National Opioid Settlement Funds: 5 Lessons for Effective Implementation

Navigate the complex opioid settlement landscape with your roadmap for turning opioid settlement funds into on-the-ground, life-saving state programs.

The United States continues to grapple with a devastating opioid crisis. Since the beginning of the epidemic, over 645,000 lives have been lost to opioid overdose deaths, with rural communities being disproportionately impacted. While 2024 saw a promising 27% decrease in overdose deaths, the billions of dollars in settlement funds from pharmaceutical companies create a critical opportunity to build upon and sustain this progress.

The Opioid Settlement Landscape 

In 2021, major pharmaceutical companies agreed to pay $26 billion over 18 years to state and local governments, with much of the funding directed toward health care and drug treatment programs. Since then, additional state-specific settlements have brought the total amount owed to more than $50 billion to help address the opioid epidemic’s ongoing impact on communities nationwide.

Over the past four years, the distribution of these settlement funds has created an opportunity to share early lessons and actionable insights regarding the continued management and impact of opioid settlement dollars.

Five Lessons Learned From National Opioid Settlements

1. Make National Guidance Locally Actionable: While flexibility is important to accommodate diverse community needs, overly vague or legalistic language can lead to confusion and inconsistent application. For example, some jurisdictions have interpreted the settlement’s approved uses to include funding for drug court probation officers, while others view such spending as misaligned with the settlement’s intent. Making guidance practical and accessible helps ensure that communities can translate funding into meaningful, on-the-ground impact.
   
   
2. Prioritize Accountability and Transparency: The misuse of funds from the tobacco Master Settlement Agreement, where funds were used to fill potholes, address budgetary gaps, or fund other projects, has impacted how local governments and stakeholders approach the management of opioid settlement funds. Learning from the misuse of tobacco settlement funds, states like Pennsylvania, North Carolina, and Minnesota have established robust reporting websites. However, many states still lack transparent expenditure reporting, undermining effectiveness.
3. Center Local Expertise in Decision-Making: Trust in the allocation of opioid settlement funds depends on the credibility of those making the decisions. When trustees or oversight bodies lack firsthand experience in substance use treatment, prevention, or recovery, it can lead to skepticism and disengagement among local stakeholders. Colorado provides an example of positive collaboration among stakeholders, as counties have formed a regional system to administer opioid settlement funds, leveraging local governments’ shared infrastructure and existing relationships. Ensuring that decision-making includes individuals with local knowledge and subject matter expertise helps bridge gaps in understanding, increases transparency, and builds the trust necessary for effective, community-centered implementation.
   
4. Build a Stronger Evidence Base to Guide Future Investments: While many opioid settlement dollars have been directed toward established interventions like medication-assisted treatment and naloxone distribution, several commonly used strategies, such as peer support services, warmline programs, and recovery specialists, lack consistent evidence due to variation in training, delivery, and evaluation. This gap does not imply these approaches are ineffective, but rather highlights the need for greater investment in research to understand their broad impact. Additionally, the lack of standardized data reporting across counties and states makes it difficult to assess what’s working and where. Standardized data reporting and coordinated evaluation efforts are essential for informed future investments.
   
5. Adopt a Whole-Person Approach to Address Substance Use: Lasting recovery from substance use disorders requires more than access to clinical treatments. Addressing housing, reliable transportation, food security, utility assistance, and other basic needs is crucial. Despite growing recognition of OUD as a public health issue, stigma continues to undermine community-level support for essential services like harm reduction programs. 

Technology as a Solution: Ohio’s Success Story 

Summit and Montgomery Counties in Ohio offer compelling examples of how opioid settlement funds can be strategically invested to strengthen recovery systems through the use of technology. Summit County’s NEXT program partnered with Unite Us to create a centralized platform that streamlined service coordination, reduced administrative burden by nearly 600 staff hours, and efficiently connected individuals to critical supports such as housing, transportation, and workforce development. 

Building on the success, Montgomery County secured a grant from the OneOhio Recovery Foundation to expand recovery services by integrating Unite Us’ platform with the local health information exchange. Through improved data sharing and coordinated referrals, this integration harnesses the Unite Us technology to break down barriers that hinder recovery from opioid use disorder, connecting individuals with the care and community resources they need when they need them.

Building a Better Future: Insights from Opioid Settlements for the Rural Health Transformation Program 

These lessons from the use of the national opioid settlement funds come at a critical moment, as the creation of the new Rural Health Transformation Program provides a powerful opportunity to apply these insights more broadly. While rural health transformation efforts are not exclusively focused on opioids, rural communities have been among the hardest hit by the epidemic. By applying these principles, rural health efforts can build durable systems that integrate technology, strengthen care coordination, and respond to community needs.

The path forward demands continued investment in evidence-based practices, transparent accountability measures, and comprehensive support systems that address the full spectrum of recovery needs. Only through such coordinated efforts can we sustain the recent progress against this ongoing public health crisis. 

See how Unite Us is helping governments integrate social care to tackle the opioid crisis.

Intern Spotlight

This summer, Alyssa was the Research and Evaluation Intern. She recently graduated with her bachelor’s degree in Health Policy and Administration and was honored with the prestigious Francis Hoffman Award for Excellence in Writing. During her undergraduate years, Alyssa also contributed as a research assistant on projects analyzing the impact of national opioid settlement funds and addressing substance use among college-aged students. Now, she’s continuing her journey in public health as a Master of Public Health student at the University of Pennsylvania.