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Research Brief: Rating the Quality and Consistency of Local Opioid Settlement Expenditure Reporting

Written By: Zoe Lindenfeld 

Study Authors: Zoe Lindenfeld, Amanda Mauri, Abigail Winiker 

Background 

As of 2025, funds from the national opioid settlement agreements with opioid distributors, retailers and manufacturers total over $50 billion, creating an unprecedented opportunity to address the devastating toll of the opioid crisis. Most settlements require that at least 85% of funds be spent on opioid remediation efforts like expanding access to medications for opioid use disorder, naloxone, harm reduction services, and peer support. However, without robust reporting requirements, it’s difficult to know whether these funds are actually being used as intended. A new study published in the Journal of Addiction Medicine examined how well states are tracking and reporting local government spending of opioid settlement funds, revealing significant gaps in transparency and accountability. 

  

Study Methods 

Researchers analyzed opioid settlement expenditure data from the 21 states that have laws requiring local governments to publicly report their opioid settlement expenditures. They evaluated each state’s reporting system across three key dimensions: funding availability (tracking all available funds including interest), funding specificity (detailed reporting on actual programs versus general categories), and funding accessibility (consistent, transparent, and analyzable data). 

  

Study Findings 

The findings reveal substantial variation in reporting quality: 

  • Most states aren’t tracking interest earned on settlement funds. Only 5 states (24%) report interest earned on local disbursements. This matters because interest can add up significantly over time, and without tracking it, communities can’t account for the full amount of money available for opioid remediation. 
  • The majority report non-remediation spending. Seventeen states (81%) submit reports of some portion of their non-remediation local expenditures to BrownGreer, the administrator for most opioid settlements. These non-remediation expenditures can include spending that may violate settlement terms, such as road construction, purchasing law enforcement equipment, or other government activities not tied to addressing the opioid crisis. 
  • About half of states provide detailed expenditure-level information. Twelve states (57%) consistently tied local settlement expenditures to specific program activities rather than broad categories like “harm reduction” or “prevention.” This level of detail is critical for understanding whether funds are being used for evidence-based interventions. 
  • Most states report expenditures at the sub-county level. Seventeen states (81%) report local expenditures at the city, township, or municipal level in addition to the county level—important for tracking how money flows to all recipient jurisdictions. 
  • Consolidation varies widely. Seventeen states (81%) report all expenditures in a single report per government unit, and 12 states (57%) consolidate all local government expenditures within the state into a single publicly accessible tracker, making it much easier to see the full picture. 
  • Two states haven’t released any data yet. Despite having laws requiring local reporting, 2 states (10%) have not made any local settlement expenditure data publicly available. Three others have incomplete or outdated reporting. 

 

Why it matters

The experience with tobacco settlement funds in the 1990s serves as a cautionary tale: less than 3% of those funds were ultimately used for tobacco prevention and cessation. Without clear reporting requirements and enforcement, settlement funds can easily be diverted from their intended purpose. Taken together, these findings underscore:

  • Accountability requires more than just mandating reporting. This study makes clear that simply requiring local governments to report their spending isn’t enough. The quality, detail, and accessibility of that reporting matter enormously for ensuring funds are used effectively. 
  • Researchers need high-quality data to evaluate impact. As interest grows in studying whether settlement spending actually reduces opioid-related harms and deaths, the availability of high-quality, granular data becomes essential. States with vague reporting categories or missing data make it impossible to understand which interventions are being funded and whether they’re working. 
  • Communities deserve transparency. Settlement funds belong to communities that have been harmed by the opioid crisis. Residents, advocates, and community organizations need accessible, detailed data to hold decision-makers accountable and ensure funds are being used in ways that align with evidence and community needs. 
  • Missing funds could be significant. When states don’t track interest earned on settlement funds or fail to report consistently, it’s impossible to know whether all available money is being spent on opioid remediation. Interest earnings and unreported expenditures could represent millions of dollars that should be helping save lives.  

 

What can be done

This study points to several concrete steps that states, localities, and policymakers can take to improve settlement fund tracking: 

  • Establish standardized reporting requirements. Future settlement agreements and national policy should include enforceable standards requiring states and localities to report on all three dimensions: funding availability, funding specificity, and funding accessibility. This means tracking interest earned, tying expenditures to specific programs, and making data publicly accessible in a consistent format. 
  • Prioritize states with better data for research. Researchers interested in evaluating the impact of settlement spending should focus on states that link expenditures to specific programs and account for all available funds. While this may introduce selection bias, it’s the only way to conduct meaningful analysis given current data limitations. 
  • Make reporting user-friendly. States should consolidate all local expenditures into a single, searchable, downloadable database. Scattered reporting across dozens of local government websites or expenditures reported in scanned PDF files makes it difficult to get a complete picture of how funds are being used. 
  • Track and report regularly. States should require annual reporting and make sure data is released in a timely manner. Some states only have data from 2022 or have inconsistent reporting across localities, which undermines accountability. Furthermore, the fact that 2 states with laws requiring reporting have yet to release any data suggests that statutory requirements alone aren’t sufficient, and additional mechanisms may be needed to ensure compliance.   

 

The bottom line

The opioid settlements represent an important opportunity to make evidence-based investments in preventing and treating opioid use disorder, expanding harm reduction, and saving lives. 

This study reveals that among states that have taken the important step of requiring local reporting, the quality and completeness of that reporting varies dramatically. Some states are setting strong examples with detailed, accessible tracking systems. Others are falling short, with missing data, vague categories, or no public reporting at all despite legal requirements.

This variation threatens the potential of the opioid settlements to address the harms associated with substance use. 

 

Study citation: Lindenfeld Z, Mauri AI, Winiker AK. Rating the Quality and Consistency of Local Opioid Settlement Expenditure Data. Journal of Addiction Medicine. 2024 Nov 8:10-97. 

Zoe Lindenfeld, Ph.D., is an Assistant Professor at the Rutgers University Edward J. Bloustein School of Planning and Public Policy. She is a health policy and services researcher focused on mitigating factors that perpetuate health inequities for individuals with substance use disorders. She has used mixed-methods research designs with qualitative, quantitative, and geospatial data to evaluate questions related to how harm reduction can be operationalized as an approach to care within clinical settings, racial disparities in the availability of hospital-based substance use treatment, factors contributing to the development of comprehensive substance use treatment models, and the feasibility of using telemedicine for opioid use disorder treatment, among others. Her research contributes to theory and understanding of disparities in the distribution of services for substance use disorders, and can inform the decisions of health system leaders, policymakers, and practitioners. Zoe earned her Ph.D. in Public Health Policy and Management at NYU School of Global Public Health.