Between 1999 and 2023, more than 500,000 Americans died of opioid overdoses. The crisis was not random. It was manufactured—by companies that minimized addiction risk, flooded communities with pills, and paid doctors to prescribe them. The litigation that followed produced the largest public health settlement in American history. Tens of billions of dollars were supposed to flow into treatment, recovery, and harm reduction.
Some of it did. A lot of it didn’t.
RFA Investigations has reviewed state spending reports, legislative audits, and publicly filed settlement accountability documents from the National Opioid Settlement Tracker—a project run jointly by KFF Health News and researchers at Johns Hopkins Bloomberg School of Public Health. What those records show is a patchwork of compliance and exploitation. Some states are doing what they promised. Others have found creative ways to spend addiction money on nearly everything except addiction.
What the Settlements Required
The landmark multistate opioid settlements—including the $26 billion deal with Johnson & Johnson, McKesson, Cardinal Health, and AmerisourceBergen finalized in 2021–2022, and the $6 billion Purdue Pharma settlement approved in 2024—came with explicit spending conditions. The National Opioid Settlement Agreement (NOSA), which governed how the distributor funds were allocated, required that at least 85 percent of state-level funds be used for “opioid remediation”—a defined category of approved uses including treatment, recovery support, harm reduction, and prevention.
The other 15 percent was left to state discretion—attorneys’ fees, administrative costs, and whatever legislatures decided to do with the remainder.
On paper, 85 percent dedicated to treatment sounds like a meaningful guardrail. In practice, the definition of “opioid remediation” in the settlement documents is broad enough to include law enforcement activities—drug court funding, naloxone for police departments, even jail-based programs that critics argue are more punitive than therapeutic. States have used that breadth aggressively.
Where the Money Is Going: The Documented Cases
West Virginia, which has one of the highest opioid overdose death rates in the country, received approximately $1 billion under the multistate settlements. Advocates raised early alarms when the state legislature proposed routing a portion of those funds through the Division of Corrections and Rehabilitation for prison programming. State records reviewed by RFA show that several line items approved by the West Virginia First Foundation—the body established to oversee settlement spending—included law enforcement equipment and forensic lab upgrades described as “opioid-related.”
In Tennessee, a legislative audit released in 2025 found that the state had deposited a portion of its opioid settlement receipts into the general fund rather than into the dedicated Tennessee Opioid Abatement Council trust. The audit flagged this as a compliance concern. The Council subsequently tightened its accounting procedures, but the initial transfers were not reversed.
Florida received more than $3 billion under the multistate settlements—one of the largest state allocations. A review of the Florida Department of Children and Families’ spending disclosures showed that a significant share of early disbursements went to law enforcement diversion programs and drug court infrastructure rather than to the residential treatment and medication-assisted treatment (MAT) expansion that public health advocates had prioritized.
“The settlements were supposed to be a Marshall Plan for addiction treatment. In too many states, they’re being treated like a general revenue windfall with addiction paperwork attached.”
The Purdue Pharma Problem
The Sackler family, which owned Purdue Pharma and made billions from OxyContin, agreed to pay approximately $6 billion to resolve opioid liability under a 2024 restructured bankruptcy settlement. The earlier 2021 deal, which would have granted the Sacklers broad civil immunity, was rejected by the Supreme Court in June 2024 on the grounds that bankruptcy law does not permit releases for non-debtors who did not themselves file for bankruptcy.
The revised settlement preserved more accountability on paper but left a fundamental question unanswered: the Sacklers admitted no wrongdoing. Members of the family who had already transferred billions out of Purdue into personal and family trusts—documented in court filings to exceed $10 billion—were not required to disgorge those funds beyond what was agreed. The settlement amount was negotiated, not adjudicated. There is no public record of a full accounting of Sackler family assets.
The money from the Purdue settlement that does reach states is being tracked through the National Opioid Settlement Tracker. But the tracker depends on voluntary state reporting, and not all states report on time or with sufficient granularity to evaluate whether approved spending categories are actually reaching the people most harmed.
Who Is Not Being Reached
The communities where opioids hit hardest were not necessarily the communities that sent the most lawyers to the settlement table. Rural Appalachia, tribal nations, and low-income urban neighborhoods that experienced the highest per-capita overdose death rates often lack the municipal legal infrastructure to navigate complex settlement claims processes independently.
Tribal nations negotiated a separate settlement pool of $665 million across the multistate deals. Advocates for tribal communities have documented that the disbursement process has been slower and more bureaucratically burdensome for tribes than for states, despite the documented severity of opioid crisis impacts on tribal lands.
Individuals who lost family members to opioid overdoses received nothing directly from most of the major settlements. There is no individual victim compensation fund comparable to what the 9/11 Victim Compensation Fund provided. The money went to governments, not to the humans who buried people.
The Accountability Gap
The National Opioid Settlement Agreement established an independent Settlement Fund Administrator to oversee spending. States are required to submit annual reports. But the enforcement mechanism for non-compliance is weak: the primary remedy is that a state can lose access to future settlement tranches if found out of compliance. No state has been formally sanctioned to date.
The Johns Hopkins / KFF settlement tracker, the most comprehensive public tool for following this money, covers most but not all settlements and depends on records that vary in quality and accessibility by state. Several states have not published required spending reports on publicly accessible websites, requiring advocates to submit public records requests to obtain documents they are legally entitled to see.
This is the receipts problem. The settlements were designed to generate accountability through transparency. But transparency that requires a public records request from a grieving family in rural West Virginia is not, in practice, transparent.
What To Demand From Your State
Every state that received opioid settlement funds is required to produce an annual spending report. If you cannot find your state’s report on the attorney general’s website or the designated settlement oversight body’s site, file a public records request. The National Opioid Settlement Agreement is a public document. Your state’s allocation is calculable from public filings. The approved uses are enumerated. The actual expenditures should be, too.
If you have information about opioid settlement funds being spent on uses that appear to fall outside the NOSA’s remediation definitions—or that appear designed to benefit politically connected contractors rather than people in recovery—contact RFA at tips@radiofreeamerica.press. We protect sources. We will read what you send.
Methodology: RFA reviewed state annual reports, the National Opioid Settlement Tracker database, legislative audit findings from West Virginia, Tennessee, and Florida, and publicly filed settlement documents. This investigation is ongoing.