Photo by Samuel Ferrara / Unsplash
West Virginia's billion-dollar opioid settlement fund has arrived — and the city at the epicenter of the crisis is watching it move through institutions that were never built to serve it.
Conny Priddy arrives at the address before the ambulance clears. Her team — the Quick Response Team, known in Huntington as the QRT — doesn't race to scenes. They come after. They sit with whoever is left. A mother at a kitchen table. A man in a bathrobe who doesn't remember the night before. A teenager who called 911 and then sat on the floor by the front door until someone knocked.
Huntington's QRT launched in 2017 as one of the first programs of its kind in the country. The idea was simple: a follow-up visit within 72 hours of a non-fatal overdose, led not by law enforcement but by a combination of social worker, recovery coach, and sometimes a paramedic. You don't show up to arrest or lecture. You show up to ask what someone needs and then try to find it.
The needs are consistent. Someone to call. A bed in a program. A Narcan kit for the people still in the house. Childcare so a parent can enter treatment. Somewhere to go that isn't the street or the same room where the overdose happened.
Priddy has been doing this work long enough to recognize what she calls the generational weight of it. Families where grandparents are raising grandchildren. Kids who learned early what it looks like when someone disappears and comes back different. Streets in the North End or Guyandotte where everyone knows which houses you watch and which ones you don't.
She knows what the funding conversations sound like from a distance — the announcements, the press releases, the language about "systems of care" and "continuum of services." She also knows what that means on a Tuesday afternoon when she needs to place someone and there are four beds available in the county and seventeen people waiting. "I hate to say it," she has said, "but you can't throw a little bit of money at it and then expect the problem to go away. It has become generational."
That is not sarcasm. That is documentation. And when the money finally came — nearly a billion dollars in opioid settlement funds flowing into West Virginia over seventeen years — Huntington was already in the habit of waiting to see who it would actually reach.
The West Virginia First Foundation (WVFF) was created in February 2022 through a Memorandum of Understanding signed by then-Attorney General Patrick Morrisey. The MOU established that 74.5% of West Virginia's roughly $980 million in opioid settlement funds would flow to this private nonprofit — not to the state government, not to counties, not to the communities with the highest documented damage. To the Foundation. The remaining 24.5% goes directly to local governments; 3% was reserved for the AG's office. Patrick Morrisey is now the governor of West Virginia.[1]
The Foundation operates as a private nonprofit. It is not subject to the West Virginia Open Meetings Act. Board deliberations are not public records. Its 11-member board is organized by region, with one vote per region — which means that Region 5 (comprising Cabell County, Kanawha County, and eight other counties, collectively accounting for an estimated 38.59% of the state's opioid crisis impact) holds exactly one vote on how the majority of settlement funds are distributed. Region 1, covering five far northern counties with 6.76% of the documented impact, holds the same single vote.[2]
Wood County Commissioner Blair Couch put the representation problem plainly in 2023: "How can you have Cabell and Kanawha in the same region? Those two big ass counties, who have suffered a lot through the opioid [epidemic], are going to have one vote on this 11-member panel." The board structure is not an administrative accident. It is a governance design that systematically dilutes the political weight of the counties with the largest documented harm. — Source: Mountain State Spotlight, July 2023
The standard grant access mechanism reinforces this structure. To receive WVFF funds, community organizations must submit a 40-page application — with supplemental letters of recommendation from elected officials, detailed program budgets, and documented outcome metrics — within a 30-day window. These requirements are not unreasonable in isolation. They are unreasonable as the only path to funds for organizations that are simultaneously running recovery houses, staffing QRT follow-ups, managing Narcan distribution, and doing it all with skeleton crews. In the 2024 grant cycle, 174 applications were submitted. Only $10.4 million of $19.2 million available was awarded. The WVFF cited "deficient applications."[3]
So we're calling community organizations that couldn't complete a graduate-level grant application in 30 days — while actively responding to overdoses — "deficient." Cool. Now explain who benefits from that framing.
The answer arrived two days before the grant deficiency announcement. On December 10, 2024, the WVFF convened a special board meeting and committed $20 million to a new program called ACCORN — the Appalachian Continuum of Care for Overdose Reduction Network. There were no disclosed partner organizations at the time of announcement. No public application process. No description of specific programs. A web search for "ACCORN" returned zero results. Marshall University, headquartered in Huntington, was confirmed as the lead institution two days later, after West Virginia Watch began asking questions.[3]
Marshall University occupies a structurally unique position in this story. It received the $20M ACCORN commitment through a non-competitive process. It also authored the Cabell County 2024 Resiliency Plan — released in November 2024 — which formally documents the service gaps the ACCORN funding is supposed to address. This creates an institutional loop: the entity that defines the problem formally also receives the institutional funding to solve it, through a process invisible to the community organizations already doing the work. The Resiliency Plan itself notes "fragmented prevention programs" and the need for "long-term, sustainable funding" — a diagnosis that arrived simultaneously with a $20M institutional solution already in motion. — Source: Marshall Health/Marshall University, November 2024
The local government share of settlement funds (24.5%) adds a third layer of displacement. Statewide FY2024 data from the WVFF's own annual spending report shows that 52.76% of what local governments actually spent went to law enforcement. Only 6.43% went to rehab, recovery, and treatment. At least nine West Virginia counties spent a combined $3.5 million paying regional jail bills with opioid settlement funds — a use permitted by the Morrisey-authored MOU's expansive definition of allowable expenditures.[4]
In Cabell County and Huntington specifically, FY2024 documented settlement spending totals approximately $368,400 — $125,000 to the QRT program Conny Priddy coordinates, $200,000 to Lily's Place (housing for mothers in SUD treatment), and $43,400 in EMS radio equipment. Federal court testimony from the 2021 opioid trial established the actual cost to properly abate the crisis in Cabell County and Huntington at $2.54 billion over fifteen years. The gap between what arrived and what was needed is not a rounding error. It is a policy outcome.[5]
West Virginia is not uniquely cynical. It is unusually legible. The mechanisms that are concentrating opioid settlement funds in institutional hands — away from community-based organizations and toward entities with political connectivity and grant infrastructure — are present across every state receiving settlement distributions.
The Johns Hopkins Bloomberg School of Public Health's Opioid Settlement tracking project has established a clear set of principles for how settlement funds should be governed: transparent decision-making, community voice, independent oversight, restrictions on supplanting existing government spending, and explicit prohibitions on uses unrelated to the opioid crisis.[6] West Virginia's MOU fails on multiple counts. The inclusion of jail bills as an allowable expenditure directly contradicts the principle of crisis-specific use. The Foundation's private nonprofit structure eliminates the transparency requirements that apply to public agencies. The standard grant timeline structurally advantages institutions over community organizations.
Attorney Frank Kearl of Popular Democracy, who has tracked settlement spending patterns nationally, is precise about the stakes: "This is their one opportunity to see meaningful justice served… Money spent in a way that is helping resolve the harms that they have suffered and continue to suffer, and so when that money is wasted, to me, it's less even about the legality or illegality and more about the justice of it."[4]
The legal context adds a specific urgency to Huntington's situation. On October 28, 2025, the Fourth Circuit Court of Appeals revived Huntington and Cabell County's $2.5 billion lawsuit against AmerisourceBergen, Cardinal Health, and McKesson — the Big Three pharmaceutical distributors. The circuit court's 49-page ruling found the lower court had misapplied the preemption doctrine. The case returns to federal court. If Huntington prevails, the potential recovery is large. But the settlement fund being distributed now — the $980 million already arriving — is not contingent on that case. It is already moving.[7]
Laura Lander, an addiction therapist and WVU associate professor of medicine who previously reviewed WVFF grant applications, frames the law enforcement allocation problem with clinical clarity: "It's not going to address the problem, it's just going to pay a bill. I'm sure everybody has regional jail bills, but it's not actually addressing the problem. It sounds like it's addressing a shortfall in the county's budget or planning."[4]
The broader implication of the Huntington signal is this: when settlement funds are governed by private structures, designed by the same officials who later manage them, and accessed through processes that systematically advantage institutional actors over community ones, the money does not reach the crisis — it reaches the infrastructure already positioned to capture it, and the communities with the highest documented harm become the most legible evidence of a system working exactly as designed.
The WVFF's argument for channeling large commitments to institutional actors like Marshall University is not without merit. Community-based nonprofits often lack the financial management infrastructure, outcome-tracking systems, and operational continuity required to responsibly administer multi-year, multi-million dollar grants. The documented failure rate in the 2024 grant cycle — 46% of available funds unawarded due to deficient applications — could reflect genuine organizational incapacity rather than a deliberately hostile process. It is possible that the ACCORN commitment reflects a board-level judgment that regional academic institutions are better equipped to produce measurable outcomes at scale. This alternative deserves acknowledgment. However, the evidence distribution does not support it as the primary mechanism: the 30-day application window, the 40-page requirement, the elected-official letter mandate, and the simultaneous approval of a $20M non-competitive commitment suggest the standard grant process was not designed to succeed for under-resourced community organizations. The problem may be genuine capacity limits — but the system does not appear designed to build that capacity. It appears designed to filter for it.
One could argue the 11-region, one-vote board structure is a deliberate effort to prevent Cabell and Kanawha counties — as the state's two dominant population centers — from capturing settlement funds at the expense of rural counties with smaller but equally real impacts. Under this reading, West Virginia's opioid crisis is genuinely statewide, and a population-weighted or impact-weighted distribution would simply redirect resources to cities that already have more institutional infrastructure. The equal-voice structure may be an attempt at geographic equity. This is a legitimate concern. However, the structure as implemented does not produce equitable distribution — it produces disproportionate under-representation of the counties with the highest documented per-capita damage. Region 5's share of documented crisis impact (~38.59%) is not reflected in its governance weight (1/11 = 9.1%). The equity argument would be stronger if the board representation were accompanied by need-weighted allocation formulas. It is not.
Research gap — community voice: This signal does not include a named Huntington community advocate (non-institutional) publicly opposing the ACCORN commitment or WVFF governance structure on the record. The opposition documented here is structural and legal, not yet voiced by a specific named local organizer. Organizations like PROACT and Recovery Point West Virginia operate in Huntington; their public positions on WVFF governance were not available at research time.
ACCORN outcome data: As of March 2026, no published outcome data exists for the ACCORN program. Marshall University's lead role is confirmed, but specific program components, contracted subgrantees, and FY2025 spending have not been made public. If ACCORN produces measurable community outcomes and transparent subgrant distribution, the mechanism analysis here would require revision upward.
What would change this signal: Publication of ACCORN program details showing competitive subgrant distribution to Huntington-area community organizations would reduce the capture inference. An increase in the WVFF's rehab/recovery/treatment allocation ratio above 20% in FY2025 data would indicate directional correction. A named community advocate publicly opposing WVFF governance would elevate the SCI Lens Coverage score. Conversely, a second non-competitive special-meeting commitment would confirm the mechanism.
[1] West Virginia First Foundation Memorandum of Understanding, signed Feb. 16, 2022, AG Patrick Morrisey. ago.wv.gov (PDF) — Tier A
[2] Mountain State Spotlight, "West Virginia First Foundation Board Explained," July 12, 2023. mountainstatespotlight.org — Tier B
[3] West Virginia Watch, "WV First Foundation commits $20M to Appalachian recovery project though details scarce," Dec. 10, 2024; "WV First Foundation opens second funding round for 2024 grants due to deficient applications," Dec. 12, 2024. westvirginiawatch.com — Tier B
[4] West Virginia Watch / WVU investigative report, "WV counties spend opioid crisis money on jail instead of recovery," July 8, 2025; "From Batman to drones: see how your local government spent opioid settlement funds," July 24, 2025. westvirginiawatch.com — Tier B
[5] Expert testimony, U.S. District Court for the Southern District of West Virginia, Case No. 3:17-cv-01362 (City of Huntington v. AmerisourceBergen Drug Corp.), 2021. CourtListener (PDF); WV First Foundation FY2024 Local Spending Report, July 2025. westvirginiawatch.com (PDF) — Tier A
[6] Johns Hopkins Bloomberg School of Public Health, Opioid Settlement Community Principles, State of West Virginia tracker. opioidprinciples.jhsph.edu — Tier A
[7] Fourth Circuit Court of Appeals, Opinion No. 22-1819 (City of Huntington and Cabell County Commission v. AmerisourceBergen Drug Corp.), October 28, 2025. ca4.uscourts.gov (PDF); Reuters, "US appeals court revives $2.5 billion opioid lawsuit in West Virginia," Oct. 28, 2025. reuters.com — Tier A / Tier B
[8] Marshall Health / Marshall University, "Cabell County releases 2024 Resiliency Plan to address opioid epidemic," Nov. 2024. marshallhealth.org — Tier B