The opioid crisis remains a significant public health concern. Roughly 44,500 people died from opioid-involved overdoses in 2025, part of nearly 70,000 drug overdose deaths overall. Both figures have fallen for three straight years, but remain high. [1] However, funding is now available to help manage the ongoing opioid epidemic courtesy of the National Opioid Settlement. [2][3]
Understanding the National Opioid Settlement
The National Opioid Settlement is a series of agreements between states, governments, and the major companies involved in the manufacture and distribution of opioids. [2][3] The agreement was reached to settle thousands of lawsuits against these companies and acknowledges their role in fueling the U.S. opioid crisis. [2][3] These settlements will result in around $50 billion being distributed to local and state governments over a period of 18 years. [4] At least 85% of these funds must be used to mitigate the harms of the opioid crisis. [2][3][4]
The first national settlements were reached in 2021, involving three major pharmaceutical distributors (AmerisourceBergen, Cardinal Health, and McKesson), alongside manufacturer Janssen Pharmaceuticals, Inc., and its parent corporation, Johnson & Johnson. [2] In 2022, further settlements were reached with pharmacy chains CVS, Walgreens, and Walmart, and two additional manufacturers, Allergan and Teva. [2]
Not only does the National Opioid Settlement require payments from these companies, but many must also change the way they conduct their operations. [2] This includes strict limitations on marketing, promotion, sale, and distribution of opioids. [2]
Settlement amounts and payment timelines
The 2021 agreements require AmerisourceBergen, Cardinal Health, and McKesson to pay a combined $21 billion over 18 years. [2] Janssen Pharmaceuticals and Johnson & Johnson are required to pay $5 billion over a maximum of 9 years. [2]
The 2022 settlements are as follows:
- Teva to pay up to $3.34 billion over 13 years. Teva must also provide either $1.2 billion of its generic version of Narcan over 10 years, or $240 million in cash instead of the product, with each state choosing its preferred option. [2]
- Allergan to pay up to $2.02 billion over 7 years. [2]
- CVS to pay up to $4.90 billion over 10 years. [2]
- Walgreens to pay up to $5.52 billion over 15 years. [2]
- Walmart to pay up to $2.74 billion, with the majority paid early in the settlement and annual abatement payments continuing through 2036. [2]
How settlement funds can be used
The settlements express that at least 85% of the funds ‘must be used for abatement of the opioid epidemic’. [2] States with higher historical overdose deaths received larger payments, with the data showing that this funding is associated with reduced overdose-related mortality. [5] The funds can be used in several areas assisting with the opioid epidemic, including:
- Prevention: Such as education and training.
- Harm reduction: Such as naloxone and sterile needle distribution.
- Treatment: Such as behavioral therapies and detoxification programs.
- Recovery support: Such as stable housing and peer support groups.
Some impactful, low-cost options for spending the opioid settlement money include: [6]
- Purchasing and distributing naloxone.
- Providing drug test strips.
- Providing sterile equipment and wound care.
- Providing transport and wifi, allowing people to access both in-person and virtual appointments and services.
How states and communities are spending the funds and its impact
Different communities have different needs when it comes to opioid use, and subsequently, their use of the settlement funds differs. There is also a considerable difference in how the funds are divided between the state councils and local counties. [7] The full opioid settlement fund spending can be tracked here.
One example is eastern rural Kentucky, which has used the funding to develop a ‘Hub’ network of community centers that helps support those struggling with opioid use, including harm reduction and housing support. [8] This has had a big impact on a local community that struggles with higher rates of substance use. [8]
In contrast, New York State has allocated millions of dollars to treatment, including providing same-day prescriptions for buprenorphine, which helps to reduce opioid cravings. [9] Treatment is seen as an effective use of the funds and generally receives the largest share compared to harm reduction and prevention. [9]
There have also been more unique uses of the funds, including a talking robot ambulance in North Carolina, designed to discuss the dangers of drugs with children. [9] The impact and effectiveness of this is yet to be determined.
What challenges remain
Even with tens of billions of dollars available, implementation of effective strategies is not guaranteed. There has been some controversy about how some of the cash has been used and whether strategies have been cost-effective. [10] This includes using settlement money to replace existing budget spending, rather than expanding current services or developing new ones. [10]
Keeping track of such a large volume of money is challenging in itself, despite the tracker website. Additionally, as these settlement payments are a limited-time resource rather than ongoing funding, there is some concern about what happens when these payments cease.
What this means for people with opioid use disorder
For individuals affected by opioid use disorder, the settlement funds represent a meaningful expansion of available support. Where funds are being spent well, people are gaining easier access to naloxone, medication-assisted treatment, and peer support that may not have existed locally before. The Kentucky ‘Hub’ network and New York's buprenorphine access programs described above are examples of this kind of impact. [8][9]
However, because spending decisions are made independently by thousands of state and local governments, access to these resources still depends heavily on where someone lives. Some communities have moved quickly and provided great new programs, but others have been slower or have directed funds toward strategies that are only loosely connected to opioid abatement. This means that individuals seeking help for opioid use may need to actively see what is available in their local area, rather than there being a consistent set of services available everywhere.
Resources and downloads
- SAMHSA National Helpline: Free, confidential, 24/7 treatment referral service.
- NASHP State Opioid Settlement Tracker: State-by-state spending allocation data.
- Opioid Settlement Tracker: National database of settlement amounts, allocations, and disbursements.
- KFF Health News Payback Project: Searchable database of specific local and state expenditures.
