All About Opioid Settlements in America and how Funds From Them are Utilized

As state and local governments reel in billions from opioid settlements to combat the entrenched drug crisis, a contentious issue has emerged. Instead of channeling these funds into new addiction treatment and prevention avenues, authorities are opting to bolster existing programs and salaries. This redirection has ignited complaints from various quarters, raising questions about the strategic utilization of these critical resources.

Shifting priorities

In Scott County, Indiana, a significant portion of the received opioid settlement, which is more than $250,000, was allocated to cover salaries for health directors and EMS staff. Similarly, Blair County, Pennsylvania, redirected around $320,000 toward a longstanding drug court initiative.

Critiques and concerns

Critics argued that this reallocation squanders a vital chance to amplify efforts in combating the crisis. Robert Kent, former general counsel for the Office of National Drug Control Policy, underscored that the essence of settlements lies in advancing initiatives, not merely maintaining existing ones.

"To think that replacing what you’re already spending with settlement funds is going to make things better—it’s not," said Kent. "Certainly, the spirit of the settlements wasn’t to keep doing what you're doing. It was to do more."

Despite the pressing need for enhanced treatment and support services, the approach risked diluting the impact of these much-needed funds.

Funding and regulations

Opioid settlements have become a fresh funding stream, in addition to conventional tax revenues, sourced from entities accused of recklessly promoting prescription painkillers. However, while settlements lack explicit restrictions on supplementing existing initiatives, various stakeholders caution against this practice.

Thirteen states and Washington, D.C., have already imposed limitations, emphasizing the importance of deploying funds to address critical service gaps.

Scott County, Indiana, received more than $570,000 in opioid settlement funds in 2022. Despite reservations expressed in public meetings, authorities opted to utilize settlement funds to compensate for resources expended during previous crises, such as the 2015 HIV outbreak.

From August 2022 to July 2023, the county reported using roughly $191,000 for the salaries of its EMS director, deputy director, and training officer/clinical coordinator, as well as about $60,000 for its health administrator. The county also awarded about $151,000 total to three community organizations that address addiction and related issues.

Similarly, Blair County, Pennsylvania, justified its allocation to sustain essential services amid fiscal constraints, despite dissenting voices advocating for more targeted interventions.

"This is an opioid epidemic, which is not being treated enough as it is now," said Marianne Sinisi, who lost her 26-year-old son to an overdose in 2018. "The county received extra money to help people, but instead it pulled back its own money. How do you expect that to change? Isn’t that the definition of insanity?"

Federal implications

"Supplantation can take many forms. Replacing general funds with opioid settlement dollars is an obvious one, but there are subtler approaches," said Shelly Weizman, project director of the addiction and public policy initiative at Georgetown University’s O’Neill Institute.

Bucks County, Pennsylvania, forfeited over $1 million in federal funds for a behavioral health crisis center. "We were probably overly optimistic about spending the money by the grant deadline," said Diane Rosati, executive director of the Bucks County Drug and Alcohol Commission.