Delaware County got singled out during Sunday night's episode of "Last Week Tonight," as John Oliver dove into how state and local governments are spending the billions of dollars they're receiving in opioid settlement funds resulting from lawsuits against drug manufacturers and distributors.
By the host's analysis, the Delaware County Health Department misspent $1 million of its money on pouches distributed to households in the county that can be used to safely dispose of opioid pills and other medications.
"(It) seems like a huge waste of money, assuming (Delaware County) has toilets," Oliver said on his show. "And if they don't have toilets, then find money to spend on that!"
A spokesperson for the Delaware County Health Department disagreed with how its drug disposal program was portrayed on "Last Week Tonight."
"DCHD is disappointed in the lack of context and this misleading take on proven, public-health, evidence-based best practices that safely and conveniently dispose of unwanted prescription and over-the-counter medications," Matthew Rankin said Tuesday. "These practices are proven to reduce unwanted medications in the waste streams and decrease the environmental impact on our natural environments."
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Over roughly the next two decades, pharmaceutical makers and distributors will pay about $50 billion to state and local governments to be used in a variety of ways that are supposed to address the public health dangers and secondary effects of opioid addiction. Oliver compared the generational sum of money to the $246 billion settlement that was reached with tobacco companies in the late 1990s.
"There can be shockingly little transparency about where this money is going — or in some cases, not going." Oliver says, citing past misuse of tobacco settlement funds — including one project in North Carolina that actually spent settlement money on a tobacco processing plant.
After the wave of opioid settlements in recent years, some observers shared concerns that similar waste and misuse could undermine legitimate efforts to address the crisis. That led to Oliver highlighting the Delaware County Health Department's drug disposal program run.
What are drug disposal pouches?
Late last year, Delaware County officials began mailing out thousands of pouches to households with the intent that they be used to get rid of expired or unused prescription drugs — including opioids. The pitch is the pouches are more environmentally friendly than flushing medications down the toilet and more convenient than using Delco's network of drug drop off boxes.
The pouches, made by Deterra, were purchased with $1 million from Delaware County's opioid settlement funds at a cost of about $4 each. Deterra's pouches contain a carbon solution that deactivates pharmaceutical ingredients — just add the pills, warm water and shake. The pouches then can be safely thrown out with the household trash without the risk of accidentally exposing anyone to the medications, someone abusing the drugs or harming the environment, the company says.
Oliver argued this is unnecessary for most opioids based on guidance from the U.S. Food & Drug Administration. The FDA has a "flush list" of drugs that the agency deems safe to discard down the drain. This includes common opioid medications like oxycontin, Percocet, fentanyl, Suboxone and more than a dozen other drugs.
The environmental and human health risks of flushing opioids down the toilet are likely "negligible," according to FDA research, but the agency doesn't outright encourage people to do it. Flushing drugs is only recommended if a take-back option or drop off box is not readily available, which tends to be the case in rural areas.
"FDA believes that the known risk of harm, including toxicity and death, to humans from accidental exposure to medicines on the flush list far outweighs any potential risk to human health and the environment from flushing these unused or expired medicines," the agency says, noting the need for additional research.
DCHD's Rankin said Deterra's pouches can be used for all water-soluble medications, not just opioids, some of which could contaminate water supplies. In Delco's view, flushing opioids down the toilet should be interpreted as the FDA's "last resort" option. DHCD also cited separate guidance from the Environmental Protection Agency that says people should not flush unused over-the-counter and prescription pills unless no other option is available.
When DHCD decided to contract with Deterra, officials considered that the county's drug drop off boxes and drug take-back events aren't always convenient options for residents. Barriers to using them can include lack of transportation and the stigma of drug disposal. The goal of the pouch program was to "meet residents where they are," Rankin said, and provide people with information about other county resources for people with addiction, like the Delco Revive program that distributes free Narcan, free testing strips for fentanyl and xylazine, and a training program for lifesaving overdose measures.
In December, when the county began mailing Deterra pouches and postcards to residents, the health department called the program an "impactful public health harm reduction strategy." About 70% of all residential addresses in the county were included in the first round of mailings, with promises to reach the remaining addresses some time this year. The first round of mailings contained a QR code for a survey where residents could give feedback on the program.
A DCHD survey found that the department's pouch campaign prompted 47% of respondents to clean out their medicine cabinets.
Spending opioid settlement money to help people in crisis
On "Last Week Tonight," Oliver cited experts who advocate for using opioid settlement money in ways that directly help people in crisis and groups who serve them. That includes hiring drug counselors and peer support specialists, as well as increasing access to medications that are used to treat people addicted to opioids. The funds also could help boost the availability of the overdose reversal drug naloxone and support other harm reduction strategies, like making fentanyl test strips more accessible to people who use drugs.
Delaware County will receive annual payments of about $3.5 million from the opioid settlement for a total of $62.5 million over the next 18 years. After the funds were announced in 2022, the county conducted town halls, roundtable discussions and surveys to gather feedback on how the money should be spent.
Rankin said the first round of opioid settlement funding — about $6.45 million — was awarded last August to target "shovel-ready" projects that could be implemented in six months. Health providers in the county got $517,056, service providers were allotted nearly $4 million, colleges received $613,819, and Delaware County government departments received a total of $1.3 million. The Deterra pouches were part of the first round of funding.
In January, the county accepted applications for the second round of settlement money and identified five initiatives that are more in line with providing direct care and resources.
Delaware County plans to hire a program coordinator for future administration of funds and create a community recovery center that will help people with substance use disorder and their families, Rankin said. Other plans include funding for prevention education and resources to help people in recovery with transportation, food, workforce training, and rent and utility payments. There will also be funding available for certified recovery specialists who will work in emergency rooms to connect people with treatment.
Oliver's larger point on the show is that since local governments will be in charge of distributing the bulk of the opioid settlement, leaders need to be informed to ensure the money is spent wisely. He pointed to a cautionary tale in Vienna, Virginia, where a council member initially expressed caution about spending opioid settlement funds on unrelated expenses, only to later approve the purchase of police K9s and SUVs weeks later.
Not all uses of opioid settlement funds will be directly centered on treatment. In some cases, they may be earmarked for improvements to community spaces that have fallen into disrepair and now attract drug activity. In December, Philadelphia awarded $600,000 in opioid settlement funds to improve six parks and recreation centers in Kensington, which has a national reputation as one of the communities hardest-hit by the opioid epidemic.
"Last Week Tonight" usually strives to strike a balance between humor and informative research. In this case, Delaware County officials believe the show's toilet punchline came at the expense of context that would have shown the health department is adhering to Oliver's larger, take-home message.
"When you don't have a plan for your money, it can be easy to spend it in a thoughtless way," Oliver said. "It's a lot harder to break into your savings when it's labeled 'college funds' and not 'holy s***, look at all this free jar money!'"