In February 2021, the global consulting firm McKinsey & Company agreed to pay nearly $600 million to 49 states, the District of Columbia, and five U.S. territories for its role in advising businesses on how to sell more prescription opioid painkillers amid a nationwide overdose crisis.
Because the McKinsey dollars come with no restrictions, states have a rare opportunity to explore more innovative and comprehensive approaches to tackling the pandemic.
“Federal and states dollars typically include restrictions on how and where funds can be spent, which inherently limits how problems are addressed,” says Chuck Klevgaard, a TA specialist with Prevention Solutions@EDC (PS@EDC).
But states can use the McKinsey funds as they please. Because they aren’t chasing siloed dollars, they can define their own priorities and develop approaches that are the best fit for their communities—including opportunities to address many of the structural causes of opioid use and overdose, such as poverty and racism.
“These dollars bring critical resources to traditionally under-funded issues,” says Klevgaard. “States haven’t seen unrestricted dollars of this size since the tobacco settlements of the ‘90’s. They’re thinking carefully about how to use them and want to make sure that the dollars don’t get re-directed, as they frequently have in the past.”
To support their efforts, PS@EDC staff have been connecting with state prevention leaders from across the country to explore their upcoming prevention needs and generate potential solutions.
Building Community Resilience
For many states, a critical area of focus in the upcoming months will be on building community resilience—by addressing the root causes of opioid misuse, such as trauma, mental illness, over-prescribing, and harmful social norms; helping adolescents and young adults develop the skills they need to make healthy choices and decisions; and breaking the cycle of intergenerational addiction through treatment, recovery supports, and prevention services.
“States are often funded to implement short-term solutions. And while it is critically important to prevent that next overdose death, we also need to think longer term. We need to change the conditions and persistent inequities that leave people vulnerable to opioid misuse,” says Klevgaard.
Producing this level of change requires broad involvement by multiple community sectors—prevention and treatment, as well as education, public safety, health care, mental health, social services, economic development, and early childhood. Thus, many states are exploring ways to use their McKinsey dollars to eliminate the siloes that can prevent sectors from working together seamlessly and efficiently. For example, several states will begin working with PS@EDC over the next few months to implement community opioid collaboratives: groups of community stakeholders dedicated to establishing and sustaining cross-sector approaches to reducing opioid misuse and overdose. By looking closely at the conditions that correlate most strongly with deaths in their community, and identifying how each sector contributes to these conditions, these collaborative teams can begin to identify shared priorities and specific strategies they can work on together.
“Through the community opioid collaboratives, communities can create a framework for collective impact,” says Klevgaard. “They can make sure health and equity are part of every discussion. And they can begin to build the community-wide infrastructure needed to inoculate communities against the next emerging crisis.”
At the same time that states are thinking long-term, they are also continuing to seek opportunities to increase the number and scale of proven prevention interventions that reduce opioid misuse and overdose. While many interventions have shown promise in these areas, including interventions to reduce subsequent overdoses among overdose survivors, few have benefited from strong evaluations, resulting in limited information on what works in different settings or among different populations.
“With the opioid crisis, the artificial lines that formerly existed between prevention and treatment haven’t gotten blurred—as they should be,” says Klevgaard. “Our ‘all or nothing’ ideas about what prevention should look like have also been challenged, forcing us to embrace harm reduction approaches. And we’ve had to engage with a new set of prevention partners in order to reach the suffering most from this epidemic. We need to reach people where they are. This means developing programs in settings that are new for the prevention field, such as food pantries, needle exchange programs, and homeless shelters.
To establish a strong evidence base for these new interventions, PS@EDC have invited states to take part in its Innovation Learning Lab, where local prevention programs can receive technical assistance to develop and evaluate their innovative overdose prevention interventions. In Wisconsin, three pilot sites are working with the Lab to evaluate a naloxone distribution program: the program relies on emergency medical services staff to disseminate naloxone kits to the family and friends of people who have experienced an overdose. PS@EDC staff will train the sites to implement the program with fidelity, help them to build a coordinated evaluation plan, and eventually, package and prepare the intervention for broader dissemination.
“By engaging programs in a comprehensive development progress that’s informed by rigorous evaluation methodologies, states can help to ensure that their prevention dollars are used wisely; that innovative programs have a strong theoretical base, grounded in community needs; and that new innovations produce sustainable outcomes,” says Klevgaard.
The McKinsey dollars offer states a unique opportunity to correct an often-fragmented prevention system by investing in systemic and coordinated community-level approaches to opioid prevention. It will be exciting to see how states capitalize on this opportunity.
To learn more about PS@EDC’s Innovation Learning Lab, Community Opioid Collaboratives, and other services to address racial and health inequity, opioid misuse and overdose, and evaluation design and delivery, contact Chuck Klevgaard at firstname.lastname@example.org.