How is $58B in opioid settlement money being spent? 5 things to know

Companies accused of fueling the opioid crisis are paying roughly $58 billion nationwide to settle lawsuits, and oversight of how that money gets spent varies widely by state, KFF Health News reported July 21. 

The money is meant to help communities recover from the addiction crisis, but with nearly half of it flowing directly to local governments and little independent review, health system leaders, providers and advocates are questioning whether the funds are reaching the people who need them most. Many of the local officials deciding how to spend it, including county commissioners and city council members, lack training in addiction policy, and settlement payouts are expected to continue for more than a decade, making the oversight gap a long-term concern rather than a one-time issue. 

Here are five things for leaders to know:

1. New York offers a window into the national pattern. In New York, about 46% of the state’s settlement share flows straight to county and city governments with little independent review of individual purchases.
   
2. Some local spending has drawn criticism. Public records obtained by the nonprofit Legal Action Center show New York counties have used settlement dollars on surveillance cameras, technology that helps police access locked cellphones, and goggles that simulate intoxication.
   
3. The lead state agency says its authority is limited. New York state’s Office of Addiction Services and Supports Commissioner Chinazo Cunningham, MD, told the state’s Opioid Settlement Fund Advisory Board in February 2025 that OASAS “has no oversight” over the 46% share sent directly to counties and “cannot dictate” what spending data those counties collect.
   
4. The state’s attorney general’s office points to other agencies. Despite New York Attorney General Letitia James’s leading role in securing the settlement, her office said state and local government partners — not her office — are responsible for distributing and overseeing the funds.
   
5. The comptroller has launched an audit. New York Comptroller Thomas DiNapoli’s office began an audit in February examining OASAS’ oversight of the settlement money, following similar reviews by comptrollers in New Jersey, Missouri and Nashville, Tenn.

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