As Mississippi waits to spend opioid settlement funds, children and families suffer

Alyson Koenig remembers finding her husband’s body. It was Mother’s Day. She and her children were at her mother-in-law’s house in Greenville, Mississippi. She walked outside and found him slumped over in his chair. She knew right away that he’d overdosed.

They had both struggled with opioid addiction for years — first prescription pain pills, then heroin and fentanyl. The month before, his mother had picked him up from the latest in a string of rehab stays.

Koenig called out for help. Her mother-in-law ran outside and began trying to revive him. They couldn’t bring him back. Kenneth “Wiley” Koenig died on May 10, 2020. He was 30 years old.

“I look over, and I see my children watching it, too,” Koenig said. "It’s very, very traumatic, and it's been six years, and I'm just now really dealing with it.”

Since 2000, more than 800,000 Americans — including more than 10,000 Mississippians like Wiley Koenig — have died from opioid overdoses. The crisis led to states filing lawsuits against opioid manufacturers, marketers, and distributors, with settlements totalling more than $50 billion nationwide. Mississippi will receive more than $400 million.

The state is far behind most others in spending the funds intended to repair some of the damage caused by the epidemic. And what has been spent so far has largely not gone toward addiction treatment or recovery support.

The crisis doesn’t just claim lives. Each death leaves behind children, parents and grandparents trying to hold families together.

In interviews and listening sessions hosted by the Gulf States Newsroom across the state, dozens of people with lived experience of addiction said they want the settlement money used to expand resources and access to treatment — including for children and families.

After Wiley Koenig’s death, Alyson Koenig’s own opioid use disorder (OUD) worsened. She’s now in treatment at the Fairland Center in Dublin, Mississippi — one of only two residential facilities in the state that accepts pregnant people and mothers with young children.

She chose Fairland for one reason: she could bring her youngest son. 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.”

Parental substance use is a major factor in making Mississippi the state with the highest rates of both infant and maternal mortality, according to data from the Mississippi State Department of Health. Advocates say a lack of treatment options and fear of punishment keep many moms with OUD from seeking care.

“They're not gonna reach out to the resources they have, because they're scared of what their consequences might be,” said Joanne Shedd, a peer support specialist at Fairland.

Shedd knows that fear firsthand. Years ago, after her newborn tested positive for drugs at birth, the state placed him in foster care.

“It was like a death,” she said. “That is how I felt when he was taken from me.”

She eventually regained custody of her son. But she’s seen families wait years to reunite. Some never do.

Mississippi has the highest rate of children in foster care in the Gulf South, according to federal data obtained and analyzed by the Gulf States Newsroom. More than 40% of those children enter foster care because of parental substance use. Fewer than half are reunited with their parents. 

Whether formally or informally, most children removed because of parental substance use who aren't placed in foster care go to live with relatives. Most often, it’s grandparents who shoulder the burden of care. While many factors can lead to the formation of “grandfamilies” — grandparents raising grandchildren — parental substance use is often cited as the most common.

American Community Survey data from the U.S. Census Bureau shows 7% of Mississippi children have a grandparent as their primary caregiver — the highest rate in the country and more than double the national average.

Other states are using opioid settlement funds to address these impacts.

Colorado allocated funds for child care so parents can attend treatment. Michigan expanded hospital programs allowing infants born exposed to drugs to remain with their mothers — an approach shown to strengthen bonding and improve outcomes.

In neighboring Alabama, officials launched a pilot program to support grandfamilies with financial assistance and resources. Louisiana is funding “Project M.O.M.,” an initiative aimed at supporting pregnant and postpartum women with substance use disorder.

Mississippi has not made similar investments.

Brenda Foster, lead nurse navigator for the Mississippi State Department of Health's Opioid and Substance Use Disorder Program, sees the gap clearly from her work connecting pregnant and parenting women to treatment across the state.

The needs are specific and addressable: transportation to appointments, transitional housing so people leaving treatment don't return to the same environment, childcare and quality staffing at treatment facilities.

"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 Mississippi Attorney General’s Office divided the more than $400 million the state received from the settlements into three pots.

The largest — 70% of the total — is controlled by the state legislature and must be spent on addressing the opioid crisis. Another 15%, also controlled by lawmakers, can be spent at their discretion. The remaining 15% goes directly to cities and counties, with no spending requirements attached.

So far, the legislature has not spent any of the 70% designated for opioid response. The smaller 15% under its control has only been used to pay attorneys’ fees.

At the local level, spending has been slow and loosely tracked. Of roughly $15.5 million in local settlement funds reviewed through public records requests by Mississippi Today reporter Allen Siegler, nearly all is either unspent as of this past summer, folded into general budgets or directed toward purchases unrelated to addiction treatment — including buying police vehicles, guns, batteries and walkie-talkies.

Less than 1% has gone toward addiction-related programs — mostly for mental health crisis response and drug courts. Only a handful of expenditures directly supported children and families affected by opioid use disorder: legal assistance for families navigating civil commitment, $5,000 to a pregnancy crisis center in Vicksburg and $1,500 for a youth and family drug court in Adams County.

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

As lawmakers prepare to spend the 70% share, they created the Mississippi Opioid Settlement Fund Advisory Council last year to review applications and recommend funding priorities. Over eight months, the council evaluated 127 applications.

At least 23 had a primary or significant focus on children, youth or families. Of the 21 top-ranked proposals, 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 this year’s legislative session.

The council's process drew scrutiny. 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. There were also no council members with lived experience of opioid use disorder.

James Moore, a recovery advocate who lost his son to a heroin and fentanyl overdose in 2015, raised concerns during the council’s final meeting in Jackson in early December.

“I don’t believe there was anything improper,” Moore said at the meeting. “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 consider bringing in independent experts with experience managing opioid settlement funds to help review future applications.

At a January listening session hosted by the Gulf States Newsroom at Moore’s bike shop in Hattiesburg, he said those most affected by the crisis should have a voice in how the money is spent.

“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.”

The settlement funds, he added, exist because of “the greed of the pharmaceutical companies and the distributors and the pharmacy chains that profited off of our loss. 

That loss is present in places like the Fairland Center in Dublin, where Alyson Koenig is trying to make sure her son doesn't lose his mother, too.

She's been at Fairland for about 40 days. She's stopped counting. She came in broken and defeated, she said. Slowly, she's started to feel like herself again. She's doing that work alongside her youngest son — 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.

“If love could save drug addicts,” she said, “there wouldn’t be anybody dead.”

This story was produced by the Gulf States Newsroom, a collaboration between Mississippi Public Broadcasting, WBHM in Alabama, WWNO and WRKF in Louisiana and NPR. 

Editor's Note: A previous version of this story mistated the year that tracking began for Mississippi deaths caused by opioids. There have been more than 10,000 deaths since 2000.