Nashville has received more than $13 million dollars from opioid makers, sellers and marketers. This summer, the city released an unflattering internal audit of the how the settlement funds are being used.
That’s why a handful of Metro Council members want to put more oversight in place. Among other things, their proposal would create a public dashboard that shows how the money is being spent and would require regular reports on how the programming is going.
Nashville is one of thousands of cities and counties that have gotten opioid settlement funding from lawsuits, which alleged the drug companies knowingly created a deadly addiction epidemic. The money is designed to alleviate the fallout from the opioid epidemic — a cause that’s open to interpretation.
In Nashville, the Metro Public Health Department is overseeing the money. Its goal is to connect people with substance use treatment before they overdose. That’s largely through a continuum of care program. The department brought in the Mental Health Cooperative and Samaritan Recovery Community to provide services.
The internal audit, released in June, says there is no question whether that’s an appropriate use of the money. That has been an issue in other communities across the country and here in Tennessee.
But it did raise several concerns about whether the money is being managed well.
Issues in the audit
The audit organizes the problems it identified by severity, and it says the issue posing the highest risk was the use of funding for staff salaries.
In fiscal 2025, the department spent almost $3 million on opioid programming, and half of that went to staff salaries. The rest went to things like treatment providers, medical supplies and IT.
The audit says the department failed to adequately track how its employees were spending their time, which meant that the money could have been paying for work unrelated to opioid abatement.
Auditors accused health department managers of interfering with investigations into that problem. Auditors contacted 34 department employees, asking for written answers to questions about their titles, primary responsibilities, how they’re connected to opioid initiatives and how much of their time they spend on opioid-related work.
Under city codes, the report says, auditors are allowed to hear directly from workers without management seeing or weighing in on the communications.
“Emails obtained showed that the program manager reviewed, edited, and provided directions to employees regarding their responses prior to submission,” the report reads. “In some cases, employees were instructed to revise their descriptions of duties or estimates of time spent on opioid-related work before sending their responses. Employees were also instructed to share written responses with the program manager prior to sending them to the auditors.”
The other concern is about oversight more generally.
There were mistakes on payments to contractors. For example, an invoice of more than $100,000 was paid to Mental Health Cooperative, even though it was meant for the Samaritan Recovery Community.
The auditors say the department isn’t doing a good job measuring how programs are working over time. Essentially, the numbers the department uses — the number of overdoses in the community and whether they’re decreasing, or the number of people served — aren’t specific enough, the report indicates.
“When performance measures are not consistently tracked, evaluated, and used to inform decision-making, the risk that program effectiveness cannot be fully assessed increases,” the report reads. “Additionally, opportunities to improve outcomes and maximize the impact of opioid settlement funds may be missed.”
Metro Council resolution
That’s why the Metro Council is considering legislation to make some major changes. One of the bill’s authors, Councilmember Erin Evans, told the Public Health and Safety Committee this week that the policy is a work in progress, and that she had a meeting scheduled with the health department to talk about the particulars.
“I don’t feel like this is adversarial to the health department,” she said during the hearing. “It’s really just how can we make this a stronger process?”
As it’s written now, the measure would shift some of the money management — accounting, financial monitoring and compliance reporting — to Metro’s finance department. It would have the finance department either hire someone or designate a current employee to be the opioid settlement coordinator. That person would, among other things, monitor more specific performance metrics and build a communication process with Metro and other government officials.
The finance and health departments would be given a few months to build an Opioid Settlement Transparency Dashboard. That would display all ongoing projects and associated standardized metrics, provide visualizations and downloadable data, and document data sources and show program schedules.
The measure was on the agenda for Tuesday’s council meeting, but Evans deferred for a week to get some more feedback.
Other communities and opioid settlement funds
Across the country, these settlement funds have fueled controversy.
When local governments get federal money for similar programs, from agencies like the Centers for Disease Control and Prevention, there are strings attached. There are strict rules on how the money can be spent, and federal bureaucrats keep an eye on whether those rules are being followed. That structure doesn’t exist for opioid settlement money. There is no federal oversight. The money has to be used to address the fallout from the opioid epidemic, but that’s pretty vague and subjective. The opioid companies aren’t paying attention. So local governments and even states are on their own.
KFF Health News has been covering this issue for years. That included a story about Greene County, in northeastern Tennessee. That jurisdiction used opioid funding to pay down county debt, build infrastructure, and buy a pickup truck to haul jail inmates to street cleaning sites. When local governments make decisions like that, they often argue their city or county has been shouldering the costs of the opioid epidemic for years, and they deserve to be paid back.
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