States are currently in the process of distributing settlements from various opioid-related lawsuits, with each state at a different stage in the process of receiving funding, setting up decision-making processes, allocating funding, and reporting on spending and investment outcomes.

Previously, in June of 2023, NASHP published a brief of publicly reported information on state opioid settlement plans and appropriations made to date, highlighting investments made with settlement funding and examples of how states are planning to allocate their funding across the substance use care continuum. Now, in the updated State Opioid Settlement Spending Tracker, NASHP outlines which states have announced awards from settlement funding or published priorities to guide settlement spending, as well as context for how each state has set up their decision making and spending processes.

Looking across states’ initial settlement investments, many state priorities and funding awards reflect a broad commitment to addressing priorities across the continuum of allowable prevention, treatment, recovery, and harm reduction abatement strategies. Connecticut, for example, identified seven different funding priorities that include increasing access to medications for opioid use disorder (MOUD), improving data infrastructure, increasing the addiction workforce, and strengthening prevention strategies, among others.

Given the longer-term time horizon of settlement funds and lack of restrictions that often accompany federal grants, many states have also chosen to prioritize investments in treatment infrastructure, including brick-and-mortar facilities, data capabilities, and workforce. Wisconsin and Indiana both awarded a portion of initial settlement funds to recovery housing, while Idaho’s Behavioral Health Council highlighted increasing the supply of behavioral health professionals as its top priority. 

More specific spending priorities have also been driven by identified gaps in service delivery or emerging challenges in the opioid crisis. Harm reduction has been a major priority for initial spending decisions, with early investments in many states reflecting the urgent need to prevent overdoses among populations most at risk of overdose and going toward the purchase of naloxone, fentanyl test strips, or syringe service materials not eligible for purchase with federal funds. In Vermont, the Opioid Settlement Advisory Committee found that overdose deaths primarily occurred in people with no connection to the treatment system, driving investments in naloxone distribution, mobile opioid medication units, outreach workers, fentanyl test strips, and wound care telehealth consultation. Additional strategies to expand access to services and address emerging challenges include housing supports and other wrap-around services, expanding access to MOUD in correctional settings, and contingency management for stimulant use.