Opioid Settlement Cash Is Going to Police Gadgets and Municipal Budgets, Investigation Finds

Money won from the companies that fueled the opioid crisis is increasingly being spent on things with only tenuous links to addiction, from law enforcement gadgets to mundane municipal needs, according to a yearlong investigation by KFF Health News. The settlement pot, which many survivors and advocates call "blood money," is expected to total about $60 billion over nearly two decades.

KFF Health News worked with the Johns Hopkins Bloomberg School of Public Health and Shatterproof, a national nonprofit focused on addiction. The team filed public records requests, scoured government websites and extracted about 17,500 expenditures, which were sorted into categories such as treatment or prevention. The result is the most comprehensive national database of how opioid settlement money was used, or left unspent, in 2025.

The cash is divided among state governments, counties, cities and, in some places, specially created opioid settlement councils. The agreements contain some spending guidelines, but the investigation found considerable flexibility, a vacuum of leadership and oversight, and significant gaps in how the public can track the dollars. Much of the questionable spending happens at the county and city level, where leaders often have no background in addiction policy and sometimes give the money to the first people who ask for it. Nationwide, local decision-makers control nearly half the money, according to OpioidSettlementTracker.com.

Advocates say the people closest to the crisis should have more say. "It shouldn't be run by these politicians," said Elizabeth Burke Beaty, a person in recovery and a New Jersey advocate who has followed the money for years. "This whole opioid settlement should be run by the people who've lost everything," she said. Burke Beaty, executive director of the Sea Change Recovery Community and Harm Reduction Center in Ocean County, writes letters, attends public meetings and produces reports giving local officials feedback on their spending. When that is ignored, she wonders whether it reflects a lack of resources or "a lack of willingness to do the right thing."

Local officials face real constraints. Unlike state governments, which have health departments and policy staff, they often work with bare-bones support and juggle other jobs. They can be bombarded by aggressive sales pitches from companies that see the settlements as a gold rush, and they must also balance budgets, keep schools running and maintain roads. Many have lost friends and family to the crisis and care deeply about using the money well.

Handing everything to the states is not a clean fix. In the Tobacco Master Settlement of 1998, cigarette companies paid hundreds of billions of dollars to states, typically without county or city involvement. Much of that money went to plugging budget gaps, and over 20 years less than 3% of tobacco settlement and tax-related revenue went to anti-smoking programs.

"It is not likely that whatever model we pick is going to work flawlessly," said Philip Rutherford, who leads substance use strategy at the National Council for Mental Wellbeing. He said local control has advantages: governments spend less on administration, can pivot more quickly as the drug landscape changes, and can test innovations. Annie Qing, who oversees health and human services work at the National Association of Counties, noted it is not unusual for local officials to take on areas where they lack personal expertise.

The database gives the public something it has lacked: a way to compare what communities are actually buying with money meant to repair the damage of the opioid epidemic. With the fund still in its early years and most of it yet to be spent, the findings raise the question of whether tighter rules, state oversight or more input from people in recovery should shape the next round of spending.