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2024 National Settlement Fund Tracking Project: What We Learned

By Benjamin Eidman & Abigail Winiker  

 

Earlier this month, KFF Health News published a two–part investigative report featuring findings from the 2024 National Settlement Fund Tracking Project. This marks the second wave of data released through a collaboration between KFF Health News, Shatterproof, and researchers at the Johns Hopkins Bloomberg School of Public Health. The team has created a standardized process for monitoring how states and localities are spending their Opioid Settlement Funds in an effort to increase transparency. The project’s public database serves as a comprehensive resource, providing detailed information on how these funds were used in 2022-2023 and now 2024. 

Researchers working on the project analyzed state reports, legislative documents, and national Opioid Settlement tracking sites, and submitted public record requests to determine how much money states received and spent during the 2024 calendar year. Expenditures were then categorized based upon pre-determined buckets and core strategies (full methodology available here). Given methodology changes, 2024 project results should not be compared directly with those from 2022-2023. 

This blog highlights key findings and takeaways from KFF Health News’ two-part report. 

 

States and localities received over $6.5 billion in Opioid Settlement Funds in 2024 and spent or committed $2.7 billion, with major allocations for critical strategies addressing the overdose crisis.  

  • $615 million (~23% of total committed funds) was allocated to treatment. 
  • $491 million (~18%) was allocated to harm reduction programs and services, including $279 million for overdose reversal medications and related training. 
  • $450 million (~17%) was allocated to recovery services for people who use drugs.

 

Notably, many spending decisions align with The Principles for the Use of Funds from the Opioid Litigation, with funds supporting efforts to save lives and reduce the harms of the opioid crisis.  

While many settlement investments align with Principle 2, (use evidence to guide spending), the project identified several notable spending activities not backed up by evidence. 

  • Several localities allocated funds to police equipment (e.g., guns, tasers, surveillance technology, and drug-sniffing K9 units). These types of investments are aligned with a punitive approach to drug policy, which prioritizes arrest and incarceration of individuals who use drugs, rather than the many well documented strategies known to reduce the harms of the opioid crisis.  
    • Years of research show that criminalizing drug use is ineffective – arresting people who use drugs increases overdose risk and has no correlation with reduced rates of substance use, treatment initiation, or recovery access.  
  • About 9% of spending tracked went to strategies to prevent addiction, however this included activities with questionable evidence (e.g., community awareness events and concerts, school assembly speakers, an MMA demonstration). 

 

Supplantation, when settlement funds replace rather than supplement existing spending, continues to be a challenge.  

  • Principle 1 discourages supplementation and promotes using settlement funds to strengthen the continuum of addiction care and enhance its capacity. However, several jurisdictions used settlement funds to pay for police and firefighter salaries.  

 

There is still a need for greater transparency from states and localities regarding spending decisions. 

  • Principle 5 emphasizes transparency in settlement fund spending decisions. However, 20% of opioid settlement money was untrackable. 
  • In 16 states, 30% or more of settlement fund spending was untrackable via public documents. 

 

Guidance documents can play an important role in supporting local officials to ensure spending decisions are transparent and informed by The Principles. 

  • Per KFF Health News, many local officials noted they received minimal guidance on spending decisions.  
  • Some states have begun issuing specific guidance to address this challenge. 
    • Colorado issued detailed guidance in 2025 prohibiting supplantation.  
    • Indiana, California, Kansas, and Virginia have published guidance on law enforcement equipment that settlement funds should not be used to purchase. 
    • Maine, Maryland, and Kentucky have new reporting requirements for localities to facilitate greater transparency. 
  • States interested in developing guidance may look to these existing examples as well as the additional resources at the bottom of this post. 

Additional Resources:

Benjamin Eidman, MSPH, is the Senior Research Program Coordinator for the Bloomberg Overdose Prevention Initiative. He has experience in Medicaid care coordination, implementation science research in surgical and mental health settings, and consulting for state Medicaid agencies. Benjamin works to bridge the research and policy communities, striving for policies that are both practical and informed by evidence.

Abigail Winiker, PhD, MSPH, is an Assistant Scientist in the Department of Health Policy and Management at the Johns Hopkins Bloomberg School of Public Health and the Program Director for the Bloomberg Overdose Prevention Initiative. Her work and training in harm reduction and health education inform her public health practice, and she strives to conduct research with direct translational implications to improve outcomes for at-risk populations.