You may see the obvious effects of the opioid crisis on a small Massachusetts city if you have driven through Holyoke in recent years. the empty shops on High Street that remained closed following the outbreak. The line forms early and remains constant throughout lunch as the volunteers distribute food at Providence Ministries on Hampden Street.
The smokers who congregate outside in the mornings are the main way to identify the recovery homes, which are nestled away in residential districts. The crisis is still present. Slowly and unevenly, the foundation for reacting to it has improved. One of the little, thoughtful components of that progress is the Holyoke settlement allocation that Mayor Joshua Garcia’s administration just finalized. The way the city decided to allocate the funds is worth a deeper examination than the financial amounts alone would imply.
By national standards, the math is tiny. Holyoke anticipates receiving around $2.4 million in total opioid settlement cash through 2039—the lengthy disbursement tail that is generated for individual communities by national settlements with pharmaceutical makers, distributors, and pharmacy chains. That is the type of figure that is frequently characterized as having undergone a significant metamorphosis. Spread across 15 years, two and a half million dollars is not a metamorphosis. If the city distributes it responsibly, it’s a consistent, modest source of revenue that can assist particular community partners carrying out particular tasks. By all accounts, Holyoke has made an effort to distribute it in a disciplined manner.
Five local non-profit organizations received the first round of grants, which were dispersed throughout what city officials refer to as a “continuum of care”—a term used to describe the entire range of services that an individual with opioid use disorder may require throughout the course of their relationship with the substance. The largest grant went to Providence Ministries, which the city has positioned as the entry-level service.
This includes clothing, hot meals, pantry support, and street-level outreach that engages unsheltered people before they’re ready to talk about recovery, based on the idea that regular, low-pressure contact is what ultimately opens the door to treatment. Targeted funding were awarded to four additional groups that assist recovery support networks, harm reduction services, opioid use disorder treatment, and reintegration programs for those who have previously been associated with the judicial system.
Speaking with those involved in opioid response policy, it seems that the choice to concentrate the initial investment on five partners instead of distributing it among fifteen or twenty smaller awards represents a more nuanced grasp of how settlement money actually yields effects. In order to increase political coverage and reduce the possibility of any one recipient underperforming, towns that receive these monies are tempted to disperse them widely, granting tiny sums to numerous organizations.
The issue with that strategy is that in order to develop efficient service delivery, opioid response programs typically need ongoing funding. One position could be funded for six months with a $20,000 stipend. That position might be covered for a year with a $100,000 grant, plus additional services that add value to the role. In this paradigm, Holyoke made the proper choice in funding fewer organizations more heavily.
The aspect of the Holyoke process that might become most significant in the future is the advisory committee structure. Those who have personally experienced substance use disorder or who have lost loved ones to the crisis make up the Citizens Opioid Advisory Committee, which offered input on the allocation decisions. It’s not a decorative composition. When evaluating grant applications, it modifies the types of questions the committee poses.
An organization’s ability to handle a $100,000 grant could be questioned by a conventional municipal review committee. In light of Holyoke’s sizable Puerto Rican population, a lived-experience committee inquires as to whether the organization’s hours truly correspond with when individuals in active use are likely to seek help, whether the staff includes individuals who have themselves gone through recovery, and whether the services are offered in Spanish. These are distinct questions that typically lead to different financial decisions.
The precise grant amounts may not be the most important aspect of the Holyoke process. It’s the framework for accountability. According to Massachusetts’s Subdivision Agreement, which governs how local governments manage settlement payments, city officials are required to make public the status of each sponsored program.
In actuality, this requirement entails quarterly reporting on the use of the funds, the results of the sponsored initiatives, and the modifications being made in response to the findings. One structural characteristic of the national opioid settlements that sets them apart from previous public health funding rounds, where transparency frequently deteriorated after the money was disbursed, is the reporting requirement. It remains to be seen if Holyoke would uphold the reporting discipline over the 15-year disbursement term. At least the framework has been constructed.
