State and local governments are receiving billions of dollars from companies accused of fueling the opioid epidemic. KFF Health News is, in a multiyear series, investigating the use — and misuse — of this opioid settlement cash. These payments will arrive over nearly two decades and help shape the nation’s response to one of the most pressing public health issues of this time.
Our articles provide a national perspective on a range of issues, including the distribution formulas that determine the amount of money each locality receives, the lack of transparency in how officials decide to spend this money and what they spend it on, and the competing interests of corporations, law enforcement agencies, budget offices of cash-strapped rural counties, and other entities vying for their share.
We’ve also compiled databases and sets of documents that we hope can help others investigate opioid settlement stories in their communities.
Please always credit KFF Health News for the reporting and the people and organizations who created different data sets for those resources, as specified below.
Tips to get started:
1. Learn the basics of where this money is coming from, what it can be used for, and who controls it.
The existence and distribution of settlement funds are the result of a long and complex legal process. Here’s a three-minute video that breaks down what you need to know to get started.
Also check out these state-by-state guides created by Christine Minhee, founder of OpioidSettlementTracker.com, and the public health organization Vital Strategies. They provide an in-depth overview of how the money flows through each state.
2. See how your state or local government has spent early settlement cash.
KFF Health News, along with the Johns Hopkins Bloomberg School of Public Health and Shatterproof, a national nonprofit focused on addiction, built a first-of-its kind database that catalogs more than 7,000 ways opioid settlement dollars were used in 2022 and 2023.
Compiling the database took more than a year and involved dozens of interviews, thousands of pages of documents, an array of public records requests, and outreach to all 50 states. You can read more about our process, including its limitations, in the methodology.
This video walks you through different ways to use the database.
3. Once you know how your jurisdiction has spent the money, dig into specifics.
The national settlements came with a list of recommended strategies. Other organizations have also come up with national principles for spending the funds and county-level guidance. Check if your community’s use of the money aligns with these best practices.
Ask how these spending decisions were made. Were community members involved in identifying priorities? Was there a fair and open process to apply for grants? How do those in the treatment and recovery communities feel about these expenditures?
Since the settlement dollars will be paid out for many years, do these reports reflect one-off spending decisions or ongoing allocations over that time? Is there a plan to evaluate the impact of the money after a few years and reshape future priorities?
4. If your community hasn’t spent any funds yet, that may still be a story.
Many people feel a sense of urgency to use this money as fentanyl floods the streets and kills tens of thousands of Americans annually. On the other hand, those in charge of the money say thoughtful spending takes time. Explore these tensions in your community.
5. Determine how much money your city, county, and state expect to receive in future years.
KFF Health News obtained data from the court-appointed settlement administrator and transformed it into a searchable database that allows you to determine the total dollar amount your city, county, or state expects to receive in future years from the largest settlement to date, with opioid manufacturer Johnson & Johnson and three pharmaceutical distributors.
Determining how much money is on its way can help you determine if your community’s current initiatives are sustainable. Prompt officials in charge of the cash to explain their long-term plans.
6. Find out what information your state or local government is required to report about its use of settlement funds.
Start with this interactive map, created by KFF Health News and Minhee, of OpioidSettlementTracker.com. It synthesizes analysis of hundreds of written plans, statutes, executive orders, and public statements to show how much your state promises to publicly report about its spending. Click on a state to see details, including:
- The percentage of funds an average person would be able to track.
- The percentage of funds that will be reported to some oversight body but not necessarily shared with the public.
Once you know what must be reported, go looking for it. Your first stop is the expenditure report tracker tab of Minhee’s site, where she has compiled any publicly available reports on settlement spending.
If a report is not linked there, but you know — from the interactive map — that one should exist, ask your state agency for it. Consider filing a public records request for it as well.
If you cannot find or retrieve the report, that may be a story itself.
7. If your state or local government lacks public reports or public involvement in its decision-making process, that might be a story too.
A KFF Health News investigation found nearly half of all states had not enacted specific reporting requirements for how they spend this money. If yours is one of them, ask why. Some people who have lost loved ones to overdose have called settlement funds “blood money” for those who died of overdoses and feel they have a right to know how the payouts are used.
You can use the interactive map to compare the level of transparency in your state to that of similar or neighboring states. Pay attention to not only the public reporting but also the reporting required to an oversight body; ask why that information is not made public as well.
If your state has an opioid settlement council, you can use this map built by KFF Health News and Spotlight PA to see whether the body allows public attendance and comment at its meetings.
Talk to people in recovery, family members who have lost loved ones to overdoses, treatment providers, advocates, and others in the field about what consequences the lack of transparency and public involvement is having in your community.
8. Check for any reports suggesting your state or local government spent money in ways unrelated to the opioid crisis.
Even states that have no reporting requirements of their own are subject to a bare-minimum national standard: reporting how much money they use on expenses unrelated to the opioid epidemic. (This can be at most 15% of the state’s settlement cash.)
Reports from state and local governments can be found here. Governments are required to submit reports only if they determine they’ve used funds for non-opioid purposes, so you may not see a report from your community. Those that do file reports list only a dollar amount, so you’ll need to contact the person who signed off for details about how that money was used. New reports are filed approximately every six months.
9. Get help for further reporting.
Watch this webinar KFF Health News hosted in April 2024 to help local reporters explore reporting avenues and story ideas on the settlements.
Minhee, who co-created the state-by-state guides with Vital Strategies and analyzed public reporting requirements, has other resources on her site, showing the lawsuits states engaged in and when they post grant applications for this money.
The official website of the opioid settlement plaintiffs contains answers to frequently asked questions and the full settlement documents.
Reporting on Addiction has guidelines, source recommendations, and other tips that can help. During an online “fireside chat” the organization hosted, KFF Health News senior correspondent Aneri Pattani shared tips with reporters on where to start and how to cover the opioid settlements at the community level. Watch the 30-minute session here.
Pattani is also available to share advice. Reach her at apattani@kff.org.
