WV counties set the rules for opioid funds — with no one watching

Everyone is going to speak during Brown’s group today; nobody gets to opt out by saying, “I don’t want to talk.�

Since October 2024, Brown has been working at Lauren’s Wish where he holds these twice-weekly sessions of his Addictive Behavior Awareness (ABA) program for people with substance use disorders. Lauren’s Wish is a nonprofit organization and triage center in Morgantown, helping people with an addiction or in recovery find treatment and connect with necessary resources.

Brown said that while incarcerated, in 2001, it became clear to him that people experiencing addiction needed guidance in four key areas: manipulation, irresponsibility, a non-caring attitude and self-esteem. So he created the concept for ABA based on his personal experience.

After his release, Brown decided he wanted to help people with substance use disorders lead a better life, so he trained to be a peer recovery coach and put his plans for ABA into action.

Today, he sees his mission at Lauren’s Wish as giving people hope. Lauren’s Wish is like a “gateway� for people getting ready to transition into society, Brown says, whether they’re seeking sober living or returning to their families.

“The saying is, in recovery, we keep what we have by giving it away. And I’m always wanting to give it away. I’ll talk to anybody about recovery,� Brown said.

Programs like Lauren’s Wish are typically kept afloat through fundraising and donations; however, they’ve recently received funding from a new source: opioid settlement funds.

These funds are the result of a global settlement, agreed to in federal court, of a class action lawsuit brought by states, counties and cities across the country against opioid distributors, manufacturers, pharmaceutical companies and others, in the wake of the country’s opioid epidemic. According to the Centers for Disease Control and Prevention, more than 720,000 people died from an overdose in the U.S. between 1999 and 2022.

West Virginia will receive about $980 million from the settlement, split into payments over 18 years. The West Virginia First Foundation — a nonprofit created by the state Legislature — will control the spending of 72.5% of the funds, local governments 24.5%, and the West Virginia Attorney General’s Office 3%.

The state Attorney General’s Office created a Memorandum of Understanding in 2022, under then-Attorney General Patrick Morrisey, that dictates what the funding can be spent on — like increasing access to treatment or prevention-education programs.

How local governments oversee that money, however, including the process through which they take applications, make awards and account for spending, is fully within the control of city and county governments.

An investigation into these processes conducted by journalism students at West Virginia University’s Reed School of Media shows the oversight and accountability built into local spending can be markedly inconsistent from county to county — with some doing very little to collect the advice and opinions of addiction experts or people with lived experience.

Detailed reporting, vague decision-making

Lauren’s Wish is an organization almost fully staffed by people in recovery. It has applied for and received opioid settlement funding from both the state and local level, and Brandon Wise, who provides grant writing assistance to nonprofits and wrote both applications for Lauren’s Wish, says the experience at each level is drastically different.

According to Wise, the application process for state funding from the West Virginia First Foundation was significantly more involved and lengthy compared to Monongalia County, where Lauren’s Wish is located. He compared the WVFF application to applying for federal grants, noting that it required strict adherence to formatting and content guidelines, specifying what needed to be included without providing a rigid layout. Failure to follow these directions “to a T� could lead to almost immediate rejection.

In Lauren’s Wish’s WVFF application, Wise provided objectives, strategies and a budget narrative with accompanying documents. Wise estimated the application was 50 to 60 pages when finished.

As of June 6, the WVFF had $19.2 million to award statewide in the four areas outlined by West Virginia’s MOU: diversion programs, youth prevention and workforce development, child advocacy centers/neonatal abstinence syndrome programs, and transitional/recovery housing expansion.

Lauren’s Wish was awarded roughly $168,000 to jumpstart its outreach department by hiring more staff to provide additional aftercare and outpatient services for clients. Their grant period runs from Feb. 1, 2025, through Jan. 31, 2026. During that time, they will pay for outreach services provided to clients past, present and future, with a focus on individuals dealing with the court system.

Derek Hudson, the founder and executive director of the Neighborhood S.H.O.P. on ÂÒÂ×ÄÚÉä’s West Side neighborhood, said it took him almost a week to fill out his WVFF application.

The S.H.O.P. is a basic needs site that offers groceries for people with and without housing, a mini laundromat, showers, a locker program and clothing. These services, located at Bream Memorial Presbyterian Church, are described as no-barrier, allowing people to access what they need at any time.

Hudson described his experience with WVFF as requiring precision but said some of the process is unclear. In the first round of statewide applications awarded in December 2024, Hudson said his organization was eliminated for not including a page stating “not applicable� where a section did not apply to them, but later resubmitted.

He applied for $200,000 to fund a reentry program to house people coming out of incarceration and help them integrate back into society to prevent recidivism and homelessness.

Hudson says he was awarded $80,000 in his second attempt at funding from WVFF and was not provided an explanation as to why he received less than half of what he requested.

According to Hudson, WVFF ​​reporting requirements were “very vague.� For successful applicants, quarterly reports are required to show how the funds are being spent and whether or not they’re completing the objectives set out in their application.

In October 2024, Wise completed and submitted a WVFF application for Jacob’s Ladder as well — a six-month, long-term residential treatment program for men in Aurora, West Virginia — which met the initial requirements and moved into the second evaluation phase.

The second phase involved a vote by a five-member board appointed by the governor. The application requested funding for scholarships that would help offset the cost of treatment at the facility not covered by an individual’s insurance. Board members voted against their application.

One settlement, 55 systems

Compared to WVFF’s process, Wise said the Monongalia County application he completed on behalf of Lauren’s Wish was not as lengthy and was more straightforward.

The county uses an online portal with boxes for applicants to fill in the requested specific information. Applicants were required to submit a project summary, proposal details and organization information. For every reimbursement or drawdown, proof of purchase must be submitted and must align with the proposal.

Monongalia County Commission President Tom Bloom says they largely modeled their application after Kanawha County, the state’s largest county in population and home to its capital city.

In distributing its funding, the Kanawha County Commission has taken some measures to be transparent, posting all applications to their website for the public and other organizations to review.

To date, the county has received a total of $3,905,023.09 in its opioid settlement payments, and so far, has funded eight organizations for $1,088,208. The Neighborhood S.H.O.P. requested $49,500 to help establish a new staff position but was denied funding on Oct. 1, 2024.

Applications in Kanawha County are accepted on a rolling basis. Every expenditure and funding request is voted on by the three elected commissioners in a public meeting that allows for community input.

The commission did not sponsor community conversations to discuss the funds, but community groups in ÂÒÂ×ÄÚÉä did hold town halls, bringing various groups together to discuss the distribution of opioid dollars and communicate those recommendations to county officials. At the Kanawha County Public Library, about 60 people attended one of these town halls in March.

Kanawha County Commissioner Lance Wheeler said the commission avoided funding new organizations or those without a “proven track record.�

When asked if the Kanawha commissioners consulted experts in the field before making final funding decisions or if they made the decisions based on their own experience, Wheeler said it was a combination of both.

He said they have relationships with the local Kanawha-ÂÒÂ×ÄÚÉä Health Department and Recovery Point Health, whom they provided funding to from the county budget, and also have experience in responding to funding requests.

In Monongalia County, the application, which is based on a general format and questions used by Kanawha County, asked organizations to provide an executive summary of their proposal, its details, budgeting and organization information, including current funding sources. The majority of questions have a 10,000-character answer limit.

Where Wise, at Lauren’s Wish, said his WVFF application was 50-60 pages, his final application for Monongalia County amounted to seven pages, plus additional tax and financial documents.

As of May 1, Monongalia County has received $1,221,683.89. According to meeting minutes from July 2024, the commission had been working to create a process to award opioid settlement funds for months, but has chosen not to hold public forums to gain community insight into the need, like some counties did.

Bloom said commissioners did not consult experts in evidence-based treatment during the application creation, review or awarding process, but rather relied on their own experience and research.

On July 31, 2024, the three-person Monongalia County Commission approved 12 of 17 applications for a total of $576,900, according to Bloom. Before funding organizations at the July meeting, he said he and the other two commissioners spent close to 30 hours reviewing the “huge� applications.

Lauren’s Wish was awarded $37,500 that day to fully integrate Brown’s ABA program into its peer recovery support services.

Monongalia County commissioners say they focused on selecting specific, established programs that could further provide their services to the community while also looking for new approaches that could assist people with opioid use disorders, with “the key being that we didn’t want to duplicate the services that are out there,� according to Bloom.

Bloom was a guidance counselor for 34 years and has been a county commissioner since 2013. With some additional research, said he felt confident in the commission making funding decisions.

While county commissioners are not required to have expertise in substance use disorders or follow a specific application, review,or awarding process, Laura Lander — addiction therapist and associate professor at West Virginia University’s Rockefeller Neuroscience Institute — said this thinking confused her.

“That’s great that they have experience writing grants, but it’s who gets the grant or what are you targeting the grant towards that is of concern,� she said.

When asked about the accountability of county commissions distributing the funds, Wise said, “I would say the county does their due diligence.�

But without input from external sources and stakeholders, Lander said funding awards are subject to a commissioner’s individual bias.

“Clearly, in other counties, based on what I’ve seen, the money used for law enforcement has the county commissioner’s ear, and we see lots of money going towards police vehicles,� she said.

Although she was not familiar with one of the 12 applications approved by the commission, Libera Inc., Lander said that Monongalia County’s awardees are “great allocations� of the funds and are directly involved with substance use disorder treatment and advocacy.

One county tries a more inclusive approach

In contrast to many counties in the state, the Preston County Commission seems to be taking a more deliberate approach to its spending. As of June 6, the county has received $803,603.42 of settlement funds as part of the local share and decided to put this money into a one-year certificate of deposit to earn interest.

This decision was influenced by the model adopted by Raleigh County, which invested its initial funds while conducting a year of planning, Preston County Commissioner Nathan Raybeck said.

Because they felt they “didn’t know enough about the issue to make a decision� themselves, especially given that “everybody under the sun is going to want a little piece of a little something,� the Preston County Commission created its own Opioid Settlement Advisory Board, Raybeck explained.

“We got a board together of the people who are most directly affected by it, the people who see this day in and day out,� Raybeck said.

The board is composed of individuals selected from the general public who have lived experience with opioid use disorder and representatives from offices such as community corrections, probation and the sheriff’s department. Currently, the board is identifying the best uses for the funds, focusing primarily on improving access to treatment and long-term prevention while researching how to tailor solutions to the specific causes and barriers.

The board’s main focus is treatment and prevention, said Dr. Lola Burke, prescribing provider and medical director for the Preston Recovery Care Program in Kingwood, who serves on the board.

“This is our chance to actually come up with some long-term solutions for this problem that has been plaguing us for a couple of decades now,� Burke said.

Raybeck said it was important not to spread the money too thin, “Because giving you $13,000, and you $30,000, and you $40,000 ain’t gonna get us anywhere.�

Absent oversight, future spending could face accountability gaps

On May 20, in Sutton, WVFF celebrated its first grant recipients, with a total of $17 million awarded to 94 organizations.

Although the timeline for the next grant application cycle has not yet been determined, organizations like Lauren’s Wish and the Neighborhood S.H.O.P. will be eligible to apply for a second round of funding. Applicants who were denied, like Jacob’s Ladder, are also able to reapply.

At the local level, county commissions are left to their own timelines and decision-making processes. Some, like Preston County, are only beginning to create these procedures, while others, like Monongalia and Kanawha counties will have another go after learning from their first rounds.

Although Lauren’s Wish was awarded funds at both the state and county levels, Bloom questions if the WVFF’s state-chosen reviewers truly know enough about local programs to make informed decisions.

There are regional boards that also make recommendations to the state WVFF reviewers during the selection process, but Bloom said regional boards are still “not local.�

Each of the six regional panels were initially supposed to be made up of two individuals from each county, but WVFF “changed the rules� during the process, according to Bloom, and now are made up of six individuals who each represent six categories of interest, like treatment and prevention.

Bloom said a lack of oversight and direction from WVFF was also an issue, but he understands that this was its first attempt at the process.

While a chunk of settlement money has been spent, this only marks the start of a statewide effort to leverage these funds for change in West Virginia. Lander hopes to see this money go into not only existing programs, but new ones as well.

“So many of the grants that were funded were just funneling money into existing programs, which is not without merit. That can be very valuable,� Lander said. “But I wish we would really think about the big picture and how to build affordable housing infrastructure in this state, because it is hard to get sober if you do not have a place to live.�

She said more representation from various stakeholders who are impacted and understand the effect of substance use disorders on the community could make a significant difference.