Payback

State attorneys general vowed that opioid settlement funds — unlike the tobacco settlement of the 1990s — would go toward tackling the underlying crisis. But in Mendocino County, officials have found a way to use some of its share to help fill a budget shortfall — a throwback to what agreement architects hoped to avoid.

Greene County, Tennessee, so far has received more than $2.7 million from regional and national settlements with opioid manufacturers and distributors. But most of the money is not going to help people and families harmed by addiction.

Billions of dollars are headed to state and local governments to address the opioid crisis. Policy experts and advocates expect the federal government to play a role in overseeing the use of the money. Failure to do so, they say, could lead to wasted opportunities. And, since Medicaid helps pay health care costs, the feds could have a claim to portions of states’ opioid settlements.

Some people say it’s reasonable for densely populated areas to receive more settlement funds, since they serve more of those affected. But others worry this overlooks rural communities disproportionately harmed by opioid addiction.

The cash represents an unprecedented opportunity to derail the opioid epidemic, but with countless groups advocating for their share of the pie, the impact could depend heavily on geography and politics.

States, tribes, and local governments are figuring out how best to spend billions of dollars from an opioid lawsuit settlement. One option they’re considering is funding peer support specialists, who guide people recovering from addiction as they do it themselves.