395.33.

In California, Los Angeles County was allocated $6.3 million from Janssen, the pharmaceutical subsidiary of Johnson & Johnson, this year. Mendocino County, which has one of the highest opioid overdose death rates in the state, was allocated about $185,000.

Access to “this information is revolutionary for people who care about how this money will be used,” said Dennis Cauchon, president of the nonprofit advocacy group Harm Reduction Ohio.

Some states, like North Carolina and Colorado, have posted their distribution specifics online.

But in most other places, tracking payment amounts requires people to make phone calls, send emails and file public records requests with every local government for which they want the information.

Thus, gathering the data across one state could mean contacting hundreds of places. For the country, that could translate to thousands. Cauchon has been seeking this information for his state since April 2022.

“Opioid remediation work is done at the local level, at the individual level, and, now, for the first time, local people working on the issues will know how much money is available in their community,” he said.

Narcan, Naloxone and new syringes are just a few items available at the Arapahoe County Health Department’s syringe access services building, in Aurora. The center distributed 560 Naloxone kits in 2021, with two doses per kit and has distributed 77 kits this year to date. Photo by PHILIP B. POSTON/Sentinel Colorado

Aurora narrowing options

Francoise Bergan, an Aurora City Council member who also serves as vice chair of the Arapahoe County regional council, said the council has so far identified six categories where money will be spent.

Expanding walk-in detox programs is on the list. Currently, hospitals shoulder part of the burden in Arapahoe County, but those facilities tend to discharge patients after just a few days, Bergan said. Sober living programs have also been tabbed for funding, as have services focusing on peer navigation, harm reduction and youth leadership.

Ceilique Hatcher, a consultant with the Steadman Group serving the council in a facilitator role, said youth leadership and outreach is particularly important for the council, which hopes to steer individuals away from substance abuse at a young age.

“The council really wants to focus on at what age substance abuse usually sets on, and sometimes it starts at youth, so what can they do to abate that and alleviate that by providing programs for youth?” she said. 

Law enforcement co-response programs pairing officers with social workers or mental health clinicians in jurisdictions where the demand outstrips available resources might also benefit from regional funds.

The group began meeting in July of last year and developed requests for proposals earlier this year. 

Bergan said the amount of settlement funds controlled by the region currently could grow by another $10 million, depending on the outcomes of other pending settlements. As of right now, the region has yet to make final decisions about where the money it controls will be spent.

But Bergan said the county urgently needs more resources to help treat individuals trapped in the cycle of opioid abuse. She said the problem is personal for her, having multiple family members who have struggled with drug and alcohol abuse.

“One of my cousins committed suicide as a result of his addiction,” she said. “I just think it’s a crisis, and unfortunately it’s a hodgepodge of services that aren’t coordinated to solve this problem right now.”

Bergan said the council hopes to issue awards out of the first few years of funding totaling close to $5.5 million later this month. The city, too, has yet to decide on how its first tranche of opioid settlement dollars should be spent.

Aurora has opted to control its own share of settlement money, along with most larger communities, while the regional council’s spending will go toward programs that benefit the larger Arapahoe County area.

The national opioid settlements are the second-largest public health settlement of all time, following the tobacco master settlement of the 1990s.

The money is meant as remediation for the way corporations aggressively promoted opioid painkillers, fueling an overdose crisis that has now largely transitioned to illicit drugs, like fentanyl. More than 105,000 Americans died of drug overdoses last year.

So far, state and local governments have received more than $3 billion combined, according to a national summary document created by BrownGreer, a settlement administration and litigation management firm that was court-appointed to handle the distribution of payments. In each state, settlement funds are divided in varying percentages among state agencies, local governments and, in some cases, councils that oversee opioid abatement trusts.

Dominic Rodriguez speaks with registered nurse Kathy Lalli after she treated his skin injuries at the Kensington Hospital wound care outreach van, parked in the Kensington neighborhood of Philadelphia, Tuesday, May 23, 2023.

Payments began in 2022 and will continue through 2038, setting up what public health experts and advocates are calling an unprecedented opportunity to make progress against an epidemic that has ravaged America for three decades. KFF Health News is tracking how governments use — and misuse — this cash in a yearlong investigation.

The latest trove of documents was obtained from BrownGreer. The firm is one of the few entities that knows exactly how much money each state and local government receives and when, since it oversees complex calculations involving the varying terms and timelines of each company’s settlement.

Even so, there are gaps in the information it shared. A handful of states opted not to receive their payments via BrownGreer. Some directed the firm to pay a lump sum to the state, which would then distribute it to local governments. In those cases, BrownGreer did not have figures for local allocations. A few states that settled with the opioid-related companies separately from the national deals are not part of BrownGreer’s data, either.

Roma Petkauskas, a partner at BrownGreer, said the settlement agreement requires the firm to send notices of payment amounts to state and local governments, as well as to the companies that settled. It shared documents when KFF Health News asked, but it is not clear if the firm will continue doing so.

Petkauskas wrote, “Settlement Agreements do not provide that such notices be made public,” indicating such disclosure was not a requirement.

People harmed by the opioid crisis say they want more transparency than the bare minimum requirements. They say, currently, it’s not only difficult to determine how much money governments receive, but also how those dollars are spent. Many people have reached out to local officials with questions or suggestions only to be turned away or ignored.

Christine Minhee, founder of, found that, as of March, only 12 states had committed to publicly reporting the use of 100% of their settlement dollars. Since then, just three more states have promised to share detailed information on their use of the money.

Legal and political experts watching the settlements say the lack of transparency may have to do with political leverage. State attorneys general have touted these deals as achievements in glowing press releases.

“Attorney General [Daniel] Cameron today delivered on his promise to fight back against the opioid epidemic by announcing a more than $53 million agreement with Walmart,” read one press release issued late last year by the state of Kentucky.

“Thousands of our neighbors have buried their loved ones throughout the opioid epidemic,” and “I am proud to have delivered this great agreement to them,” said Louisiana Attorney General Jeff Landry, in a July 2021 announcement when one of the earliest settlements was finalized.

Greater transparency, including the specific payment amounts for each local government, may take the wind out of some of those press releases, Minhee said. “It’s hard to politicize things when you can’t present the numbers in a vacuum.”

If one community compares its several-hundred-dollar payout to another community’s multi-thousand-dollar payout, there may be political fallout. Concerns have already arisen in rural areas hit hard by the crisis that the distribution formula weighs population numbers too heavily, and they will not receive enough money to address decades of harm.

Still, experts say making this data public is a crucial step in ensuring the settlements fulfill the goal of saving lives and remediating this crisis.

Solutions have to be community-led, said Regina LaBelle, director of the addiction and public policy initiative at Georgetown University’s O’Neill Institute. “In order to do that, the communities themselves need to know how much money they’re getting.”

If their county is receiving $5,000 this year, it wouldn’t make sense to advocate for a $500,000 detox facility. Instead, they might focus on purchasing naloxone, a medication that reverses opioid overdoses. Knowing the yearly amount also allows people to track the funds and ensure they’re not being misspent, LaBelle added.

For Cauchon, of Harm Reduction Ohio, the local-level payment data is key to ensuring settlement dollars are put to good use in each Ohio county.

“Knowledge is power and, in this case, it’s the power to know how much money is available to be used to prevent overdoses,” he said.

Nick Gallagher reacts as volunteer registered nurse Jennifer D’Angelo treats his skin wounds the Savage Sisters’ community outreach storefront in the Kensington neighborhood of Philadelphia, Wednesday, May 24, 2023. Xylazine can cause severe skin wounds, but whether it is leading to more deaths — as suggested by officials in Washington — is not yet clear, according to health and law enforcement professionals on the front lines of efforts in New Jersey, New York and Pennsylvania. (AP Photo/Matt Rourke)

A new threat for an existing threat

A powerful animal sedative in the illicit drug supply is complicating the U.S. response to the opioid crisis, scrambling longstanding methods for reversing overdoses and treating addiction.

Xylazine can cause severe skin wounds, but whether it is leading to more deaths— as suggested by officials in Washington — is not yet clear, according to health and law enforcement professionals on the front lines of efforts in New Jersey, New York and Pennsylvania. In fact, early data suggests the drug may inadvertently be diluting the effects of fentanyl, the synthetic opioid behind most overdose deaths.

Federal health officials say the drug has been reported in 48 of 50 states during the last two years, including Colorado.

“Working with the Boulder County Drug Task Force, Boulder County Public Health has learned that xylazine is being distributed in the county’s illicit drug supply, and residents should take extra precautions to stay safe,” Boulder health department officials said in a statement in May.

There is broad agreement, however, that much more information is needed to understand xylazine’s impact, to craft ways of disrupting illegal supplies and to develop medicines to reverse its effects.

“We don’t know whether xylazine is increasing the risk of overdose or reducing the risk of overdose,” said Dr. Lewis Nelson of Rutgers New Jersey Medical School, who advises federal regulators on drug safety. “All we know is that there are a lot of people taking xylazine and a lot of them are dying, but it doesn’t mean that xylazine is doing it.”

In almost all cases, xylazine — a drug for sedating horses and other animals — is added to fentanyl, the potent opioid that can be lethal even in small amounts. Some users say the combination, dubbed “tranq” or “tranq dope,” gives a longer-lasting high, more like heroin, which has largely been replaced by fentanyl in U.S. drug markets.

Like other cutting agents, xylazine benefits dealers: It’s often cheaper and easier to get than fentanyl. Chinese websites sell a kilogram for $6 to $20, no prescription required. Chemicals used to produce fentanyl can cost $75 or more per kilogram.

“Nobody asked for xylazine in the drug supply,” said Sarah Laurel, founder of Savage Sisters, a Philadelphia outreach group. “Before anybody knew it, the community was chemically dependent on it. So now, yes, people do seek it out.”

Xylazine’s effects are easy to spot: Users experience a lethargic, trance-like state and sometimes black out, exposing themselves to robbery or assault.

Sharday Miller, walks away holding extra bandages she received after having her skin treated at the Kensington Hospital wound care outreach van parked in the Kensington neighborhood of Philadelphia, Tuesday, May 23, 2023. Xylazine, a powerful animal sedative that’s moving through the illicit drug supply is complicating the U.S. response to the opioid crisis, causing gruesome skin wounds and scrambling longstanding methods for treating addiction and reversing overdoses. (AP Photo/Matt Rourke)

“It’s a delayed reaction. I could be walking down the street, it’s 45 minutes later,” says Dominic Rodriguez, who is homeless and battling addiction. “Then I wake up, trying to piece together what happened.”

In humans, the drug can cause breathing and heart rates to drop. It’s also linked to severe skin ulcers and abscesses, which can lead to infections, rotting tissue and amputations. Experts disagree on the exact cause of the wounds, which are much deeper than those seen with other injectable drugs.

Naloxone, a medication used to revive people who have stopped breathing, doesn’t reverse the effects of xylazine. Philadelphia officials stress that naloxone should still be administered in all cases of suspected overdose, since xylazine is almost always found in combination with fentanyl.

“What it is doing is making the deadliest drug we’ve ever seen, fentanyl, even deadlier,” Anne Milgram, head of the Drug Enforcement Administration, told attendees at a recent conference.

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