Little Accountability for the Billions in Opioid Fund Spending

Companies accused of recklessly marketing and distributing prescription opioid painkillers are paying roughly $58 billion to settle lawsuits over their role in fueling the addiction crisis. It’s a pot of gold eyed by addiction treatment providers, companies creating the latest opioid-related products, and government officials struggling to balance budgets.

Nearly half of that money is going to local governments, to be distributed by county commissioners and city councilors. The idea is that local leaders know their communities best and can do justice to these payouts, often described as “blood money” by people who’ve lost loved ones to an overdose.

But many local leaders have little to no training in addiction policy and may lack robust local health departments and policy guardrails to assist them.

That’s the start of a recent story by KFF Health News reporter Aneri Pattani looking at the lack of oversight by state and local governments in New York and around the country in tracking how these dollars are being spent. In New York, government entities have collectively received about $3.1 billion in opioid settlement dollars, according to the Opioid Settlement Tracker, a comprehensive database of settlement funds.

The story notes that local governments in New York have direct control over nearly half of those funds – 46% – and have devoted tens of thousands of dollars to projects far afield from opioid treatment – things like surveillance cameras, technology to help people access locked phones and goggles to simulate being drunk.

While likely legal, many people who spoke with Pattani considered the purchases a slap in the face because they don’t directly help people dealing with addiction or their families. 

In collaboration with public health researchers, KFF Health News has spent years collecting data on settlement money and has continually found the money has been spent on law enforcement gear, unproven prevention methods and to fill holes in local budgets.

When advocates have raised concerns about the spending to various agencies, pleading for greater oversight, the agencies have punted responsibility to each other, Jasmine Budnella, director of drug policy at VOCAL-NY, an advocacy organization tracking the settlement money, told KFF Health News.

It feels “like the Spider-Man meme, where it’s like everybody pointing at each other,” Budnella said. “Somebody needs to be able to have the stick and slam their hand on the table and be like, ‘You’re doing this wrong and this is the consequence.’”

The experience in New York provides a microcosm of regulators evading oversight as different interests vie for a piece of the money.  Each state and local government handles the money differently, with little role from the federal government. 

The settlement, paid by companies accused of recklessly marketing and distributing prescription opioid painkillers, offers more than 100 suggested expenditures for “opioid remediation.” But, the list is broad and open to interpretation. Many states, including New York, designate some of the funds as  unrestricted, allowing for general spending.

Meanwhile, the Trump administration has cut funding for some addiction services. And while overdose deaths have fallen from their peak in 2022, 122 people died of opioid overdoses every day in 2025, according to provisional data from the Centers for Disease Control and Prevention.