MONTGOMERY — Alabama prison officials could soon see a portion of a national opioid lawsuit settlement help reduce abuse and violence within the state’s prisons.

Earlier this year, Alabama Attorney General Steve Marshall announced that the state would receive nearly $250 million during a 10-to-15 year timespan in opioid settlement money from specific pharmacies and drug manufacturers for their role in what officials have said is an ongoing opioid epidemic.

HB 465 was signed into law earlier this year to allocate the first $10 million — $1.5 million to Alabama Department of Corrections for inmate treatment programs and $8.5 to the Alabama Department of Public Health, which would disperse the funds after a competitive grant process.

Department of Corrections allocated $1.5 million

Deborah Crook, deputy commissioner of health services for ADOC said the department plans to use some of its funds to start a residential substance abuse treatment program for inmates within state prisons.

“This is not a nicety. To offer this is absolutely a requirement that we offer treatment within the facilities,” Cork said. “Individuals can choose not to be a part of the program, but we have a constitutional obligation to provide service.”

The program calls for the facilities to be equipped with medication assisted treatment coordinators, support nursing staff, drug treatment staff and additional specialists.

The National Institute of Drug Abuse notes that 65% of incarcerated individuals have a substance abuse disorder. In Alabama, that equates to nearly 14,000 of some 21,000 inmates statewide.

Crook said that as the U.S. Department of Justice continues its investigation into ADOC for inmate sexual assaults and violence, she hopes that having a medication assisted opioid use disorder program has a positive impact.

“Our goals for this obviously (are) to first to save lives, but also to reduce the assaults within the facilities — both physical assaults and sexual assaults within the facilities — to reduce coercion, extortion, violence, all of those things,” Crook said. “It’s going to have an impact on our environment as a whole. We are hoping that we will see that changing the environment, we will also be able to have some impact on recidivism.”

ADOC is also partnering with Alabama Department of Mental Health and Alabama Bureau of Pardons and Paroles to help provide effective transitions upon inmates’ release.

The settlement fund plan will allow ADOC to give inmates with previous opioid addictions an injectable naltrexone near their release date. The drug is intended to block the subject craving for opioids.

Drugs would be administered monthly to help prevent recidivism.

The impact of opioid use in Alabama

Cam Ward, director of the Alabama Bureau of Pardons and Paroles, said the crime recidivism rate in Alabama is between 28% and 30%. He noted that almost all property crimes can be traced back to drug-related incidents.

He said compared to other drugs, those on probation have seen an increase in positive drug tests for opioids.

“You’ve actually seen a slight decline in certain drugs such as meth. You’ve seen a little bit of a decline in cocaine, but you’re seeing opioids overtaking the rest at a slow pace,” he said. “I predict, in the next four or five years … I think opioids will overtake the rest of your overdose issues. It’s become too easy to get ahold of, and it certainly is easy to get addicted to.”

St. Clair County Circuit Judge Philip Seay, who has also presided over the county’s drug court for more than a decade, also noted that many cases he’s seen stem from opioid-related issues.

According to the 2023 Gulf Coast High Intensity Drug Trafficking Areas Treatment Survey, methamphetamine and fentanyl are almost tied as the drugs which are the greatest threat in Alabama. Heroin is second, followed by controlled prescription drugs, marijuana, cocaine and new psychoactive drugs.

The survey indicates that in 2021, fentanyl and other opioids became the greatest drug threat for law enforcement, outpacing methamphetamine by only 3%. Treatment and prevention respondents in the survey ranked fentanyl as the second greatest drug threat, followed closely by methamphetamine.

The biggest increase in mental health admission data was attributed to fentanyl in 2021, according to the Department of Mental Health. The overdose death rate in Alabama continues to increase with Jefferson County alone reporting 316 fentanyl related overdose deaths in 2021, a 68% increase from 188 fentanyl-related overdose deaths in 2020, according to DMH.

Nancy Bishop, state pharmacy director for the Alabama Department of Public Health called the increase in the number of emergency room patients for fentanyl overdoses “frightening.”

“You will find any substance contaminated with fentanyl — from marijuana to cocaine, to what looks like a Percocet (oxycodone) pill or what looks like a Xanax pill — but they’re illicitly manufactured (with pill presses), and it’s got fentanyl in it,” Bishop said.

In Alabama and other states, naloxone — a medication used to reverse an opioid overdose — has been dispersed to medical professionals and first responders. Approximately 14,000 naloxone kits have been dispersed throughout the state according to Kim Boswell, commissioner of the Alabama Department Mental Health.

“It’s very common to see AEDs in almost every building in Alabama public buildings. It should be that we also probably have a dose of naloxone in every building that’s available as well because this problem doesn’t just affect one population or one set of people,” said retail pharmacist and committee member Rep. Phillip Rigsby, who also serves as a volunteer firefighter. “This is across the board. I’ve seen it in my professional and in my volunteer life.”

Bishop said many opioid-related overdoses and deaths are likely under-reported. She noted that toxicology reports aren’t performed after every death.

“There’s no consistency among coroners about how an overdose death is recorded,” she said. “We are making great efforts to educate coroners since systems are being developed to improve the accuracy and the timeliness of overdose death data and how it’s collected and we’re trying to make it easier for them to report electronically.”

Bishop also suggested that more health care providers and prescribers view the prescription drug monitoring program before prescribing opioids to a patient, as it allows them to view opioids and other controlled medications patients may have received from other clinicians to determine whether a patient is receiving opioid dosages or combinations.

The number of prescribers using that increased 64% in the last five years, and pharmacists have increased use of it by 33%, Bishop said.

“We still have education to do, and it is ongoing on how to use the PDMP system and we have regular PDMP trainings throughout the state,” she said.

State planning for the rest of opioid settlement funds

The Oversight Commission on Alabama Opioid Settlement Funds was created earlier in 2023 to “develop a statewide plan for the investment and use of opioid settlement funds and review the expenditure of funds appropriated to agencies and entities to ensure expenditures achieve the best results for Alabama’s opioid crisis.”

The commission held a meeting Sept. 28 at the state capitol with Kim Boswell, commissioner of the Alabama Department of Mental Health, telling the commission that $37 million in federal funding is on hand so far.

The department is tasked with coming up with a competitive grant process for the $8.5 million the department was given through HB 465.

Boswell said the preference is for grants to be awarded to “evidenced programs that make a difference” with a focus on underserved and vulnerable populations, counties with high overdose rates and services that support diversion from drug-related arrests and incarceration. She said priority populations also include foster care and kinship care, justice-involved, veterans, pregnant and parenting women, people who inject substances, youth, adolescent, transition-age individuals, rural populations and the older population.

The commissioner will host future meetings to hear input the allocations of the remainder of the $250 million in opioid settlement funds.