“Our objective was to get that money out as quickly as we could because the people of Pennsylvania are dying and those related to those dying were looking at us to do the job, to change the tide of what the opioid disaster has done,” Rep. Jim Gregory, R-Hollidaysburg, said.

Gregory, who has spoken of his struggle with drug addiction, was appointed to the trust in August 2022 as the House appointee. He lost his re-election bid in April, and Rep. Jim Struzzi took his place on the board in July.

Despite some delays in approving county projects, he saw the trust as effectively carrying out its duties.

“I feel like Pennsylvania was doing a much better job than other states,” Gregory said. “We were just recognizing the wisdom of how to avoid making similar mistakes that other states have made.”

Making the trust work better, he argued, will require more communication between the trust and county leaders.

“It’s a partnership between the board of trustees and those county governments that were tasked with knowing how and what to do with that money on a timely basis,” Gregory said. “I think we could do a better job of working together.”

Some of the problems, too, may be growing pains. A number of counties are set to go through the appeals process to dispute rulings of the trust that some spending was not authorized. The first test, brought in early September by Somerset County, did not change the trust’s decision, though they praised the county’s work nonetheless. As local leaders see what others are doing, future problems may pop up.

“We all need to make sure it’s being used to backfill the amount of damage that has been done to families, victims, and our economy,” Gregory said. “The ripple effects that we are all paying for … we’re also recognizing that every person in Pennsylvania has been impacted by this, and that’s what that money is really meant for.”

While the bulk of the money will get spent by county governments, the General Assembly will also decide how to use a portion of the $1 billion coming to Pennsylvania over the next 18 years.

Gregory had proposed a grant program to support recovery services that eventually passed in the House as part of a different bill by Rep. Arvind Venkat D-Pittsburgh, but it’s sat in the Senate since then. The legislature is running out of time.

Money for that program could come from the opioid settlement money, Gregory noted, but with only a handful of session days left, it could expire.

“There are opportunities sitting on the table as we speak that that money could be put toward, and it’s important to me because it’s my bill,” Gregory said. “But right now, I don’t feel good about its prospects. It’s disappointing.”

Though Pennsylvania has been one of the worst-hit states for overdose deaths — more than 5,000 residents have died annually for years now — there’s some hope that it may not stay that way. Public health data has picked up on a national decline in overdose deaths, almost 11%.

“After a spike in 2022, we see opioid overdose ED visits drop to some of the lowest levels in nearly a decade in the second half of 2023,” wrote Nabarun Dasgupta of the University of North Carolina, looking at Allegheny County.

Priorities of state leaders matter to ensure that the money gets spent, and spent well — and local priorities matter, too.

Gregory noted that county officials are quick to use money for farmland preservation, but some have moved slower on figuring out how to use opioid settlement money.

“Imagine how farmers in their community would feel if they didn’t make use of that money if they didn’t use it toward farmland preservation,” Gregory said. “If they would treat it like they do farmland preservation, then you can understand how they would move more aggressively.”

Local support — and criticism — could be key. Leaders don’t focus on something if communities don’t make hay of a problem.

“There should be no excuse for not getting out the opioid settlement money and treating it as important before it goes away,” Gregory said.