As Mississippi Holds $400M in Opioid Funds, Families Struggle Without Support

It was Mother's Day when Alyson Koenig walked outside her mother-in-law's house in Greenville, Mississippi, and found her husband slumped in a chair. Kenneth "Wiley" Koenig, 30, had overdosed. Her children watched as the family tried to revive him. They couldn't bring him back.

Six years later, Alyson Koenig is finally getting treatment for her own opioid use disorder — but only because she found one of Mississippi's two residential facilities that accept mothers with young children. She brought her youngest son with her to the Fairland Center in Dublin. Her older children are living with their grandmother.

"It was either bring him or die," she said. "If I wasn't able to bring him, I wouldn't come, because I wouldn't have anybody to take care of him."

Koenig's story reflects a broader crisis across Mississippi: families torn apart by addiction, grandparents raising grandchildren, and a severe shortage of treatment options. Yet the state is sitting on more than $400 million in opioid settlement funds — money intended to repair the damage caused by the epidemic — and has spent almost none of it.

A State in Crisis

Mississippi will receive over $400 million from national opioid settlements with pharmaceutical manufacturers and distributors. The money is meant to address the fallout from a crisis that has killed more than 10,000 Mississippians since 2015.

But nearly two years after the first payments arrived, the state has left most of the funds untouched.

The Mississippi Attorney General's Office divided the settlement into three portions. The largest — 70 percent, or roughly $280 million — is controlled by the state legislature and must be spent on addressing the opioid crisis. Another 15 percent can be spent at lawmakers' discretion; so far, it's only been used to pay attorneys' fees. The remaining 15 percent goes directly to cities and counties with no spending requirements.

According to an investigation by Mississippi Today reporter Allen Siegler, of the $15.5 million in local funds reviewed through public records requests, nearly all remains unspent or has been folded into general budgets. Less than 1 percent has gone toward addiction-related programs. Some funds were used to buy police vehicles, guns, batteries, and walkie-talkies.

The largest child-focused expenditure was nearly $15,000 for a police department's D.A.R.E. program — an abstinence-only drug education model that multiple studies have found ineffective and potentially harmful.

Meanwhile, Mississippi leads the nation in several grim statistics tied to the opioid crisis. Parental substance use is a major factor in the state having the highest rates of both infant and maternal mortality in the country, according to the Mississippi State Department of Health.

Mississippi also has the highest rate of children in foster care in the Gulf South, with more than 40 percent entering the system because of parental substance use. Fewer than half are reunited with their parents.

Grandparents Bearing the Weight

For children who don't enter formal foster care, the burden of care often falls to grandparents. U.S. Census Bureau data shows that 7 percent of Mississippi children have a grandparent as their primary caregiver — the highest rate in the country and more than double the national average.

These "grandfamilies" form for many reasons, but parental substance use is the most common.

While other states are directing opioid settlement funds toward these issues, Mississippi has not. Colorado allocated funds for child care so parents can attend treatment. Michigan expanded hospital programs that allow infants born exposed to drugs to remain with their mothers — an approach shown to strengthen bonding and improve outcomes. Alabama launched a pilot program to support grandfamilies with financial assistance, and Louisiana is funding an initiative to support pregnant and postpartum women with substance use disorder.

Brenda Foster, lead nurse navigator for Mississippi's Opioid and Substance Use Disorder Program, sees the gap every day. She works to connect pregnant and parenting women to treatment across the state.

"We need a lot more resources," Foster said. "There are a lot of barriers — if we could just address those and do something with those with some of this money, that would be great."

The barriers she cited are specific and solvable: transportation to appointments, transitional housing so people leaving treatment don't return to the same environment, child care, and quality staffing at treatment facilities.

Missing Voices

To guide spending of the 70 percent share designated for opioid response, Mississippi lawmakers created an advisory council last year. Over eight months, the council evaluated 127 applications requesting funds.

At least 23 applications had a primary or significant focus on children, youth, or families. Of the 21 top-ranked proposals, only five directly addressed those needs. Several family-centered programs — including transitional housing for people in recovery and residential treatment for women and girls — landed in lower tiers, making their funding less certain.

The recommendations are not binding. Lawmakers will decide what, if anything, to fund during the current legislative session.

The council's process drew criticism. Many of the highest-ranked applications came from organizations represented on the council itself, meaning members could discuss and clarify their own proposals in ways other applicants could not. More notably, the council included no members with lived experience of opioid use disorder.

James Moore, a recovery advocate who lost his son to an overdose in 2015, raised concerns during the council's final meeting in Jackson in December.

"I don't believe there was anything improper," Moore said. "But obviously, there was an appearance when we're sitting across the table, grading each other's applications and multimillion-dollar requests."

Moore urged lawmakers to bring in independent experts with experience managing opioid settlement funds to review future applications. At a listening session hosted by the Gulf States Newsroom in January, he said the voices of those most affected by the crisis should be heard.

"The voices that we heard through this opioid settlement council process were the voices of organizations that are in this business, or that are in this as an avocation," Moore said. "We did not hear from the general public."

What Families Need

At the Fairland Center, Alyson Koenig is trying to make sure her son doesn't lose his mother, too. She's been in treatment for about 40 days. She came in broken and defeated, she said. Slowly, she's started to feel like herself again.

But she got one of the last open beds.

"What if they didn't have a bed open?" she asked.

She knows what she would do with the opioid settlement funds: more treatment programs for people who use drugs and more resources for their families.

Joanne Shedd, a peer support specialist at Fairland who has her own history of losing a child to the child welfare system because of her substance use, echoed that call. She said many mothers with opioid use disorder won't seek help because they fear losing their children.

"They're not gonna reach out to the resources they have, because they're scared of what their consequences might be," Shedd said.

As Mississippi lawmakers prepare to decide how — or whether — to spend the state's opioid settlement funds this year, advocates say the need is clear. Treatment capacity is insufficient. Families are being torn apart. Children are growing up without their parents.

The settlement funds exist, Moore said, because of "the greed of the pharmaceutical companies and the distributors and the pharmacy chains that profited off of our loss."

Now, families like Koenig's are waiting for Mississippi to turn those funds into help.

"If love could save drug addicts," Koenig said, "there wouldn't be anybody dead."