Now over two years into the process of spending the millions of dollars awarded from various opioid-related lawsuits, many states and localities have begun to award funding to health systems, nonprofits, and others implementing strategies to abate the opioid crisis. NASHP’s tracker, State Opioid Settlement Spending Decisions, provides up-to-date information on state-level settlement funding and priorities, as well as additional details on each state’s unique decision-making and spending processes.
Recent updates to the tracker include new settlement investments, priorities, and activities in 2024 and early 2025. Key themes and highlights from these updates include:
- Efforts to increase transparency across settlement spending decisions
- Initiatives to support localities with best practices related to opioid settlement spending
- Investments to reach communities that continue to face increasing rates of overdose
- Support for the integration of substance use services into broader behavioral health support systems
The examples below further dissect these themes and highlight relevant state examples supported by opioid settlement funding.
Increasing Transparency Across Settlement Spending Decisions
While many states continue to report on spending from statewide agencies or abatement funds (and to a lesser extent, local expenditures), a number of states have announced new tools or initiatives to improve transparency of opioid spending decisions at the state and/or local levels. In addition to new dashboards and reports that provide insights on funded projects and grantees, legislation passed and being advanced in states such as Utah and Maryland create additional oversight and reporting requirements related to settlement spending. Transparency efforts announced in recent state reports include:
- Florida — The governor and state legislature are informed by the Statewide Council on Opioid Abatement (SCOA), which is housed within the Department of Children and Families, on state opioid settlement expenditures. According to the most recent annual report from SCOA, fiscal year 2024–2025 allocations include funding ($5 million) to support the Opioid Data Management System, which collects information from all parties receiving settlement funding on their expenditures, implementation plans, and patient-level service claims from providers. This data system provides the state with a transparent process for monitoring settlement expenditures and the impact of funded projects.
- Georgia — The Georgia Opioid Crisis Abatement Trust administers and reports on funding from the state and regional shares of opioid settlements. Following the first round of grant awards from the state share, the Trust implemented a dashboard that highlights awardee organization name, implementation location, project category (e.g., prevention, treatment, recovery, etc.), and award amount. Users can also use the dashboard to filter awards based on what the project funds (e.g., allocates naloxone, provides housing, includes media campaigns, etc.), making it easier to highlight the overarching goal of the funded project.
Supporting Localities with Best Practices Related to Opioid Settlement Spending
Each state has their own set of policies and procedures for awarding settlement funding that vary in who the money is directed to (e.g., states, cities/counties, a statewide abatement fund), how the money is distributed (through state procurement processes, through a partner organization that manages the grant process), and how the money is being invested to fill unique gaps and needs in the substance use continuum of care.
Though some states may not have authority over local spending, they can still offer support or technical assistance to promote best practices for spending or help identify areas of need within communities. Specific efforts to support local partners include:
- Nevada — The Fund for a Resilient Nevada, administered by the Nevada Department of Health and Human Services (DHHS), holds the state’s share of settlement funding. Highlighted in DHHS’ annual report, which details settlement allocations from the fund, Nevada invested in a statewide opioid training and technical assistance center to support local training and education on addressing opioid use. This Nevada Opioid Center of Excellence will help localities identify gaps in service offerings and evaluate and build capacity to implement new programs that address opioid use.
- Oklahoma — Oklahoma’s Opioid Abatement Board is authorized through legislation to review and approve applications for state settlement funding, with support from the state’s Office of the Attorney General (AG). The AG’s Office partnered with Healthy Minds Policy Initiative, a local nonprofit, to develop a list of priority opioid abatement strategies that will inform grant programs and best practices for settlement spending. The list features eight priority strategies, including medications for opioid use disorder, contingency management, and recovery housing, among others. It also provides criteria to assist in evaluation of grant applications.
Reaching Communities that Continue to Face Increasing Rates of Overdose
While fatal overdose rates have decreased as a whole across the country, some states and communities continue to see increases, emphasizing the need for settlement funding to reach those most affected by the opioid crisis. Installing grant programs catered to local-level funding recipients or organizations that serve communities with increasing rates of overdose is one strategy states have been using to meet this need. Some of these grant programs include:
- South Dakota — South Dakota’s Department of Social Services (DSS), advised by the South Dakota Opioid Abuse Advisory Committee, is responsible for disbursing funds from the state share of settlement funding. Highlighted in the state’s 2024 annual report on opioid settlement funding, a total of $671,807 was allocated in fiscal years 2023 and 2024 to support the Community Grant Program, which awards communities and organizations working at the local level to address unique opioid abatement needs. The spring 2024 cycle of the DSS’ Community Grant Program awarded a total of $362,242 in state settlement funding across 11 projects that support American Indian and Alaska Native populations, individuals returning from incarceration, and other community-level investments.
- Virginia — The Virginia Opioid Abatement Authority (OAA) distributes settlement funding from the state’s Opioid Abatement Fund, which holds the largest share of settlement funding coming to the state. The OAA’s 2024 annual report highlights the Operation STOP! (Specifically Targeted Overdose Prevention) grant program, a funding opportunity unique in that it is only open to select cities and counties where Black residents experienced an opioid overdose death count above 20 and fatal overdose rate increases over 100%, throughout the past five years. The Operation STOP! program also requires applicants to partner with a community-based organization to implement proposed projects, further driving the goal of building infrastructure and addressing needs at the local level.
Integrating Substance Use Services into Broader Behavioral Health Support Systems
Settlements provide a unique opportunity for investing across supports that improve substance use and behavioral health outcomes, including stable housing and health care access. Funding has also been used by states to invest in behavioral health infrastructure, such as increasing capacity of treatment centers, hiring additional staff, and developing workforce pipelines. Integration investments include:
- Connecticut — The Connecticut Opioid Settlement Advisory Committee (OSAC) is responsible for ensuring appropriate allocations of state settlement funding. In a recent update from OSAC, Connecticut announced funding recommendations totaling over $67 million from the state share of settlement funding, which includes an investment in supportive housing as a means to promote recovery. This investment covers rental assistance program housing subsidies, client supports, and trauma-informed case management services to assist individuals with opioid use disorder in securing housing and maintaining housing stability.
- Pennsylvania — Fifteen percent of Pennsylvania’s settlement funding is appropriated by the Pennsylvania General Assembly to state agencies, such as the Pennsylvania Department of Drug and Alcohol Programs (DDAP), which support statewide grant programs. DDAP recently announced grant awards, partially funded by settlement funds, totaling nearly $20 million to 12 organizations providing substance use “drop-in” services, which include harm reduction services, case management, public restrooms and laundry services, and health screenings and care, among other examples. Awarded organizations are in various cities and counties across the Commonwealth and will receive funding over a 29-month period.
Looking Forward
Amidst changes at the federal policy level, opioid settlements remain a critical source of funding to support state investments across substance use prevention, treatment, harm reduction, and recovery supports. As states continue to gain experience in distributing settlement funding and navigating needs at the local level, there will be additional changes to improve efficiency and impact of settlement investments. NASHP will continue tracking these changes across all states, highlighting bright spots and addressing common challenges in the settlement space.
Acknowledgments
NASHP’s State Opioid Settlement Spending Decisions tracker and ongoing work to support state leaders in opioid settlement planning and spending are supported by the Foundation for Opioid Response Efforts (FORE).
