Opioid crisis settlements have totaled over $50 billion. But how is that money being used?

A series of settlements from lawsuits related to the opioid crisis have flooded billions into the United States. This influx of money, advocates say, presents a unique opportunity for the U.S. to fund treatment solutions for substance use disorder and the overdose epidemic. 

The settlement money comes from a number of legal battles around the nation and the world. Companies including Purdue Pharma, Johnson & Johnson and Walgreens have settled, to the tune of billions of dollars, for their role in fueling the opioid crisis through actions like downplaying the risks of prescription opioids and promoting the use of the drugs. 

Christine Minhee, attorney by training and founder of OpioidSettlementTracker.com, has compiled data on the settlements tracking the amount of money allocated and where states have decided to spend it. According to her data, which is used by state governments and the Centers for Disease Control and Prevention, the total pot of funds available from the settlements has reached around $54 billion dollars, with nearly half of the money coming from a $26 billion dollar 2022 settlement with drug manufacturers and distributors, and more funds expected from ongoing legal battles. 

States are required to spend 85% of their settlement funds on opioid remediation, with 70% of that allocated to future remediation, Minhee says, to prevent a repeat of the 1998 tobacco settlement controversy, when just 3% of billions of dollars was used for treatment and cessation of smoking. Remediation can include funding harm reduction, treatment options and more. States have wide discretion over how they choose to spend the money. 

In many states, advisory boards have been created to make recommendations on the best way to allocate the available funds. A non-exhaustive document, called Exhibit E, provides routes for states to take, Minhee explained. The 15-page document includes three pages of required techniques and 12 pages of recommended ones. Minhee said that she’s found that about half of states are following Exhibit E to the letter in both sections, while the other half of the country is following the requirements but “remixing” the rest of the document. Required techniques include funding “gold standard” programs like naloxone distribution, medication assisted treatment, and more. 

In Rhode Island, some of the settlement money is being used to try a tactic relatively new to the United States: About $2 million dollars have been allocated for the establishment of overdose prevention centers. These sites, also called OPCs, are places where people who use drugs can consume substances in a safe, clean environment with trained medical staff who can handle overdoses and other side effects. Brandon Marshall, the Scientific Director of PreventOverdoseRI (PORI), which collaborated with the state government to develop settlement spending recommendations, said that the committee looked at the “vast scientific literature” supporting OPCs to make the decision. 

“They are legal under a (2021) state law, so the committee recommended that some investments be made in this approach, particularly in the era of a highly toxic and contaminated drug supply,” Marshall told CBS News. “We know that fentanyl and other analogues are involved in many deaths, and those can be effectively reversed and prevented in a supervised environment like an overdose prevention center.” 

The Rhode Island overdose prevention centers won’t be the first approved sites in the United States: In Nov. 2021, New York City opened the country’s first sanctioned OPCs. Two such sites are operated by OnPoint, a harm reduction organization in Manhattan that works to connect with people who use drugs and provide care. OnPoint says that the sites have reversed 701 overdoses in the 15 months they have been operating, and while they have the approval of local government, they are currently funded with private money, something that OnPoint executive director Sam Rivera says makes operations “difficult.” He said that at one point, it looked like the centers would have to close in Feb. 2023 because of the uncertainty of their funding. 

While New York’s advisory board recommended using the state’s settlement money to continue to fund existing overdose prevention sites and create more, governor Kathy Hochul’s administration rejected that recommendation. In a letter to the advisory board, State Office of Addiction Services and Supports Commissioner Chinazo Cunningham said that the recommendation “violates State and Federal Laws, rules and/or regulations,” saying that state money cannot be used to fund OPCs. 

Rivera, who emphasized that overdose prevention centers and other efforts from OnPoint have reduced open-air drug use and removed 1.7 million tons of waste from the streets, said that Hochul’s decision felt like “a slap in the face,” especially since the settlement funds are not state dollars. 

“I was so sure that we were going to be OK, especially since (Hochul) created this board to advise her. They advised her, and she vetoes what they suggested,” Rivera said. “The money shouldn’t even be negotiable. This money is for people. It’s a lawsuit. It has nothing to do with tax dollars, with city, state or federal dollars. This is a lawsuit won for opioid users who we serve, who we keep alive.” 

Other states and municipalities, including cities like San Francisco and Chicago, are considering opening overdose prevention centers, but Rivera said he worried that the decisions made in New York City could impact efforts to open such sites. 

“I spoke in San Francisco, to the city council, and all they talk about is the ‘New York model,'” Rivera said. “And yet, we’re here fighting to get the New York model funded by New York. … I do worry that it (Hochul’s decision) gives other jurisdictions the opportunity to say ‘New York is so great, but they’re not funding it themselves, so why should we?'” 

The New York board issued dozens of other recommendations across ten categories. All but two, including the OPC suggestion, have been approved by the Hochul administration. Hochul’s administration has funded crisis centers for evaluation, care and treatment, has developed mobile medication units, decriminalized possession of naloxone, and more. 

“As someone who has personally experienced loss from an overdose, Governor Hochul is deeply committed to combating the opioid epidemic and to saving lives,” a spokesperson for the governor told CBS News. “Together with our Department of Health and Office of Addiction Services and Supports, we will continue to explore the legal implications of this approach and how it impacts our communities to determine how best to reduce harm and keep New Yorkers safe.”

Nationwide, other states and municipalities are considering hundreds of other recommendations, including added funding for law enforcement, the development of new treatment facilities and the expansion of existing services. 

Marshall said that Rhode Island is taking care to consider “the whole continuum of care,” including social determinants of health like housing and healthcare access.  

In the meantime, experts and advocates hope that the billions of dollars available will be used to fund the best options available, as well as to research new solutions to the overdose crisis.

“We do want to use this funding to understand what is promising and build more evidence around what could work particularly well, given the current state of the crisis and how rapidly it is evolving,” Marshall said. “We need to be innovative and use the funding for states and jurisdictions to implement novel interventions and build that evidence base for other states to benefit from. … There isn’t a single intervention which is going to get us out of this crisis.”