Opioid Settlement Funds Let UW Health Clinic Expand Addiction Care

Opioid settlement money from Dane County has allowed the UW Health Compass Program in Madison to extend its hours, widening access to a walk-in addiction clinic that treats people who use drugs without an appointment. The program operates out of the UW Health clinic at 1102 S. Park St., opened in January 2024, and has grown in stages — first through a state grant that paid for care to uninsured patients, and now with settlement dollars routed through the county.

"Opioid settlement funding has been essential to expanding that work, and additional public and private support helps us continue to respond to what our patients and community need," Dr. Elizabeth Salisbury-Afshar, medical director of the Compass Program and an addiction medicine physician with UW Health, said in a statement announcing the extension.

A clinic built on the walk-in model

The Compass Program was designed around a simple premise: the biggest obstacle between a person with a substance use disorder and effective treatment is usually not motivation but the intake process. Patients are seen on a first-come, first-served basis and can also be referred by a primary care physician, an urgent care clinic, an emergency department or a state agency. The clinic treats people with or without insurance, and it is explicitly not a detox facility — its team works with patients who need a higher level of care to connect them to one.

The clinical offering centers on medication for opioid use disorder. The team — a physician or advanced practice clinician, a nurse care manager, a medical assistant, a peer support specialist and a social worker — can prescribe buprenorphine, sold as Suboxone, and extended-release naltrexone, sold as Vivitrol, along with basic wound care, hepatitis and sexually transmitted infection testing and treatment, and family planning services. The social worker handles the material problems that determine whether treatment holds. "Whether it's housing, transportation, food or clothing, these are necessities our patients are requesting that are vital to their ability to be healthy," Salisbury-Afshar said in an account of the program's first year.

That combination — same-day medication plus navigation into ongoing care — matters because medication for opioid use disorder has the strongest evidence base of any intervention for dependence, and buprenorphine in particular can be started the day a patient is assessed. In the program's first 14 months, it saw 128 unique patients, 31 of whom had their care covered by the state grant.

Salisbury-Afshar framed the expansion as an obligation to keep pace with demand. "Our goal is to build a program that responds to the needs of our community and continues to grow and adapt as those needs change," she said. "We want to provide a flexible, low-barrier model that meets people where they are and makes it possible for them to receive care when they are ready."

Where the money comes from

Wisconsin joined a group of states and municipalities in suing the manufacturers, distributors and pharmacy chains behind prescription opioids and settled its claims in a series of agreements. Under the terms, the state is set to receive more than $874 million between 2022 and 2038, with a large share directed to counties and municipalities for local treatment, prevention and recovery work.

Dane County has spread its portion across a range of programs, with a plan approved earlier this year that included $200,000 for the Compass Clinic alongside money for medication-assisted treatment and overdose prevention. In August, a county subcommittee moved to hold settlement-funded programs at their 2026 levels for the following year, with members cautioning that any reallocation had to account for the balance on hand and the fact that the payments are annualized across a long schedule.

That arithmetic is the quiet constraint behind the clinic's expansion. Settlement payments run through 2038, but each year's allotment is finite, and programs that hire staff and extend hours need a funding source that does not vanish when a grant cycle ends. The Compass Program learned that lesson once already: the state grant supporting free care for uninsured patients was scheduled to end in September 2025, and Salisbury-Afshar said at the time that the clinic would need ongoing public or philanthropic support because the program exists in part to serve people whose insurance will not cover addiction care.

"Everyone with a substance use disorder deserves access to life-saving medications and clinical services," she said. For now, the settlement dollars buy a wider window in which someone in Madison can walk in and start treatment the same day. People seeking care elsewhere can find standard outpatient programs and other levels of care through the site's treatment directory.