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Opioid grants mostly funded prevention, but also raised questions

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Opioid grants mostly funded prevention, but also raised questions

Oct 24, 2024 | 10:58 am ET
By Nick Stonesifer
The Prescription Opioid Settlement Distribution Fund has been marked by suspected fraud, questionable priorities and links between leadership and grantees. | SPOTLIGHT DELAWARE PHOTOS BY JACOB OWENS / NICK STONESIFER
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The Prescription Opioid Settlement Distribution Fund has been marked by suspected fraud, questionable priorities and links between leadership and grantees. | SPOTLIGHT DELAWARE PHOTOS BY JACOB OWENS / NICK STONESIFER

This is the third story in a three-part investigation, where Spotlight Delaware analyzed all of the grant applications, contracts signed by recipients and grant reports shared with the lieutenant governor’s office to determine how funds have been allocated in the state. Part 1 is available here, and Part 2 is available here.
If you or someone you know is struggling with addiction, here’s a list of treatment centers in Delaware. 

Last year, 527 people died from an overdose in Delaware. 

And while that total marked a small year-over-year decrease for the first time in a decade, it’s still one of the highest number of deaths on record in Delaware. That sparked a sense of urgency to get millions of dollars from a new fund to support organizations on the front line.

But two years and $15 million later, those recipients spent most of their time on prevention education efforts like community events, pamphleting, swag, youth sports, student presentations and TikTok videos rather than offering direct treatment services.

The state pushed out dozens of six-figure grants to organizations, some of which had little experience in substance abuse prior to their awards.

Over two months, Spotlight Delaware analyzed hundreds of pages of emails, applications, tracking reports and contracts obtained via the Freedom of Information Act and interviewed nearly a dozen people close to the commission that oversaw the funds. An investigation found many of the organizations already had connections to Lt. Gov. Bethany Hall-Long, who oversees the fund as a co-chair.

Additionally, multiple organizations were approved for awards despite “serious concerns” from the attorney general’s office.

Prevention versus treatment

There are an estimated 140,000 people living in Delaware with substance use disorder, and more than 500 people died from drug overdoses in each of the last two years, according to state officials. For a decade, Delaware has seen a growing number of fatal overdoses – and the Prescription Opioid Settlement Fund was seen as an important tool for turning the tide.

The Prescription Opioid Settlement Distribution Commission (POSDC), an appointed body staffed by the lieutenant governor’s office that reviews and recommends grants from the settlement fund, sought guidance from the Delaware Drug Overdose Fatality Review Commission (DOFRC) in November 2022 to help develop its strategy.

DOFRC, a more tenured body that takes a sample of overdose deaths from previous years to better understand the preceding circumstances, outlined four strategies for the POSDC – get people housed, increase access to naloxone, incorporate mental health into treatment and offer intervention in drug-related police encounters.

But a Spotlight Delaware examination of POSDC grant reports up until Aug. 29, shows prevention efforts accounted for nearly 60% of how grantees are spending their time. The second highest category with 30% of efforts was harm reduction, which includes distribution of drug testing kits and naloxone, a medication capable of reversing the effects of a potentially fatal overdose.

Only 13% of efforts went to direct treatment, including entry into detox, enrollment into medication-assisted treatment programs, and funding peer-support services.

In its latest recommendations in its 2023 annual report, DOFRC highlighted the need to reach those reentering society from incarceration and increasing peer-support services for those on parole or probation.

More than a quarter of those who died from overdoses last year and who had served a jail sentence of less than a year, died within three months of their release, the report said, highlighting the precarious circumstance of reintegrating into society.

But grant reports from 70 opioid grant recipients show only 2% of recorded efforts were aimed toward people involved in the criminal justice system.

Missing reports

Through a Freedom of Information Act request, Spotlight Delaware obtained data that the attorney general’s office tried to get for nine months and found many grantees are inconsistently sending monitoring reports – with some going months without sending in any data, despite reminders from the state and a requirement that they be submitted monthly.

Another FOIA request filed by Spotlight Delaware in early September is pending for all attachments, receipts and supplementary data shared with the government to further understand how recipients quantify their work. Those records are explicitly required to be kept by grant recipients per the terms of their grant contracts and are subject to FOIA.

The POSDC has not provided that information to date and stated that it would need more than two months to compile it.

Meanwhile, Attorney General Kathy Jennings has repeatedly raised concerns regarding the approval and oversight process of grants from the fund, which her office helped to secure from opioid manufacturers and distributors following the addiction crisis that spiraled out of the proliferation of pain pill production.

One grantee that was awarded $570,000 is under investigation for “potential fraud” of the fund, while another $475,000 invested in a planned community center is in jeopardy after the city of Wilmington filed for foreclosure on the building over significant unpaid taxes.

When asked this month about efforts by several specific grant recipients to fulfill their stated objectives, Lt. Gov. Bethany Hall-Long, who oversees the opioid fund as chair of the POSDC, said in a statement that the funds are meant to “reach some of the hardest hit by the opioid crisis.”

“Many of these organizations are minority-run and have direct connections to the communities they serve,” she said. “We can have the necessary conversations about continuous quality improvement and accountability without harming the very organizations working hard on-the-ground to reach those impacted.”

A common connection

In a small state like Delaware where connections are common and providers are limited, many of the same names pop up. But in the case of Delaware’s opioid fund, many of the recipients have ties to those in leadership, and some POSDC board members actively run organizations that received awards.

One connection is evident through a baby formula program run through Hall-Long’s office. The program was designed to get formula out to families in need following a 2022 shortage due to a large-scale recall.

Her office partnered with multiple organizations up and down the state to distribute formula that the state government was able to secure from manufacturers. Of those formula partners, 11 are also awardees from the state’s opioid fund.

While the organizations that partnered with the program are likely participants, like the Food Bank of Delaware or the Delaware Regional Dream Center, it tells a larger story of connections between the commission and its recipients.

The familiarity of those involved with the opioid fund also raises questions around the makeup of the commission, where some members are leaders of organizations that received grants. Organizations like Brandywine Counseling and Community Services, atTAcK Addiction, and the Delaware Division of Substance Abuse and Mental Health, have seats on the commission and take votes on funding decisions.

To avoid a conflict of interest, voting members who have ties to organizations must abstain from votes where their applications are considered.

However, the makeup of the POSDC is noticeably different from other appointed state grant-making boards, such as the Council on Development Finance and Transportation Infrastructure Investment Fund Council, which are chaired by professionals rather than elected officials.

Code Purple cracks the door

Allegations of fraud against Code Purple Kent County, a Dover-based nonprofit, are what sparked questions of oversight around the money. A letter to Jennings from Delaware Auditor Lydia York said her office had “reason to believe” that dollars awarded to a Code Purple were “secured with fraudulent documentation.” 

Spotlight Delaware interviewed a director at Code Purple Kent County, Ennio Emmanuel, before the fraud allegations were public. In his interview, he said the grant came as a surprise, since much of the work they had done in the past was around homelessness and food insecurity.

“It was a shock when we got the grant, honestly,” he said. “We were just starting to get into addiction treatment and trying to learn that because we weren’t that type of nonprofit.”

Spotlight Delaware held this interview in person and saw sensory deprivation tanks, red-light rooms and different bath scrubs.

It is unclear whether or not opioid grants were used to pay for these items. 

Code Purple’s Dover location closed in September after a massive fire. Dover fire marshals would not comment on the investigation, and the attorney general’s office said the fire would have no bearing on its investigation into the nonprofit.

Nonprofits approved despite questions

Two nonprofit organizations, Love and Hope Rescue Mission and Women of Exception, were awarded a total of $220,000. But emails obtained by Spotlight Delaware show the attorney general’s office raised “serious concerns” about both organizations prior to their award.

Websites for both organizations prominently feature pictures of leaders posing with Hall-Long.

The AG’s office worried that Love and Hope Rescue Mission was ineligible to receive the funds because it didn’t appear to have the required two years of operating documents prior to receiving the grant.

It based this suspicion on Love and Hope’s Form 990 filings, a document that tax-exempt organizations must send annually to the IRS with information about their finances.

“We’re going to have to explain to the Committee why they were recommended for a grant when it appears from their 990 that they shouldn’t have passed the screening guidelines,” State Solicitor Patricia Davis, who heads the Delaware Department of Justice’s Civil Division, wrote in an email to the POSDC.

Records from the IRS show Love and Hope has a Form 990 from 2022, as well as a Form 990 postcard from 2021, which is reserved for organizations earning less than $50,000 during a tax period.

Davis also wrote that Love and Hope’s 2022 Form 990 showed an “unexplained loss” of $83,000. The solicitor wrote that she consulted a certified public accountant who said it was “highly suspicious accounting for a nonprofit.”

The lieutenant governor’s office said in a statement that the Department of Justice has worked collaboratively with the POSDC on awards “to assess grantees throughout the entirety of this grant program.”

“With respect to Love and Hope Rescue Mission and Women of Exception, these applications, as well as a few others, were flagged by the DOJ for further review,” the office said. “Upon the DOJ’s request, both DOJ and POSDC staff conducted a joint review to ensure compliance with application guidelines.”

In September, Spotlight Delaware reported the lieutenant governor’s office overpaid Love and Hope Rescue Mission by $20,000 and its contract incorrectly funded $30,000 more than was approved. While the organization promptly repaid the funds, the episode raised questions about oversight of the significant pot of money.

Neither Guilande Dice, the founder of Women of Exception and a program manager for Love and Hope Rescue Mission, nor Rose Simon, the executive director for Love and Hope, responded to requests for comment on the concerns.

Other questions raised

Of the awardees from Delaware’s opioid settlement fund, some like DSAMH or Limen Recovery and Wellness were likely recipients. But on examination of dozens of applications and awards, some organizations have much less experience serving those struggling with addiction.

Two youth sports organizations, the Rodney Street Tennis Association and the Roberto Clemente Baseball League, both received $100,000 grants for youth prevention campaigns that essentially tack onto their existing sports programs.

Nearly all of the organizations that accepted grants are based in Delaware. But one organization, the Richard J. Caron Foundation, a nonprofit organization that operates a national network of Caron Treatment Centers, is based in Pennsylvania and has no facility in Delaware.

It was awarded more than $100,000 to do research and establish training materials for Delaware doctors to understand the warning signs and treatment of substance abuse in elderly patients. Hall-Long has boosted Caron in the past few years, and accepted an award from the organization at its 2022 gala.

Prior to its award, the commission asked for clarity on why Caron would be included in the grants, according to meeting minutes. Hall-Long replied that Caron would be offering services unavailable in Delaware.

Media campaign raises questions

DETV, a local television station based in Wilmington, was awarded more than $133,000 to “implement a media strategy to promote access to information on opioid use, particularly synthetic opioids like fentanyl.”

According to its grant application, DETV estimated that it would cost $1,250 to produce a single TikTok post and nearly $12,000 to produce three webinars to help educate the public about the dangers of opioid abuse. It also factored more than $30,000 of indirect costs into its grant application to fund the staffing of the project.

However, a review of postings reported as having fulfilled DETV’s grant metrics show that the clips produced by the nonprofit newsroom utilized freely licensed material from the U.S. Centers for Disease Control and Prevention and National Institutes of Health, with little information about resources in Delaware. Both the CDC and NIH said those materials are free for public use.

Spotlight Delaware could not identify any webinars hosted by DETV regarding opioid use in the last year, although it has hosted a few interviews on the topic and did participate in and livestream the Delaware Opioid Prevention Symposium hosted by the Behavioral Health Consortium, which is also chaired by Hall-Long and featured her in the program.

DETV also reported that comments Hall-Long made about opioids during a debate in her gubernatorial campaign that it livestreamed were to be counted toward fulfillment of its grant objectives.

When asked about the connections of Hall-Long to DETV’s grant deliverables, founder and CEO Ivan Thomas said that, “In her role, the lieutenant governor is responsible for delivering anti-opioid/drug messages. It would be irresponsible not to highlight and share her work and guidance related to opioid awareness.”

Hours after Spotlight Delaware reached out with questions regarding its grant progress, DETV made social media posts with links to “opioid help and support resources.”

But one link it provided takes people to the Kent Sussex Community Services website, a former addiction services provider in the region that closed permanently in 2020. The website today instead features ads for penis enlargement tools, weight-loss medication and hair-growth supplements.

The lieutenant governor’s office did not address direct questions about if this post was made using opioid grants. 

Thomas said the funding the organization received is to support staff that make posts related to opioid awareness. He said he was unaware of the issues with the Kent Sussex Community Services website.

“When my staff posted this link, it worked as we accessed the content, viewed it for potential impact and then shared it on our platform,” Thomas said. “We post hundreds of messages on our platforms and it is not customary to check past posted links, so we were unaware that the hijacking occurred.”

The link is still live on its social media and web page along with other addiction resources.

Where to go from here?

Much of the scrutiny around the settlement fund started in the wake of public outcries from Jennings. But in the past, she approved many of the grants now called into question. 

When reached for comment about having approved these grants, despite her call now for better guardrails, she sent Spotlight Delaware a statement acknowledging her part in what transpired.

She said that early on in the process, there was a push to get money out the door quickly and limit the amount of overdose deaths, but she now wants more planning around the funds.

“Leadership means learning from your mistakes,” Jennings said. “There are clear lessons in this experience and my priority is applying them and being a good steward of these funds.”

Hall-Long said she and Jennings, co-chairs of the commission, take their responsibilities on the commission seriously. She also pointed to the decrease in overdose deaths between 2022 and 2023.

“As this is still a relatively new commission, we are constantly striving to improve our processes to ensure more transparency and accountability,” she said.

Spotlight Delaware released its investigation of the state’s opioid fund prior to a POSDC meeting on Monday, Oct. 28, where independent consulting firm Social Contract is set to make recommendations for ways the fund can improve and will likely guide the direction of the POSDC for the months and years to come.