"A staggering $58 billion in opioid settlement funds is being distributed nationwide, yet concerns are mounting that much of this crucial money is being misallocated on non-essential items, diverting vital resources away from effective addiction treatment and prevention efforts. The lack of robust oversight and clear guidelines is creating a significant risk of squandering a historic opportunity to combat the ongoing opioid crisis."
The substantial financial settlements reached with pharmaceutical companies accused of fueling the devastating opioid addiction crisis, totaling approximately $58 billion, represent a critical, albeit complex, opportunity to address the epidemic. While intended to fund remediation efforts, the distribution and oversight of these funds have become a focal point of concern. A significant portion of this money is allocated to local governments, empowering county commissioners and city councilors to make spending decisions based on their perceived community needs. However, many of these local leaders lack specialized training in addiction policy and may not have well-equipped public health departments to guide these expenditures. This gap in expertise and infrastructure has led to instances where funds are reportedly being spent on items such as surveillance equipment, law enforcement technology, and even novelty items like "drunk goggles," which critics argue do not directly address the root causes or consequences of substance use disorders. This situation has sparked widespread calls for more stringent oversight and accountability to ensure that these funds are channeled into evidence-based interventions that can genuinely save lives and support recovery.
The distribution of opioid settlement funds across the United States presents a complex landscape, with nearly half of the total $58 billion allocated to local governments. This decentralized approach aims to leverage the intimate knowledge local leaders possess about their communities’ specific needs. However, this autonomy has also raised significant concerns about the efficacy and appropriateness of spending. In New York, for example, public records obtained by the Legal Action Center reveal that local governments have allocated substantial sums to items like surveillance cameras and data extraction technology for police, as well as items that simulate intoxication. While these purchases may be legally permissible under the broad terms of the settlement agreements, they are viewed by many, including families who have lost loved ones to overdose, as a profound misdirection of funds that should be dedicated to direct addiction treatment, prevention, and recovery support services.
Jasmine Budnella, director of drug policy at VOCAL-NY, an advocacy organization dedicated to supporting those impacted by the drug war, has voiced strong concerns about the potential for "rogue" spending by local entities. She describes a frustrating cycle where advocates and affected families attempt to raise these issues with state agencies, only to be met with a diffusion of responsibility. "It feels like the Spider-Man meme," Budnella remarked, illustrating the perceived buck-passing between agencies. "Somebody needs to be able to have the stick and slam their hand on the table and be like, ‘You’re doing this wrong and this is the consequence.’" This sentiment underscores a broader national challenge: ensuring that the vast financial resources generated by these settlements are translated into tangible improvements in public health outcomes related to the opioid crisis.
Extensive data compiled by KFF Health News, in collaboration with the Johns Hopkins Bloomberg School of Public Health and the addiction nonprofit Shatterproof, has consistently highlighted questionable spending patterns. These patterns include the allocation of settlement money towards law enforcement equipment, such as bulletproof vests and night-vision goggles, as well as unproven prevention initiatives, like hiring a "drug-awareness magician" for children. Furthermore, funds have been used to plug general budget gaps in some municipalities, a practice that critics argue circumvents the original intent of the settlements. The lack of a clear, federally mandated oversight mechanism has created a vacuum, leaving many to question who is ultimately responsible for ensuring accountability in the expenditure of these critical funds.
The fragmented nature of the settlement agreements themselves contributes to this oversight challenge. While the agreements mandate that a majority of the funds be used for "opioid remediation," the list of over 100 suggested expenditures is broad and subject to interpretation. Compounding this issue, many states, including New York, designate a portion of these settlement dollars as "unrestricted," granting local governments significant latitude in their spending decisions. The federal government, which did not play an active role in the litigation that led to these settlements, offers minimal guidance or oversight. This leaves advocates and families with limited power to effect change, despite their direct experience with the devastating impact of the opioid crisis.
The situation is further complicated by ongoing federal budget cuts that have strained addiction-related services and increased the demand for funding. While recent data indicates a slight decrease in overdose deaths from their peak in 2022, the crisis remains acute, with an estimated 186 lives still being lost daily. Alexis Pleus, whose son Jeff Dugon died of a heroin overdose in 2014, expressed the sentiment of many who are dismayed by the current allocation of resources. "We really are wasting this opportunity to use these funds to turn the epidemic around," she stated. Pleus, who now runs a nonprofit receiving settlement funds for drug user support and family services, emphasizes the urgent need for effective oversight. "We need oversight," she asserted, highlighting the critical importance of ensuring these funds are used to spare other families the profound heartache her family has endured.
In New York, the responsibility for overseeing the use of opioid settlement funds is theoretically distributed among three key entities: the Office of Addiction Services and Supports (OASAS), the Attorney General’s office, and the Comptroller’s office. Each plays a distinct role, but the effectiveness of their oversight is under scrutiny.
The Lead State Agency: Office of Addiction Services and Supports (OASAS)
OASAS is designated as the "lead state agency" for New York’s opioid settlement funds. Its responsibilities include distributing a portion of these dollars through grants, guided by recommendations from the state’s Opioid Settlement Fund Advisory Board. Crucially, OASAS possesses the authority to "engage in oversight and audits of projects and programs" funded by these settlements and can "withhold future funds" from local governments that fail to comply with specified requirements.
Jerry Gretzinger, a spokesperson for OASAS, acknowledged the agency’s oversight role, stating, "OASAS has a duty to ensure these funds are used responsibly and strategically to build programs that will have a lasting impact in reversing this crisis." Currently, the office is conducting audits of 19 local governments’ fund utilization to verify compliance with "reporting and recordkeeping requirements." However, advocates argue that this focus may not adequately address the broader question of whether funds are being spent on appropriate, evidence-based interventions.
A significant point of contention arises from the state budget language enacted last year, which mandates local governments to publicly report their settlement expenditures. While OASAS collects links to these reports on its website, it does not review the accuracy or comprehensiveness of the data provided, relying solely on "the information as it is provided" by the localities. Christine Khaikin, a deputy director at the Legal Action Center, described this approach as falling short of true oversight, stating, "That doesn’t feel like oversight."
Members of the Opioid Settlement Fund Advisory Board have also urged OASAS to enhance its data collection and evaluation of fund usage. During a February 2025 meeting, OASAS Commissioner Chinazo Cunningham, when questioned about the 46% of settlement money directly controlled by counties and cities, stated, "OASAS has no oversight over these portions of dollars." She further elaborated that the agency "cannot dictate exactly what that information is" regarding the specific data collected by each county. This stance has led to frustration among those who believe OASAS should exercise more direct authority.
Examples of Spending Decisions Fueling Calls for Oversight in New York
The Legal Action Center’s investigation into New York’s opioid settlement spending uncovered a range of expenditures. While many counties reported investments in addiction treatment, recovery, and prevention initiatives that align with expert recommendations, others revealed questionable uses. Cortland County, for instance, allocated $150,000 to "Sheriff Jail" with no further explanation, and the county did not respond to requests for clarification. Sullivan County’s records show expenditures exceeding $30,000 for Cellebrite technology (used for cellphone data extraction) and over $37,000 for Tasers, with county records attributing these purchases to unrestricted funds.
These types of expenditures, even if legally permissible, are seen by families affected by the crisis as a moral failing. Alexis Pleus stated, "Anything that is not directly tied to people who are struggling with opioid addiction or the loss of someone is a poor use of funds." Her organization, which provides services to individuals with substance use disorders and their families, has received settlement funds from Broome County.
Furthermore, many jurisdictions have yet to spend a significant portion of their allocated funds, a trend observed in other states as well. Local officials often cite the need for careful planning, but some advocates suspect that the interest generated by these unspent funds may be an underlying motive. Nassau County faced public backlash after transferring nearly $14 million in accrued interest from unused opioid settlement funds to its general fund, although the money was subsequently moved back. Advocates fear similar maneuvers are occurring elsewhere but are difficult to detect within complex financial documents. Jasmine Budnella of VOCAL-NY expressed the ongoing burden on advocacy groups: "It feels like it’s up to us all – the organizers, the advocates, the service providers – to be constantly watching. It’s frustrating."
The Top Law Enforcement Officer: Attorney General’s Office
New York Attorney General Letitia James has been a prominent national figure in prosecuting pharmaceutical companies involved in the opioid crisis, frequently announcing the billions of dollars secured for the state. However, when asked about her office’s role in ensuring the appropriate expenditure of these settlement funds, her office deferred responsibility. Spokesperson Grant Fox stated, "While our partners in state and local governments distribute and oversee these funds, we will continue our work to hold accountable the companies responsible for fueling the spread of addictions and overdoses."
This position contrasts with the expectations of many, including state Senator Nathalia Fernandez, who chairs the Senate Committee on Alcoholism and Substance Use Disorders. Senator Fernandez, who has sponsored legislation related to settlement funds, believes the Attorney General’s office should play a more active enforcement role. "The money is here because of their efforts," she said. "I believe it is under the Office of the Attorney General to enforce." Jasmine Budnella echoed this sentiment, stating, "It would be a shame for all of their work that they have done to secure all this funding for it to be misspent."
In contrast, Attorneys General in states like Michigan and Kansas have taken more proactive steps by issuing guidance on how opioid settlement money cannot be spent, including restrictions on many law enforcement-related expenditures that have drawn concern from advocates in New York. The New York Attorney General’s office did not respond to inquiries about whether it would consider creating a similar list.
The Fiscal Watchdog: Comptroller’s Office
Some have suggested that the State Comptroller, as the chief fiscal officer of New York, could assume a more significant oversight role, potentially by conducting or mandating audits. The Reason Foundation, a libertarian think tank, recently proposed model legislation requiring independent financial reviews for recipients of more than $1 million in settlement cash, with simpler reporting for smaller grants. Mariana Trujillo, a co-author of the Reason Foundation plan, clarified that the model "is not telling states what is and what isn’t an appropriate use. We’re simply trying to ensure recipients follow through with their promises."
While no state has yet adopted this model legislation, the office of New York Comptroller Thomas DiNapoli confirmed it is undertaking an audit. This process, initiated in February, "is looking at OASAS’s oversight" of the opioid settlement money, encompassing both state and local funds. Spokesperson Mary Mueller stated that any future enforcement actions "will depend on the results of our current work and our ongoing monitoring."
The New York Comptroller’s office is following a precedent set by similar audits in New Jersey, Missouri, and Nashville, Tennessee, which have addressed the use of settlement funds. These initial steps offer a glimmer of hope for advocates and researchers concerned about the long-term impact of these funds. Layal Bou Harfouch, a co-author of the Reason Foundation’s model law, noted the "craziest stories" of misuse, including funding concerts and police shooting ranges, and expressed optimism that greater focus and oversight could still make a difference. "If we can prevent that at least a little and have these funds be a bit more focused, I don’t think it’s too late," she concluded. The ongoing efforts by these state entities are crucial in determining whether the billions of dollars from opioid settlements will effectively contribute to turning the tide of the addiction crisis.
