The ink’s not yet dry, but Arkansas stands to collect well over $250 million over the next dozen years in settlement money won in litigation against the pharmaceutical companies, drug store chains and other businesses that profited from the nation’s opioid epidemic.
Though the COVID-19 pandemic swallowed up headlines in recent years and nearly relegated the opioid crisis to back-page news, the state has been ravaged by opioid addictions and overdose deaths since 2020, and is second only to Alabama in the number of legal opioid prescriptions per 100 people. In 2021, 618 Arkansans lost their lives to opioid overdoses, up from 546 Arkansans in 2020 and 401 Arkansans in 2016. Sixty percent of the fatalities in 2021 were caused by illicit fentanyl, a wildly potent synthetic opioid that flooded into the state from the drug-trafficking world, marketed to a swelling population of addicts created when unchecked pharmaceutical companies pushed unprecedented amounts of legal prescription opioids into doctor’s offices across the country for their own profit.
One of those deaths was Hagan Jones, a 22-year-old Arkansan who died on March 19, 2019, within minutes of inhaling a single line of what he believed to be cocaine. His toxicology report, his mother Staci James told us, showed that he actually ingested five times the lethal dose of fentanyl. “I had heard of fentanyl in passing,” James said, “but didn’t even know how to spell it.” Distraught by the immeasurable and sudden loss and feeling alone, she took a “raw, emotional” text message she’d composed to a close friend and posted it on Facebook instead. “I’ve historically been a person who did not air out my dirty laundry,” she said. The post circulated widely, and within days James was hearing from families and organizations across the country and began, in her words, “basically stalking” memorial services of people she knew had died as a result of an overdose. “I know that sounds morbid,” she said. (It doesn’t sound especially morbid when James says it; she’s warm and effusive and addresses me as “Hon,” and when she reports that she identified strongly as a “team mom” to Hagan and his high school football buddies, it tracks.) “But I would go, and I would stand in front of them just so they could look in the eyes of someone who knew exactly what they were going through. Because that’s what I was lacking. I have a very loving family, and I had amazing friends, but … how do I put this in the words that are gonna make sense? I was so lonely. I could have been standing in a room of 1,000 people — and known every one of them, and loved every one of them, and I still would have felt like I was completely and utterly alone.”
Along with two other grieving mothers, James paid a visit to then-state drug director Kirk Lane, who encouraged them to start a nonprofit to tell their stories. That group, Hope Movement Coalition, spent much of the pandemic doing advocacy work around the opioid crisis — raising funds to offset funeral costs for impacted families, purchasing headstones, paying for daycare in cases where the deceased left behind a young child. “I’ve been to the border wall,” James said. “I’ve been to the White House. We had our ‘Can You See Me Now?’ banners on the National Mall. I was invited to sit at the DEA’s first opioid family summit this past summer.” The coalition is partnering with a New York City-based group called Partnership to End Addiction, which is building a text messaging platform to connect opioid-impacted families who don’t use social media.
Now, with funding from opioid settlements, the nonprofit is hiring two case managers to assess and meet the needs of families impacted by an overdose death. “We will figure out if they’re food secure, housing secure, financially secure,” James said. “Are they going to have to take in a little one they weren’t prepared to take in? If so, do we need to go through the court system? Was there something already in place for guardianship?”
When it comes to perceptions about the opioid crisis, James said, the focus tends to be solely on the person who died, but that’s not the whole story. “Hagan left behind 39 close family members across four counties in Arkansas. Four parents, five grandparents, four siblings, a fiancee and a baby on the way, 10 aunts and uncles and 13 cousins, and a great-grandmother. … Last year, we lost 618 people. If we did the same math — if those families are about the size of mine, that’s 24,000 people in Arkansas.”
Since James visited Kirk Lane’s office in 2019, Lane’s taken a new gig as director of the Arkansas Opioid Recovery Partnership, meaning he now oversees the dispensation of Arkansas’s opioid settlement money — $16 million so far, with an additional $200 million-plus to come over the next decade or so.
Talking to Lane feels like talking to someone who’s half-officeholder, half-cop, and there’s a good reason for that. Lane started out in law enforcement, working at the Pulaski County Sheriff’s office and later as chief of police in Benton. It was during that time that he became interested in medication disposal programs like Arkansas Takeback, the state’s prescription drug monitoring program, and programs to increase the availability of naloxone — a medication that can reverse an opioid overdose. It was also a time, he said, when he began to realize that not everyone in law enforcement was connecting the dots between legal opioid prescriptions and the dependencies they fostered — dependencies that could swiftly turn a patient recovering from a sports injury or a wisdom tooth extraction into an addict. “A lot of times,” Lane said, “the prescription pills were discounted by law enforcement as not being part of the problem.”
Arkansas was primed to be hit hard by opioids “because of our culture, and the fact that we were a strong meth state,” he said, but also because “we have a tremendous problem with overprescribing in our state. We’ve been No. 2 in the nation for overprescribing for over 15 years, and even though we’re at our lowest point that we’ve ever been at in 15 years, we’re still almost twice the national average. The criminal cartels took advantage of that … flooding us with heroin and synthetic opioids like fentanyl.”
Another big misunderstanding? That the best way to help someone after an opioid overdose is to lock them up for possession.
“For a long time, I’ll just tell you, I was one of those investigators that went to an overdose scene and did not pursue anything. Society had taught law enforcement, pretty much, that stigmatizing language — that that person got what was coming to them because they were using drugs. And that is the wrong mindset.” Instead, Lane said, addiction should be treated like the disease that it is. “Help doesn’t always have to mean going to jail. I think we need to be creative in rethinking, ‘Do these people need to be handled in a criminal fashion, or are these people being victimized? Should we be criminally incarcerating them or pushing them to seek help and making that available to them?’”
Lane and the team at the Arkansas Opioid Recovery Partnership are hoping that the influx of settlement cash should equip the state to do exactly that.
On March 15, 2018, a coalition of Arkansas cities, counties and the state began a long and often contentious legal battle which originated in the Crittenden County Circuit Court, unifying as co-plaintiffs in a lawsuit filed against 65 opioid manufacturers, distributors and criminally convicted Arkansas pharmacies and health care professionals. The agreement yielded a settlement fortune to be divided, as literature from the Association of Arkansas Counties details, in “an equal split of Arkansas settlement dollars among the state, counties and cities — one-third of every Arkansas dollar is allocated to the state, one-third of every Arkansas dollar is allocated to cities and one-third of every Arkansas dollar is allocated to counties.”
Arkansas’s approach to the litigation, Little Rock lawyer Colin Jorgensen told us, was a bit of an anomaly. “We’re the only state where the governments actually united as plaintiffs together in a single case instead of everybody filing individual lawsuits.” Jorgensen spent a decade working at the attorney general’s office and was then recruited by the Association of Arkansas Counties. Since 2018, he has served as attorney for Arkansas counties in litigation against opioid companies.
The money Jorgensen helped secure for the state, two-thirds of which (the city and county shares) is overseen by the Arkansas Opioid Recovery Partnership, is under court supervision and held in what’s called a Qualified Settlement Fund at a custodial bank. The settlement document dictates where the money can go; it is strictly for programs to address the opioid epidemic. Established nonprofits, like sober living facilities, are eligible to apply for settlement funding. “The recovery community is already there,” he said. And meetings with support groups are typically provided at no cost.
The Partnership does not fund programs that are duplicated elsewhere in government infrastructure; naloxone for law enforcement officers, for example, is already provided for by the University of Arkansas’s Criminal Justice Institute. “My opinion is that naloxone should be like defibrillators and fire extinguishers,” Jorgensen said. “It should be that available.”
Jorgensen has a personal connection to the work he’s doing; he’s in recovery himself. “Wild Turkey’s my favorite drug,” he said. “And what I tell people is: The stigma is baseless. And people know this, if they’re honest, that addiction is a disease. The medical community is unanimous on this. There is no outlier, medical professional or otherwise, that says addiction is a moral failure that arises from bad choices. That’s incorrect, and there’s nobody involved in this effort who had that misconception.”
The partnership program went live Nov. 4, 2022, with its application process, meaning that organizations aimed at combating the opioid crisis in Arkansas could apply for funding from the state’s opioid settlement fortune. By mid-February, a total of 34 applications had been filed and 16 programs had been approved to receive funding. Crucial, Jorgensen said, was that local governments drove the effort. “It was always perceived first as a local problem,” he said. “Where the county, city, first responders, all the types of boots-on-the-ground public servants we have — were in the best position to do something about it to help people.”
Not everybody doing work around opioid abatement will get funded. An organization called Central Arkansas Harm Reduction, which operates a drop-in center in Southwest Little Rock, does not expect to be funded by the settlement money. When this reporter visited the headquarters on Chicot Road, I found four people working at laptops set up in a multipurpose room: Amber Kincaid, Shelby Darden, Eric Reese and Rahem White. Collegial and quick to laugh, the quartet gave a tour of the office, which it shares with other adjacent organizations, and which gave a glimpse into the group’s day-to-day efforts — corkboards advertising mail-order HIV testing kits, access to fentanyl testing kits, Central Arkansas Library System’s gender-expansive clothing closet pop-up and Our House’s career center program. In another room, boxes of inventory are tracked on a dry-erase board: latex gloves, naloxone vials, tampons, toothpaste, syringes, condoms.
When asked what the organization does, Kincaid said, “We help reduce the harms associated with drug use, whether that means providing naloxone for overdose reversal, or safe injection kits with syringes and alcohol pads. With our partnership with Arkansas RAPPs [Reaching Affirming Positive Progressive Systems], we’re also able to offer HIV testing, and we can actually deliver that to them or send it through the mail so there’s a really low barrier” to access. “We help people stay alive through their journey with using substances so that they can ultimately make decisions about their health, because you can’t make decisions about your health if you’re dead.”
The group delivers supplies each Sunday afternoon within Pulaski County, taking orders on a hotline and filling them in-house. They mail naloxone to anyone who wants it, free of charge, with naloxone kits provided by a Clinton Foundation-adjacent organization called Direct Relief. The demand for naloxone, Kincaid said, is “extreme. We run through our supply every week.”
“Our approach is a no-strings-attached, resources no-matter-where-you’re-at approach,” Darden said. “For other organizations, abstinence is a requirement for care.”
Reese, who’s been the resource development coordinator at the organization for about a year and a half, said his interest in harm reduction work is twofold. “My dad died of a cocaine-induced stroke,” he said. “This was 11 years ago, and my dad, as well as my uncles, have always dealt with substance abuse issues. And my family was usually like, ‘Get away, get outta the house, we don’t want anything to do with you.’ And that’s pretty hard. Going through that with my dad really stuck with me.” Watching his relatives bounce in and out of recovery, Reese said, was illuminating. “For me there was too much of that in the Black community, and no one was really doing anything around addiction and harm reduction. If we’d had harm reduction when my dad was going through this, he would still be here.”
Secondly, Reese is a social worker, and that work, he said, intersects with harm reduction. “These issues are hitting Black and brown communities in Arkansas more than the white community. But we always see a white face with it.”
Kincaid, a former pre-K teacher who’s served as the organization’s outreach/operations coordinator since July 2020, was drawn to working with marginalized Arkansans because she’s experienced housing insecurity herself. “My perspective was like, I’ve been there. I know how hard it is to get benefits, keep benefits, the recertification process, where the food banks are, when they’re open, when you should go to get the best selection vs. going at the end of the month and getting 30 cans of beans. That you possibly can’t even open!”
A bulk of the organization’s funding has historically come from private donations, “usually outside of Arkansas,” Reese said, and from organizations like AIDS United and Gilead Sciences, a pharmaceutical company that focuses on treatments for HIV/AIDS, hepatitis B, hepatitis C and other conditions.
If there’s a tension between abstinence-focused models like the ones the partnership funds and the efforts of Central Arkansas Harm Reduction, it’s one that is not presented as adversarial. “Recovery is included under the harm reduction umbrella,” Kincaid said. “It’s part of our family. It’s a way of reducing harm. It’s not the only way of reducing harm. If recovery worked for everybody, we wouldn’t have substance abuse problems. So obviously something else is needed.”
“But we’re the right hand in recovery,” Reese said. “You can’t do recovery if you’re dead. We meet people right where they are to keep them alive, to get them to the next step so they may be able to go to recovery.”
“Nobody objects to naloxone,” Jorgensen told us. “Of course you should save somebody’s life if they’re dying. But then you move toward things like fentanyl strips, and clean needle exchange programs, and safe use sites like the ones they have in Canada,” he said, and abatement efforts become more controversial. And, importantly, settlement funding becomes unlikely. “We won’t see all forms of harm reduction in Arkansas. There’s too much important work that everybody agrees on, so let’s do it.”
“Fentanyl took my child from me,” James told us. “But stigma is what nearly killed me. Stigma silences. Stigma makes you think that you or your loved one are less than. Stigma puts us in a place of isolation that we’re terrified to come out of. These leaders in the churches, in the schools, in the counties, in the cities, in the small towns, have got to be the ones to stand up and say something because their silence is going to keep families from information they need, and they are literally aiding and abetting. Stigma is simply not understanding that it can, and it might, be you. If my son had died from cancer, I would have had more support than I knew what to do with.”
Arkansas’s opioid problem, Lane echoed, “is something that every person needs to be involved with to solve. It can’t be pushed off on law enforcement, or the medical field, or any one field. It’s gonna take all of ’em to make a real difference.”