(Photo / South Dakota Searchlight)
South Dakota should spend opioid settlement money in the coming years to address the needs of people entering or leaving prisons and jails, according to an assessment prepared for the state Department of Social Services.
The department commissioned the $325,000 statewide needs assessment to help guide the state’s investment of settlement dollars. The inadequacy of the programs and services for addicted people in the justice system was a major takeaway, the department secretary told members of the Legislature’s budget committee on Monday at the Capitol in Pierre.
“This is a more intense addiction once you get to that level of opioid use disorder,” Secretary Matt Althoff said. “We still see, as is so often the case, the justice involvement. Laws get broken, they become incarcerated or they become prosecuted, and they are also struggling with addiction.”
The money comes from the makers and sellers of opioid painkillers linked to spikes in addiction and overdose deaths. South Dakota is expected to receive about $99 million in settlement funds through 2038. The state’s collected $32.8 million so far, with 70% of the money tagged for statewide dispersal and 30% going directly to localities.
Thus far, the state has awarded all but $2.7 million of its share through a three-tiered grant system, with awards ranging from $5,000 on the low end to more than $50,000 on the high end. The largest single award went to Avera Health, which is using its grant for an addiction-focused psychiatric residential treatment facility in Sioux Falls.
Medication-assisted addiction treatment
In the future, treatment for those released on supervision could involve the use of medications for opioid use disorder, a class of pharmaceuticals that, at therapeutic levels, deaden the craving for the drugs without producing the high or spurring a higher tolerance and a need for higher doses.
The Department of Corrections already offers the medications inside its institutions, but it has concerns about the availability of the drugs and follow-up care on the outside, said Brenna Koedam, who leads the Department of Social Services’ Behavioral Health Division.
The two departments have discussed where they might begin with a collaborative effort, Koedam said, which could be with eight outside prison locations for follow-up care to parolees using the medicines.
The Department of Social Services and Unified Judicial System have also begun talks on the drugs’ possible use for people on probation, Koedam said. On Tuesday, court system spokeswoman Alisa Bousa said the state courts are interested in “any additional educational and engagement tools that would benefit the probationers.”
At the legislative meeting, Koedam told lawmakers that a stigma and “misconceptions” still surround buprenorphine, methadone and naltrexone, the three medications approved for opioid use disorder by the Food and Drug Administration.
The department needs to “continue to get the education out there in regards to how effective these medications can be” when administered as part of an addiction treatment program, said Koedam.
Rep. Terri Jorgenson, R-Piedmont, wanted to know how long people take the drugs, on average.
“This isn’t a lifelong thing, is it?” Jorgenson said.
Koedam told her the answer is complicated and depends on the individual. Some, she said, may use them long-term.
Sen. Taffy Howard, R-Rapid City, said she recognizes that reliance on a non-intoxicating medication is preferable to opioid use, but asked if “we’re trading one addiction for another addiction.”
For some people, Koedam said, such medicines can be “maintenance” medications, not dissimilar to drugs for blood pressure or depression that people commonly take for a lifetime. Some people, she said, will remain on the anti-addiction medicines “for the course of their lifetime.”
Sen. Red Dawn Foster, D-Pine Ridge, urged the department to prioritize “innovative” approaches to addiction for those inside institutions.
“I know a lot of inmates are self-medicating, so this is some type of need,” said Foster, referencing the use of illicit substances in prisons and jails.
Next steps for funding
Questions of ongoing funding bubbled up throughout the meeting. Jorgenson said the settlement money is finite and noted the department’s mention that the award amounts will grow smaller as 2038 draws near.
Howard, meanwhile, said “I’m seeing a lot of new programs,” and said she wasn’t convinced that taxpayers won’t be expected to keep paying for them.
“When somebody comes and asks for this grant, have you considered saying, ‘I need your commitment that you aren’t going to ask for ongoing dollars from this,’” Howard said.
The department denied a sizable stack of funding applications because it prioritized programs that wouldn’t need ongoing money from the state, Althoff said.
“Why did we say ‘no?’ Because a lot of it was not sustainable,” he said.
The next round of funding awards will prioritize applications in the mid-range of the department’s three-tiered grant system, which it calls “organizational” grants of up to $50,000.
The small awards were designed for projects at the idea stage, Althoff said, while the large ones were more about developing infrastructure. Over the next year, the goal will be to get projects into the operational and sustainable stage.
Near the end of the briefing, Sen. Paul Miskimins, R-Mitchell, praised the department’s willingness to take on opioid addiction. Miskimins, a retired dentist who said he tightened his approach to painkiller prescriptions as their addictive nature became clear, said he hopes lawmakers and the general public remember the human cost of the drugs behind the settlement money.
“One of the finest ladies in my practice was arrested for stealing medications out of a medicine chest at a rummage sale because she was addicted and hiding it from everybody in the world,” said Miskimins. “She was a Sunday school teacher.”
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