Aneri Pattani
Officials in Irvington, New Jersey, had an concept. To elevate consciousness concerning the risks of opioid use and dependancy, the township may host live shows with well-liked R&B artists like Q Parker and Musiq Soulchild. It spent greater than $600,000 in 2023 and 2024 to pay for the exhibits, even footing the invoice for VIP trailers for the performers. It purchased cotton sweet and popcorn machines.
In many circumstances, this kind of neighborhood occasion can be unremarkable. But Irvington’s live shows stood out for his or her funding supply: settlement cash from corporations accused of fueling the opioid overdose disaster.
As a part of nationwide settlements, greater than a dozen corporations that offered prescription painkillers are anticipated to pay state and native governments upward of $50 billion over almost twenty years. Governments are alleged to spend many of the windfall combating dependancy. Officials who negotiated the settlements even outlined suggested uses and established different guardrails to keep away from a repeat of the Tobacco Master Settlement Agreement of the Nineteen Nineties, from which paltry amounts went to anti-smoking packages.
But there’s nonetheless vital flexibility with these {dollars}, and what constitutes a very good use to 1 individual may be deemed waste by one other.
In Irvington, township officers mentioned they used the cash appropriately as a result of the live shows lowered stigma round dependancy and related individuals to therapy. But appearing state Comptroller Kevin Walsh referred to as the live shows a “waste” and “misuse” of the settlements, which resulted from the overdose deaths of lots of of 1000’s of Americans.
Similar disputes are intensifying nationwide as officers start spending settlement cash in earnest — all whereas grappling with slashed federal grants and looming cuts to Medicaid, the state-federal public insurance coverage program that’s the largest payer for dependancy therapy.
To make clear these discussions, KFF Health News and researchers on the Johns Hopkins Bloomberg School of Public Health and Shatterproof, a nationwide nonprofit targeted on dependancy, carried out a yearlong effort to doc settlement spending in 2024. The group filed public information requests, scoured authorities web sites, and extracted expenditures, which have been then sorted into categories resembling therapy or prevention.
The result’s a database of greater than 10,500 methods settlement money was used (or not) final yr — probably the most complete nationwide useful resource of its type. Some highlights embody:
States and localities spent or dedicated almost $2.7 billion in 2024, in line with public information. The bulk went to investments dependancy specialists think about essential, together with about $615 million to therapy, $279 million to overdose reversal drugs and associated coaching, and $227 million to housing-related packages for individuals with substance use issues.
Smaller, although notable, quantities funded regulation enforcement gear, resembling night time imaginative and prescient gear, and prevention efforts that specialists referred to as questionable, resembling hiring a drug consciousness magician.
Some jurisdictions paid for primary authorities providers, resembling firefighter salaries.
The cash is managed by completely different entities in every state, and about 20% of it’s untrackable by way of public information.
This yr’s database, together with expenditures and untrackable percentages, shouldn’t be in contrast with the one KFF Health News and its companions compiled last year, as a consequence of methodology changes and state finances quirks. The database can’t current a full image as a result of some jurisdictions don’t publish reviews or delineate spending by yr. What’s proven is a snapshot of 2024 and doesn’t account for choices in 2025.
Still, the database helps counteract an inclination towards secrecy among some of those in control of settlement cash and confusion amongst individuals making an attempt to track it.
More than $237 million — about 9% of all trackable spending in 2024 — went to efforts broadly geared toward stopping dependancy, in line with public information. These ranged from placing on neighborhood consciousness occasions, just like the live shows in Irvington, to hiring psychological well being counselors in faculties.
Many of the examples raised pink flags for researchers, together with:
Suffield, Connecticut, held a 1950s-style sock hop, at which children and seniors wore poodle skirts, posed with inflatable guitars, and pledged to stay drug-free.
Vernon, Connecticut, hosted a mixed martial arts demonstration, at which a fighter spoke about his expertise with dependancy.
Hardy County, West Virginia, spent $60,000 to restore a college monitor.
“There is no evidence” to again these efforts, mentioned Linda Richter, who leads prevention-oriented analysis on the nonprofit Partnership to End Addiction.
Elected officers just like the occasions as a result of “you can announce to the community that you did something,” she mentioned. But until they’re a part of bigger initiatives that incorporate different approaches, resembling screening college students for psychological well being considerations or supporting mother and father combating dependancy, they’re unlikely to have lasting affect.
And when settlement funds pay for these one-offs, there’s much less left for strategies “that we do know work,” Richter added.
School meeting audio system have been additionally well-liked, with three Connecticut cities spending greater than $30,000 complete for former Boston Celtic Chris Herren to share his addiction story with college students.
“You get 1,200 kids in the gym and you can hear a pin drop when he talks,” mentioned Joe Kobza, superintendent of faculties in Monroe. He described Herren’s talks to college students and oldsters as “pretty impactful.”
But emotional affect isn’t essentially efficient, Richter mentioned. Speakers usually discuss medication messing up their lives despite the fact that they’ve change into rich celebrities. “The messages are so mixed,” she mentioned.
Many native officers admitted their spending choices weren’t evidence-based. But they meant nicely, they mentioned. And they acquired little to no steerage on use the cash.
Kelly Giannuzzi, Suffield’s former director of youth providers, who organized the sock hop, mentioned the objective was to boost consciousness and fight loneliness.
Hardy County Commissioner Steven Schetrom mentioned spending cash on monitor repairs made sense, since he’d seen the constructive affect the game had on his son’s life. He needed different children to have the identical alternative.
David Owens, a spokesperson for Vernon, mentioned the city’s blended martial arts occasion was the kickoff to an ongoing campaign, meant to point out folks that athletics may help them construct connections and keep away from medication. The occasion introduced out younger males, who are sometimes tough to achieve, he mentioned.
But the city has no manner of understanding if the occasion had lasting traction.
In New Jersey, appearing Comptroller Walsh released a report this summer time calling on Irvington township officers to repay the settlement cash spent on the live shows.
“If they’re going to hold big parties, that’s up to them and the taxpayers,” Walsh advised KFF Health News. “But they can’t use opioid money for that.”
He additionally prompt the live shows have been political rallies for the mayor, Tony Vauss.
Irvington officers strongly objected to the report and unsuccessfully sued Walsh to attempt to block its launch. Vauss advised KFF Health News it was “misleading and flat-out wrong.”
Vauss mentioned the township distributed overdose reversal drugs on the live shows and unfold messages about looking for assist. At least 4 individuals sought therapy on-site, the township mentioned in its lawsuit.
“We felt as though we did everything correctly,” Vauss mentioned.
However, a few of the analysis Irvington cited within the lawsuit to assist its case appeared irrelevant, resembling a study in rural Ghana and a graduate thesis.
Irvington officers didn’t reply to questions on these citations.
As this dispute — and others prefer it nationwide — proceed, individuals affected by the disaster say it’s essential to recollect the ethical weight of those settlements.
It’s “blood money,” mentioned Stephen Loyd, an dependancy medication physician who was as soon as hooked on opioids and has served as an professional in a number of opioid lawsuits.
He’s seen many relations lose mother and father, youngsters, and siblings.
“I don’t know how I would look a family in the face” if this cash isn’t used to forestall extra losses, he mentioned.
Read the methodology behind this mission.
KFF Health News’ Henry Larweh; Shatterproof’s Kristen Pendergrass and Lillian Williams; and the Johns Hopkins Bloomberg School of Public Health’s Abigail Winiker, Samantha Harris, Isha Desai, Katibeth Blalock, Erin Wang, Olivia Allran, Connor Gunn, Justin Xu, Ruhao Pang, Jirka Taylor, and Valerie Ganetsky contributed to the database featured on this article.
The Johns Hopkins Bloomberg School of Public Health has taken a number one function in offering steerage to state and native governments on the usage of opioid settlement funds. Faculty from the varsity collaborated with different specialists within the discipline to create principles for using the money, which have been endorsed by over 60 organizations.
Shatterproof is a nationwide nonprofit that addresses substance use dysfunction by way of distinct initiatives, together with advocating for state and federal insurance policies, ending dependancy stigma, and educating communities concerning the therapy system.
Shatterproof is partnering with some states on tasks funded by opioid settlements. KFF Health News, the Johns Hopkins Bloomberg School of Public Health, and the Shatterproof group that labored on this report should not concerned in these efforts.
