The following story was reported by The Utah Investigative Journalism Project in partnership with KUER, The Standard-Examiner and St. George News.
The opioid epidemic has had a profound toll on social worker Mindy Vincent.
First, she buried her sister, who died from an opioid overdose in 2014. During the next decade, over 40 of her clients would die from the epidemic. Those tragedies have fueled her professional career, including founding Utah Harm Reduction Coalition, a nonprofit whose services include substance misuse treatment and syringe exchanges.
Lately, though, those tragedies have also fueled something else: Vincent’s frustration over how funds meant to combat Utah’s opioid crisis are — or aren’t — being spent.
A review by The Utah Investigative Journalism Project of account ledgers, budget documents, funding proposals and other public records found that a majority of counties in the state have spent little to none of the opioid funding they’ve received.
“It is disturbing to me that the money is just sitting around,” Vincent said. “My sister lost her life for that money and so did a lot of other people's family members.”
The funding comes from national legal settlements with drug companies that have resulted in billions flowing to state and local governments across the country. More money will be dispersed over the next decade.
Utah counties have received a combined $56 million, but only 14% of the funds have been spent.
Advocates worry counties are sitting on money that could save lives. The most recent data from the Utah Department of Health and Human Services estimates an average of 400 Utahns die each year from prescription or heroin overdoses.
“There's people dying right now today,” Vincent said. “When someone says we're just going to sit here and wait for [the funds] to build up, what I hear is we're just going to let people die while we sit around and decide what to do.”
Rep. Raymond Ward, R-Bountiful, isn't surprised many counties have not spent their funds. Along with Sen. Jen Plumb, D-Salt Lake City, Ward sponsored legislation on opioid settlements and has worked as a family physician with patients with opioid addiction.
“Each county got a little portion of that settlement. … In many cases, for an individual county, that would turn into an amount that wasn't super easy to start a new program up,” he said. “I hope they figure out a way to put the money to its good use. The settlement wasn't meant for the money to just come sit in the bank somewhere and not be helpful.”
‘A county-by-county strategy’
Although the state created a “blueprint” on how to best use the funds, deciding how to spend the money has been a sort of “choose your own adventure” for the counties.
“It's really a county-by-county strategy,” said Evan Done with Utah Support Advocates for Recovery Awareness. He added, “the process has been more opaque” in some counties.
USARA serves individuals and families recovering from substance use disorders. The nonprofit has received settlement funds from the state as well as Salt Lake and Grand counties for its recovery centers and peer recovery coaches.
Counties’ approaches have included creating grant application processes for nonprofits, approaching organizations directly and dispersing funds internally to county health departments and sheriffs’ offices. Sometimes it’s been a mix of multiple approaches.
Tooele County, for example, created a detailed grant process for organizations to apply for funds, including reporting requirements. The county reported spending nearly half of its $949,000, with grant awards ranging from treatment for individuals at the county jail to a transitional housing program for individuals with opioid use disorders.
While some counties have required detailed reports on how the funds are being used by groups and agencies who have received awards, a handful told the Utah Investigative Journalism Project they were not tracking the funds after they had been dispersed or could not provide detailed records showing specifics on how the funds were used.
Garfield and Summit counties, for example, provided the total amounts they received and spent from opioid settlements — but no records to confirm those amounts. The Investigative Journalism Project is waiting for the Utah State Records Committee to hear appeals on records requests to both counties.
Sevier County has used less than a quarter of its funds, but the $72,000 or so it has spent went to the sheriff’s office. Clerk/Auditor Steven Wall said his office does not track how the funds are spent once they’ve been transferred into the sheriff’s budget.
Following a request, Sevier County Sheriff Nathan Curtis compiled a spreadsheet of how the funds were used between July 2023 and June 2024. Curtis later added that he had neglected to include the wages for a second deputy assigned to drug court and pre-trial services and noted the document “did not include the cost of any of the equipment the employees use as it is not as easily broken down.”
Unclear reporting requirements
Counties’ reporting of the funds appears to be hit or miss.
Ward’s 2023 bill, SB155, designated the Utah Department of Health and Human Services as the reporting agency for county opioid funds.
Records obtained through a request to DHHS suggest only two-thirds of counties submitted reports on how they used the funds in 2023 and only a quarter did so in 2024.
That picture is complicated by the involvement of the Utah Association of Counties, a private nonprofit that acts as an advocate and service provider for the counties. In practice, it is acting as the reporting agency for the funds.
Katherine Rhodes, the association’s legislative policy analyst, said the counties appointed the association as its reporting entity based on a non-binding statewide agreement that was signed prior to the 2023 legislation. She said the association and DHHS worked it out so that the association sends the state the reports “as needed.”
The group said it has received more reports than obtained through DHHS, but did not offer a corrected count. Unlike the state agency, it is not subject to public records laws.
Rhodes said there isn’t yet a specific format for the reports. Those reviewed by the Investigative Journalism Project were as varied as a short email, a bulleted list of the amounts the county received or an eight-page report that included detailed account ledgers.
The association does require counties to report annually on their proposed uses of the funds and actual expenditures and to publish online how much they received and spent.
Ward argued the counties should report to the public how the funds are used. However, he said he was unsure “who ought to rightfully report to who and what ought to happen to them if they didn't submit a report.”
On one hand, Ward said he sees the concern of counties reporting to a private nonprofit. On the other, he said the legal settlement did not give the state permission to decide how the counties spend their funds.
“I’m open to the discussion,” he said. “I don't know that it would be simple to settle that out.”
Weighing the options
The statewide agreement suggests over a hundred uses for the funds.
They include obvious options — like buying opioid-overdose antidotes and funding treatment and recovery services — as well as more holistic solutions like providing housing and employment training or researching the non-opioid treatment of chronic pain.
Although counties began receiving opioid settlement payments more than two years ago, some counties don’t yet have a concrete plan.
For example, Daggett County, which has received the second smallest amount at nearly $14,000, said it plans on accruing the funds for future use. The Morgan County Commission has only approved $685 to cover vandalism in a city park with a vinyl wrap promoting drug prevention — barely a dent in its $110,000. And Millard County said it hasn’t approved a plan for its $216,000 but has discussed using them to equip sheriff's deputies and emergency responders with counteracting drugs like Naloxone.
“It's alarming to me — both as a professional in this space and as a person in recovery — to hear that there are opioid settlement funds coming to our state that aren't being used,” Done of the Utah Support Advocates for Recovery Awareness said. “Those funds could be distributed to organizations that are doing great work in our communities to help mitigate the opioid crisis.”
Some counties are pointing fingers at restrictions on how the funds can be spent. Both SB155 and a second bill sponsored by Plumb and Ward in 2024 prevent funds from being used to reimburse counties for expenses and programs they were already funding — a practice known as supplanting.
“If you only ever supplant, then the net effect would be that the new money that came in just got spent on something else,” said Ward. He added he’s open to changing the rules if necessary.
Rhodes said the Utah Association of Counties is pushing to remove counties from the legislation, which she said the state wrote without their input.
She said the statewide agreement already lists out approved uses and the restrictions and additional reporting measures in the legislation make it more difficult for counties to spend their funds.
Both Iron and Davis counties pointed to the legislation to explain why they haven’t spent the funds.
Davis County said it planned to use its funds to recoup costs from building and operating the medical wing in its jail and for a jail medication prevention program. However, it claims recent legislation stopped that plan in its tracks
Davis County Clerk/Auditor Curtis Koch canceled an interview with the Utah Investigative Journalism Project and did not reschedule.
Advocates Done and Vincent named a variety of funding options they believe would make a big difference in Utah communities, such as recovery support services, medication-assisted therapy, Naloxone and Narcan, and headstones for individuals who died from opioid overdoses.
Vincent — who said none of the state’s 29 counties have approached her organization about opioid settlement funding — said the need for more resources is particularly acute in rural areas.
“The more remote somebody is, the more rural they are — the scarcer the resources,” she said. “Some of these kinds of resources, like methadone clinics, are not in very many rural places, people cannot access Naloxone very easily.”
Regardless of how the funds are spent, the money doesn’t come close to undoing the damage done by opioids.
“If I was putting a percentage on it, I would say, this is a compensation for 1/100 of the damage that has been done,” Rep. Ward said.
