Local opinion: Opiate settlement funds begin to heal our community

“Moral injury” is the phrase we doctors use to describe the distress one feels when they are forced to witness the suffering of others. As a long-time citizen of Tucson, where voter initiatives have repeatedly improved access to healthcare, I know this term describes the sadness and frustration we experience at the enormity of substance dependency and homelessness on our streets. It’s even likely that this frustration drives punitive sentiments when we feel that nothing productive is being done. Afterall, we know that the several hundred overdose deaths a year in our county alone are sadly only a small slice of the larger problem of substance dependency which includes long-term health consequences, legal problems, housing insecurity, family discord and threats to essentially every part of our social fabric. This is paired with the ever-shifting drug supply to create a complex series of challenges that defy a single solution. So, it might come as a welcome update to hear about the ways that Pima County and our cities have joined together to address this complex issue.

At the end of 2021, the One Arizona Agreement was negotiated as a strategy to distribute funds to local jurisdictions with the option for each to join with the County or take their funds separately. The Cities of Tucson, South Tucson and Marana joined Pima County in an effort to aggregate the real funds and expertise required to address this shape-shifting crisis. We are fortunate here that there are already many agencies in this space doing amazing, innovative work dedicated to the communities they serve. The challenge is how to use the funding to fill gaps and knit programs together to create unbroken and inclusive pathways for affected individuals to achieve sustained recovery.

The Regional Opioid Settlement Advisory Committee (ROSAC), a group of concerned citizens who represent the four jurisdictions, has been working on just that. The first couple of years (while awaiting settlement distributions to accumulate), funds went primarily to increasing free access to the opiate reversal agent Naloxone, increasing access to medications for dependency, and treatment of pregnant women. During this time, the committee has worked to learn about local programs that already exist and the people they serve, as well as studying what has worked in other places. As a result, the funding priorities for the next 3 years (an anticipated $24 million) include:

Prevention programming for youth (better to prevent substance dependency than treat the consequences)

Peer-navigation (draw on the expertise of individuals with lived-experience while simultaneously providing a living wage for these same people who are often shut out of other employment)

Wrap-around services (to interrupt the cycle of substance dependency and homelessness)

Law enforcement co-response (pair officers with outreach professionals who can offer an alternative track of treatment and recovery)

A sobering center (an alternative to our street corners and washes but where individuals are offered services). Details about this funding can be found on the Pima County website.

There have already been some clear successes: overdose deaths and near overdose both went down in 2024 compared to 2023; there are extremely effective medications to treat opiate use disorder (in fact, more effective than for many other chronic diseases) which are now readily prescribable by primary care providers; our County health department provides connection to care resources for both individuals and their physicians; and free Narcan nasal spray is now available at all Pima County libraries and other hot-spots, with many community members trained and ready to save a life.

While we no doubt still have many days of “moral injury” ahead of us as we continue to grapple with the harmful effects of substance misuse, settlement funds — expected to flow in over the next decade to support a myriad of interventions — should give us hope that our communities are on a pathway to recovery.