Eighty-five percent of opioid settlement money – $42.5 billion – is subject to no oversight

Letter Text (PDF)

Washington (September 27, 2023) – Senator Edward J. Markey (D-Mass.), chair of the Senate Health, Education, Labor, and Pensions (HELP) Subcommittee on Primary Health and Retirement Security and a member of the U.S. Commission on Combating Synthetic Opioid Trafficking, and Representative David Trone (MD-06), co-chair of the Commission on Combating Synthetic Opioid Trafficking and the Bipartisan Mental Health and Substance Use Disorder Task Force, today urged the Biden administration to more closely scrutinize and oversee over $50 billion in national opioid settlement money. State and local governments will receive this money over the next 15 years as a result of settlement agreements between state and local governments and the opioid manufacturers and distributors and pharmacies that created this epidemic. This settlement funding includes $26 billion from the 2021 settlement agreement involving Janssen, Johnson & Johnson, Cardinal Health, McKesson, and AmerisourceBergen. The letter was also signed by Senators Dick Durbin (D-Ill.), Ron Wyden (D-Ore.), and Sherrod Brown (D-Ohio), and Representatives Lloyd Doggett (TX-35), Jeff Jackson (NC-14), Sheila Jackson Lee (TX-18), Barbara Lee (CA-12), Brittany Pettersen (CO-7), Shri Thanedar (MI-13), and Paul Tonko (NY-20).

The lawmakers urged the Biden administration to ensure that these funds are redistributed to the communities directly harmed by the opioid epidemic through investments in opioid remediation. Opioid remediation includes initiatives such as expanding access to naloxone and increasing funding for substance use disorder treatment programs.

Only 15 percent of expenditures from the opioid settlement funds are required to be reported; the remaining 85 percent, or $42.5 billion, are subject to no oversight. History demonstrates the potential risk of failing to understand how the funding is used. In 1997, tobacco companies entered into a $368 billion settlement for states and cities to use, yet less than three percent of those funds were directed toward smoking prevention and cessation programs. Some experts have referred to the use of tobacco settlements as a cautionary tale.

In their letter to the Biden administration, the lawmakers wrote, “The opioid settlements — more strongly tethered to addressing the opioid epidemic — will give state and local governments an opportunity for historic investments to address this crisis. But we cannot risk looking back decades from now at these settlements as a squandered opportunity. Already, non-governmental entities are tracking the settlement funding and seeing a wide disparity in spending transparency and the amount of non-opioid-related funding. Meanwhile, the Biden administration and Congress are deciding how to spend billions of dollars in federal funding to address the opioid epidemic, with no clear understanding of how federal efforts will interact with state and local initiatives.”

They continued, “The severity of an opioid epidemic felt by every community across the country and that costs the American public trillions of dollars annually requires us to leverage to the fullest extent possible every dollar available to combat it. As you have recognized, ‘expanding access to treatment for substance use disorder, lifesaving interventions like naloxone, and recovery support services will reduce the harms of addiction and the overdose epidemic.’ To maximize our response, we must understand how funding from the federal government interacts with local and state spending drawn from the opioid settlements.”

To understand how the Office of National Drug Policy (ONDCP) oversees these national opioid settlements, the lawmakers request the Biden administration answer the following questions by October 20, 2023:

1. How will ONDCP oversee faithful utilization of the settlement funds?
2. Has ONDCP considered requiring states that receive federal opioid use disorder or substance use disorder funding to adhere to and publicly report on the opioid abatement stipulations of the settlement agreements? If so, how? If not, why not?
3. Has ONDCP identified how states may appropriately use the settlement funds for opioid abatement— much like the Centers for Disease Control and Prevention made recommendations to the states on how they could use funds from the tobacco master settlement agreement for tobacco cessation?
4. Has ONDCP worked with states to ensure that the allocation of settlement funds is equitable and need-based? If so, how? If not, why not?

Senator Markey has been a longtime advocate for communities impacted by the opioid epidemic. In July, Senator Markey applauded the inclusion of his bipartisan and bicameral Department of Defense Overdose Data (DOD) Act as part of the National Defense Authorization Act (NDAA) to record military overdoses, protect service members, and military families living with substance use disorder. In June, Senators Markey and Rick Scott (R-Fla.), along with Senators Marco Rubio (R-Fla.) and Thom Tillis (R-N.C.) and leaders of the House of Representatives’ Bipartisan Mental Health and Substance Use Task Force, announced a bipartisan resolution to designate June 6th as Naloxone Awareness Day. In March, he and his colleagues introduced their bipartisan, bicameral Modernizing Opioid Treatment Access Act, legislation that would improve access to methadone, a SUD medication treatment, by modernizing outdated rules. In December, Senator Markey secured provisions of his bipartisan Opioid Treatment Access Act (OTAA)—legislation that reduces wait times for patients qualifying for methadone medication treatment and expands access to methadone clinics—into the end-of-year omnibus spending package.

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