Opioid Settlement Funds Face Spending Scrutiny

State and local governments deployed about $3.7 billion in opioid settlement money last year, with some funds spent on non-opioid projects.

Updated on Nov. 13, 2026 in Substance Abuse

Flat-color editorial illustration of a glass jar of gold coins on a cream surface, with a few coins spilling toward a separate red stack, in deep red, cream, and navy. — State and local governments deployed about $3.7 billion in opioid settlement money last year, with some of it spent on projects unrelated to opioid abatement. AI Illustration. Upload story photo >

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State and local governments deployed approximately $3.7 billion in opioid settlement funds last year, money that originates from legal settlements with pharmaceutical companies. Reporting shows some of that money was diverted to general municipal expenses with little connection to opioid abatement.

Why it matters

Nearly half of the settlement money is controlled by local decision-makers, and oversight varies widely by state. Several states have adopted unallowable lists to curb diversion, and total payouts are expected to reach $60 billion over nearly two decades, making the rules governing its use consequential nationwide.

Reported spending figures show $3.7 billion deployed last year, with $60 billion in total payouts projected over nearly two decades. Total misuse of the funds has not been quantified, and it is unclear how much self-reported spending will be independently verified.

The players

Iowa Attorney General's Office

The state office that receives county opioid settlement reports but does not evaluate spending appropriateness or approve individual expenditures.

New Jersey Department of Human Services

The state agency that would be authorized to review county and city opioid settlement spending reports under a proposed bill.

The details

In Iowa, county reports go to the Attorney General's office, which does not evaluate spending appropriateness or approve individual expenditures. Indiana lacks statutory authority to enforce how localities spend the money, and Spencer County used settlement cash to buy eight automated external defibrillators, an item on Indiana's unallowable list. Camden, New Jersey spent $150,000 on street lighting, and Gilmer County, West Virginia spent $36,200 on a pickleball court.

Last year: State and local governments deployed $3.7 billion in opioid settlement funds.
Over nearly two decades: Total opioid settlement payouts are expected to reach $60 billion.

Health Landscape

Several states have adopted unallowable lists that bar settlement money from funding general law enforcement tools or standard emergency medical supplies, yet local spending still reaches items like defibrillators and street lighting. That gap between state-level restrictions and local decisions shapes how the broader $60 billion opioid settlement will be used over the coming decades.

Residents in states with weak oversight may have limited ability to see how local governments spend opioid settlement money. Those who want to track spending in their own county can check whether their state requires public reporting and whether local officials have posted expenditure details.

The takeaway

Opioid settlement money is intended for abatement, so checking whether local governments publish detailed expenditure reports is a practical way to see whether funds are being used as designed.