South Dakota Study Urges Opioid Settlement Funds for Inmates

South Dakota should steer a growing share of its opioid settlement money toward people entering and leaving jails and prisons, according to a $325,000 statewide needs assessment the state Department of Social Services presented to the Legislature's appropriations committee on Monday at the Capitol in Pierre. The state expects roughly $99 million from the national settlements through 2038 and has collected $32.8 million so far.

The department commissioned the assessment to guide where those dollars go, and the inadequacy of programs for addicted people caught up in the justice system emerged as one of its central findings. Secretary Matt Althoff told lawmakers the pattern is familiar: severe opioid use disorder, then arrest.

"This is a more intense addiction once you get to that level of opioid use disorder," Althoff said. "We still see, as is so often the case, the justice involvement. Laws get broken, they become incarcerated or they become prosecuted, and they are also struggling with addiction."

Where the gap shows up

The state Department of Corrections already offers medications for opioid use disorder inside its institutions. The problem, said Brenna Koedam, who leads the Department of Social Services' Behavioral Health Division, is what happens after release — whether the drugs are available on the outside and whether anyone follows up.

The two departments have discussed where a joint effort might start. One option is eight locations outside the prison system that would provide follow-up care to parolees already taking the medications. Social Services and the state's Unified Judicial System have also opened talks about using the drugs for people on probation. Alisa Bousa, a spokeswoman for the courts, said the system is interested in "any additional educational and engagement tools that would benefit the probationers."

Lawmakers press on the medications

Much of the hearing turned on the three medications the Food and Drug Administration has approved to treat opioid use disorder — buprenorphine, methadone and naltrexone. Koedam told the committee that stigma and "misconceptions" still surround them, and that the department needs to "continue to get the education out there in regards to how effective these medications can be" when they are part of a broader treatment program.

The questions from legislators reflected exactly the misgivings she described. Rep. Terri Jorgenson, R-Piedmont, asked how long people typically stay on the drugs. "This isn't a lifelong thing, is it?" she said. Koedam answered that it depends on the individual, and that some people do take them long-term.

Sen. Taffy Howard, R-Rapid City, said she understood that relying on a non-intoxicating medication is preferable to street opioids but wanted to know whether "we're trading one addiction for another addiction." For some patients, Koedam said, the medicines function as maintenance drugs no different from those people take for years for high blood pressure or depression, and some will stay on them for life.

Sen. Red Dawn Foster, D-Pine Ridge, pushed the department to prioritize innovative approaches for people who are locked up. "I know a lot of inmates are self-medicating, so this is some type of need," she said.

The money runs out

Running underneath the discussion was a question about how long any of this can last. South Dakota's settlement share is finite, and the annual payments shrink as 2038 approaches. Jorgenson noted that the awards will only get smaller. Howard said she was seeing "a lot of new programs" and was not convinced taxpayers would not eventually be asked to keep them running, suggesting the department extract a commitment from grant recipients not to return for ongoing money.

Althoff said the department has already been screening for that. It has awarded all but $2.7 million of its statewide share through a three-tiered grant system, with individual awards ranging from $5,000 to more than $50,000 — the largest going to Avera Health for an addiction-focused psychiatric residential treatment facility in Sioux Falls. Many applications were rejected precisely because they depended on money the settlement cannot promise forever. "Why did we say 'no?' Because a lot of it was not sustainable," he said. The next round will favor mid-tier "organizational" grants of up to $50,000, with the goal of moving projects from the idea stage toward something that can operate on its own.

The state's spending has drawn scrutiny before, from legislators who once faulted the department for leaving much of the money unspent to critics who questioned how the first grants were divided. Sen. Paul Miskimins, R-Mitchell, a retired dentist who said he tightened his own painkiller prescribing as the drugs' addictive nature became clear, closed the briefing by asking his colleagues to keep the human cost in view.

"One of the finest ladies in my practice was arrested for stealing medications out of a medicine chest at a rummage sale because she was addicted and hiding it from everybody in the world," Miskimins said. "She was a Sunday school teacher."