Hawaii's Opioid Money Went to a Meth Crisis, Records Show

Hawaii has received $51.4 million of a $150 million opioid settlement and about $36 million in federal State Opioid Response grants, in a state where methamphetamine kills more than twice as many people as opioids do. An investigation published Thursday by Honolulu Civil Beat traced how a decade of opioid-designated money built naloxone distribution, test strip programs and an opioid coordinator's office in a state whose dominant drug has never had an equivalent plan.

The gap is not a secret inside state government. Twelve pages into the 58-page report that launched the Hawaii Opioid Initiative in 2017, the Department of Health wrote that "aside from alcohol, methamphetamine remains Hawaiʻi's most prevalent drug of misuse among adults." The department also noted the state has one of the highest incarceration rates in the country for methamphetamine-related convictions, then organized its spending around the drug that was dominating federal grant priorities on the mainland.

A plan built for a drug that was not the main problem

Then-Gov. David Ige announced the initiative as the opioid epidemic spread east, saying the warning signs were appearing in the islands. Ige told Civil Beat his administration "just wanted to make sure we weren't being discriminated against in terms of receiving federal funds," which he believed would benefit the community more broadly.

The arithmetic at the time pointed the other way. Around 2017, meth overdose deaths in Hawaii were two and a half times opioid deaths; nationally, opioid deaths were more than four times as common as meth deaths. Only 8.5 percent of the state's treatment admissions that year were for opioids, while five times as many were for amphetamines. Nationwide, more than a third of admissions were opioid-related and 10.2 percent were for amphetamines.

More than 1,500 people have died of direct meth toxicity in the years since, according to the investigation, a figure that understates the toll because deaths from the long-term health effects of smoking ice are often not counted when the drug has cleared the blood before autopsy.

What the money bought, and what it could not

Federal opioid grants paid for naloxone, fentanyl test strips and syringe exchanges. The number of naloxone kits the state distributed rose from 3,029 in 2020 to 67,328 four years later, to the point that a June 2025 health department presentation to the state Advisory Commission on Drug Abuse and Controlled Substances suggested the state might be approaching naloxone saturation.

Treatment, meanwhile, accounted for 19 percent of Hawaii's federal opioid grant money. Of roughly $4 million in annual grant revenue, about $750,000 was designated for treatment. Congress changed the law at the end of 2019 so the grants could cover stimulants, and since then about three-quarters of that treatment money has gone to meth, which is listed as the primary substance by six of every 10 people admitted to publicly funded care. The CDC puts the 2025 share at almost half of admissions for meth, against 12 percent for heroin and other opiates.

The settlement money is harder to redirect. Eighty-five percent of the $150 million must be spent on opioid treatment and prevention, with payments scheduled through 2038.

Brian Baker, chief executive of the treatment provider Hina Mauka, told Civil Beat the two facts should not coexist. "We've got this money that, quite frankly, is not being used" for meth, he said, "and then we have people dying from meth addiction."

The mismatch is written into the rules and into the meetings

Civil Beat counted the minutes of the advisory commission that guides state drug policy: from 2023 through 2025 the word "opioid" appeared 103 times and "methamphetamine" 16. The health department filled positions for a committee on spending settlement money and hired an opioid response coordinator in 2025. There is no equivalent coordinator for meth.

Researchers who study drug policy say the imbalance is national in origin rather than a Hawaii failure of attention. Keith Humphreys, a Stanford psychiatry professor, said meth has long been a bigger problem in the Western United States but that federal policy is driven more heavily by the East. Rosanna Smart, co-director of the RAND Drug Policy Research Center, said the opioid crisis "kind of sucked all the oxygen out of the room," and that the cost was a holistic treatment approach that would have worked regardless of which drug was in the headlines.

A treatment system that skews older and sicker

The population using meth in Hawaii is older than the opioid population and less likely to seek care. A state health department grant report in January found that only 27 of 1,910 clients in publicly funded treatment were 65 or older, and about 20 percent were between 45 and 65. Smart called older users a particularly difficult group to engage and retain.

Sen. Jarrett Keohokalole, who was elected to the House in 2014 in part to work on meth, described his reaction to a 2018 briefing on the opioid initiative: "Why are we focused on opioids? That's a Midwest, Northeast problem. We have a meth problem." He said he came to understand that much of the state's treatment money came from a federal government encouraging opioid programs, and that a state short of resources was not going to refuse it.

People who have worked inside the state's treatment system describe the result in personal terms. Michele Navarro Ishiki, a former meth user who left the treatment field, said she got "tired of seeing your people fall like flies because the rest of the world is shifting to focus on opioids." Treena Becker, a University of Hawaii researcher who published a 2024 paper on meth overdoses, said health officials reacted with surprise when she presented the findings: "They're like, 'We forgot about meth. We thought meth was a problem 30 years ago.'"

What the state says it wants to do next

John Valera, who runs the health department's Alcohol and Drug Abuse Division, acknowledged to Civil Beat that methamphetamine and stimulants are the larger problem for overdose deaths. He said the department wants to expand residential and therapeutic living programs, particularly on the neighbor islands, promote cognitive behavioral therapy and contingency management, and build a year-round public information campaign that reaches older users rather than only high school students.

The commission asked the state to recalibrate the opioid initiative toward meth as long ago as 2021. What has followed is modest: a student video contest with a methamphetamine awareness category, a fentanyl public service announcement that mentions mixing the two drugs, and about $17,000 over three years toward an annual End Meth summit.

The pattern the investigation documents is structural rather than a single official's oversight. Federal money arrived with conditions attached, and a state short of treatment dollars shaped its plan around the money. States where stimulants dominate now face the same question: whether the infrastructure built for opioids can be repointed at the drug that is actually killing people. For readers looking for care, the stimulant treatment programs directory is a starting point, and the national picture is set out in our reporting on concurrent meth and fentanyl use and on Minnesota's split overdose trends, where opioid deaths fell while the all-drug toll rose.