A year after the federal government awarded nearly $485 million in grants nationwide to combat opioid addiction, Arkansas had spent less than 6 percent of its allotment -- the lowest percentage out of any state.
Arkansas was awarded $3.9 million, but had spent just $223,804 as of April, according to records obtained by The Associated Press under the federal Freedom of Information Act.
Among the 50 states, the District of Columbia and four U.S. territories, the average jurisdiction had spent 56 percent of its award, the records show.
Utah, New Mexico, Oregon, North Carolina and Wyoming had each spent more than 90 percent of their allotments.
Spending slightly faster than Arkansas was California, which had spent just over 8 percent of its $44.8 million award. No other state had spent less than 10 percent of its funding.
The grants were part of almost $1 billion approved by Congress to curb opioid abuse under the 21st Century Cures Act of 2016.
Kirk Lane, who was appointed Arkansas' drug director about four months after the state's grant was awarded last year, said the state's biggest impediment has been finding enough doctors who are authorized and willing to prescribe drugs, such as buprenorphine, that treat opioid addiction.
The doctors must obtain waivers from the federal Drug Enforcement Administration to prescribe the drugs at their office, rather than in a treatment center.
"What we did not realize is that we didn't have things in place, such as DEA-waivered docs, training, understanding of the program, and all of a sudden, you're given this money very quickly," Lane said.
The grants were the first round of funding awarded under the 2016 law. Arkansas received another $3.9 million under the second round of funding announced in April.
The funding was distributed according to a formula favoring states with more overdose deaths and treatment needs.
An AP analysis found states, such as Arkansas, that expanded Medicaid under President Barack Obama's health overhaul reported spending their allocations more slowly than states that didn't expand the health insurance program to poor, childless adults.
Why? In the 33 states that expanded Medicaid, the insurance program already covers addiction treatment for nearly everyone who is poor and needs it.
Medicaid allows states to go beyond the basics with the grant money, while non-expansion states have to fill in for basic needs with fewer dollars, said Brendan Saloner, an addiction researcher at Johns Hopkins Bloomberg School of Public Health.
In effect, Medicaid expansion states had a running start on the opioid crisis, while states without the extra Medicaid funding hastened to catch up.
"Non-expansion states are dealing with populations more likely to be uninsured and more likely to need coverage for addiction treatment," Saloner said.
In contrast, states with Medicaid expansion can use the grants to create new infrastructure, "asking providers to take risks by investing in new personnel, new systems and new ways of doing things," Saloner said. "The puzzle is how to keep momentum going after the funds are gone."
In Arkansas, Lane said finding uninsured or underinsured people eligible for assistance has been less of an obstacle than finding doctors and nurse practitioners who can prescribe drugs to treat opioid addiction.
To address the shortage, the University of Arkansas for Medical Sciences is using $600,000 from the state's grant money to provide one-on-one help as well as weekly video conferences for doctors who prescribe the drugs.
While the state still needs to recruit more doctors, Lane said it has made progress and is now spending the money more quickly.
He said he hopes to have the first year's allocation of $3.9 million spent by May, when the funding is set to expire, and plans to secure an extension on the deadline to spend the second installment.
Last month, the state was awarded an additional $10 million over two years to continue projects started with the earlier grants and to start new projects.
"A lot of times it's flying the airplane as we're building it," Lane said. "That's what it basically came down to."
To compare states, AP obtained year-end reports and analyzed actual expenditures from May 2017 through April 2018.
States were required to report on money actually spent, not what they intended to spend.
Arkansas had provided treatment to 227 people at an average cost of about $86 per person. It had also provided recovery services, a category that includes training and housing, to 265 people, at an average cost of $223.70 per person.
In total, states used the money to provide treatment to nearly 119,000 people with opioid addiction, including nearly 3,000 pregnant women. More than 33,000 people received recovery services, such as training and housing.
In some states, structural delays -- choosing contractors through competitive bidding, for example -- led to less time for invoices to be submitted and paid by the end of the period. California officials said such processes and a deliberate effort to build an entirely new treatment structure explain why the state still had $41 million of its grant left after the first 12 months.
Information for this story was contributed by Carla K. Johnson, Nicky Forester and Philip Marcelo of the Associated Press; and by Andy Davis of the Arkansas Democrat-Gazette.
A Section on 10/23/2018