As of January 23, 2025, the opioid crisis continues to ravage communities throughout America, which brought about a historic settlement from pharmaceutical companies and distributors totaling over $50 billion. But recent investigations have raised disturbing questions about how those funds are being spent and whether they are effective. By all accounts, many states are not making good use of the huge sums of money supposedly dedicated to fighting opioid addiction and overdose deaths. This story looks at the status of opioid settlement money, highlighting disparities in spending and potential consequences for communities in need.
The background of the opioid settlements
There’s a new database that tracks how state and local governments across the country are spending the billions of dollars in opioid settlement funds. But there aren’t many entries for Ohio and most states involved in the settlement.
“And that’s because there are almost no requirements for the entities in Ohio to report how the money is being used,” said Aneri Pattani, a senior correspondent with KFF Health News.
She and her colleagues worked with researchers at the Johns Hopkins Bloomberg School of Public Health and Shatterproof, a nonprofit dedicated to addiction, to build the database tracking settlement funds. It’s the most detailed tool to date to do so, outlining more than 7,000 ways the money has been used nationwide. Records indicate that between 2022 and 2023, Ohio received $158 million in opioid settlements. However, roughly half of the money is untraceable, meaning there aren’t public records showing how it’s being spent.
The opioid settlements have arisen from thousands of lawsuits filed against the major pharmaceutical companies that have been accused of fueling the opioid epidemic with overly aggressive marketing and distribution practices. Under the landmark national settlement deal reached in January 2022, $26 billion over 18 years is to be given to states and local governments for “opioid remediation.” The latter includes paying for prevention, treatment, and recovery support strategies aimed at harm reduction. This has left each state to decide on how to spend the money in response to its specific needs and priorities. However, the complexity of handling the large amount of money has been overwhelming for the implementation process.
Discrepancies in fund allocation
Recent findings show that many states have yet to use their share of the settlement funds effectively especially Ohio. Indeed, a recent review by several watchdog groups found that even though some states have announced spending plans, actual expenditures have been slow or nonexistent.
- Slow spending: In some states, little of the allotted money has actually been spent on approved programs. For instance, Wisconsin, as of early 2025, had received more than $780 million, with only a very small fraction of this amount being committed to community programs aimed at overdose prevention and treatment.
- Administrative delays: Many states are experiencing administrative delays in disbursing the funds. Complexity in approval procedures and lack of clear guidelines has resulted in a significant backlog in implementation of approved programs.
- Lack of transparency: There is concern over the tracking and reporting transparency of these funds. In some cases, the local governments are reporting to get little or no information on their share of the settlement money or where it is spent.
These discrepancies raise serious questions about whether those who are to benefit from the settlements, those addicted, are indeed getting the help they so badly need.
Community impact: Where is the money going?
The slow rollout of opioid settlement funds has very important implications for communities grappling with addiction and overdose crises. A majority of the states have committed to spending at least 70% of their settlement funds explicitly on opioid remediation efforts. However, a significant portion of the money either remains unspent or is misplaced.
- Underfunded programs: The local entities tasked with prevention and recovery efforts typically need to receive their funding in a timely manner to be able to operate. Delays in disbursement leave many programs with a budget shortfall, unable to provide necessary services.
- Rising rates of overdose: It is of greater concern that inaction is occurring with the continued rise in overdose-related deaths attributed to opioids. Due to delayed action in harm-reduction strategies like naloxone (Narcan) and fentanyl test strips, there are record fatality rates seen in communities.
- Inequitable distribution: There are also concerns about inequitable distribution among urban and rural areas. Some rural communities report receiving significantly less funding compared to their urban counterparts, despite facing similar or even greater challenges related to opioid use disorder.
Calls for accountability
In response to these findings, advocates and community leaders are now calling for greater accountability in the use of opioid settlement dollars:
- Strengthened oversight: More and more, independent bodies located at both the state and local levels are needed to oversee how settlement funds are expended. Otherwise, such oversight would help to make sure that money is spent on effective programs and not lost in administrative red tape.
- Public reporting requirements: The advocates call for the compulsory public reporting of fund allocation and expenditure to bring transparency into the situation. This will empower community members to hold their governments accountable for how they manage these critical resources.
- Community engagement: This may lead to better-targeted interventions, through involving local communities in decision-making processes around fund allocation, to address specific regional needs.
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