Opioid Settlement Spending on Prevention

When Shatterproof, Johns Hopkins University School of Public Health, and KFF Health News partnered to track opioid settlement spending across the country, we knew that there was broad variation in how states were approaching the funds.  So many factors influence the priorities for settlement funds in each state and local government — Medicaid expansion, population demographics, the split of state/local control, etc.

But the one thing decisionmakers across the country agree on and should prioritize is investing in effective, evidence-based primary prevention strategies. 

The database of opioid settlement expenditures we created categorizes each expenditure according to the four common categories along the continuum of care (prevention, treatment, recovery, and harm reduction), as well as the nine core strategies outlined in Exhibit E, which was created as part of the settlements by experts to suggest the most impactful areas for opioid settlement spending. 

Nationwide, in 2024, over $615 million was spent on treatment, $450 million on recovery, and $490 million on harm reduction, including naloxone.  Only $237 million was spent on prevention.  This represents only 9% of total opioid settlement expenditures. 

We also weren’t able to differentiate between evidence-based prevention investments and spending on “prevention” initiatives that have no evidence of effectiveness, like one-time speakers or events. 

Partnership to End Addiction has released a report, Guidance for  Investing the Opioid Settlement Funds in Primary Prevention, that explains not only what constitutes evidence-based prevention, but lays out how decisionmakers can determine which prevention interventions are most needed in their communities and offers examples of jurisdictions that have spent opioid settlement funds on these initiatives. 

We know that young people who receive effective, evidence-based prevention programming are better equipped to delay initial use of drugs, and more likely to have the coping strategies to practice healthy behaviors and overcome adverse childhood experiences. 

OxyContin was approved by the FDA in 1995.  Nearly 30 years later, we’ll never know how many lives could have been saved by early investments in prevention programs that work.