After years of work, a little-known advisory committee has submitted its recommendation to Palm Beach county commissioners on how to spend $148 million over 20 years from opioid lawsuit settlements.
Many loved ones of committee members have died from substance abuse. The committee insists others don’t die, too.
At a workshop Tuesday, county commissioners will hear the panel’s plan for person-centered and recovery-oriented care rather than the traditional focus on treatment.
The 18-member committee, called the Palm Beach County Advisory Committee on Behavioral Health, Substance Use and Co-Occurring Disorder, suggests 90% of the money go toward the so-called “social determinants of health,” such as housing, recovery support, job training, youth assistance and prevention.
Ten percent would go to acute care, the system that many committee members blame for treating their loved ones and putting them back on the street without the services they need to keep them from relapsing.
“This is really important, many of us who have contributed to this plan over the years are no longer with us today,” committee Chair Maureen Kielian said at the panel’s May 13 meeting.
“We're here. We're not here today to do the exact failures that this plan recommends remedying.”
Not everyone on the committee supports the emphasis on post-treatment care.
The Palm Beach County Health Care District, a taxpayer-supported agency, submitted written criticism, saying “If this plan is intended to reflect a unified community vision addressing the behavioral health needs for our community, it does not yet achieve that objective.
“Better access to care, expanded behavioral health services, crisis response and call centers that meet (federal) guidelines, and expanded care coordination are recurring needs identified for Palm Beach County. The report needs more focus on these critical areas."
County officials also have raised concern. They considered adding recommendations on a specific allocation of the money, something the committee did not attempt. As recently as last Tuesday, County Administrator Verdenia Baker told commissioners that this Tuesday's workshop might be delayed because the plan still had a “few kinks in it.”
But county officials on Friday agreed to move forward, placing the committee’s presentation as the third item on Tuesday’s workshop agenda.
You can see the county’s presentation here and the committee’s full plan here.
While the committee’s core membership, appointed in November 2022 by county commissioners, is closely aligned with the substance abuse community, including family members, treatment providers and clergy, the panel also has a heavy dose of government representation.
Included are the Palm Beach County State Attorney’s Office, the Palm Beach County Sheriff’s Office, county Fire Rescue, the Florida Department of Health, the county Health Care District and the Southeast Florida Behavioral Health Network, a nonprofit contractor that distributes state and federal money for behavioral health services in Palm Beach, Martin, St. Lucie, Indian River and Okeechobee counties.
Still, the voices of loved ones drove the committee’s work.
Kielian, the director of Southeast Florida Recovery Advocates and a mother whose son lives with chronic relapsing addiction, emphasized the point at a March 14 committee meeting.
“I guess I could stick my head in an ivory tower and tell people everything is OK, but it’s not,” she said. “Be mindful of the settlement funds. They’re really not just settlement funds. They were born out of blood.”
A corrupt business model
For years, Palm Beach County and particularly Delray Beach, was considered the recovery capital of the United States. Patients hooked on opioid-based painkillers, such as Purdue Pharma’s OxyContin, flocked to the area to get clean.
A fraudulent feeding frenzy followed, turning sober homes where patients went to get healthy after detox into million-dollar businesses built on expensive and unnecessary urine tests reimbursed by insurance. Some sober home operators encouraged or tolerated relapse since it meant more urine tests and more profit.
In 2018, after law enforcement began to crack down, Florida and Palm Beach County sued drug manufacturers, distributors and retailers over their role in promoting opioid-based painkillers. The money to be distributed to the county and several cities comes from settling those lawsuits.
Already, the county and cities have received payments for two years, amounting to $25.5 million. County officials expect they will get another $122.5 million over the next 18 years, bringing the total to $148 million.
Ending ‘treat and street’
The committee incorporated its recommendations on spending the money into an updated Behavioral Health and Substance Use Disorder Plan, subtitled “Advancing a Resilience and Recovery Ecosystem of Care.”
Members spent two years revising the master plan, initially developed in 2022, and supplemented by data and studies conducted by Florida Atlantic University’s College of Social Work and Criminal Justice.
“Today, we will present recommendations … to help mitigate the treat-and-street methodology … the dehumanization of the most vulnerable patient populations being transported with only their possessions in a trash bag, social services that are not person-centered, programs with failing patient outcomes,” Kielian said at the May 13 meeting in which the committee endorsed the proposals.
“Wholeheartedly, these recommendations … are done respectfully,” she said, “honoring the lives of our sons, daughters, fathers, mothers, husbands, wives, aunts, uncles, grandparents and very, very dear friends that are being lost to this public health emergency.”
Key recommendations
The recommendations for spending the opioid settlement money are part of a broad menu of strategies, including:
- Provide housing, peer support, care coordination and flexible spending.
- Focus housing on stable placement and affordability, including transitional, recovery, supportive living and permanent housing.
- Establish a neutral care-coordination entity providing assessment, level-of-care determination, referral, prior authorization and payment of certain care and care monitoring.
- Expand syringe programs and recovery and treatment services, including those that use drug therapy, to end addiction.
- Promote “recovery-ready work environments” and expand transportation and employment opportunities for individuals with substance abuse disorder and co-occurring mental health conditions.
- Create public awareness campaigns and community-based education or support services that build resilience, recognize adverse child experiences and are trauma-informed.
- Expand the county’s substance abuse and mental health research capacities and enhance its monitoring, surveillance, data collection and evaluation capabilities.
The committee’s exact wording can be found on Page 72 of the plan here.
This story was originally published by Stet News Palm Beach, a WLRN News partner.
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