Federal officials have launched an audit of the D.C. government’s handling of millions of dollars in grants that the city has been awarded over the past two years to treat opioid addiction and reduce fatal overdoses.
The audit appears to focus on grant money that was not spent as intended to combat the opioid epidemic and on federally funded programs that D.C. government officials failed to implement, according to documents outlining the inquiry obtained by The Washington Post.
Officials with the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA) notified the city of the audit on Jan. 9, and this week are visiting D.C. government offices and at least one treatment provider that received grant money.
D.C. Deputy Mayor for Health and Human Services Wayne Turnage confirmed the audit in a written statement Tuesday evening.
“In confronting this epidemic, we obviously value our partnership with SAMHSA and welcome the review and feedback as we continue to seek opportunities to better leverage federal grants and effectively serve District residents,” Turnage said.
A SAMHSA spokesman declined to comment, saying the agency does not discuss ongoing audits.
The audit comes after The Post reported last month on widespread lapses in the city’s response to a surge in fatal overdoses caused by heroin cut with fentanyl, a lethal synthetic opioid. Those deaths have been concentrated among older African Americans, many of whom had used heroin for decades — a population different from the rural, white drug users often associated with the national opioid epidemic.
The Post found that officials at the D.C. Department of Behavioral Health failed to carry out multiple initiatives for which they obtained federal grant money — including teams of counselors to perform street outreach to heroin users and a program to steer overdose victims into addiction treatment at the District’s public hospital. The medical provider contracted by the city with $1.46 million of its federal money did not treat a single patient for opioid addiction in connection with the grant.
That provider, Medical Home Development Group, hired staff and leased office space in anticipation of new patients — referred through federally funded programs run by the city — who would be treated with buprenorphine, a medication that diminishes opioid cravings.
But the District failed to do its part to implement those programs or identify patients for treatment, company officials said. In the absence of direction from the D.C. government, Medical Home Development Group ultimately used the grant money to provide primary care and some other medical services to drug users who were already receiving treatment for their addiction with methadone, they said.
Audrey Whetsell, the company’s chief executive, said she was scheduled to meet with SAMHSA auditors Wednesday at Medical Home Development Group’s main office in Foggy Bottom. Whetsell said she planned to share with auditors problems the company had encountered working with the city.
“We were kind of left to our own devices, basically,” she said.
Former Department of Behavioral Health director Tanya Royster was removed from her position by the mayor in late November, after Royster was interviewed by The Post and shortly before the newspaper published its series on the city’s opioid response.
Over the past two years, the city has received $4 million from SAMHSA as part of grants awarded to state governments across the country to combat the opioid epidemic.
In a letter notifying the city of the audit, Jack Goldberg, director of SAMHSA’s Office of Financial Advisory Services, said the agency would be scrutinizing both the management of those funds and the city’s plans for using an additional $21 million in federal grant money it expects to receive this year for proposed opioid programs.
A follow-up letter to city officials from Goldberg suggests the scope of the audit. Among other things, Goldberg requested detailed records of how the department has spent its grant money; a list of all grant-funded programs that were never implemented, along with explanations; the number of people offered addiction treatment services with grant money; and information about how the city managed subcontractors that obtained federal funds.
D.C. Council member and health committee chairman Vincent C. Gray (D-Ward 7) said he was “deeply concerned” by news of the audit, including its potential to put at risk the $21 million in new federal grant money. Gray said he hoped Department of Behavioral Health officials would be “as forthcoming as they possibly can” with federal auditors.
“There were resources that were there. They were obviously not used, to the detriment of people that desperately needed that type of opioid intervention,” Gray said. “There needs to be accountability, full accountability, for the number of lives that have been lost in the District of Columbia.”
Between 2014 and 2017, the District’s rate of fatal drug overdoses rose by 209.9 percent — an increase higher than that of any state and the ninth highest among all U.S. counties, according to Centers for Disease Control and Prevention data. (The agency does not track deaths by city.)
In 2017, the city saw 279 fatal opioid overdoses, according to the D.C. chief medical examiner — a figure higher than the number of homicides that year. More than 4 in 5 victims were black.
In addition to problems with the District’s use of federal grant funds, The Post found that city officials mismanaged other initiatives to reduce overdoses.
The District government distributed the lifesaving overdose antidote naloxone at a far lower rate than other cities with comparable opioid problems and ignored demands for more of the medication from community treatment providers.
The D.C. Council has scheduled a hearing later this month to examine failures in the city’s opioid strategies and assess plans Mayor Muriel E. Bowser (D) has for future initiatives to address the epidemic.