SALT LAKE CITY — Utah lawmakers heard a recent presentation on how to spend money the state expects to reap from the $26 billion nationwide opioid settlement with four major drug companies.

But just how much money Utah is in line for — when and if it comes — remains up in the air.

The state just recently, through some late-hour negotiations, met the deadline for local governments — counties in Utah's case — to decide whether to participate in the settlement. Twenty-seven of the state's 29 counties joined the agreement.

But Grand and San Juan counties want no part of the agreement, opting to go to trial on their own because of the paltry sums of money they say the settlement would bring them. Both of the two small, remote counties are skeptical when it comes to the state doling out dollars.

Last July, Johnson & Johnson and three of the country's largest drug distributors — AmerisourceBergen, Cardinal Health and McKesson — agreed to pay $26 billion to states to resolve thousands of lawsuits over their roles in the opioid crisis, though they have admitted no wrongdoing. Of the total, $5 billion would come from Johnson & Johnson and $21 billion from the three distributors.

About 90 percent of local governments in 45 states joined the settlement by the Jan. 26 deadline, and the drug companies have until Feb. 25 to decide whether to go ahead with the agreement. If all parties agree to move forward, the first payments would be made by the distributors in the spring and Johnson & Johnson in the summer.

Despite the final details still being worked out, legislators, communities and treatment providers are already hitting up the state with ideas on how to spend the settlement dollars. The agreement includes a long list of how states may use the money.

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"It's really hard to spend the money when we don't know when it's coming and how much we have," Brent Kelsey, interim director of the state Division of Substance Abuse and Mental Health told a legislative subcommittee last month.

Utah's portion of the settlement is somewhat of a moving target.

When the Utah Attorney General's Office announced the agreement last year, it put the figure at $309 million over 18 years. Now, the office estimates the amount at $272 million over that time. It drops to $260 million without Grand and San Juan counties.

In Utah, roughly half the money would go to the state, while the remainder goes to the 27 counties based on a formula that includes the number of deaths, number of pills distributed, the rate of opioid use disorder and population.

Why these Utah counties are passing on settlement

While neighboring Grand and San Juan counties often don't see eye to eye on southeastern Utah issues, they're on the same page regarding the opioid settlement.

Grand County Attorney Christina Sloan said the agreement is structured to benefit the drug companies, the state and urban Utah, in that order. The bottom line, she said, is that often overlooked rural Utah loses out — again.

"The attorney general promised to take care of rural Utah and to acknowledge the unique impact the opioid crisis has cost us, but has failed to do so with this settlement," Sloan said in an email.

Sloan said the state never committed to any possible distribution figure to the county in writing, but its likely share from the agreement is about $128,000 total paid out over 18 years.

"That's $7,000 a year, an offensive gesture. So we risk nothing by proceeding to trial," she said.

San Juan County was looking at about the same amount, said San Juan County Attorney Kendall Laws.

"That's spitting in the face of family members and people who have been dealing with the opioid epidemic. That's ludicrous is what that is," he said.

Grand County, which has about 9,600 residents, was chosen as the "bellwether" in the case for southeastern Utah, which has among the highest rates of opioid addiction in the state.

"We are small enough that every single elected official has been personally affected by deaths and ruined lives in our county related to opioid addiction. And the losses go on and on for years. Plus add the impact of those living and battling and recovering from opioid addiction who haven't succumbed," Sloan said.

San Juan County, which has a population of 14,500, can't find a full-time therapist willing to work at its health department. And the money from the settlement would not be anywhere enough to attract one, Laws said. An alcohol or drug assessment for a client is 90 days out, Laws said.

"That's hard to fathom for someone from the Wasatch Front," he said.

Laws said San Juan has nothing to lose by going to court in hopes of getting a much bigger return, which he estimates could take three to five years.

"Why wouldn't you roll the dice?" he said.

Using Centers for Disease Control and Prevention models based on population, Grand County estimates its past, present and future damages at $36 million, Sloan said. Using its opioid attorneys' more conservative model based on the county's actual costs, the county's damages are around $19 million, she said.

"Even if we only recover a fraction of that conservative estimate, we gain millions more via litigation than settlement," Sloan said.

A spokesman for Utah Attorney General Sean Reyes said Reyes is working "tirelessly" to obtain Utah's fair share of opioid settlement proceeds.

"In this litigation, Utah recovers the maximum recovery when the state, counties and cities work together. The Legislature and counties are working to ensure that scarce resources are being divided fairly," spokesman Rich Piatt said.

"No recovery can address the full scope of the problem but working in unity assures the best result. Our office will continue to take steps to recover money to combat the opioid epidemic."

How will Utah spend the settlement money?

As Grand County now goes it alone, the Utah Opioid Task Force's opioid settlement advisory committee presented state lawmakers with a blueprint for how to use the settlement money in a hearing last month. The report offers guidance for policymakers and stakeholders to leverage the funds and maximize the benefit to the community and alleviate some of the harms caused by opioids.

"It is an unprecedented opportunity to invest in solutions to potentially change people's lives, save lives and reroute the course of this crisis in our state," Jennifer Plumb, advisory committee chairwoman, told the Social Services Appropriation Subcommittee.

The committee relied on a survey of 110 "subject matter experts" in public health, addiction, medicine law enforcement, criminal justice and other areas to develop the blueprint, she said.

Plumb said in an interview that she'd like to see a transparent process where the state solicits requests for proposals for specific programs where outcomes and expectations could be measured.

Every community, she said, should decide for itself what it needs to deal with the opioid crisis. "But those conversations are challenging ones in this state," Plumb said.

Families who experienced the tragic consequences of opioid addiction heard the word settlement and thought it meant a check would be coming their way, but that's not how it is, Plumb said.

"The skepticism from the public is pretty profound," Plumb said. "I think the more transparency and clarity in how the decisions are being made about where the funds go and who's getting the funds will really help the public because I can see people saying, 'My son's dead and I get nothing but that company got (money).'"

Several state agencies and the Utah League of Cities and Towns endorsed the opioid advisory committee's blueprint, but the Utah Association of Counties did not.

"I'm a little bit concerned about getting ahead of things when we're still in negotiations and we already have an advisory committee suggesting where the money should be spent," said Brandy Grace, the association's executive director.

Grace said the association was in the middle of final talks with counties about joining the settlement and didn't have commitments from two of Utah's largest counties when she received the advisory committee's plan. She said it didn't seem appropriate to sign on to a document about spending when there wasn't agreement on the settlement.

Steve Hunter, the association's government affairs director, said a large advisory committee might not be the best way for the dollars to trickle down to people who need it. He said Utah's 13 behavioral health centers run through counties should be involved in the decision.

The association has not yet taken a position on how to spend the money, but agrees it must go for opioid treatment and abatement.

Regardless of disparate views about how the opioid settlement found should be allocated, everyone agrees that they don't want it to go the way of the nationwide tobacco settlement of 20 years ago.

While Utah law required some of that money to go to tobacco, alcohol and drug prevention programs and drug courts, lawmakers diverted it to other agencies and the state's general fund.

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