The opioid epidemic remains one of the deadliest public health disasters in American history. While the nature of the crisis has evolved from overprescribed painkillers to illicit fentanyl and increasingly lethal synthetic drugs, the devastation continues to claim lives in communities across the country. At this pivotal moment, governments have been handed an unprecedented opportunity to fight back. The question is whether they will use it wisely.
Read more Hubris Sinks Canada
Before the first opioid settlement dollars were ever distributed, Americans were given a promise. The billions recovered through lawsuits against opioid manufacturers, distributors, and pharmacies would not become another government windfall. They would be used to help the communities devastated by addiction. They would fund treatment, expand recovery services, strengthen prevention efforts, support law enforcement, and save lives.
Now comes the test of whether government intends to keep that promise. Over the coming years, nearly $58 billion in opioid settlement funds will flow into states and local communities across America. At a time when illicit fentanyl continues to poison neighborhoods, overdose deaths remain unacceptably high, and dangerous new synthetic drugs like nitazenes and xylazine are emerging, these resources represent one of the greatest opportunities in a generation to turn the tide against the opioid epidemic.
But opportunity means little without accountability. Last month, leaders from across the country gathered in Denver for the inaugural National Opioid Settlement Conference, a first-of-its-kind effort dedicated to ensuring settlement dollars are spent transparently, effectively, and for the people and communities they were intended to serve. The conference reflected an encouraging recognition that these funds require careful stewardship.
Unfortunately, recent audits and spending reports suggest that recognition has not yet become reality everywhere. In Kentucky, a report released by the Kentucky Center for Economic Policy found that local governments had spent only about ten percent of the opioid settlement dollars already distributed to them, despite the continuing need for treatment and recovery services across the state.
That distinction matters. Government does not have to commit outright fraud to betray the public’s trust. When documentation is incomplete, oversight is weak, and taxpayers cannot determine where the money actually went; accountability has already broken down.
These are not isolated incidents. A previous national investigation by KFF Health News documented jurisdictions using opioid settlement funds on projects with little or no connection to addiction remediation. Other reporting has found governments using settlement dollars to replace existing spending rather than expand treatment and prevention programs that otherwise would not have existed.
That was never the purpose of these settlements. These dollars were not intended to balance budgets, plug fiscal shortfalls, increase payrolls, or finance unrelated government priorities. They were intended to confront one of the deadliest public health crises in American history.
More than 600,000 Americans have died since the opioid epidemic began. While prescription opioid deaths have declined, illicit fentanyl has become the dominant driver of overdose fatalities, flooding communities through counterfeit pills and increasingly sophisticated trafficking networks. New synthetic drugs such as nitazenes, which are reported to be even more potent than fentanyl, and xylazine, are making an already deadly crisis even more dangerous.
Communities need these resources now. Not for them to be sitting idle in government accounts and certainly not diverted to purposes that have little to do with fighting addiction.
The encouraging news is that many states are demonstrating exactly how these funds should be used. Across the country, settlement dollars are expanding crisis stabilization centers, launching mobile treatment clinics, increasing access to medication-assisted treatment, equipping first responders with naloxone, supporting recovery housing, funding partnerships between law enforcement and behavioral health professionals, and helping communities build long-term treatment capacity. These investments save lives while strengthening local public safety and public health systems.
Read more They want reparations, and they’ve come to collect
They also demonstrate an important principle. The issue is not whether governments have enough worthy ideas on which to spend this money. It is whether taxpayers can see where every dollar goes and whether those expenditures actually comply with the purpose of the settlements.
That requires more than good intentions. Every state should establish public boards tracking settlement expenditures, require standardized spending reports, maintain dedicated settlement accounts separate from general revenues, and conduct regular independent audits.
Local governments should be required to submit detailed spending plans with measurable goals before receiving funds and publicly report outcomes after dollars are spent.
Some states have already shown that this can work. South Carolina maintains a public reporting portal allowing citizens to track grant awards and expenditures, while Missouri publishes comprehensive annual reports detailing how both state and local settlement dollars are allocated. These models prove that transparency does not hinder innovation. It has the power to strengthen public confidence.
The Reason Foundation has also proposed extending the familiar Single Audit framework to opioid settlement recipients, an idea policymakers should seriously consider. Billions of dollars intended to save lives deserve the same level of financial scrutiny taxpayers already expect for other major public expenditures.
None of these reforms are particularly complicated. What they require is the political will to remember that this money does not belong to government.
It belongs to the families who buried loved ones. It belongs to the communities hollowed out by addiction. It belongs to every American who was told these historic settlements would help prevent another generation from suffering the same fate.
The opioid settlements represent one of the largest public health investments in American history. They should become one of the greatest accountability success stories as well.
Americans deserve the confidence that every settlement dollar is traceable, auditable, and spent exactly as promised. Anything less would not simply waste money.
It would break faith with the very people these settlements were meant to help.
Julio Rivera is a business and political strategist, cybersecurity researcher, founder of ItFunk.org and ReactionaryTimes.com, and a political commentator and columnist. His writing, focused on cybersecurity and politics, has appeared in major publications around the world.
Read more What history should our museums teach?
Image: RawPixel.com