Opioid settlement money: questionable local spending found in 2025 national database

Mixed · 2State and local governments spent about $3.7 billion in opioid settlement funds in 2025, according to a KFF Health News investigation with the Johns Hopkins Bloomberg School of Public Health and Shatterproof, a national addiction nonprofit. 1 2 Mixed · 2The team filed public records requests, searched government websites and built a database of more than 17,500 expenditures, which it calls the most comprehensive national resource of its kind. It sorted them into categories such as treatment or prevention. 1 2 Mixed · 2The money comes from companies sued for pushing painkillers and fueling the opioid crisis, and is expected to total about $60 billion over nearly two decades. It is split among states, counties, cities and, in some places, special opioid settlement councils. The settlements contain some spending guidelines but also considerable flexibility, limited oversight and gaps in how the public can track the money. 1 2

Left · 1Large amounts went to treatment, recovery housing and other initiatives that many researchers and affected families say fit the settlements' purpose. Other expenditures had tenuous ties to addiction, including $150,000 for street lighting in Camden, New Jersey; $130,000 for Flock cameras in Carmel, Indiana; at least $84,000 for city insurance, utilities and vehicle repairs in Mullens, West Virginia; and $36,200 for a pickleball court in Gilmer County, West Virginia. 1 Left · 1Much of the questionable spending happened at the county and city level, where leaders often have no addiction-policy background. Local decision-makers control nearly half the money nationwide, according to OpioidSettlementTracker.com. Supporters of local control say local officials know their communities best. 1 Left · 1Elizabeth Burke Beaty, a New Jersey recovery advocate, said the settlement "should be run by the people who've lost everything". Philip Rutherford of the National Council for Mental Wellbeing said no model will work flawlessly, and that local control offers lower administrative costs, faster adaptation and room to test innovations. Annie Qing of the National Association of Counties said officials routinely decide matters outside their expertise and should consult experts. 1

Left · 1Reporting notes that giving states full control has been tried: under the 1998 Tobacco Master Settlement, much of the money plugged budget gaps, and over 20 years less than 3% of tobacco settlement and tax-related revenue went to anti-smoking programs. 1 Left · 1Defibrillators were one contested category: about 100 localities in 20 states committed $3.7 million to AEDs, cardiac monitors and accessories. Southfield, Michigan, bought six Lifepak cardiac monitors for about $350,000, and Mayor Kenson Siver said they help responders judge whether interventions are working in complex overdoses. Paramedic Dalton Barrett of Edgecombe County, North Carolina, said AEDs are rarely used in opioid overdoses, which typically involve stopped breathing treated with oxygen or naloxone, and that such purchases more likely plug general-budget gaps. 1 Centre · 1A companion KFF Health News report on housing found that more than $340 million, about 9% of the roughly $3.7 billion, went to housing-related initiatives in 2025. Housing is an allowable use but not a core strategy in most agreements. 2

Centre · 1Connecticut put about $59 million into a program giving rental vouchers and case management to people with a verified substance use disorder; participant Jason Fazekas, 49, said having his own apartment changed his life. Elsewhere the link is less clear: New Brunswick, New Jersey, spent $520,000 on "homeless services", and a city spokesperson did not say what was funded or how it related to addiction. The city's report to the state described the money as "budgetary offsets and allocations". 2 Centre · 1Dan Kelly of the Michigan Association of Counties said maintaining the connection to opioid remediation is the most important piece. Recovery advocates fear governments will use the money to replace general funding for existing services or to reduce the visibility of homelessness. The database notes it does not capture all spending, since some reports may have been missed and many jurisdictions publish none. 2