Millions of dollars have flowed into Montana over the last year to help combat the opioid crisis, but the vast majority remains unspent. That’s according to reporting from KFF Health News, which found some states are off to a slow start in distributing settlement money paid by opioid manufacturers and sellers. Reporter Katheryn Houghton joined Montana Public Radio’s Austin Amestoy with the details.

AUSTIN AMESTOY: Katheryn, help put this into context for us. How much money has Montana received from these settlements at this point, and how much has actually been distributed so far?

KATHERYN HOUGHTON: So, at this point, we know there’s more than $13 million that has arrived in Montana, and the biggest share of that remains untouched. So, most of Montana’s settlement dollars — 70% — are going into an opioid abatement trust. And, the goal behind that trust is that local governments or organizations can request funding through it. So, there’s actually a grant portal where they submit their ideas of ways to respond to the crisis and how this money could get used. At this point, that trust is only met once, and it was to really define their basic rules of operation. They’re not due to meet again until April, so we’ve still got a couple of months. And, we’re now looking more than a year in, but we’ve still got a couple of months before any of this money would actually make it out into the communities.

AUSTIN AMESTOY: And, $13 million over the course of a year — I mean, that’s a lot of money. But, how much more are we talking about, and how long is that expected to be rolling in to the state?

KATHERYN HOUGHTON: Montana’s due to receive $80 million over the next, roughly, two decades. So, it’s a pretty slow process. The money is coming in very gradually, and I should say that there are small slices of the pie that are being sent directly to local governments, but that funding is not being tracked. And then, another slice that’s going directly to a state fund. But, when I talked to officials by the end of November, they had yet to touch their share as well.

AUSTIN AMESTOY: I mean, that’s a pretty substantial amount of money. And, we know from your reporting this is coming from settlements with opioid sellers, manufacturers — what do we know about the scale of the actual opioid crisis in Montana at this point?

KATHERYN HOUGHTON: So, we know that these drugs are getting stronger and less expensive. So, they’re getting the hands of more people and they’re more deadly. So, in Montana, we’ve actually seen a large jump in the number of people who are hospitalized because of an overdose. And with that, we’ve also seen an increase of people who are actually dying from an overdose. So, in 2021, we saw 200 people die of an overdose. And when you’re talking about a state of a little more than a million, that’s a pretty big impact.

AUSTIN AMESTOY: It’s pretty apparent that the crisis is not unwinding on its own, which is part of what this pool of settlement money is intended to help solve. I am curious, though – what’s the holdup in Montana with distributing those funds? And, have other states been issuing their dollars up to this point?

KATHERYN HOUGHTON: The the biggest reason I’ve gotten from those in charge of doling out this money is that, you know, “This is a lot of money over a long time. We need to make sure to set up the system well, so that it’s done right; so that we make sure this money is going to be used in a way that’s actually going to help curb this problem.” We know that Montana isn’t alone. There are a few states that have really taken their time in setting up systems. That means they haven’t actually touched the lion’s share of their funding. But, we did find other states that have been distributing this funding for months.

AUSTIN AMESTOY: It’s actually very reminiscent of COVID-19 relief dollars in some ways. And, I think with that, you know, the urgency felt very built-in and present, given it being a pandemic-scale event. But, the opioid overdose epidemic is similar in a lot of ways. I think it’s just a little bit more behind-the-scenes than something like COVID-19 was. I just think that comparison there is kind of interesting.

KATHERYN HOUGHTON: No, I think that is interesting, because you are talking about, like, unprecedented pools of money coming into Montana like you were with the pandemic. So, one of the things that I heard from somebody who’s on the board of the trust, who is also working in, kind of, local efforts in a rural county in eastern Montana, was that, you don’t get a chance to right a wrong like this very often with this big of a backing, with this many resources. And so, you want to make sure you don’t mess it up.

AUSTIN AMESTOY: Well, on that note, are the health care providers that you spoke with in Montana confident that, once all this money’s paid out to the state, once it’s in the hands of people who can make change — are they confident the money can be successful in, sort of, reversing the trends we’ve seen with the opioid crisis?

KATHERYN HOUGHTON: Well, yes. First off, more money is always a good thing when you’re trying to increase access to services or treatment, especially in a broad, rural state like Montana, where everything’s really far-scattered at this point. I will say, there’s a lot of questions on how this money’s going to be used, but I talked to behavioral health and addiction treatment providers who are frustrated that this money hasn’t been tapped into yet. They’re seeing a workforce shortage, they’re seeing waitlists for their services, they’re seeing too few resources for people once they’re discharged from their services. And, they say that money now, even if it’s just from this initial pool of funding, would be really helpful if they could start getting that cash.

AUSTIN AMESTOY: Reporter Katheryn Houghton with KFF Health News. Katheryn, thank you so much for sharing your reporting with us.

KATHERYN HOUGHTON: Thank you so much for the time.