Dubious Buys Raise Alarm Over Local Control of Opioid Cash

State and local governments dispersed approximately $3.7 billion in opioid settlement funds during the previous year, surpassing the annual income of 42,000 American families combined. These funds originate from corporations that were sued for aggressively marketing painkillers, contributing to the opioid crisis. While many resources were directed towards addiction treatment and recovery housing, some expenditures exhibited little connection to the crisis, such as $150,000 allocated for street lighting in Camden, New Jersey, and $36,200 spent on a pickleball court in Gilmer County, West Virginia.

KFF Health News, in collaboration with Johns Hopkins Bloomberg School of Public Health and Shatterproof, investigated these expenditures through public records requests and government website analysis, uncovering 17,500 instances of how the funds were utilized or left unspent in 2025. The resulting database is the most extensive national resource detailing the use of opioid settlement money.

Despite spending guidelines within the settlement agreements, significant flexibility exists, coupled with a lack of leadership, oversight, and public tracking methods. Much of the questionable spending transpires at the county and city levels, where local leaders often lack addiction policy expertise and may award funds hastily.

Elizabeth Burke Beaty, a person in recovery and advocate from New Jersey, expressed concerns about local control, stating that those directly affected by the crisis possess the most insight into how funds can be deployed effectively. She argues that the entire opioid settlement should be managed by individuals who have experienced its devastating consequences firsthand.

Although local decision-makers control nearly half of the funds, many have limited knowledge in addiction policy and may succumb to aggressive sales tactics from companies seeking settlement money. Burke Beaty, who oversees a recovery center, sees daily the individuals directly impacted by the crisis, highlighting the urgent need for a more tailored approach to allocating these funds.

As executive director of the Sea Change Recovery Community and Harm Reduction Center, Burke Beaty has offered assistance to local leaders, but her efforts have sometimes been met with indifference. She questions whether this disregard stems from ignorance or a lack of commitment to addressing the opioid crisis effectively. The debate over who should control the opioid settlement money continues, with various models facing challenges and limitations.