Cuts in Medicaid payments to behavioral health providers are forcing cuts at Kentucky's largest provider of treatment for addiction. (Getty Images)
Opioid settlement cash is not inherently political. It’s not the result of a law passed by Congress nor an edit to the state budget. It’s not taxpayer money. Rather, it’s coming from health care companies that were sued for fueling the opioid crisis with prescription painkillers.
But like most dollars meant to address public health crises, settlement cash has nonetheless turned into a political issue.
Gubernatorial candidates in several states are clashing over who gets bragging rights for the funds — which total more than $50 billion and are being distributed to state and local governments over nearly two decades. Among the candidates are attorneys general who pursued the lawsuits that produced the payouts. And they’re eager to remind the public who brought home the bacon.
“Scoring money for your constituency almost always plays well,” said Stephen Voss, an associate professor of political science at the University of Kentucky. It “is a lot more compelling and unifying a political argument than taking a position on something like abortion,” for which you risk alienating someone no matter what you say.
In Kentucky, Attorney General Daniel Cameron, the Republican candidate for governor, wants sole credit for the hundreds of millions of dollars his state is receiving to fight the opioid epidemic. In a post on X, formerly known as Twitter, he wrote that his opponent, former attorney general and current Democratic Gov. Andy Beshear, “filed a lot of lawsuits during his time [in] office, but in this race, there is only one person who has actually delivered dollars to fight the opioid epidemic, and it’s not him.”
However, Beshear filed nine opioid lawsuits during his tenure as attorney general, several of which led to the current payouts. At a January news conference, Beshear defended his role: “That’s where these dollars are coming from — cases that I filed, and I personally argued many of them in court.”
Polls indicate that Beshear leads Cameron ahead of the Nov. 7 election.
Christine Minhee, founder of OpioidSettlementTracker.com, who is closely following how attorneys general handle the money nationwide, said voters likely don’t know that the opioid settlements are national deals crafted by a coalition of attorneys general and private lawyers. So when one candidate claims credit for the money, his constituents may believe “he’s the sole hero in all of this.”
Candidates in other states are touting their settlement credentials, too. North Carolina Attorney General Josh Stein, a Democrat, lists securing opioid settlement funds at the top of the “accomplishments” section of his 2024 gubernatorial campaign website. West Virginia Attorney General Patrick Morrisey, a Republican gubernatorial candidate for 2024, has repeatedly boasted of securing the “highest per capita settlements in the nation” in news conferences and on social media and his campaign website.
In Louisiana, Attorney General Jeff Landry, a Republican who was recently elected governor, ran on a tough-on-crime platform, with endorsements from sheriffs and prosecutors. As attorney general, he led negotiations on dividing opioid settlement funds within the state, resulting in an agreement to send 80% to parish governments and 20% to sheriffs’ departments — the largest direct allocation to law enforcement in the nation.
It’s a common joke that AG stands for “aspiring governor,” and officials in that role often use big legal cases to advance their political careers. Research shows that attorneys general who participate in multistate litigation — like that which led to the opioid settlements and the tobacco settlement before it — are more likely to run for governor or senator.
But for some advocates and people personally affected by the opioid epidemic, this injection of politics raises concerns about how settlement dollars are being spent, who is making the decisions, and whether the money will truly address the public health crisis. Last year, more than 100,000 Americans died of drug overdoses — 2,135 of them in Kentucky.
Average people “don’t really care about the bragging rights as much as they care about the ability to use that funding to improve and save lives,” said Shameka Parrish-Wright, director of VOCAL-KY, an advocacy group that champions investments in housing and health care.
“What I see in my state is a lot of press conferences and news pieces,” said Parrish-Wright, a Democrat who is active in local politics. “But what plays out doesn’t get to the people” — especially those deeply affected by addiction.
For example, when Beshear celebrated a decrease in the state’s overdose deaths, his announcement overlooked the increasing deaths among Black Kentuckians, Parrish-Wright said. And when Cameron’s appointee to the state’s opioid abatement advisory commission announced that $42 million of settlement funds were being considered to research ibogaine — a psychedelic drug that has shown potential to treat addiction — Parrish-Wright’s first thought was “most poor people can’t afford that.” To obtain it, people often have to travel out of the country.
The ibogaine announcement caused additional controversy. It’s an experimental drug, and, if approved, the $42 million allocation would be the single-largest investment from the commission, which is housed in Cameron’s agency. The Daily Beast reported that a billionaire Republican donor backing Cameron’s gubernatorial campaign stands to reap massive profits from the drug’s development.
Neither Cameron’s office nor his campaign responded to requests for comment.
Beshear’s office declined an interview request but referred KFF Health News to his previous public statements, in which he criticized the potential investment in ibogaine. He has suggested Cameron — whose campaign has emphasized support for police — is not putting his money where his mouth is.
“If you only provide $1 million to law enforcement and 42 to pharma, it doesn’t seem like you’re backing the blue. It seems like you’re backing Big Pharma,” Beshear said at a May news conference.
He also said his two appointees to the commission were caught off guard by the public announcement on ibogaine, despite their role overseeing settlement funds.
Minhee, founder of OpioidSettlementTracker.com, said she’s concerned that mixing politics with settlement funds could result in ineffective investments nationwide.
“If some of this money is going to be politicized to advance careers of attorneys general who support the war on drugs, then that is literally using monies won by death to feed into more death,” she said.
Parrish-Wright, of VOCAL-KY, said she worries that candidates — and some voters — will forget about the significance of the money once ballots are cast.
“We cannot let it fade after the election cycle,” she said.
Her solution depends in part on politics. She’s on the ballot herself Nov. 7, for a seat on Louisville’s Metro Council. If she wins, she said, she intends to keep the settlement in the public conversation.
This story is republished from?KFF Health News?is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at?KFF — the independent source for health policy research, polling, and journalism.
]]>The national opioid settlements are the second-largest public health settlement of all time, following the tobacco master settlement of the 1990s. The money is meant as remediation for the way corporations aggressively promoted opioid painkillers, fueling an overdose crisis that has now largely transitioned to illicit drugs, like fentanyl. More than 105,000 Americans — including 2,135 in Kentucky — died of drug overdoses last year. (KFF Health News illustration; Getty Images)
Thousands of local governments nationwide are receiving settlement money from companies that made, sold, or distributed opioid painkillers, like Johnson & Johnson, AmerisourceBergen, and Walmart. The companies are shelling out more than $50 billion total in settlements from national lawsuits. But finding out the precise amount each city or county is receiving has been nearly impossible because the firm administering the settlement hasn’t made the information public.
Until now.
After more than a month of communications with state attorneys general, private lawyers working on the settlement, and the settlement administrators, KFF Health News has obtained documents showing the exact dollar amounts — down to the cent — that local governments were allocated for 2022 and 2023. More than 200 spreadsheets detail the amounts paid by four of the companies involved in national settlements. (Several other opioid-related companies will start making payments later this year.)
For example, Jefferson County, Kentucky — home to Louisville — received $860,657.73 from three pharmaceutical distributors this year, while Knox County, a rural Kentucky county in Appalachia — the region many consider ground zero of the crisis — received $45,395.33.
In California, Los Angeles County was allocated $6.3 million from Janssen, the pharmaceutical subsidiary of Johnson & Johnson, this year. Mendocino County, which has one of the highest opioid overdose death rates in the state, was allocated about $185,000.
Access to “this information is revolutionary for people who care about how this money will be used,” said Dennis Cauchon, president of the nonprofit advocacy group Harm Reduction Ohio.
Some states, like North Carolina and Colorado, have posted their distribution specifics online. But in most other places, tracking payment amounts requires people to make phone calls, send emails, and file public records requests with every local government for which they want the information.
Thus, gathering the data across one state could mean contacting hundreds of places. For the country, that could translate to thousands.
Cauchon has been seeking this information for his state since April 2022. “Opioid remediation work is done at the local level, at the individual level, and, now, for the first time, local people working on the issues will know how much money is available in their community.”
Interactive chart: Find out how much opioid settlement cash your locality received
Only larger public health settlement involved tobacco industry
The national opioid settlements are the second-largest public health settlement of all time, following the tobacco master settlement of the 1990s. The money is meant as remediation for the way corporations aggressively promoted opioid painkillers, fueling an overdose crisis that has now largely transitioned to illicit drugs, like fentanyl. More than 105,000 Americans died of drug overdoses last year.
So far, state and local governments have received more than $3 billion combined, according to a national summary document created by BrownGreer, a settlement administration and litigation management firm that was court-appointed to handle the distribution of payments. In each state, settlement funds are divided in varying percentages among state agencies, local governments, and, in some cases, councils that oversee opioid abatement trusts. Payments began in 2022 and will continue through 2038, setting up what public health experts and advocates are calling an unprecedented opportunity to make progress against an epidemic that has ravaged America for three decades. KFF Health News is tracking how governments use — and misuse — this cash in a yearlong investigation.
The latest trove of documents was obtained from BrownGreer. The firm is one of the few entities that knows exactly how much money each state and local government receives and when, since it oversees complex calculations involving the varying terms and timelines of each company’s settlement.
Even so, there are gaps in the information it shared. A handful of states opted not to receive their payments via BrownGreer. Some directed the firm to pay a lump sum to the state, which would then distribute it to local governments. In those cases, BrownGreer did not have figures for local allocations. A few states that settled with the opioid-related companies separately from the national deals are not part of BrownGreer’s data, either.
Roma Petkauskas, a partner at BrownGreer, said the settlement agreement requires the firm to send notices of payment amounts to state and local governments, as well as to the companies that settled. It shared documents when KFF Health News asked, but it is not clear if the firm will continue doing so.
Petkauskas wrote, “Settlement Agreements do not provide that such notices be made public,” indicating such disclosure was not a requirement.
People harmed by the opioid crisis say they want more transparency than the bare minimum requirements. They say, currently, it’s not only difficult to determine how much money governments receive, but also how those dollars are spent. Many people have reached out to local officials with questions or suggestions only to be turned away or ignored.
Christine Minhee, founder of OpioidSettlementTracker.com, found that, as of March, only 12 states had committed to publicly reporting the use of 100% of their settlement dollars. Since then, just three more states have promised to share detailed information on their use of the money.
Glowing press releases
Legal and political experts watching the settlements say the lack of transparency may have to do with political leverage. State attorneys general have touted these deals as achievements in glowing press releases.
“Attorney General [Daniel] Cameron today delivered on his promise to fight back against the opioid epidemic by announcing a more than $53 million agreement with Walmart,” read one press release issued late last year by the state of Kentucky.
“Thousands of our neighbors have buried their loved ones throughout the opioid epidemic” and “I am proud to have delivered this great agreement to them,” said Louisiana Attorney General Jeff Landry, in a July 2021 announcement when one of the earliest settlements was finalized.
Greater transparency, including the specific payment amounts for each local government, may take the wind out of some of those press releases, Minhee said. “It’s hard to politicize things when you can’t present the numbers in a vacuum.”
If one community compares its several-hundred-dollar payout to another community’s multi-thousand-dollar payout, there may be political fallout. Concerns have already arisen in rural areas hit hard by the crisis that the distribution formula weighs population numbers too heavily, and they will not receive enough money to address decades of harm.
Still, experts say making this data public is a crucial step in ensuring the settlements fulfill the goal of saving lives and remediating this crisis.
Solutions have to be community-led, said Regina LaBelle, director of the addiction and public policy initiative at Georgetown University’s O’Neill Institute. “In order to do that, the communities themselves need to know how much money they’re getting.”
If their county is receiving $5,000 this year, it wouldn’t make sense to advocate for a $500,000 detox facility. Instead, they might focus on purchasing naloxone, a medication that reverses opioid overdoses. Knowing the yearly amount also allows people to track the funds and ensure they’re not being misspent, LaBelle added.
For Cauchon, of Harm Reduction Ohio, the local-level payment data is key to ensuring settlement dollars are put to good use in each Ohio county.
“Knowledge is power and, in this case, it’s the power to know how much money is available to be used to prevent overdoses,” he said.
This story is republished from?KFF Health News, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.
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