Over the past several years, pharmaceutical companies and drug distributors have agreed to pay more than $50 billion to settle thousands of lawsuits brought by states, cities, and counties across the United States. These settlements — the largest of their kind in history — are meant to help communities recover from the opioid crisis that claimed hundreds of thousands of lives. But where is that money actually going? And is it reaching the people who need it most?
More than 3,000 cities, counties, and states sued the manufacturers and distributors of prescription opioids, arguing those companies created and fueled the addiction crisis through deceptive marketing and lax oversight. The result was a series of landmark agreements:
The settlement agreements generally require that at least 85 percent of the money be spent on "opioid remediation" — a broadly defined term that includes treatment, recovery support, harm reduction, and prevention. The remaining 15 percent can be used at states' discretion, including for legal fees.
In 2022 and 2023 alone, more than $6 billion flowed to states and localities. An analysis by NPR and researchers found that of the funds tracked so far, about a third had been spent or formally committed, about a third had been set aside for future spending — and the final third was essentially untrackable, because many jurisdictions had not produced public spending reports.
Of the funds that could be tracked, states allocated, on average:
Specific examples include New York spending $7.5 million on low-threshold buprenorphine treatment programs, California allocating more than $14 million to distribute naloxone to providers serving people experiencing homelessness, and Colorado directing 10 percent of its funds toward addiction infrastructure — telehealth, workforce training, and transportation to treatment.
Public health advocates have raised serious concerns about transparency and accountability. Unlike the 1998 tobacco settlement — in which most states eventually redirected the money away from public health — opioid settlements include explicit remediation requirements. But enforcement relies heavily on public reporting, and that reporting is uneven.
As of late 2024, only about 16 states had promised to publicly report 100 percent of their settlement spending. A roughly equal number had not committed to publishing any public accounting at all. Researchers also found that governments reported spending more than $240 million on purposes that did not qualify as opioid remediation — much of it on legal fees and some diverted to general government funds.
A STAT News investigation found that some settlement money was flowing to projects with limited evidence of effectiveness, raising the question of whether billions of dollars will move the needle on the crisis at all.
Settlement money isn't the only source of funding for states. The federal government also plays a direct role through SAMHSA's State Opioid Response (SOR) grants, which fund treatment, recovery support, and harm reduction across all 50 states. In fiscal year 2025, HHS distributed more than $1.5 billion in SOR continuation awards, helping states maintain and expand services including medication-assisted treatment (MAT), naloxone distribution, and recovery coaching.
Beyond direct spending, federal policy shapes how tens of millions of Americans access addiction treatment through their insurance. The Mental Health Parity and Addiction Equity Act (MHPAEA) — first passed in 2008 — requires that insurance plans cover mental health and substance use disorder treatment on equal terms with physical health care. It was meant to end the longstanding practice of insurers imposing stricter limits on behavioral health care than on, say, surgery or cancer treatment.
Enforcement of parity has been uneven for years. In September 2024, the Biden Administration issued strengthened final rules that explicitly required insurers to analyze and document whether their coverage restrictions for mental health and addiction were truly equivalent to those for medical and surgical care. Those rules were set to take effect January 1, 2025.
However, in May 2025, the Trump Administration announced it would not enforce the new provisions. Advocates warn that without enforcement, many people seeking addiction treatment may continue to face higher out-of-pocket costs, stricter prior authorization requirements, and narrower networks of behavioral health providers than patients with physical health conditions face — even when the law says they shouldn't.
These policy decisions happen at the state and federal level, but communities can influence them. Here's where to start:
Need help now? If you or someone you love needs support for addiction or mental health, you don't have to wait for policy to change. Call or text 988 (Suicide & Crisis Lifeline) for immediate mental health support, or call SAMHSA's National Helpline at 1-800-662-4357 (free, confidential, 24/7) to be connected with treatment near you.
At Empower Next Project, we believe that the billions of dollars now flowing through opioid settlements represent a historic — and time-limited — opportunity to rebuild a system that has long failed people with addiction. Getting the policy right isn't abstract: it means more treatment slots, more recovery housing, more naloxone, and more lives saved. We'll keep tracking it, and we invite you to join us.
This article is educational and is not a substitute for professional legal, medical, or financial advice. Policy details change frequently; check with official government sources for the most current information. For substance use and mental health support, call SAMHSA's National Helpline at 1-800-662-4357 or call/text 988.