What spending reports can’t tell us about the opioid settlement

As the special project manager for Doña Ana County Health and Human Services, I help coordinate our county’s opioid settlement work. I’ve learned that spending these resources responsibly involves much more than identifying a worthy project and writing a check. Local governments are being asked to strengthen behavioral health systems that, in many parts of New Mexico, have been under-resourced for decades. Before services can expand, communities often have to establish governance, engage stakeholders, navigate procurement, develop contracts, create evaluation plans and determine how programs will be sustained after settlement payments end.

Much of that work never appears in a financial report, yet it often determines whether these investments produce lasting change.

In Doña Ana County, our first priority was to build framework for decision-making. Rather than working separately, Doña Ana County and the City of Las Cruces established a joint Opioid Settlement Advisory Council bringing together local government, healthcare, behavioral health, recovery, public safety and community partners. That collaboration allows us to coordinate priorities across jurisdictions while reducing duplication of effort, an approach that our Health and Human Services Director, Jamie Michael, recently presented at the National Association of Counties (NACO) Annual Conference.

Vital Strategies provided funding for an opioid settlement coordinator and much of the early convening and planning work of the advisory council. That support allowed Doña Ana County and the City of Las Cruces to build the administrative and collaborative foundation for this work. Building implementation capacity before launching major funding initiatives was a deliberate decision because we believed the community would be better served by thoughtful, coordinated investments than by spending quickly.

The State Auditor’s report also identifies a challenge that many local governments know well: the shortage of qualified providers, particularly in rural communities. Funding alone cannot create services where organizational capacity does not exist.

When Doña Ana County offered opioid settlement funding to expand services for pregnant and parenting people, infants, and families affected by substance use disorder, no organizations applied. The response made clear that while the need is significant, the local provider capacity to deliver these services remains limited.

Those challenges have also shaped how we finance this work. Rather than viewing opioid settlement dollars as a stand-alone funding source, we intentionally pursued a braided funding strategy that aligns these investments with other opportunities. Our work is coordinated with the Region 3 Behavioral Health Regional Plan developed under New Mexico’s Behavioral Health Reform and Investment Act (BHRIA). Early Access BHRIA funding supports projects such as transitional housing for people leaving incarceration and the expansion of Assertive Community Treatment (ACT) services.

No single funding source will rebuild New Mexico’s behavioral health system. Settlement dollars represent an extraordinary opportunity, but they are finite. Coordinating them with state investments, Medicaid, philanthropy and local partnerships offers a stronger foundation for developing services that communities can sustain over time.

None of this diminishes the importance of accountability. The public deserves transparency in how settlement dollars are being spent. Expenditure reports are an important part of that accountability, but they should be understood alongside the planning, collaboration and capacity-building that make meaningful investments possible. If we focus exclusively on dollars spent, we risk overlooking the work required to ensure those investments achieve the outcomes communities expect.

Doña Ana County is also committed to making this work transparent as it evolves. Information about the County’s opioid settlement efforts is available on the Doña Ana County Opioid Settlement webpage and will continue to expand as our public dashboard is developed.

The State Auditor’s report should encourage important questions about how these funds are being used. I also hope it encourages a broader conversation about what successful implementation looks like, particularly in rural states where provider shortages, workforce challenges and fragmented systems make this work especially complex. New Mexico has an opportunity to invest these dollars wisely while strengthening the partnerships and infrastructure that will improve lives long after the settlement funds are exhausted.