The recent $7.4 billion opioid settlement signed onto by all 50 States and U.S. territories with Purdue Pharma marks another milestone in the national effort to combat the opioid epidemic. The Purdue settlement – along with earlier settlements with other drug manufacturers, distributors, and pharmacy chains – brings the total amount of funds available to over $50 billion. States will receive these payouts and hopefully use them to take advantage of this once-in-a-generation opportunity to rebuild lives, restore communities, and turn the tide in a crisis that has claimed over 700,000 American lives.
While this latest, high-profile agreement represents an important step toward justice, it is quickly becoming a major challenge for state officials who must distribute the settlement funds. The settlements contain binding legal requirements and prioritize core strategies and approved uses. States must establish administrative structures and processes to facilitate funding decisions, maintain oversight, and ensure accountability. The process must also be transparent, fair, and open to all those who have been affected by the epidemic and those who care for them. And although building remedial structures is essential, the process must also bring into sharp focus a broader and more pressing question: how will these dollars be spent?
Already, there are troubling signs. Reports from some states that have received payouts from earlier opioid settlements reveal that portions have been used to pay for longstanding programs, fill budget gaps, or even fund unrelated infrastructure and law enforcement acquisitions. While technically permissible in some cases, this kind of “supplantation” misses the mark. These funds were not meant to maintain the status quo. They were meant to provide actual remedies for those injured by opioids.
The Purdue settlement has renewed the debate, as advocates and victims claim there is a lack of clarity and consensus surrounding how states and localities plan to use the settlement funds. Frustration has been voiced that the agreement does too little to guarantee the money will go directly toward addiction treatment, prevention, and recovery services—and there are fears that allocating this settlement towards this very purpose will be overlooked.
Some communities are already leading the way—using funds to open new crisis response centers, provide wraparound care to families affected by addiction, and integrate behavioral health care more deeply into the public health and public safety systems. Vermont, for example, is using funds to support a hub and spoke model to increase capacity and access. These networks are now able to provide daily support, counseling, and medication to patients living in remote areas. Models like Vermont’s and others demonstrate that with focus, foresight and accountability real change is possible.
But the real promise of these settlements is to not only support the kinds of efforts that were previously out of reach for many communities, but also to ensure that funding meets the current needs within each state. Although expanding access to evidence-based treatment, increasing the availability of overdose-reversal medications, and addressing social determinants like healthcare, housing, and transportation for individuals in recovery are probably the most pressing issues, without a needs assessment it will be difficult to target and prioritize these services to meet the greatest needs in each state.
Johns Hopkins and other public health experts have developed a set of important principles, resources, and indicators “for monitoring opioid litigation spending” that encourages the use of a needs assessment. The process for identifying a community’s health needs and assets can, in the context of opioid settlement planning, help determine which interventions can save the most lives and identify important challenges and current methods for navigating them. Needs assessments can also pinpoint the strengths and weaknesses of a community’s capacity and other issues that warrant more investment.
That’s why this moment, coinciding with the Purdue settlement vote, is so important. States must recommit to a systematic approach that is transparent, encourages collaboration, community engagement, and public accountability in how these funds are distributed and spent. They should avoid the temptation to simply backfill existing spending and instead prioritize investments that expand treatment capacity, reduce overdose deaths, and break the cycle of addiction at its roots.
The good news is that momentum may be on our side. The CDC recently reported a 24% drop in opioid overdose deaths, the largest annual decrease in years. But this progress is fragile, and the rise of even more potent synthetic drugs like nitazenes and xylazine means we cannot afford to let up.
With billions more still to be distributed over the coming years, the decisions states and localities make now will shape the trajectory of the opioid crisis for a generation. These settlements will not solve the crisis on their own, but they offer something we’ve never had before: the resources to match the scale of the challenge.
Let’s use them the way they were meant to be used—boldly, wisely, and with the urgency this crisis demands.
Brenda Destro, Ph.D. served as the Acting Assistant Secretary for Planning and Evaluation at the U.S. Department of Health and Human Services (HHS) from 2018-2021 and was previously a Senior Public Health Advisor to the Senate Committee on Health, Education, Labor, and Pensions (HELP)
