Companies accused of recklessly marketing and distributing prescription opioid painkillers are paying roughly $58 billion<\/a> to settle lawsuits over their role in fueling the addiction crisis. It\u2019s a pot of gold eyed by addiction treatment providers, companies creating the latest opioid-related products, and government officials struggling to balance budgets.<\/p>\n Nearly half of that money is going to local governments<\/a>, to be distributed by county commissioners and city councilors. The idea is that local leaders know their communities best and can do justice to these payouts, often described as \u201cblood money\u201d by people who\u2019ve lost loved ones to an overdose.<\/p>\n But many local leaders have little to no training in addiction policy and may lack robust local health departments and policy guardrails to assist them.<\/p>\n That has resulted in spending decisions that many clinicians, researchers, and addiction recovery advocates say are unlikely to save lives or treat substance use disorders.<\/p>\n In New York, where about 46% of the opioid settlement money<\/a> is directly controlled by local governments, counties have spent tens of thousands of dollars on surveillance cameras, technology to help police access data on locked cellphones, and goggles that simulate being drunk, according to public records obtained by the nonprofit advocacy group Legal Action Center<\/a> and shared exclusively with KFF Health News. Though the purchases were likely legal, many people consider them a slap in the face because they don\u2019t directly help people struggling with addiction or their families.<\/p>\n Without oversight, counties have the chance \u201cto go rogue\u201d with this money, said Jasmine Budnella<\/a>, director of drug policy at VOCAL-NY, an advocacy organization that is tracking settlement money as part of its mission to serve people affected by the war on drugs.<\/p>\n When advocates and families of overdose victims raise concerns to the various state agencies that could hold localities accountable, those agencies often punt to one another, Budnella and other local advocates said.<\/p>\n It feels \u201clike the Spider-Man meme,<\/a> where it\u2019s like everybody\u2019s pointing at each other,\u201d Budnella said. \u201cSomebody needs to be able to have the stick and slam their hand on the table and be like, \u2018You\u2019re doing this wrong and this is the consequence.\u2019\u201d<\/p>\n The experience in New York provides a microcosm of regulators evading oversight responsibility nationwide while varied interests vie for the financial windfall.<\/p>\n Years<\/a> of data collected<\/a> by KFF Health News, the Johns Hopkins Bloomberg School of Public Health, and the addiction nonprofit Shatterproof have found that settlement money was spent on law enforcement gear<\/a>, such as night-vision goggles and bulletproof vests; unproven prevention initiatives<\/a>, such as a drug-awareness magician for kids; and budget stopgaps<\/a>.<\/p>\n It\u2019s unclear who should \u2014 or will \u2014 take action<\/a> on such expenditures that many people harmed by the crisis consider questionable.<\/p>\n In each state, control of the money is split among various entities, creating a leadership vacuum. The federal government plays little to no role<\/a>. Advocates and families who\u2019ve lost loved ones have pushed for accountability but have limited power. A few states have passed new laws, but change is slow and uneven.<\/p>\n The settlement agreements<\/a> require the majority of the money to be spent on \u201copioid remediation,\u201d with more than 100 suggested expenditures<\/a>. But the list is broad and open to interpretation. Further complicating the issue, many states \u2014 including New York \u2014 designate some portion of the settlement dollars as unrestricted, which allows for general spending.<\/p>\n Meanwhile, federal budget cuts have threatened addiction-related services<\/a> and created more demand<\/a> for funding. And though overdose deaths have decreased since peaking in 2022<\/a>, they still claim about 186 lives per day.<\/p>\n \u201cWe really are wasting this opportunity to use these funds to turn the epidemic around,\u201d said Alexis Pleus<\/a>, a Binghamton, New York, resident, whose 28-year-old son, Jeff Dugon, died of a heroin overdose in 2014.<\/p>\n He was a chef who loved to rib Pleus about her bad knife skills. She thinks of him and smiles every time she peels garlic the way he taught her. If the money could spare other families such heartache, that would give her solace.<\/p>\n \u201cWe need oversight,\u201d said Pleus, who runs a nonprofit that is receiving opioid settlement cash from her county to serve people who use drugs and provide support groups for families.<\/p>\n In New York, there are three prime watchdog contenders: the Office of Addiction Services and Supports, the attorney general, and the comptroller.<\/p>\n The Lead State Agency<\/strong><\/p>\n New York\u2019s opioid settlement documents designate the Office of Addiction Services and Supports<\/a> as the \u201clead state agency<\/a>.\u201d<\/p>\n It distributes a portion of settlement dollars via grants, according to recommendations from the state\u2019s Opioid Settlement Fund Advisory Board<\/a>. It also has the power to \u201cengage in oversight and audits of projects and programs\u201d funded by settlement cash and \u201cmay withhold future funds\u201d from local governments that do not comply with certain requirements, according to the agreement.<\/p>\n Agency spokesperson Jerry Gretzinger told KFF Health News the office has not yet exercised its power to withhold funds but understands its oversight role.<\/p>\n \u201cOASAS 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,\u201d Gretzinger wrote in a statement.<\/p>\n The office is currently auditing 19 local governments\u2019 use of the money to ensure compliance with \u201creporting and recordkeeping requirements,\u201d he said. However, that may not encompass the broader question of whether money was spent on appropriate uses, which many advocates want addressed.<\/p>\n Some people are frustrated with the narrow role OASAS has carved out.<\/p>\n For example, language included in last year\u2019s state budget<\/a> required local governments for the first time to publicly report how they spent settlement money. OASAS collected links to those reports<\/a> on its site. But it does not review the accuracy or detail of that data, instead relying on \u201cthe information as it is provided\u201d by localities, Gretzinger said.<\/p>\n \u201cThat doesn\u2019t feel like oversight,\u201d said Christine Khaikin<\/a>, a deputy director at the Legal Action Center, which obtained public records about local spending in New York.<\/p>\n Members of the state\u2019s Opioid Settlement Fund Advisory Board have also pushed the office<\/a> to provide more data and evaluation of how dollars are being used. But at a February 2025 meeting<\/a>, OASAS Commissioner Chinazo Cunningham deflected.<\/p>\n \u201cOASAS has no oversight over these portions of dollars,\u201d she said of the 46% of settlement money that goes directly to counties and cities. \u201cIn terms of what kind of data each county collects,\u201d she added, \u201cwe cannot dictate exactly what that information is.\u201d<\/p>\n![\"Newsletter](\"https:\/\/kffhealthnews.org\/wp-content\/plugins\/kff-shared\/dist\/\/images\/newsletter-icon.png\"){kind=icon}
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