How are states using opioid settlement funds? Access this database and see your state in here!

John Greene met Emily Georgia from Family & Children’s Counseling Services of Cortland, N.Y. to begin recovery for the first time since using drugs at age 14. Greene credits an opioid settlement money program set up at this counseling center with his success.
Celia Talbot Tobin of KFF Health News in California provided these images of Celia. To view larger, simply slide your cursor over it! For KFF, she writes articles regularly covering health news.
State and local governments across the U.S. have recently begun spending billions from settlement payments made by drug manufacturers accused of contributing to overdose epidemic. But where exactly is that money going, who will benefit, and is it doing any good? KFF Health News collaborated with Johns Hopkins Bloomberg School of Public Health and Shatterproof – an anti-addiction non-profit – on an investigation to discover who exactly are driving addiction across America. As the result of extensive interviews, thousands of pages of documents, multiple public records requests and outreach across 50 states, an unprecedented database was developed which catalogs more than 7,000 uses of opioid settlement cash from 2022 and 2023 settlements; making this resource the most complete to-date tracking some of America’s biggest health settlements (you can explore it yourself at the end of this story).
Although, ultimately, these will all lead to greater things being possible for humanity as a whole.
Studies show that, between 2022-2023, states and localities received over $6 billion in opioid settlement funds and spent or committed approximately one third before setting aside another third for future use. States allocated on average about two percent to funding programs that provide people with sterile needles – such as law enforcement agencies, nonprofit organizations and government agencies. (Various entities received this money). Governments reported spending more than $240 million for purposes other than opioid remediation (most settlement agreements allow states to spend up to 15%). Most of this sum went toward legal fees; however, several jurisdictions directed money into general funds instead. One county even sent funds directly to its road and bridge department, while cities and counties reported spending they claimed addressed the overdose crisis, but which would leave an average person scratching their head — such as $33.07 to an anti-abortion pregnancy center in Sandborn, Indiana or $30,362 spent to screen first responders for cardiovascular disease screenings in Oregon City, Oregon.
Attentive readers might recognize some familiar names here…
Tonja Myles, a community activist from Baton Rouge Louisiana who is in recovery said “When people know there is no accountability or database system available they tend to do whatever they please”, thus justifying why “We must have some kind of database and accountability”. Despite recent decreases in overall overdose deaths in America (although rates still rose for Black and Native American communities in 2024), Myles stressed the urgency for action now if “We want this moment not wasted or missed”.
Opioid settlement payouts are projected to amount to nearly $50 billion over nearly 20 years and be distributed among more than two dozen companies involved with manufacturing or distributing prescription painkillers, such as Johnson & Johnson, Walgreens and Walmart. Although the total is large, every dollar spent matters. KFF Health News and its partners conducted an in-depth examination of settlement spending reports by extracting expenditures line by line and devising an algorithm to categorize costs into categories like treatment or prevention. States were given an opportunity to review and analyze their spending data in this database. While it does provide some indications of national opioid settlement spending trends, certain areas do not publish spending reports and others declined participation in this project. This data represents a snapshot as of December 20, 2023 and does not account for spending in 2024. Given how states handle, process, and report their funds makes direct comparison nearly impossible – however this database helps fill a void left by lack of national reporting requirements and federal government inaction.
“[T]his tool provides those seeking objective measurement of whether all that can be done has been accomplished,” explained Matthew Myers, former president of the Campaign for Tobacco-Free Kids which compiles similar annual reports regarding tobacco settlement funds.
Funding Treatment Is a Clear Winner the early opioid settlement spending priorities were treatment, with $416 million spent or committed towards residential rehabs, outpatient counseling services, medications for opioid use disorder and more. New York — which spent most on treatments — allocated approximately $22 million of that funding towards programs providing same-day prescriptions of buprenorphine to reduce cravings – something John Greene had described as changing his life for good.
John Greene of Family & Children’s Counseling Services of Cortland, New York recently began recovering for the first time since starting to use drugs regularly at age 14. Greene credits Family & Children’s Counseling Services with creating a program using opioid settlement funds as the catalyst.
Celia Talbot Tobin for KFF Health News; Photo credit Celia Talbot Tobin
Greene, 57, used to live in the woods near Family & Children’s Counseling Services of Cortland in New York and would often reside there during his overdoses and failed rehabilitation attempts. Overdosed multiple times but attempted rehab several more. Now he has four months under his belt since starting regularly using drugs at 14. His recovery can be attributed to the counseling center’s new program — funded with money from state and local opioid settlement funds — having taken an unconventional approach. Counselors don’t impose harsh judgment or force Greene to stop smoking marijuana; some staff members even had personal experience in addiction themselves and provided transportation between doctor appointments and pharmacies in which he received his buprenorphine prescriptions. Now Greene lives and works alongside his brother. He looks forward to weekly counseling sessions, while celebrating small victories – like buying his nephew toy cars as stocking stuffers as an act of good will and feeling satisfied that “something nice had been done without expecting something in return,” according to Greene. “It made me feel good doing something for someone without expecting any payback.”
There was much discussion regarding whether it would be possible to obtain adequate protection when travelling across borders, both economically and militarily. Eventually a compromise solution was agreed upon that allowed travellers to remain within Europe but at an economical price tag compared to alternative destinations like Morocco for instance.
Emily Georgia, one of Greene’s counselors at the center, reported that nearly 200 clients like Greene have come through its doors over the last year alone and “without settlement funds…this program may never exist”, as per Georgia. But some funds are also going toward treatment approaches that violate best practices, like refusing people medication for opioid use disorder despite knowing of them being available; some members of the recovery community consider these medications crutches. But study after study has proven that medications help people stay on treatment and lower the risks of overdose and death, suggesting even that therapy without medication might actually be more harmful than none at all. Settlement funds shouldn’t “prop up a system that denies people the choice they need for medication”, noted Regina LaBelle, professor of addiction policy at Georgetown University. Babies: Forgotten Victims of the EpidemicWhile treatment received an unprecedented surge in early opioid settlement spending, another aspect of this crisis went overlooked – neonatal abstinence syndrome is an increasingly recognized disorder whereby babies exposed to drugs while pregnant can experience withdrawal symptoms as they emerge into life.
While many would see this as the perfect opportunity for them to show their stuff off onstage or behind a computer monitor – especially given that there’s so little on offer here to begin with! – some will still try their luck. In which case it’s probably best they remain away.
Jacob’s Hope in Mesa, Arizona provides care to substance-exposed newborns and their parents. A certified nursing assistant comforted an infant recently arriving there as they adjusted to life at Jacob’s Hope Nursery.
Ash Ponders writes for KFF Health News
Nationwide, more than 59 newborns a day are diagnosed with congenital abnormalities; yet only about $8.4 million was committed towards settlement payments related to it between 2022-2023 – this represents less than 0.5% of funds publicly reported as spent or committed during that time frame.
Experts in public health and addiction, along with affected families, blame stigma as being at fault. “Facing the reality that one’s mother may be using drugs is difficult and sometimes overwhelming,’ stated Ashley Grant, 38-year-old mother of three from Mesa, Arizona. Rather than confront this truth head-on and try to work through it themselves it may be easier just to try to ignore or let their situation lapse – which almost happened with Ashley.” Grant was surprised when she learned she was expecting her third child last year – at which time, her partner was in jail and she was using drugs after eight years of recovery, estranged from family members, and uncertain of how she’d manage during these nine months of gestation. She learned of Jacob’s Hope during a visit to a methadone clinic and its booth for substance-exposed newborns and their mothers, providing services including therapy sessions and parenting courses as well as diaper delivery service and playpen delivery right in her neighborhood. Nursery staff connected her with an appropriate therapist as well as dropped off diapers and playpens at her home address. Grant and her baby boy spent approximately one week after giving birth at Jacob’s Hope after giving up breastfeeding for birthing purposes. Nurses showed Grant how skin-to-skin contact helped ease withdrawal symptoms while more frequent feedings and burpings helped alleviate any potential gastrointestinal discomfort, something common among substance exposed newborns. Grant has now had about five months of recovery. She received training as a peer recovery specialist, hoping one day to join Jacob’s Hope to assist other moms like herself; but its future remains unknown. Jacob’s Hope Nursery opened for business this past January but nearly shut down due to low reimbursements and delayed payments from insurers, according to Lyndsey Steele, its associate director. With community donations keeping the nursery operating, however, its survival remains tenuous as Lyndsey Steele notes. She concluded by noting the nursery “is hanging by a thread”. Jacob’s Hope received approximately $250,000 from Arizona opioid settlement funds in 2022; but due to controversial moves within Arizona legislature this year, their share has now been given over to Department of Corrections instead.
Unfortunately for our economy and society overall, however, many have to resort to illegal or less-than-honorable means in order to afford basic needs like shelter. Nonetheless, here we go again with another set of unfounded allegations, with this time an added layer of confusion due to some rather dubious “experts”.
Jacob’s Hope has turned its efforts over to local governments, which control their own settlement dollars and can issue grants directly. Jacob’s Hope’s home city, Mesa, announced last fall that grant applications should open soon; Steele hopes it won’t come too late for vulnerable babies who were forgotten victims during this epidemic.
Jo Jones (left), founded Jacob’s Hope Nursery in Mesa, Ariz. to care for newborns exposed to substances. Lyndsey Steele (right), associate director for Jacob’s Hope in Mesa Arizona is looking forward to using any settlement money she might secure to keep the nursery operational.
Ash Ponders for KFF Health News |
Heart disease screening, robot ambulances and more Opioid settlement expenditures have generated heated discussions. They typically fall into three categories: money for law enforcement; funding youth prevention programs and purchases unrelated to opioid crisis. Settlement dollars have been spent nationwide to purchase body scanners, K-9 units, bulletproof vests, patrol trucks as well as laptops and printers for police officers and sheriffs – spending that has often exceeded what was intended by the settlement agreement. Oregon City, Oregon recently spent over $30K screening first responders for cardiovascular disease. Police Chief Shaun Davis indicated his staff are more at risk due to responding to opioid-related emergencies and trauma, increasing their risks of having a heart attack. “This seems to me like you are trying to defray costs from other budget items,” according to Stephen Loyd, chair of Tennessee’s Opioid Abatement Council. “No indication exists that any opioid funds were ever intended for such expenses.”
However, they also want their investments protected, and this involves using insurance as well.
Youth prevention remains another contentious area. Although most agree it’s essential for young people to avoid developing addictions, stopping children is more complicated than expected and close to half a million settlement dollars have gone to DARE programs like Drug Abuse Resistance Education program – known simply by its acronym D.A.R.E – since 2009. Robeson County, N.C. recently used some settlement money to purchase “Andy the Ambulance”, an interactive robot ambulance equipped with big eyes and an audio system so human operators could discuss potential dangers associated with drugs with passersby. Patrick Cummings of EMS said his team has taken their robot robot to churches and elementary schools across Houston. While no studies exist to prove its efficacy, Cummings believes educating children seems like an investment as “if they never try it they won’t become addicted”. Up to 15% of each state’s funds is allotted for discretionary spending, which means it could go anywhere. Flint, Mich. recently spent nearly $10,000 on signage for a community service center even though this expense did not fall under “opioid remediation,” in other words not related to combatting opioid crisis.
Unfortunately for him though, that day had come… And here comes his only child…! The four of them together form what’s known as The Arsene Lupin Legacy Club
Caitie O’Neill, the city spokesperson, insisted that “the building sign makes it possible for residents to locate” the center which houses city services like Narcan kits, Fentanyl testing strips and substance abuse referrals. Jurisdictions across 29 states reported non-remediation spending between 2022-2023 as required under opioid settlement agreements on an honor system – no one checked whether 21 other states and Washington, D.C. reported accurately or truthfully.