Hawaiʻi can address substance abuse with $33 million from opioid manufacturer settlements — and that number is expected to continue to grow.
However, managing and spending the funds has been a work in progress.
The state began receiving the funds about three years ago and was awarded another $15 million in April.
It’s not yet clear how much money the state will get in total. While it will depend on the outcome of future court cases, some estimates show nearly $80 million.
How funding can be spent
The state can spend the money to address substance abuse issues but has to follow rules outlined in a memorandum of agreement.
Most of the fund will need to be used to address opioid misuse specifically, but a small portion can be used to combat other drug use.
About 85% of the total fund will go to the state and the remaining 15% will be given to the counties. The counties with larger populations, like Honolulu, will get more funding while smaller counties, like Kauaʻi, will get less.
The Hawaiʻi Opioid Settlement Advisory Committee, with representatives from the state and all the counties, is the body that decides which projects get funded.
Grant Giventer, state Department of Health Opioid Settlement coordinator, explained that they are in the process of making the fund more transparent.
Hawaiʻi is one of seven states in the country without publicly available documentation on how it spends the money.
“We're trying to build a dedicated website to the Opioid Settlement Fund so that we can put the numbers out there and work on being transparent in terms of how much is there and how you could apply,” Giventer said.
“Hopefully we’ll finish the procurement with that and get something up for the fall. We expect that that will include something that would allow folks outside the government to be able to submit a proposal," he continued.
There hasn’t yet been a formally established process to receive funding — especially for non-government organizations.
Tracking where the money goes
So far, the state has spent about $2.7 million of the fund. The City and County of Honolulu received about $1.3 million. Another large chunk was spent to purchase naloxone, better known as Narcan, a drug that can reverse the effects of an opioid overdose.
One of the more unique expenditures was $21,000 for training earlier this year in Hilo with the Hawaiʻi Island Fentanyl Task Force.
“We kind of shared with these people and I think it might have been about 60 that came from off-island, and we shared our story with them,” said Wally Lau, one of the leaders of the task force.
“Of course, they, like us, were seeing the issue of overdoses, whether it's from fentanyl or other opioids happening in their community," he said.
The Hawaiʻi Island Fentanyl Taskforce started in 2021 and is the first of its kind in the state. The group has been providing education, bringing awareness to the problem and distributing Narcan to communities around Big Island.
The Hilo workshop helped jumpstart task forces on the other islands.
Michael Miranda, leader of the Kauaʻi task force and a representative on the Opioid Settlement Advisory Committee, explained that Kauaʻi had its first meeting two weeks after the workshop and has already pulled together treatment providers, prosecutors, police, fire department and community members.
“We're trying to recruit people from different sectors and it's slowly growing with every meeting that we've had,” Miranda said.
“We're focusing on prevention, harm reduction and treatment — trying to get people into treatment and manage their substance misuse.”
'They thought it was safe, but the bugger was laced'
Both Lau and Miranda were concerned about overdoses where marijuana or other less addictive substances were laced with fentanyl. They both said people sometimes don't realize that they're taking opioids.
“The saying that we use over here is: they thought it was safe, but the bugger was laced,” Lau said.
“That's how two little teenage girls — good kids, I know the parents ... good kids. But every kid experiments, right? It's just that they experimented and the damn thing was laced with fentanyl.”
Lau attributes the success of the Hawaiʻi Island Task Force, which has been able to give out 3,000 Narcan kits, to community building.
He recalled two mothers meeting at a Narcan pop-up that the task force hosted. Both shared their stories. One mother’s son was saved by Narcan and she was coincidentally seated next to another mother who lost her daughter to a fentanyl overdose.
“I'm going to talk to them and see if they're willing to share their story at our upcoming summit because yes, it is very sad what happened, but the other side is we've got to give our community a sense of hope, you know, because we can't seem like this, we're in a hopeless situation,” Lau said.
Lau emphasized that while the data is important, it’s the personal stories that move people to action.
Timeline for settlement funds
There is no time limit to spend the opioid settlement funds and several more projects are being finalized.
The Department of Health’s Harm Reduction Services Branch is finalizing an agreement for more clean syringe access, especially on neighbor islands.
The agreement would also fund a hepatitis coordinator for those who might need to be tested, as well as an opioid use coordinator to link people to treatment.
The Hawaiʻi Island Fentanyl Task Force is also finalizing an agreement to use some of the settlement fund to pay for two years of operations. Lau said the task force has been sustained by its members, volunteers and the Hawaiʻi Health & Harm Reduction Center, which has helped to provide them with Narcan.
Lau explained that the task force is working on expanding its reach beyond those directly impacted by someone who uses drugs.
“You get the people that are directly, like myself. I had family members so I'm like right there, right?” he said.
“But you got those that are arm's length away. We're saying, even though you're arm's length away from the issue, with what is happening, we all should be aware. Everybody should carry a Narcan, just in case.”
