The conversation on June 20 did not make a favorable impression on the residents of Kensington.
The Philadelphia area is critical center opioid crisis in the country, and the city decided to spend $7.5 million to address the opioid problem, improve quality of life there. But that day, the Pennsylvania Board of Supervisors was set to vote on whether to overturn the city's decision.
It was a difficult issue with serious implications – both for Kensington residents and for people across the state, as the decision could set a precedent for what spending the council would allow for years to come.
However, many people were excluded from the discussion.
The Pennsylvania board does not allow members of the public to speak at its meetings, a rule that sets it apart from about two dozen similar opioid boards across the country.
“This is another moment where people who are not connected to this community are making decisions for this community, and I think that's inappropriate,” said Bill McKinney, a Kensington resident. whose non-profit organization participates in some of the city's settlement-funded initiatives. “The ones who have suffered the most aren't at the table.”
It's one example of how the public, including people who have lost loved ones to the opioid crisis or deal with it on a daily basis, typically don't have a say in how best to use this windfall to repair the damage. They're eager to offer solutions for dollars that many of them look at the blood moneyBut a first-of-its-kind survey by KFF Health News and Spotlight PA found that in many places, their voices are being systematically ignored.
In at least 39 states and Washington, D.C., advice consisting of government officials, doctors, law enforcement officials and others who make decisions about how to spend compensation money. These powerful groups are influencing drug addiction policy and funding at a time when over 100,000 Americans die every year from overdoses.
At least 14 of those boards — including Pennsylvania’s — routinely block members of the public from speaking at their meetings. Four of them routinely hold their meetings in secret, barring the public from even attending or observing.
The survey also found:
- Most boards do not make video recordings of their meetings publicly available online for those who cannot attend in person. While some boards have said the recordings can be made available through public records requests, at least one — the Minnesota Opioid Epidemic Advisory Council — deletes its recordings after they are used to create meeting minutes. (Minnesota law does not require a board to record its public meetings or post the recordings online.)
- At least five states have used committees or task forces that meet privately, or have policies allowing such private meetings. In Pennsylvania, such task forces have become the subject of controversy, with victims, advocates and even one council member questioning their legitimacy(The Pennsylvania Foundation for Opioid Abuse and Addiction's chief operating officer said the task force meetings are not required to be public. They make recommendations that are then acted upon by the full board.)
Practice that excludes discussion of public spending is 'unconscionable', says Stephen Loydchair of the Tennessee Opioid Action Council, which regularly allows the public to attend and comment at its meetings. “This is the population we serve here. They should have a voice in this process.”
Different positions on public debate
The people directly affected by the issue are a fixture at Tennessee council meetings. This year, commentators included several parents holding pictures of their dead children and holding back tears, and at least one disillusioned member of the community.
IN June meeting In Memphis, Peter Hossler, an associate professor at Rhodes College, said he was “very angry” about how the board's recent decision grants totaling $81 million It seemed like he was shortchanging the western part of the state.
Loyd called such criticism “priceless,” comparing it to the feedback he received from loved ones during his recovery journey.
“We have to be accountable,” he told KFF Health News and Spotlight PA. “And then we have to fix it.” Hossler’s comments change the course of the board’s discussions about the next round of grants, Loyd added.
Lloyd believes that people who have been let down by the current system know what needs to be improved “better than anyone else.”
“I want to talk to people who were told not to take their medications in prison, who were lying there and refusing to take them,” he said. “I want to talk to people who came out of prison with no money, with a couple of felonies hanging over their heads, with three meetings they had to make that week or they would violate their probation, and they don’t have a car or a driver’s license.”
States have cited a variety of reasons for limiting public participation. Some states have laws that do not require boards to take public comments at meetings. Several officials said they had tried to get feedback in other ways. A New Jersey official said his council had conducted public hearingsbut its monthly meetings are not public.
Some officials may worry Such public comment would add to the length of sessions, which already last several hours, but several states address this problem by limiting each person's comments to a few minutes.
For communities of color, being left out of the opioid crisis debate could compound the negative impacts of not only today’s overdose crisis but also the earlier crack epidemic. Many people felt that the government’s response at the time was ineffective and harmful.
If the money allocated for the settlement is used only to “build on what is already there, you have already failed,” he said. Philip RutherfordSubstance Use Disorders Expert at the National Council on Mental Wellness.
IN Meeting in July 2023 Illinois Settlement Council, Fanya Burford-Berry said the current system is not working for women of color with substance use disorders, putting them at risk loss of custody of one's childrenBurford-Berry, director of Chicago's West Side Heroin/Opioid Task Force, hopes comments like hers will encourage the council to support solutions tailored to women of color, including by bringing together more organizations that already work in those communities.
“When you allow more people to participate and then they have an idea and they get excited about it, then you get more people involved and the healing circle can become wider,” she said.
“The Moment of Re-Trauma”
Pennsylvania has 13 state legislators. opioid problem resolution council has the power to withhold future funding if it decides local governments have spent their money poorly. At its June meeting, the board — which includes a state senator representing part of Kensington — voted against Philadelphia uses 7.5 million dollars for park improvements, home renovations, rent reductions and other initiatives in Kensington. (Later Philadelphia appealed the rejection; the issue is under consideration.)
McKinney, a Kensington resident and executive director of the New Kensington Community Development Corporation, called the council's decision a “re-traumatization moment” for residents and criticized the way they were silenced.
“I think it's unfortunate that it was decided to do it this way,” McKinney said.
Others were also disappointed with the performance of the Pennsylvania Board of Adjustment.
Gail Groves Scott, a public health policy advocate who has a child in persistent recovery from opioid use disorder, attended a board meeting in person last year. She said the public’s ban on commenting on meetings prevents them from offering feedback at critical times, such as when the board reviews the district’s spending plans or contracts for its operations.
“We could question those decisions or add information that they might not be aware of,” Groves Scott said. “It's frustrating that despite a lot of people pushing back, they haven't changed.”
Some supporters say that closed meetings of working groupswhich make recommendations on which programs to approve, hide why the entire board of directors takes certain actions.
Pennsylvania trust fund officials defended their practices.
Briana Anderson, the fund's chief administrative officer, downplayed the group's role, saying it doesn't make specific decisions about how settlement funds are spent but only reviews choice made by local authoritiesAnderson added that state law does not require the fund to provide public comment at its meetings, but the public is encouraged to participate at the local level.
Pennsylvania's practice stands in stark contrast to how boards operate in places like Illinois, Kentucky and Oregon, which typically allow public comment at both full board meetings and smaller committee meetings. In Kentucky, an open process allowed members of the public to weigh in on the heated debate for funding research into ibogaine, a psychedelic drug that has shown potential to treat addiction. At least eight people spoke in favor of drug at the January meeting of the council.
Back in Tennessee, council Chairman Loyd said he hopes to expand public participation by creating an advisory group made up largely of people who have personally experienced addiction or their loved ones.
He also encouraged other township councils to take advantage of opportunities to hear from people in their states.
“As a result, you will make better decisions. I cannot be convinced otherwise,” he said.
Methodology
In June and July, reporters from KFF Health News and Spotlight PA surveyed opioid addiction resolution boards in 39 states and Washington, D.C., to assess their general and standard public engagement practices. The team also reviewed board websites, meeting minutes, agendas, and, in some cases, hours of meeting recordings. These boards serve a variety of functions, including directly deciding how to spend money, making recommendations, or providing oversight. While they go by a variety of names, including advisory boards, boards, committees, and commissions, we refer to them as boards as a broad, encompassing term.
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