Amid Opioid Overdose Crisis, Yale Program in Addiction Medicine Advises State on Drug Company Settlement Spending

The majority of the estimated $206 billion resulting from the Tobacco Master Settlement Agreement have not gone to address smoking or public health. Following a similar settlement of a multi-state litigation, the state of Connecticut is expecting around $600 million to address the state’s opioid overdose crisis, which resulted in 1,340 overdose deaths in 2023 alone. To avoid the experience of the Tobacco funds, Yale faculty are proactively providing recommendations on how to spend these funds.

With overdose-related deaths in the state at an all-time high, the arrival of these funds provides an opportunity for Connecticut to supplement ongoing efforts to address the harms of opioid use in the state.

To guide the state in the use of these funds to reduce opioid-related injury, overdose and death in the state, faculty and staff from the Yale Program in Addiction Medicine of the Yale School of Medicine and Yale School of Public Health, comprising the Connecticut Opioid REsponse (CORE) Initiative, recently released a 66-page report outlining evidence-based funding priorities to advise the Connecticut Opioid Settlement Advisory Committee (OSAC) on distribution of opioid settlement funds. The OSAC was created by the Connecticut Legislature in 2022. The Connecticut Department of Mental Health and Addiction Services (DMHAS) oversees the OSAC’s distribution of settlement funds from opioid manufacturers.

David Fiellin, MD, professor of medicine (general medicine), of emergency medicine, and of public health; assembled the expert team and tapped Benjamin Howell, MD, MPH, MHS, assistant professor of medicine (general medicine), to lead the writing of the new report.

“The OSAC and DMHAS reached out to Dr. [David] Fiellin to reassemble a team to provide a document that would give recommendations to the OSAC on how to spend those funds. Over the last year, we generated the now finalized report. It was a broad charge to summarize the current best evidence available on how to address opioid overdoses and provide recommendations on how the funds should be spent on things that have a good chance of having a positive impact on the overdose crisis," explained Howell.

Yale faculty and staff were previously recruited by the Governor’s office for their expertise in addiction medicine in 2016, when the CORE Initiative was first developed. The CORE team were commissioned to create a strategic plan to address the overdose epidemic in Connecticut which helped inform state policy and practice.

The new report updates and expands upon the 2016 document, explained Emma Biegacki, MPH, program manager, Yale Program in Addiction Medicine.

“The funds are now coming to the state government through settlements related to litigation with various drug companies and distributors. This prompted the state to enlist the CORE team and ask for a revised report, an update based on the latest evidence of what Connecticut should be spending these settlement dollars on. The devastating and ongoing impact of fentanyl on the overdose crisis in Connecticut has increased the urgent need for effective interventions,” said Biegacki.

“When the settlement was made between these entities and the state's Attorney General, it explicitly said that there will be guardrails on how the money should be spent, a document called Exhibit E. A group at Johns Hopkins created principles for the use of these funds that were our starting place. We knew we wanted to focus on things with strong evidence that, in the short term, would save lives,” described Howell.

The team met with state agencies and organizations that provide services in the state and with people from impacted communities to understand how these stakeholders think funds should be used. In addition to the recommendations outlined below, the robust report notes what Connecticut currently has in terms of resources or programs suggested in one comprehensive place.

The Connecticut Opioid REsponse (CORE) Initiative Report on Funding Priorities for the Opioid Settlement Funds in the State of Connecticut outlines the following seven priorities:

1. Increase Access to the Most Effective Medications (Methadone and Buprenorphine) for Opioid Use Disorder Across Diverse Settings
2. Reduce Overdose Risk and Mortality, Especially Among Individuals at Highest Risk and Highest Need with Linkage to Treatment, Naloxone, and Harm Reduction
3. Improve the Collection, Analysis, Sharing, and Use of Data Across Agencies and Organizations Relevant to Addressing the Opioid Overdose Crisis
4. Invest in Training and Support to Increase the Size of the Addiction Workforce and Help Non-Specialists to Provide Services
5. Simultaneously Deploy and Evaluate Select Primary, Secondary, and Tertiary Prevention Strategies
6. Invest in Efforts to Reduce Community Stigma Against Opioid Use Disorder and Opioid Use Disorder Treatments
7. Address Social Determinants and Structural Needs of At-Risk and Impacted Populations

“Hopefully as the subcommittees within the broader OSAC are reviewing requests for funding, they'll use this guidance to help identify strong proposals. There are also some relevant appendices in the report that outline things that we do not believe should be funded for lack of evidence. We focused specifically on readily actionable, readily fundable interventions that could be implemented in the near-term,” said Biegacki.

In addition to Howell, Fiellin, and Biegacki, other authors include Robert Heimer, PhD, professor of epidemiology (microbial diseases) and of pharmacology; Gail D’Onofrio, MD, MS, Albert E. Kent Professor of Emergency Medicine, Professor of Epidemiology (Chronic Diseases) and professor of medicine (core addiction); William Becker, MD, professor of medicine (general medicine); and Kimberly Sue, MD, PhD, assistant professor of medicine (general medicine); and of social and behavioral sciences.

Individuals interested in the proceedings of the OSAC may visit the OSAC website to review meeting minutes and materials. The OSAC meets regularly via videoconference and meetings are open to the public.

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