Where did the money come from and do these programs make sense?

In recent years, state and local governments have focused upon spending money (not a new exercise for government) received as proceeds from a lawsuit — spending a lot of it, as a matter of fact — $26 billion, to be exact. Some of that money, of course, flowed to our state and communities.

The North Dakota Legislature authorized use of some of these funds for programs such as the one administered by Fargo Cass Public Health which is currently experiencing heightened scrutiny. The law, originally passed in 2017 was amended in 2019 and again in 2021, lacks express permission to distribute pipes used to administer illegal drugs such as crack and meth — the topic which has captured recent public attention.

The funds in the opioid settlement come primarily from the “big three” pharmaceutical companies — McKesson, Amerisource Bergen, and Cardinal Health — and one manufacturer — Johnson & Johnson. They were sued over allegations that they didn’t adequately warn patients of the addictive properties of opioid pain killers and that they aggressively marketed them to doctors. Many Americans who were prescribed the drugs became addicted to them and, in some cases, the medications were overprescribed. In others, addicted patients are believed to have resorted to illicit drug use when they were no longer able to obtain the prescription drugs. This belief has led to programs which arguably enable, rather than treat, addiction.

The settlement made the three pharmaceutical distribution firms liable for $21 billion over 18 years and the manufacturer liable for up to $5 billion over nine years, with up to $3.7 billion paid during the first three years [according to information from NAAG (the National Association of Attorneys General)].

Legal settlements and use of proceeds

As they often are, the settlement agreement was reached to avoid taking the case to its completion through the legal process. Like the tobacco lawsuit of several years ago, states sued and settled, but the premises of the two cases were very different. 

In the tobacco settlement, states were successful where individuals had failed. Individuals were repeatedly unable to draw a clear cause-effect relationship with their own smoking and resulting diseases and lost many law suits as a result. States, however, were successful in demonstrating that they had spent huge sums of money — generally and collectively, over their population, — on treating the diseases which tobacco use had caused. Accordingly, the proceeds amounted to states being reimbursed for money already spent, so the settlement dollars could logically be used to make the states financially “whole”.

In the opioid settlement, conversely, the misbehavior which led to addiction was the issue. It is logical, therefore, that the funds should be used to treat it. States’ attorneys general, in fact, reported that “the substantial majority of the money (was) to be spent on opioid treatment and prevention” and North Dakota has shared that focus.

This begs the question of whether or not these programs are really appropriate. Recent criticism of the “needle exchange” program is that it seems to have, instead, largely become a needle distribution program and recently has expanded to the distribution of the pipes which are common in meth and crack use, with no clear legal authority to do so.

Do we really want to enable illegal drug use?

With increased scrutiny, people are asking how the money is being spent and whether the programs implemented are effectively treating and preventing opioid addiction or actually furthering addiction.

Efforts like the Fargo Cass Harm Reduction Center have become popular around the country as a way to reduce the negative effects of illegal drug use – such as overdosing and the transmission of bloodborne infectious diseases.

While the desire to reduce harm is admirable, we need to ask ourselves if condoning, normalizing, and enabling a harmful activity like illicit intravenous drug abuse is something we want our government to foster.

To help answer that question one should visit East Franklin Avenue in South Minneapolis. It’s an area that has become ground zero for fentanyl addicts and the homeless encampments that come with this population.  Hennepin County has been providing free needles to this population for 10 years now, and the fentanyl addiction problem and associated problems (homeless encampments, discarded needles, filth and trash, and violent crime) have increased to intolerable levels for some neighborhoods. An area library bathroom and nearby light rail stations have become frequent locations for overdoses.

Of course, the agencies that support these programs go to great lengths to publish studies and data that suggest the situation would be far worse without the needle exchange programs. But those “findings” belie common sense and the reality of what neighborhoods and towns that support these programs have experienced.  The fact is that the needle exchange programs attract illicit drug users, and the combination of an air of permissiveness and the congregation of addicts in an area often lead to problems such as those found in Minneapolis.

Furthermore, not all the data supports the concept of needle exchanges.  A comprehensive analysis of the effects of these programs by the National Bureau of Economic Research in Cambridge Massachusetts determined that, while transmission of some infectious disease was reduced, the county-wide mortality rate of intravenous opioid drug users actually rose between 23-42% in the first three years following the opening of a Syringe Exchange Program (SEP).

While it is not scientific proof, the experiences of Fargo seem to support this data.  The Fargo Cass Harm Reduction Center opened in 2018 and began its needle exchange program at that time.  According to media reports, the number of overdose deaths in 2018 was 26.  In 2019 the number rose to 29, and by 2020 the number of overdose deaths increased to 45. Unfortunately, things don’t seem to be improving.  According to a the Fargo PD, it has responded to more overdoses so far in 2025 than in the past four years combined.

Irony and Questions

Ironically, the items distributed in such programs would otherwise be classified as illegal drug paraphernalia, which could subject those possessing them to criminal liability, yet our government is distributing them to illegal drug users.

An increasing number of citizens are questioning the wisdom and effectiveness of both the needle exchange program and its expansion to pipe distribution and whether these are appropriate uses of the settlement dollars, in the first place. Elected officials on the local and state level should take a closer look at these reasonable questions.