As the opioid epidemic continues to devastate communities, attention has turned to how best to allocate the billions in opioid settlement funds. With over $50 billion from settlements, states and localities have a unique opportunity to address the crisis, but missteps from previous settlements, like the tobacco settlement, serve as a warning. In a recent conversation, Dr. Michael Giles, founder and CEO of Sonara Health, shared his insights on innovative solutions for opioid treatment and the challenges facing effective allocation of these funds.
Opioid Settlement Funds: A Critical Opportunity
The opioid settlement funds present an unprecedented opportunity to reduce opioid-related harm through treatment and intervention. However, Dr. Giles pointed out that previous large settlements, such as the 1998 Tobacco Master Settlement Agreement, show that without careful oversight, funds can easily be misallocated. Only a small fraction of the $250 billion in tobacco settlement funds were directed to tobacco prevention and cessation efforts. A similar risk exists with opioid funds, which are already facing some diversion to unrelated projects.
Dr. Giles stressed the importance of prioritizing evidence-based interventions and expanding access to life-saving treatments for opioid use disorder (OUD). Without strong oversight, settlement funds may not reach the programs that need them most, missing an opportunity to create meaningful change.
Innovative Solutions for Expanding Treatment Access
Dr. Giles developed the Sonara Health platform to address one of the major challenges in opioid treatment—access to medication-assisted treatment (MAT), especially methadone. Many patients in opioid treatment programs (OTPs) must visit a clinic daily to take methadone, which can be a major barrier to staying in treatment. Sonara’s solution allows patients to take their doses at home under remote supervision, using technology to ensure adherence to treatment protocols.
Sonara has shown promising results, with retention rates significantly higher than traditional methods. Dr. Giles explained that by giving patients more flexibility and trust, the platform improves both adherence and overall quality of life. Despite its success, widespread adoption of the technology faces hurdles, particularly with reimbursement. Many OTPs are limited in the types of services they can be reimbursed for, leaving innovative solutions like Sonara unfunded by traditional payers.
Barriers to Adoption and the Role of Settlement Funds
While the potential for technologies like Sonara is clear, Dr. Giles highlighted the lack of payer incentives and reimbursement structures to support such innovations. OTPs have rigid billing structures, and the current healthcare system does not readily accommodate new technologies or care delivery models. However, opioid settlement funds could be used to pilot and expand these tools, particularly in rural areas where daily in-person treatment is especially burdensome.
Sonara has already seen success in rural states like Alaska, where clinics have adopted the platform to improve patient care in remote areas. This use of technology, Dr. Giles argued, is a model for how opioid settlement funds can be allocated to drive long-term improvements in treatment access and retention.
Learning from Past Mistakes: Ensuring Accountability
In discussing his recent white paper on the strategic allocation of opioid settlement funds, Dr. Giles underscored the importance of learning from the mistakes of previous settlements, such as the tobacco settlement. He stressed that settlement funds should be directed toward proven interventions, not diverted to unrelated projects or used to fill budget gaps. The funds offer a rare opportunity to invest in life-saving treatment, but only if they are allocated wisely.
To ensure funds are used effectively, Dr. Giles advocates for clear guidelines and accountability measures. He also emphasized the need to support innovative technologies like Sonara, which can increase treatment access and improve patient outcomes.
The Path Forward
Looking ahead, Dr. Giles sees a critical need for both payer reform and stronger oversight of how settlement funds are used. Legislative efforts in states like New Jersey and Ohio aimed at modernizing OTPs and supporting the adoption of new technologies. These efforts are crucial to ensuring that opioid settlement funds are used to drive innovation and improve outcomes for those struggling with opioid use disorder.
Dr. Giles’ work with Sonara Health highlights the importance of leveraging technology to expand access to treatment. By supporting innovations like remote monitoring, states and localities can ensure that settlement funds lead to lasting improvements in how opioid use disorder is treated.
Conclusion
The opioid settlement funds offer a unique chance to make meaningful progress in the fight against the opioid epidemic. But to succeed, we must focus on evidence-based strategies, innovation, and accountability. As Dr. Giles’ work demonstrates, integrating new technologies into treatment programs can significantly improve patient outcomes and help ensure that the billions in settlement funds are used to their fullest potential.