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The trust last year approved about $906,000 for an Allegheny County program that supports parents and guardians “who need child care support while undergoing treatment or job seeking and do not qualify for state funded child care subsidies.”

A national coalition of harm reduction, recovery, and other groups described this program as a good use of settlement funds. Testimony from officials at PolicyLab at Children’s Hospital of Philadelphia also highlighted this program and suggested other counties could consider a similar approach “to invest in child care system gaps.”

Funds were dedicated to increasing salaries in child welfare and probation offices that have historically not been “compensated fairly or equitably for the additional requirements the opioid epidemic has caused,” the county said in a spending report. The trust board rejected the choice. But after an appeal from Cameron County, the trust’s Dispute Resolution Committee in January decided to send the issue back to the full board.

At the board’s public meeting in February, trust officials approved the funds for the child welfare portion, which totaled about $9,000, but they did not reach a final decision on the county’s probation workers.

The trust rejected $30,000 for this program. The program is available to children in ninth through 12th grades from the county’s largest school district, and it provides mentors and weekly opportunities for outdoor activities, according to testimony as summarized in the county’s appeal.

Tom VanKirk, chair of the trust, told county officials that trust members were assessing whether settlement money goes directly to help prevent opioid abuse and not just whether something is “a nice project.”

The county appealed to Commonwealth Court in October, arguing that the initiative was compliant as an evidence-informed program. In response, attorneys for the trust maintained that the county’s program is not compliant.

The trust originally rejected these efforts in June. One member said that “the trust is not a community development program,” while another said they needed “to do the letter of the law when it comes to Exhibit E.” That’s a settlement document that describes approved uses for the money, but also says strategies “may include, but are not limited to,” those listed.

Philadelphia appealed, arguing that trust officials “ignored the empirical relationship between trauma and substance use” and that interventions targeting the most at-risk communities “are effective at preventing opioid misuse and abuse.” A committee of the trust reversed the rejections for these initiatives. At the same meeting, the committee also decided the city’s use of the funds for rent and mortgage assistance was compliant.

The trust originally rejected these efforts in June. One member said that “the trust is not a community development program,” while another said they needed “to do the letter of the law when it comes to Exhibit E.” That’s a settlement document that describes approved uses for the money, but also says strategies “may include, but are not limited to,” those listed. A committee of the trust upheld the rejections for these initiatives.

The city later appealed to Commonwealth Court, arguing Philadelphia is using interventions that “target root causes of addiction and are supported by empirical studies and the latest recommendations from national leaders.” Philadelphia’s appeal describes $3.4 million it says was wrongly denied, although figures previously released by the trust describe a lower amount.

Attorneys for the trust argued that the city “failed to establish that providing handouts to residents and small business owners in Kensington would remediate or prevent” opioid use disorder or “mitigate the effects of the opioid epidemic.”

Settlement documents list funding media campaigns to prevent opioid use and misuse, as well as other public education efforts, as approved uses for the money.

Searching for “advertising” in Spotlight PA’s spending database shows eight results, including $200,000 for a Carbon County program. The database also shows similar programs elsewhere: $150,000 for media campaigns in Bucks County, about $263,000 for a fentanyl awareness campaign in Monroe County, and $300,000 for a public education campaign in Allegheny County.

Trust officials and Northampton County have sparred over a newsletter portion of a media campaign. The trust decided only about $4,200 out of about $22,000 spent on the newsletter effort was compliant, according to an appeal from the county.

The county argued that all of the money should be allowed and that the “newsletter combined prominent placement of the ‘Fake is Real’ advertising with information about county resources.” In its response, attorneys for the trust said the “vast majority of the content in the County Newsletter has nothing to do with” opioid use disorder “remediation or prevention.”

Exhibit E, a settlement document that describes allowable spending, specifically lists increasing funding for jails to provide treatment to inmates with opioid use disorder as a priority for the funds.

Millions of dollars in settlement money have gone to medication, counseling, or other treatment-related purposes in Pennsylvania jails. Searching for “prison” or “jail” in Spotlight PA’s spending database shows more than 30 results, including in Allegheny, Berks, Bucks, Butler, Chester, Clearfield, Cumberland, Elk, Erie, Lancaster, Lehigh, McKean, Mercer, Perry, and Westmoreland Counties. The level of detail available on each program through trust records varies widely.

The trust approved each of those programs. A report from the Pennsylvania Institutional Law Project said the expansion of opioid use disorder medication in jails is “an important and much-needed shift” but noted “much more work remains to be done.” A national coalition of harm reduction, recovery, and other groups supports using settlement funds to increase access to opioid use disorder medications in prisons and jails, but not as a replacement for existing money for these efforts.

The trust approved $65,000 for this program, which the county said aimed to prevent the smuggling and distribution of illicit drugs. “Prior to installing this system we had an inmate smuggle opioids into the facility, resulting in 3 overdoses,” the county’s report said. “One of the three resulted in the death of an inmate.”

A national coalition of harm reduction, recovery, and other groups criticized a Michigan county for a similar use of settlement funds, calling a body scanner for a jail an example of problematic spending.

The trust offered guidance discouraging this type of spending, even though opioid settlement money flows to some district attorneys’ offices in the state. The trust’s explanation said “the services of an assistant public defender are required to be provided by the counties.” A national coalition of harm reduction, recovery, and other groups criticized the disparity between prosecutors and public defenders. In a lawsuit, the ACLU of Pennsylvania did as well.

The trust later approved funding for a social worker position within a public defender’s office.

A trust official previously told Spotlight PA and KFF Health News that state law doesn’t require the trust to offer public comment at its meetings and the public is encouraged to participate at the local level.

Pennsylvania’s board is one of at least 14 similar opioid councils that routinely block the public from speaking at their meetings, a first-of-its-kind survey from Spotlight PA and KFF Health News found last year. A former member of Maine’s opioid council cited the findings as she urged her council to allow comment at all regular meetings. And in a change, Pennsylvania’s opioid settlement board in February agreed to host a public listening session later in the year.