How Will States Spend $26 Billion in Opioid Settlement Funds?

Money from nationwide opioid settlements is finally coming to local governments. 

For years, high-profile lawsuits against opioid manufacturers and distributors have made headlines. Now, many of those lawsuits are being resolved, and states must decide how they’ll spend this influx of cash. 

New reporting from NPR and Kaiser Health News (KHN) takes a look at how some of these local governments are planning to spend the funds.

Settlement funds are protected from blatant misuse — but there are still gray areas. 

The biggest opioid settlement so far amounts to $26 billion. That money will be paid out in installments spread out over 18 years, and will impact more than 3,000 cities, counties, and states.

Thanks to advocacy and guidance from experts, some protections are already in place to ensure these funds are spent appropriately. The settlement agreement specifically stipulates that states must spend at least 70% of the funds on “opioid-related expenses.” It includes a list of expenses that qualify, such as the purchase of naloxone, the overdose reversal medication. The settlement also allows for 15% of funds to be spent on administrative costs.

While the risk of funds being entirely misspent — say, on filling potholes or closing budget gaps — are low, there are other risks to contend with, such as a lack of transparency and inclusion within the allocation process.

Some states have already begun distributing funds toward science-based programming. 

Rhode Island, for example, has hit the ground running. According to NPR and KHN, “its Executive Office of Health and Human Services, which controls 80% of the funds and works with an opioid advisory committee, released a plan to use $20 million by July 2023.” 

That includes $900,000 for recovery supports (including family resources), $4 million for mental health programs in schools and communities, and $2 million for an overdose prevention center.

Spending decisions tend to reflect local priorities. “Maine is dedicating 3% of its statewide share for special education programs in schools,” NPR/KHN reports, “and Colorado has allocated 10% to addiction infrastructure, like workforce training, telehealth expansion, and transportation to treatment.”

Some states are off to rockier starts. 

In Ohio, the advisory board responsible for deciding how funds will be spent has said they won’t guarantee full transparency with the public. Instead, according to NPR/KHN, “it has adopted a policy that meetings can be closed if the board decides the content is ‘sensitive or confidential material that is not appropriate for the general public.’” This has led to worries from local individuals directly affected by the opioid epidemic, as well as a lawsuit from an Ohio-based harm reduction group.

In Louisiana, the allocation process appears to have “barely begun.” NPR and KHN reporters were unable to get specific questions answered by state officials, and the last official comment on the matter was made by the state attorney general over a year ago.

"It's not going to magically end this crisis. But if it's used well and used thoughtfully, there is an opportunity to make a real difference." 

That’s according to Sarah Whaley, a researcher at Johns Hopkins Bloomberg School of Public Health. Shatterproof has partnered with Johns Hopkins and a coalition of additional expert partners to advise on opioid settlement spending, ensuring funds are put toward programming proven to prevent and treat addiction. 

Want to add your voice? Use our simple tool to contact your local officials with just a few clicks. Let them know how important it is to spend this funding well — lives depend on it.