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New State Specific Factsheets For Opioid Settlement Funds

By: Kate Boulton, JD, MPH

Senior Legal Technical Advisor, Vital Strategies Overdose Prevention Program


Since the finalization of the national settlement with the “big three” pharmaceutical distributors (McKesson, AmerisourceBergen, and Cardinal Health) and manufacturer Johnson & Johnson almost a year and a half ago, observers have been flooded with news coverage about these billions of dollars alongside significant—if often unanswered—questions. To put it plainly, disentangling where the money is going, the types of strategies it will support, and what guardrails will govern a complex, multi-year process is challenging even for people who work in this field. Thus, while the opioid settlement funds have been rightly heralded as a crucial opportunity to strengthen the public health response to our nation’s overdose crisis, it is also an opportunity that might be wasted on a continuation of status quo programs and policies.  


The United States has a long history of violent and harmful responses to drug use, supported by gargantuan public expenditures toward the criminal legal system. Funds from the opioid settlements present a real chance to change course from this history, but that change requires that more voices be heard. People who use drugs and the supportive communities around them must be integrated at every stage of the processes that will determine how settlement funds are used. More than that, these community voices must lead the way.  


Opaque, confusing, and poorly communicated information about settlement-related funding processes will make this essential community involvement more difficult and less likely. While some states and localities have made a concerted effort to ensure the inclusion of community input on the use of settlement funds, many have not.  


Because of this, and to empower communities to demand involvement in the spending of opioid settlement funds, Christine Minhee of and the Vital Strategies Overdose Prevention Program partnered in 2023 to create comprehensive guides for every single U.S. state and the District of Columbia that answer critical questions such as:  

  • How much money is my state getting and what is the allocation between the state and local governments?  
  • Who makes decisions about settlement spending at the state and local levels? 
  • Where there is an advisory structure such as a Council or Committee, who is on it and is there any inclusion of people with lived experience or other kinds of relevant expertise?  
  • Does my state have additional parameters or requirements for the use of settlement funds beyond what can be found in Exhibit E of the national settlements?  
  • How do I track funds, and are there any accountability processes built into my state’s plan? 
  • How can I engage and what are the specific opportunities for me to get involved?   
  • What are the key, state-specific resources available to community advocates like me?  


Instead of poring over an MOU or sleuthing to find those emergency regulations, a community advocate can consult their state’s guide for a concise, accessible explanation of what’s going on where they are. At a glance, someone can learn that their state has committed 20% of its funds directly to sheriffs (Louisiana) or that their state’s law allows settlement funds to be spent on “evidence-informed harm reduction pilot programs and demonstration studies” (Connecticut). Each guide also offers concrete recommendations on resources to learn more and how to get involved, such as where to go apply for grant opportunities, details on the frequency of an advisory council’s meetings and how to submit public input, or a state’s most recent public health publications on overdose and priority areas for investment. 


At the heart of the guides is a commitment to community empowerment and enabling participation in the process of allocating, spending, and tracking the use of opioid settlement funds, particularly for those who have been disproportionately harmed by the overdose crisis and the decades-long investment in punishment rather than public health.  


About the Author

Kate Boulton is a legal and public health professional and currently Senior Legal Technical Advisor to the Vital Strategies Overdose Prevention Program. In this role, she focuses on promoting harm reduction approaches to reduce overdose and promote the health and rights of people who use drugs.