Cuyahoga County Executive Chris Ronayne announced a county plan last week to invest its opioid settlement dollars into a co-responder program that pairs mental health workers with first responders and a new behavioral crisis center. 

The mental health facility would primarily serve adults in mental health crises or experiencing substance use issues when it opens in Cleveland’s Central neighborhood next year. The project is in partnership with the county’s Alcohol, Drug Addiction & Mental Health Services (ADAMHS) Board. 

“The crisis center will actually serve as a front door for our system,” said Scott Osiecki, the CEO of the ADAMHS Board, in a Cuyahoga County Council committee meeting Tuesday.

The county plans to put $3.5 million into the co-response program and $7 million into construction at the crisis center. The funding comes from opioid settlement dollars – money from lawsuits the county filed against drug manufacturers and distributors that accused them of fueling an opioid addiction crisis. 

The two new projects are the most recent examples of how the county is using settlement money to battle the ongoing opioid crisis. The crisis peaked in 2017, when Cuyahoga County recorded 729 overdose deaths. Since then, overdose deaths have fallen – hitting an eight-year low last year, though they are still higher than before the epidemic. 

Since Cuyahoga County received its first payout in 2020, it has spent or dedicated about $81 million of the settlement money. 

Brandy Carney, the county’s director of Public Safety and Justice Services, said the county has been “very thoughtful and intentional” about spending the funds for a continuum of addiction services, from prevention to harm reduction to intervention and recovery. 

More programs will be announced in coming months, Carney said.

How much money does Cuyahoga County have to spend?

Cuyahoga County initially received $121 million from opioid lawsuit settlements, Carney said. 

The county invested the money, and it has earned interest. The county also has received about $3.2 million from federal lawsuits since last October, Carney said. 

Now, the county’s opioid mitigation fund sits at $136.7 million, she said at a County Council Public Safety and Justice Affairs Committee meeting.

Ohio also received a separate opioid settlement. While some of that money will ultimately benefit Cuyahoga County, the state has its own process to disburse it. 

How much of the opioid settlement has the county spent?

About $81 million of Cuyahoga County’s opioid settlement funds have been spent or dedicated to specific projects, according to data the county shared with Signal Cleveland. That doesn’t include the recently announced behavioral health crisis center and co-responder program. 

About $29.5 million went to projects that the county considers completed. They include:

• $6.7 million for the START program at the county’s Division of Children and Family Services. The program connects pregnant mothers and newborn children who test positive for drugs with a child protection specialist and a family advocate who works with the parent through addiction treatment. The investment of opioid funds increased staffing.  
• $5.4 million for Stella Maris, a nonprofit offering medical detox for people going through drug or alcohol withdrawal. The money paid to add 32 residential treatment beds and expand several outpatient programs.
• $5 million to MetroHealth to expand the Cleveland Heights Medical Center to treat more mental health and addiction patients. The expansion opened in 2022, and a psychiatric care emergency department was added last year.

More details of completed projects can be found here:

The other $51 million are invested in projects the county considers to be ‘open’ or still ongoing.

That includes almost $32 million to operate the county’s flagship project, a diversion center at 1804 E. 55 St. in Cleveland. The center offers short-term, inpatient treatment for mental health and substance use disorders. It’s meant to provide law enforcement with a drop-off location for people in crisis besides the emergency room or jail, but it also accepts residents who want to admit themselves or family members. It opened in 2021. 

The $32 million investment is budgeted for the center’s operations from 2020 to 2026, and it pays for a variety of services. For one, it pays the ADAMHS board to offer crisis intervention training to police officers countywide, Carney said. This type of training prepares law enforcement officers to respond to individuals experiencing mental health crises.

The money is also used to hire FrontLine Service to screen everyone coming to the diversion center over the phone before they arrive. And the budget pays the nonprofit Oriana House to run the day-to-day operations of the diversion center, such as hiring psychiatrists and nurses and taking in patients. 

The county plans to close the diversion center sometime after the new behavioral health crisis center opens in fall 2026, since the two facilities will serve similar purposes. It’s not clear exactly when the diversion center will close. The county has the option to operate the diversion center through 2027 by allocating more opioid settlement money. 

Other ongoing projects the county is funding include: 

• $11 million for a variety of one-time expenses like construction projects to improve addiction and treatment resources in Cuyahoga County. That includes another investment in Stella Maris: $5.5 million for the nonprofit to purchase a property and turn it into housing where people in recovery can receive suboxone, a medication to treat opioid addiction, Carney said. And $4.2 million went to the Greater Cleveland YMCA, which is renovating an apartment building for individuals in addiction recovery, she added. 
• $5 million to create an Opioid Innovation Fund, administered by the Cleveland Foundation. The fund is supposed to invest in early-stage products and companies that can help prevent and reduce opioid addiction.
• MetroHealth received about $2.6 million between 2021 and 2024 to set up addiction services within the Cuyahoga County jail. That included an on-site methadone program, a medication-assisted form of treatment for people going through opioid addiction. The county will soon consider whether to renew this contract. 

More details of the ongoing projects can be found here:

How did the county decide where to spend its opioid settlement?

When Cuyahoga County received its settlement, it created an opioid mitigation fund. That ensures the settlement dollars are spent solely on the opioid epidemic – not mixed in with other county duties.

The Cuyahoga County Executive’s office has taken the lead on deciding how to invest the funds. 

Some counties – including nearby Summit County – created boards with community members to make recommendations for spending opioid settlement money. Cuyahoga County doesn’t have a direct equivalent. 

But Carney said pre-existing groups in Greater Cleveland serve a similar function. That includes the U.S. Attorney’s Heroin and Opioid Task Force – which includes representatives from Cleveland hospitals, the courthouse, police, individuals with lived experience and many more – and a local board set up to distribute opioid funds coming from the state level. 

“We have a lot of boards, there’s a lot of meetings, and often it’s – not necessarily the same people, but we feel like … everyone’s represented,” Carney said. 

Carney said that her staff and other county officials sit on the existing boards and use them to get feedback on county funding plans – such as the recent $3.5 million expansion of the co-response program. 

“It’s something we look at, we talk about on the boards – and people have seemed to really get around this co-response model,” Carney said. “… And so that’s when we moved forward with making the recommendation to set up a budget for that program.”

What are the county’s next steps?

Carney said she will soon be bringing even more proposals to the County Council for how to spend the remaining opioid settlement funds. 

That includes a $12 million, three-year contract with The Centers, the nonprofit that will be operating the new behavioral health crisis center. 

The county is also looking to sign another contract with MetroHealth to provide opioid treatment services in the jail over the next two years. Another $1.5 million investment would expand an opioid-awareness campaign that so far has just focused on one neighborhood. 

“The goal is to grow throughout the county to different neighborhoods that need additional support services for the opioid epidemic within their community,” Carney told County Council members on Tuesday.

The county could also decide to run the diversion center for one more year after the behavioral health crisis center opens, costing an additional $6 million. 

If the various projects are all approved, the county’s opioid mitigation fund would shrink to approximately $4 million, Carney said. Some federal funds would also still be left to spend.