Just two years have passed since state and local governments began receiving their share of more than $50 billion in opioid settlement funds — the result of a settlement reached with companies that played a role in driving the overdose epidemic. While the money will be spread over 18 years, there are already reports of questionable spending.

Given the mounting death toll from overdoses in the United States, the federal government — with its unique depth of knowledge and resources — has an important role to play in ensuring these funds are well spent. Federal efforts can help align various funding sources and better meet the needs of local communities. The federal government can and should work with states to identify resource gaps and facilitate data and community-driven decision-making.  

Recent media reports have included stories about spending on items only tangentially related to the issue of reducing overdose deaths or curbing opioid use disorder. In one Pennsylvania county, local officials bought stickers with settlement dollars. The stickers reminded retailers not to sell alcohol to people under the age of 21. An entire segment of Last Week Tonight with John Oliver highlighted other examples of spending with tenuous connections to the allowable uses of the settlement agreements, including spending for a law enforcement device used to restrain suspects.

Fortunately, in Pennsylvania and California, safeguards were put in place to prevent the use of settlement money. But these stories point to a bigger issue — the lack of local public health capacity to address substance use disorder. Some local government officials have even admitted that they lack a sufficient public health infrastructure or understanding of how to effectively spend the money. The federal government can help by building local public health capacity to improve spending practices.

While state attorneys general and the private attorneys who originally brought the cases against the opioid industry maintain they have put enough guardrails in place, others are skeptical. Attorneys in the opioid litigation sought to avoid a rerun of the budget raids that occurred in the wake of the tobacco master settlement agreement. In fact, just recently, the Arizona governor was sued by the attorney general of her own state, claiming that opioid settlement funds were being illegally spent to plug holes in the state’s budget.

Enforcement and watchdogs are important, but more needs to be done to maximize these dollars. Facilitating collaboration, sharing best practices, building local community capacity, and helping governments integrate settlement money into other ongoing funding sources are all sorely needed.  

The federal government did not play an active role in the multi-district litigation that resulted in the multi-billion-dollar settlement. In 2018, the Trump administration chose not to become a party to the litigation, leaving the litigation to state and local governments. But this does not preclude a role for the federal government in providing opportunities for learning collaboratives and building decision-making processes informed by local data and the needs of communities.

Some might argue that state and local governments, together with local communities, are best positioned to understand local needs. This is true. However, the federal government is uniquely positioned to play an important, ongoing role. In fact, once the Purdue bankruptcy settlement is approved, the federal government is poised to receive money from its civil and criminal settlement with Purdue and the family that owns the company, the Sacklers. Once the Purdue bankruptcy settlement is final, the money from the U.S. Department of Justice settlement is currently slated to be returned to the U.S. Department of Treasury’s general fund. Given the human cost of the overdose epidemic, taxpayers would be better served by having this money dedicated to abating the opioid epidemic, ensuring transparency, and matching and aligning all the streams of addiction funding to save lives.

Some state and local government officials will agree with the late President Reagan’s statement that the nine most terrifying words in the English language are: I’m from the government, and I’m here to help. But the fact remains that the federal government appropriates the majority of funds for the nation’s treatment and prevention programs and that the National Institute on Drug Abuse is the world’s largest funder of drug use and substance use disorder research. Nonprofit organizations and academic institutions have developed several quality resources to guide opioid litigation spending. But these efforts simply cannot match the federal government’s expansive resources.

In the face of an epidemic costing 100,000 lives every year, we need to get this right.

The survivors and their families are counting on us.

DISCLAIMER: The views and opinions expressed in this piece are those of the author and do not reflect the views of the O’Neill Institute.