Is Your County Using Opioid Settlement Money Effectively? A Plain-English Guide for Families and Advocates

Is Your County Using Opioid Settlement Money Effectively? A Plain-English Guide for Families and Advocates

Hook: If your family has been touched by the overdose crisis, you probably want one simple thing: money sent to your county to help end overdoses should actually be used to save lives. But as of 2026, tens of billions in opioid settlement funds have landed in state and local coffers with weak rules, confusing reports, and few consequences — and that leaves families and community groups asking: how do I find out what my county is doing, and how can I push for evidence-based spending?

Executive summary — the most important facts first

Over $50 billion from national opioid settlements has been allocated to states, counties, and cities. Many jurisdictions are still deciding how to spend the money. A 2024–2025 wave of reporting, including tools created by KFF Health News, Johns Hopkins, and Shatterproof, found wide variation in how funds are used: some communities invest in treatment, harm reduction, and data systems; others shift money into law enforcement equipment or to cover general budget gaps. In 2026 the policy landscape is changing: advocates are winning more transparency rules in some states, and public scrutiny is higher than ever.

How the opioid settlement tracker works — and why it matters

Think of an opioid settlement tracker as a financial X-ray for your county’s response to the opioid crisis. The most widely cited trackers gather public documents, press releases, and municipal budget records to map where settlement payments go and how they’re described.

What these trackers show

• Disbursement amounts and recipients: which counties, cities, or states received payments and how much.
• Reported uses: program descriptions — e.g., “treatment expansion,” “Naloxone distribution,” or “public safety equipment.”
• Timeframe: when payments were made and the schedule of future payments.
• Source documents: settlement agreements, local ordinances, budget entries, and press statements (when available).

Why a tracker is essential for families

Without a tracker, it’s nearly impossible for families and advocates to move from worry to action. Trackers turn fragmented public records into searchable, county-level reports you can use to ask officials accountable questions — and to demand evidence that funds are reducing overdoses.

Step-by-step: How to interpret where your county’s money is going

Use this short checklist while you review a county entry in the tracker.

1) Verify the numbers and timeline

• Compare the total disbursed with the county’s own budget documents. Does the tracker match local records?
• Check the payment schedule. Many settlements spread payments over years — watch for one-time vs ongoing commitments.

2) Read the stated purpose closely — and read between the lines

Local officials often use broad categories like “community health” or “public safety.” Ask: does the description match proven addiction responses (medication-based treatment, harm reduction, recovery supports), or is it vague enough to allow many different uses?

3) Map dollars to evidence-based activities

Use this short evidence checklist to classify spending as high, mixed, or low evidence:

• High-evidence: medication for opioid use disorder (MOUD — buprenorphine, methadone, naltrexone), low-barrier treatment access, syringe services, naloxone distribution, peer recovery programs, and post-overdose outreach.
• Mixed-evidence: large-scale public education campaigns, some prevention programs without evaluation, or new programs without piloting and metrics.
• Low-evidence or risky: one-time infrastructure projects with no link to treatment or harm reduction, routine replacement of general budget items, or law enforcement purchases unrelated to overdose response.

4) Look for measurable outcomes and accountability

Good spending plans include targets and evaluation: number of people started on MOUD, increases in treatment capacity, naloxone kits distributed, referrals from emergency departments, reductions in overdose deaths. If you don’t see measurable goals, press for them.

Red flags your county may be misusing settlement money

Watch for these warning signs — they’re the clearest indicators that settlement funds may not be aligned with evidence or community needs.

• Vague spending categories — terms like “public safety” or “community programs” without detail let officials spend money on unrelated items.
• Funds used to backfill budget shortfalls — settlements were intended to address the opioid crisis, not replace ongoing obligations like Medicaid or general operating deficits.
• Law enforcement purchases unrelated to overdose prevention — weapons, vehicle upgrades, or surveillance tech that doesn’t support overdose response should raise alarms.
• No community input — if survivors, clinicians, harm-reduction groups, and family members were not consulted, ask why.
• No evaluation plan — absence of metrics, independent evaluation, or public progress reports.
• Short-term, one-off projects — programs that end when the grant does rather than building sustainable treatment capacity.

“Some communities are using settlement money to buy naloxone and expand treatment — while others have routed money into law enforcement or used it to plug budget holes.” — Paraphrase of reporting from KFF Health News and partners (2024–2025 coverage)

Evidence-based programs to push for — plain-language descriptions

When advocating, name specific, proven strategies. Officials respond better to clear, concrete proposals than to general pleas.

Medication for opioid use disorder (MOUD)

MOUD (methadone, buprenorphine, naltrexone) is the single most effective treatment to reduce opioid mortality. Ask for funds to expand MOUD access in primary care, emergency departments, jails, and mobile clinics. Prioritize low-barrier models: same-day starts, no prior authorization, and take-home doses where clinically indicated.

Harm reduction services

These include syringe services, widespread naloxone distribution, and safe-use education. Harm reduction saves lives and connects people to treatment. Ask for funding to support community-based organizations already doing this work.

Peer recovery and culturally competent support

Peer recovery specialists (people with lived experience) increase treatment engagement. Fund training, hiring, and integrating peers into emergency and community settings.

Post-overdose outreach and linkage programs

When someone survives an overdose, rapid outreach programs linked to MOUD and housing supports dramatically increase chances of recovery. These programs should be prioritized for immediate funding.

Data, evaluation, and public dashboards

Allocate a portion of funds to build local data systems that track overdoses, naloxone distribution, MOUD starts, and treatment wait times. Public dashboards promote accountability and allow community groups to monitor progress — consider platform options and reviews like NextStream’s platform review when planning.

Practical advocacy steps families and community groups can take now

Below is an action plan you can use this week and over the next 6 months.

1) Use the tracker — then verify locally

1. Find your county on a reputable opioid settlement tracker (KFF Health News and the opioidsettlementtracker.com projects are widely used). Take screenshots and note the date.
2. Match the tracker entry to your county’s official budget or resolution. If numbers don’t match, ask for clarification in writing.

2) Demand a public spending plan with clear goals

Contact your county commissioners, treasurer, or health department and ask for a written plan that includes:

• Specific programs to be funded
• Budget line-items and multi-year commitments
• Measurable outcomes and evaluation plans
• Community advisory board membership, including survivors and clinicians

3) Show up and speak up

Attend county budget hearings and public health board meetings. Prepare a 2-minute public comment that names the program you want funded (e.g., “Please allocate $250,000 per year to expand buprenorphine in our emergency departments”). Be concise, factual, and bring one pager(s) summarizing the evidence.

4) Build a coalition and amplify lived experience

Coalitions including family members, recovery groups, clinicians, harm-reduction organizations, faith leaders, and local businesses are powerful. Center people with lived experience in leadership roles — officials respond when constituents show up together with a clear ask. Look for local case studies and coalition models such as community fundraising and outreach examples (see related case studies below) to structure your effort.

5) Use public records and FOIA requests

If spending plans or contracts are hard to find, file public records requests for: settlement agreements, vendor contracts, evaluation plans, and meeting minutes where spending was discussed. You can often find templates and legal help through state transparency organizations.

6) Push for guardrails at the state level

While many funds are local, some states control a share of settlement dollars. Advocate for state legislation that requires:

• Minimum percentages for treatment and harm reduction
• Public dashboards and annual audits
• Protections against using funds to replace Medicaid spending

What to say — one-sentence scripts that get attention

Use these short phrases in emails, comments, and calls:

• “Please publish the county’s opioid settlement spending plan and measurable goals within 30 days.”
• “I request that at least X% of these funds go to evidence-based treatment and harm reduction.”
• “Will any settlement funds be used to replace Medicaid or other recurring health budget items?”
• “Please add survivors and clinicians to the advisory committee overseeing these funds.”

How to push back when you see red flags

If you identify suspicious or weak uses of funds, escalate strategically.

1) Ask for justification in public

Request the written rationale linking the proposed expenditure to overdose prevention. Officials often won’t have a defensible answer for law enforcement purchases unrelated to addiction response.

2) Mobilize media and local partners

Local reporters and statewide health journalists are interested in how large sums are spent. A focused press release demonstrating the gap between stated goals and actual line items can force transparency — consider communications tactics and simulations from crisis comms playbooks like futureproofing crisis communications.

3) Seek oversight from state or federal agencies

If funds are clearly misused or diverted to non-eligible items under the settlement terms, ask your state Attorney General’s office or the settlement administrator to review. In some states, lawmakers have created oversight committees to audit spending.

Measuring success: the metrics your county should publish

Concrete metrics tell you whether programs are working. Ask your county to publicly report, at minimum:

• Number of people who start and remain on MOUD (30-, 90-, 365-day retention)
• Naloxone kits distributed and reversals reported
• Treatment capacity increases (beds, clinics, prescribers)
• Number of overdose response/peer outreach contacts
• Overdose deaths and non-fatal overdose trends (with context)
• Annual third-party evaluation reports

2026 trends to watch — what’s changing this year

Several important developments in 2025–2026 affect how advocates can push for accountability:

• Greater public scrutiny: sustained reporting through late 2025 increased pressure on counties to publish plans and evaluations; expect more public dashboards in 2026.
• State-level rulemaking: a growing number of states considered or enacted clearer guidance on eligible uses of settlement funds; check whether your state has new rules this year.
• Integration with Medicaid strategies: as states adjust Medicaid policies in 2025–2026, advocates are increasingly focused on ensuring settlement funds expand access, not replace Medicaid coverage.
• Data investment: more jurisdictions are using funds to build data systems to measure outcomes — a critical step toward evidence-driven allocation.

Real-world example (how communities have used funds well — and poorly)

Across the country, spending diverges. In communities that have taken a best-practice approach, settlement funds expanded MOUD in hospital EDs, seeded mobile clinics, supported syringe services and naloxone distribution, and paid for peer navigators and housing supports — paired with public dashboards and independent evaluations.

In contrast, other places have routed money to broad “public safety” line items, or used funds to purchase equipment for law enforcement without a clear link to overdose prevention. Those choices drew criticism from survivors and public-health advocates and, in some cases, led to state investigations or mandates for greater oversight.

Model budget allocation — a starting framework (use locally, adapt as needed)

Every community is different. This model is not a mandate, but a template advocates can use when proposing allocations:

• Treatment & MOUD expansion — 35–45%: increase clinic capacity, pay for prescribers, and reduce barriers to care.
• Harm reduction & naloxone — 15–25%: support syringe services, naloxone distribution, and mobile outreach.
• Recovery supports — 10–20%: housing, employment programs, peer recovery specialists, childcare for treatment participants.
• Prevention & youth programs — 5–10%: evidence-based school and community prevention initiatives.
• Data, evaluation & oversight — 5–10%: public dashboards, independent evaluations, and community advisory boards.

Local priorities and needs will change the percentages. The key is to prioritize long-term treatment capacity and harm reduction rather than one-time purchases that don’t reduce overdoses.

Final checklist: What to demand from your county right now

1. Public, written spending plan within 30 days of your request.
2. Clear line items and percent allocations tied to evidence-based programs.
3. Named measurable outcomes and schedule for public reporting.
4. Community advisory board that includes survivors, clinicians, and harm-reduction groups.
5. Independent annual evaluation and a public dashboard.
6. Prohibition on using funds to replace Medicaid or unrelated general fund obligations.

Closing: Where families and advocates can make the difference

Opioid settlement dollars are a rare opportunity to rebuild local systems and save lives. But money alone does not guarantee impact. In 2026, your county’s choices matter more than ever: whether those dollars become long-term treatment capacity, lifesaving naloxone on the street, and stronger data — or whether they disappear into vague “public safety” pots or budget gaps.

Start with the tracker. Then show up: request the spending plan, demand measurable outcomes, center survivors in the process, and push for independent evaluation. When families and community groups organize and act with clear, evidence-based requests, counties change their plans. You don’t need to be an expert — you need to be persistent, focused, and informed.

Call to action

Use the opioid settlement tracker today to find your county’s entry. If you see gaps or red flags, print this checklist, gather allies, and request a public spending plan. Join or start a community coalition to monitor results and demand evidence-based programs. If you want help drafting a public comment or FOIA request, reach out to state advocacy networks or public-interest law groups — and keep the pressure on until you see measurable progress.

Want a one-page version of this guide or a sample public comment? Email your county health advocate or visit opioidsettlementtracker.com and KFF Health News to download resources and templates.

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