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Are Big Opioid Settlements Short-Changing Rural Areas?

Ten people died from drug overdoses in Pamlico County, N.C., last year 10. The year before it was 12 — an all-time high. Those losses reverberate deeply in the rural county, a tightknit community of 12,000 on the eastern shore. Over the past decade, it’s had the highest rate of opioid overdose deaths in North Carolina. “Most folks know these individuals or know somebody who knows them,” said Tm Buck, the county manager and a lifelong resident. “We all feel it and we hate it when our folks hurt.” The county is receiving money from national settlements with opioid manufacturers and distributors to address the crisis. By the time those billions of dollars are divided among states and localities, using formulas partially based on population, what trickles down to hard-hit places like Pamlico County can be a trifling sum, reports News From The States.


Out of one multibillion-dollar national settlement, Pamlico County is set to receive $773,000 over nearly two decades. By contrast, Wake County, home to the capital city of Raleigh, will get $36 million during the same period, even though its opioid overdose death rate for the past decade ranked 87th in the state. Buck said his county’s share “is not a lot of funds per year. But I’m glad we have something to try to reduce that overdose number.” Rural communities were harbingers of the opioid crisis. State and local governments filed thousands of lawsuits against drug companies and wholesalers accused of fueling the crisis, resulting in a plethora of settlement deals. The largest to date is a $26 billion settlement that began paying out this year. As the funds arrive, some people say it’s reasonable for densely populated cities and counties to receive more, as they serve a greater number of residents. Others worry such an approach misses an opportunity to use that money to make a difference in rural communities that have been disproportionately affected for decades. “You could really diminish what is effectively generational, more than 20 years of harm in rural areas,” said Robert Pack of East Tennessee State University’s Addiction Science Center.

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