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Creating Tribal Partnerships to Maximize the Impact of State, County and Municipalities Opioid Settlement Funds

By: Andrea Medley and Henry Larweh

Opioid Litigation Settlements: Tribal & State Context

The 574 federally-recognized tribes across the United States have received the first portion of what is slated to be close to $1.5 billion in tribal opioid settlements paid out over the next 15 years. In a separate settlement, the states have been allotted over $50 billion throughout the next 18 years, with some states receiving initial payments since May 2022. While the settlement funds create opportunities for enhanced prevention, harm reduction and treatment resources, programs and services, there are concerns from tribal leadership that the settlement dollars will not reach far enough in their communities. Many tribes note that issues of “extreme poverty, high unemployment rates, geographic remoteness, high rates of opioid misuse, increased levels of drug addiction and death, and lack of health care and treatment facilities” are cause for increased funding and resources for the tribes. 

Nationally recognized guidance for state and local settlements urge states to focus settlement funds on disproportionately impacted communities and some states have been asking how to work with tribes. Tribes are also asking what they can work with the states when it comes to partnering on the opioid settlement dollars. There is no legal or formal obligation under the state settlement agreement for states to provide funding to tribes; it is at the discretion of each state, and each state has created their own unique spending plan under their settlement agreement. However, tribal and state partnerships are critical, given the disproportionately high overdose rates amongst American Indian and Alaska Native people and inadequate access to substance-use related services in many AI/AN communities. Partnerships are especially vital for 63 state-recognized tribes who are unable to participate in the tribal opioid settlements, given that these settlements are only available to federally recognized tribes. In addition to the hardships that AI/AN communities experience, there is also an opportunity for states to learn more from how AI/AN communities have addressed the overdose crisis even while being under-resourced, which has been accomplished through incorporating community-based, cultural approaches creating an opportunity for mutual exchange.

Forming partnerships can be difficult given the history of mistrust between some tribes and states. Though there are many factors that may impact the relationships between states and tribes, but an example from recent history are the  Big Tobacco settlements in the 1990s, Though tribes were not included in the Big Tobacco settlements, state governments used the impact of cigarettes on tribal community members as part of their negotiations with the tobacco companies and did not set aside money from the $276 billion settlement for the tribes.. 

The Big Picture: A Scan of State Reports

To better understand the overall picture of states that are formally working with tribes and tribal organizations around opioid settlement funds, in June 2023 we completed a scan of publicly available state reports, including spending agreements, memorandum of understandings, dashboards, action plans, bills/legislation, and meeting minutes. Of the 110 documents published between May 2021 and March 2023, 81 had no mention of the search terms: Native American, American Indian, Tribal, Tribal Nation, Alaska Native, or Tribal Health Organization. Of the 29 reports reviewed that recognized and included American Indian/Alaska Native (AI/AN) populations, it was identified that there are varying degrees to which the states and tribes are partnering around these state settlement dollars.


For the documents that mentioned AI/AN populations, several contained AI/AN demographic data, but lacked a commitment to providing funding directly to AI/AN communities. Others mentioned a commitment to funding, but needed relationships to inform or encourage tribal communities or Indigenous-serving organizations to apply.

This scan is a snapshot in time, and while efforts may have changed since its completion, this work underscores the need for increased communication amongst tribes, counties and states to create equitable impact in the spending of the settlement funds. In summary, our scan demonstrates an ongoing need for increased opportunities for reciprocal learning, partnerships for shared services and resources, racial equity supports, and instances to support the same populations of people who are using opioids on these shared territories.

The Relevance of Relationship Building

Since the settlements for states and tribes have been separate processes, there has been a plethora of resources and education provided to states to guide the  allocation of state opioid settlement dollars. There has also been increased funding for experts to track settlement updates, create resources, and gather information about settlement spending. Less efforts and energies have been dedicated or extended to the tribal opioid settlement funds. 

A lack of attention and information available on tribal opioid settlements and tribal matters had led to increased  confusion and miscommunication with tribal community leaders. Some individuals at the tribal leadership and community level have reported not knowing about the settlements or being unsure of how funds would be disbursed – a sentiment also heard at the state and county level. Conversations with some tribal community leaders highlight initial misunderstanding about the timeline of settlement funds and how or why states decided to allocate funds for tribes. Some tribal leaders also expressed that states who did open some of their state funds to tribes only provided short windows  to apply for funding. Some also mentioned that these grant opportunities were not well communicated to the tribes and ultimately which resulted in tribes’ apprehension or decisions to not apply for state allocations of tribal funding. 

Similar experiences with state funds have also been expressed by local organizations vying for a portion of the settlement. Despite the separation of the settlement dollars, lessons learned can and should be shared by leaders and advocates. Experts working on initiatives to ensure proper use of settlement funds should also find ways to collaborate with tribal experts to build resources and share information. 

Opportunities for Partnership 

Some states have promising examples of state-tribe partnerships: Washington State is one of these examples. In Washington, the Washington State Healthcare Authority released a FAQ resource which explicitly outlines opportunities for tribes to provide input on uses of the state settlement funds and expresses a commitment to collaborate and consult with the tribes. This pledge, in concert with a $15.4 million dollar commitment from the Washington State Attorney General for “tribes and urban Indian health programs for opioid and overdose response activities”, is a promising example of partnership that includes the vital elements of partnership: relationship-building, collaboration and meaningful engagement.

Learning more about which states and tribes are working well together is a vital part of creating a process for shared priorities and resources between the states and tribes. We need to have a broader conversation about these issues and how to partner on these efforts to ensure that everyone who needs to be at the table is invited. To strengthen and build these relationships, we recommend that states:

  • Start relationship building with tribes before the work happens
  • Learn more about the local tribal communities, tribal health organizations and cultural safety through attending trainings and community events, as well as personal research and reading 
  • Include tribal leadership throughout the process of building applications for funding
  • Provide clear deadlines and processes for funding well in advance of the funding deadlines 
  • Learn more about how tribal communities are planning on spending the tribal opioid settlements
  • Check out the new Tribal Principles website for culturally relevant, Indigenous-centered guidance on spending the tribal opioid settlements