tee

July 28, 2023

To Kent County Leadership:

For +20 years, the opioid epidemic has caused significant harm to individuals, families, and
communities across Michigan and in particular, Kent County. On-behalf of the affected residents of the
State of Michigan, the Michigan Attorney General participated in various successful lawsuits resulting in
“Opioid Settlement Funds” meant to rectify these harms through spending on community based efforts.
To restore justice to affected communities, opioid settlement money must first be spent on saving
lives.1 The most direct and cost-effective way to impact affected communities is through increasing
harm reduction services.

As such, we are concerned that Kent County Health Department (KCHD) and Kent County Commission
(KCC) have not created a specific funding pathway for harm reduction services in line with the needs of
community members who use these services. It is an ethical imperative that each dollar of this
settlement money be spent well and spent to rectify the harms caused by the defendants. An
essential way to do this is through funding community based harm reduction efforts.

Harm reduction is a longstanding (+30 years) and well researched public health approach that has the
goal of reducing harms associated with risky activities (e.g., driving without a seatbelt), including drug
use. Since the beginning, research has found that drug use focused harm reduction consistently
decreases drug use, decreases risky drug use, decreases healthcare costs, decreases crime, and is
cost-effective (Appendix 1). As such, investing in harm reduction services results in significant public
health savings, improves public health outcomes, and enhances the well-being of individuals and
communities affected by drug use. Harm reduction services aim to reduce the negative consequences
associated with drug use by meeting people where they are and bring health services to historically
marginalized people and those most harmed by the defendants. Harm reduction approaches include:
naloxone distribution to high risk communities, syringe service programs, and drug checking. Because
harm reduction services are in the community working with the most impacted people, they can serve
as an important bridge to evidence-based treatment, provide a safe “waiting area” to keep people alive
while they are not able to otherwise access treatment services, and are most attuned to the needs of
the vulnerable people they serve.

Kent County’s harm reduction services are an unequivocal public health success story. Since
their introduction in the late 1990’s, harm reduction services in Kent County have led to a significant
reduction in HIV cases related to injection drug use and consistently low overdose mortality data
compared to the rest of MI. Residents of Kent County have benefited from the vital partnership between

1
https://opioidprinciples.jhsph.edu/
harm reduction services and local government, including its inclusion within the Kent County Opioid
Task Force (KCOTF), and massive cost savings for Kent County from using this approach. However,
some communities and some community leaders still frame harm reduction as “controversial” and treat
it as a political issue rather than a public health strategy. Harm reduction is a public health approach
that needs public health advocates to educate the community and successfully implement these
approaches.
While harm reduction works in Kent County, the need for expanded services remains
significant. Black people in Kent County have a 3x higher overdose death rate than White people and
this gap continues to widen. Kent County continues to experience increasing rates of deadly fentanyl
contamination. Poly-substance use, including methamphetamine, continues to rise. Hepatitis C is rising
and HIV remains a significant issue. Overdose deaths, while lower than other counties, remain
stubbornly high. To effectively combat this multifaceted rise in negative public health outcomes, Kent
County must continue to support harm reduction efforts. Whether it be through continued expansion of
syringe access programming, addressing modes of use beyond injection, drug checking programs, post
overdose response wellness visits, or community based recovery coaching, harm reduction in Kent
County has been innovative, and it has continued to shift to meet emerging needs and disparities.

The successful use of opioid settlement dollars will require KCHD to work hand in hand with local harm
reduction services to identify and prioritize the needs of the most vulnerable and most impacted
members of our community.

Our Concerns
Harm reduction is an essential part of any response to the opioid crisis, yet there is some disconnect
with the historical importance of harm reduction services and the decision making process for allocating
the opioid settlement dollars. As such we have specific concerns for the KCHD:

1. We ask the KCHD to request a needs assessment conducted in coordination with the Michigan
Association of Counties Technical Assistance Hub2 prior to any funding requests or
disbursement.
○ In conjunction, we ask that the KCHD request a pause in how the funds are disbursed by
the Kent County Commissioners (KCC) pending this needs assessment.
○ This needs assessment will lead to more effective use of the funds and a clearer ability
to understand how requests are aligned with the stated purpose of the funds or best
practices documents.
○ Any fund disbursement in absence of a needs assessment is against the spirit of
restorative justice and the purpose of the opioid settlements.
2. We ask that KCHD advocate for the KCC to establish a dedicated harm reduction funding
stream from the opioid settlement money. This harm reduction funding stream must be
separated out from other domains (i.e., treatment or recovery supports).
○ While elements of harm reduction are present among other domains that address the
opioid epidemic, harm reduction specific services must be prioritized based on their high

2
https://micounties.org/opioid-settlement-assistance-request-form/
 impact on the most affected community members and robust cost effectiveness. This
harm reduction funding stream can include:
i. Enhancing programming and outreach to better address growing racial health
disparities among people who use drugs in the community
ii. Expanding supply distribution at syringe access programs for community
members
iii. Implementing new harm reduction strategies to address the changing drug
supply affecting vulnerable community members
3. We ask that any requests for opioid settlement money from the KCHD to the KCC include harm
reduction specific project(s) as enumerated above.
○ This request is in alignment with KCOTF recommendations based on community
engagement meetings that included multiple harm reduction specific projects for funding.
4. We request the KCHD re-evaluate their approach to community engagement meetings related
to the opioid settlement funds.
○ The impression of affected communities is that their voices are not heard and given
ample consideration by KCHD leadership.
○ The KCHD has an obligation to engage affected communities and make sure opioid
settlement money will directly benefit those most affected people.
○ Successful community engagement includes the input of those most harmed by the
opioid epidemic in the design and implementation of strategies designed to serve those
communities.
○ Successful community engagement is also responsive to these needs.
○ It is not clear what engagement is happening outside of the KCOTF. This is particularly
concerning considering the recommendations of the KCOTF related to funding for
specific harm reduction strategies have been disregarded.
5. We request transparency on KCHD prioritization of recommendations made by the KCOTF:
○ How were decisions made regarding what community recommended interventions would
be put out for vote?
○ What were the results of this KCOTF vote?
○ How were the results of the vote used to determine which projects would be put forth to
KCC for funding?
○ How were partners related to the KCHD submissions chosen and evaluated?
○ Who’s educating the KCHD related to opioid settlement money? How were these
educators chosen?
6. We request a decision making flow chart for the KCHD related to opioid settlement money
especially regarding what proposals are put forth to the KCC.

Opioid Settlement funds must meet the acute need for expanded harm reduction services in our
community. KCHD serves a vital role of educating about harm reduction services to the KCC and
advocating for evidence-based, cost effective harm reduction services on behalf of the residents of
Kent County.

Respectfully submitted,
The Intervention Committee of The Kent County Opioid Task Force