San Mateo County poised to see more opioid settlement funds

Numerous corporations, ranging from wholesale distributors to pharmaceutical firms and pharmacy benefit managers, have or continue to face lawsuits related to their roles in exacerbating the opioid epidemic. In addition to Kroger, supermarket chains like Publix have also faced litigation.

Several cities in the county, such as San Mateo and Belmont, have opted to join the Kroger settlement case. The state is poised to receive up to $122 million in abatement, or opioid remediation, funding, although the amount each city is entitled to is yet to be determined.

Similar settlement payments have proved instrumental for the county in treating substance abuse disorders. Since 2022, it’s received almost $3 million from several distributors as well as $1.9 million from pharmaceutical firms Janssen and Mallinckrodt. That has helped expand staffing and program development in places like the county’s Redwood City Navigation Center, county jail, as well as several other case management and education outreach efforts. It’s also ramped up access to medication-assisted treatment, such as suboxone, or buprenorphine.

“As of April 1, emergency medical services countywide now stock buprenorphine and can intervene and provide that information should they arrive on the scene. They’re obviously using naloxone to reverse overdoses and save lives, but if somebody is in opioid withdrawal or they lost access to medication, they can administer buprenorphine in the field,” Mary Fullerton, clinical services manager for San Mateo County, said.

Some cities, including Belmont, have joined opioid settlement cases, including Kroger’s, but opt to have their funds transferred to the county due to its more built-out programs.

But with the prospect of additional disbursements, some localities, such as San Mateo, are choosing to redirect the funds toward their own programs. The city will receive about $820,000 from the other settlement cases over almost two decades and has already received about $30,000 annually for the past several years. The council recently voted to join the Kroger settlement case and have the funds reallocated to the city, not the county, as it did with previous settlement cases.

“The impetus for the switch was because we have homeless outreach activities that occur within San Mateo, and we think there is potential to use those opioid settlement funds in connection with those outreach activities,” City Attorney Prasanna Rasiah said.

But despite the much-needed boost to such initiatives, the payments are entangled with robust reporting requirements, and some of it has to be used toward hiring an independent contracting service. That certainly helps prevent the misuse of the funds, but it also adds another layer of complexity.

“The reporting requirements are pretty hefty from the state on what we’re allowed to spend, on how we have to track, how we have to report, so it’s quite comprehensive, and that takes up a bunch of time,” Fullerton said.

The disbursements are also inconsistent, especially as some of the corporations involved in the cases, such as Mallinckrodt, filed for bankruptcy.

“One of the biggest challenges of the opioid settlement funding has been the way that federally and statewide the distributions happen. It’s kind of unpredictable,” Fullerton said. “It takes time, and it should, but because I come from the treatment end, I want to have this stuff yesterday.”

Still, with a high opioid overdose rate, any and all assistance is welcome. From the two-year 2016-18 period to 2018-20, the opioid overdose rate in the county increased by 50%. While much of the settlement funds must go toward directly treating individuals with substance abuse disorders, there is still a lot to be done on the prevention side for all drug addictions. The proliferation of prescription misuse by youth, such as Adderall, can lead to long-term addiction. And some telehealth firms, such as Done, have recently been the subject of criminal investigations for promoting such medications on social media sites, targeting audiences who don’t necessarily need them.

“Now, if you’re getting Adderall or some other medication, you could be getting it from Snapchat, and it very likely is not what it says it is,” Fullerton said. “The landscape is shifting rapidly in this world and so to be able to keep up with it and to have some support through the opioid settlement dollars, it’s really a valuable tool at this time to help us reach that whole sector.”