First published in the author’s personal Substack on November 9, 2026.
The Mat-Su Borough has about $2.3 million in opioid settlement money coming over 18 years. Right now, it is being handed out in small grants that are paid in advance, measured by head count, and will not add many treatment beds. We can do better, and the rules already allow it.
Where the money came from
For about twenty years, prescription painkillers moved through a supply chain that failed at nearly every link. Manufacturers marketed opioids as low risk. Wholesale distributors shipped volumes to small-town pharmacies that no legitimate prescribing could explain. Pharmacy chains filled prescriptions that should have raised red flags.
Thousands of states, counties, cities, and tribes sued. The result was a series of national settlements worth about $50 billion. The three largest distributors agreed to pay up to $21 billion over 18 years. Manufacturers including Johnson & Johnson, Teva, Allergan, and Purdue paid roughly the same. CVS, Walgreens, Walmart, and Kroger paid about $15 billion.
Alaska’s share of the first round was $58 million, split between the state and nine local governments. The Mat-Su Borough was one of them. This money comes from the companies, not from taxpayers. It is still public money now, and we have every right to ask whether it is doing any good.
What the money can be used for
The people who negotiated these deals remembered the 1998 tobacco settlement. States got more than $200 billion from it and spent very little on helping people quit smoking. So this time the money came with a rulebook, a document called Exhibit E. At least 85 percent must go to opioid remediation: treatment, prevention, recovery, and harm reduction.
The list is broader than most people think. Exhibit E covers opioid use disorder and any co-occurring substance use disorder. That matters here, because most people in Valley treatment programs use more than one drug, often meth together with fentanyl.
It allows residential and inpatient treatment, recovery housing, job training, job placement, and transportation for people in recovery. Nothing in Exhibit E says the money can only go to nonprofits.
What the borough has done so far
In 2023, the Borough Manager formed a five-member committee to assess local needs. Three of the five voting members came from addiction treatment organizations that could later apply for the money, and two of them were from the same organization. The committee had no physician, no one from an emergency room or hospital, and no independent or for-profit provider.
After public meetings and a survey, the Assembly adopted a split: 30 percent treatment, 30 percent prevention, 10 percent recovery, 10 percent harm reduction, and 20 percent for media outreach during the first five years.
The Borough has no health powers under state law, so at first it could spend the money only on training, education, and publicity. The first grant round was open only to 501(c)(3) nonprofits. Of about $233,000 available, about $63,000 was awarded.
In 2025, Houston, Wasilla, and Palmer transferred limited health powers to the Borough for settlement spending only. The Assembly accepted the transfer in August 2025 with Ordinance 25-086. The Borough can now pay for actual treatment and recovery services.
The current round closes December 4, 2026, with $704,763 to cover three years. Each organization may apply once and receive no more than $25,000 a year. The application no longer requires nonprofit status outright, but it still includes questions written for nonprofits. Grants are paid in advance, and the only performance measures are the number of clients served and the communities in which they live.
The problem with how it is set up
Do the math on treatment. Thirty percent of $704,763 is about $211,000 over three years. At $25,000 a year per grantee, that funds about three organizations.
Nothing in the rules requires that money to buy a single treatment day for a single resident. It can go to wages, training, or overhead. And because the only measure is a head count, we would never learn whether anyone remained sober a year later.
The number of people in the Valley struggling with addiction runs into the thousands. Small grants spread thin, with no tracking of results, will not change that.
Use every bed we have
The Borough doesn’t run a hospital or a treatment center, and it doesn’t need to. Under the 2025 ordinance, its job is to pass settlement money through to the people who do the work. It can work with any qualified provider, not just a handful of local nonprofits.
Instead of small grants, the Borough could buy treatment days for Valley residents from any state-licensed provider with an open bed, whether nonprofit, for-profit, or tribal. The provider bills Medicaid or insurance first, as it already does. Settlement money covers only what is left: people with no insurance, stays longer than insurance will pay for, gaps while a Medicaid application is pending, and recovery housing after discharge.
That stretches a small fund several times further and puts beds that already exist to use. It also pays for something you can count: a specific resident, treated on a specific day.
Mat-Su Regional is planning a 45-bed behavioral health center. North Star and Alaska Regional in Anchorage are both for-profit. None of that capacity is part of the Borough’s plan today. It should be.
Tax fairness for providers who treat addiction
Nonprofit treatment centers pay no property tax on the buildings they use. A for-profit provider pays full property tax on the same kind of building serving the same patients. If we want more beds, that gap works against us.
Alaska law already gives the Borough a tool. AS 29.45.050(m) lets a municipality partially or totally exempt economic development property by ordinance, if the ordinance sets clear eligibility rules and requires a written application. The Borough could give a for-profit provider the same break a nonprofit gets, limited to the part of the facility used for addiction treatment and recovery and nothing else in the business.
The exemption should carry conditions. The provider accepts Medicaid, serves Borough residents, and reports outcomes the same way every other publicly supported provider does. The Borough Attorney should confirm the details, but the tool appears to be there. Using it would bring private investment to a problem public money can’t solve alone.
How we compare nationally
KFF Health News, working with Johns Hopkins and Shatterproof, went through how state and local governments spent settlement money in 2022 and 2023. On average, about 18 percent went to treatment and 14 percent to recovery services such as housing and transportation. Prevention came in lower.
Mat-Su has that close to backwards. We put as much into prevention as into treatment, and recovery is tied for the smallest share. Our grants are smaller and more scattered than in most places, and our outcome tracking is close to nonexistent. Weak tracking is common across the country, but that is no reason to accept it here.
In fairness, the Borough has not spent this money on things that don’t qualify, which some governments have done. The issue here isn’t misuse. It is whether the money buys recovery that lasts.
A better path forward
Finishing a 30-day program is not the finish line. A 2025 review by researchers at Massachusetts General Hospital and Harvard found that the risk of relapse doesn’t drop to the level of the general population until a person has about five years of sustained remission. The same review found that people in recovery housing did better than those without it on staying sober, income, employment, and avoiding new criminal charges.
What happens after treatment decides whether treatment worked. Someone who leaves a program with no stable place to live and no way to earn a living will very likely end up back where they started. Here is what I would do.
Shift the balance toward recovery. Keep treatment at 30 percent, raise recovery from 10 to 25 percent, lower prevention to 15 percent, and keep harm reduction at 10 percent. When the 20 percent media share expires around 2028, move it to recovery too.
Build a path from treatment to housing to work. Fund structured recovery housing where residents keep a schedule, share the chores, and hold each other accountable. Pair it with vocational training through Mat-Su College, apprenticeships, and local employers. Working models already exist. Oxford House residents run their own homes and pay their own rent. Delancey Street in San Francisco teaches residents a trade over several years without government operating money.
Measure what matters. Every provider that receives public money or a tax exemption, nonprofit or for-profit, should report how people are doing at six months, one year, three years, and five years. Are they housed, working, sober, or back in treatment? Graduation counts are not results.
Fix the committee. Physicians, emergency and hospital staff, and licensed mental health clinicians should hold the majority. One seat goes to a nonprofit provider and one to a for-profit provider. No one whose organization is applying should score the applications.
Pay for treatment after it is delivered, not before. And require every grantee to disclose all other public funding it receives for the same services.
Going all in on self-sufficiency
People who work in recovery will tell you the same thing. Getting someone from treatment to a steady paycheck takes months, sometimes a year. Without housing and money to live on during that stretch, relapse is the likely outcome. If public policy is serious about helping these people, it has to pay for the whole stretch, not just the first 30 days.
Parts of this already exist here. Alaska Addiction Rehabilitation Services, on a 116-acre farm in Wasilla, combines residential treatment, transitional housing, work therapy, and vocational training. CITC’s Chanlyut in Anchorage gives residents work experience in a commercial kitchen. MyHouse and Covenant House run job readiness classes for young adults. Those are good foundations, but none of them carries an adult through months of serious training while housing them.
The providers see the gap too. A March 2026 report from True North Recovery described major gaps in transitional and sober housing, especially for people leaving detox or corrections.
What we need is a pathway: six to twelve months of structured recovery housing while a person earns a real credential. A welding certification, a commercial driver’s license, an electrical or HVAC apprenticeship, or training for a pipeline trade. Training that leads to a wage someone can support a family on, not a certificate that leads nowhere.
Most of the money already exists in separate pots that rarely get combined. Settlement funds can pay for recovery housing and job training under Exhibit E. The state’s housing finance corporation administers federal recovery housing money. Federal workforce funds through the Alaska Job Center Network can pay tuition. Registered apprenticeships pay wages while the person learns, so they can start paying part of their own rent. The public cost shrinks as the person stands on their own.
The timing matters. If a gasline gets built, Alaska will need a large trades workforce. Training Valley residents in recovery for those jobs serves both needs at once.
This is not cheap, and it is not quick. But a person who finishes a program like this becomes a working, taxpaying neighbor instead of a repeat admission. That is a return on public money worth paying for, and the outcome tracking proposed above will tell us whether it is working.
A word to our nonprofits, and to my fellow conservatives
To the nonprofits doing this work: opening the door to more providers does not take anything away from you. The need is far larger than the beds we have, and your own reports say so. Every provider would be paid the same way and measured the same way, and a program with strong results has nothing to fear from that. If the goal is helping people, more open beds is good news for everyone in this field.
To my fellow conservatives, I expect two objections. The first is that this grows government. It does not. This is settlement money paid by drug companies, and the legal agreements require it to be spent on remediation. No new tax dollars are involved. What I am proposing actually shrinks the Borough’s role: instead of picking a few grantees, it pays any qualified provider for treatment delivered and measures the results. That is more market, not more bureaucracy.
The second objection is that people made their own choices. Choices do have consequences. Right now, though, we all pay them, through property crime, overdoses in our neighborhoods, kids in foster care, jail beds, and emergency rooms. The National Institute on Drug Abuse has long estimated that each dollar spent on treatment saves several dollars in crime and criminal justice costs. And many of the people struggling today started with a prescription from their own doctor, which is why this settlement exists in the first place.
Nothing about this is a handout. Structured housing with chores, months of serious training, real work, and outcomes tracked for years asks more of a person than the system we have now. It is a ladder, and they have to climb it themselves.
Compassion is a conservative value too. Second chances and helping your neighbor run deep in the faith many of us share. I would rather pay for a path to a paycheck than keep paying for jail beds and emergency rooms.
What you can do
Ask your Assembly member and your city council to open this money to every provider with an open bed, shift it toward recovery, and require real outcome reporting.
We have a lot of neighbors struggling with addiction and a modest amount of money to help them. Let’s use every bed we can find, and judge the results by whether people are still well five years from now.
