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This year, about $1.5 billion has landed in state and local government coffers from court settlements made with more than a dozen companies that manufactured, sold, or distributed prescription painkillers and were sued for their role in fueling the opioid crisis.

This story also ran on NPR. It can be republished for free.

That money has gone from an emerging funding stream for which people had lofty but uncertain aspirations to a coveted pot of billions of dollars being invested in real time to address addiction.

Altogether, the companies are expected to pay more than $50 billion to state and local governments over nearly two decades.

Meanwhile, more than 100,000 Americans have died of drug overdoses annually in recent years, underscoring the urgent nature of the crisis.

KFF Health News has been tracking the funds all year and covering the windfalls mixed impact in communities across the country. Here are five things weve noticed in 2023 and plan to keep an eye on next year:

1. The total amount of settlement money state and local governments expect to receive is a moving target.

Before the start of the year, national settlements were in place with at least five companies, and several other deals were in the final stages, said Christine Minhee, founder of OpioidSettlementTracker.com.

Today, most states are participating in settlements with opioid manufacturers Johnson & Johnson, Teva Pharmaceutical Industries, and Allergan; pharmaceutical distributors AmerisourceBergen, Cardinal Health, and McKesson; and retail pharmacies Walmart, Walgreens, and CVS. Many are also settling with the national supermarket chain Kroger. More from This InvestigationPayback: Tracking the Opioid Settlement Cash

Opioid manufacturers and distributors are paying more than $54 billion in restitution to settle lawsuits about their role in the overdose epidemic, with little oversight on how the money is spent. Were tracking how state and local governments use or misuse the cash.Read More

Several of these deals began paying out in the second half of this year, leading to bumps in states opioid settlement pots.

But there have been dents and slowdowns too.

Mallinckrodt Pharmaceuticals, a manufacturer of generic opioids, originally agreed to pay $1.7 billion as a result of its 2020 bankruptcy filing to state and local governments, as well as people directly affected by the crisis. But the company filed a second bankruptcy in August, slashing $1 billion from that figure.

Purdue Pharma, perhaps the best known of all the companies for its creation and marketing of OxyContin, had agreed to pay $6 billion as part of its bankruptcy proceedings. But the Biden administration objected to the deal this summer, and the case now lies in the hands of the Supreme Court. At its core is the question of whether its legal for the Sackler family to gain immunity from future civil cases about the opioid crisis under the companys bankruptcy deal when they have not filed for bankruptcy as individuals.

The Supreme Court heard arguments in December and is expected to rule on the case next spring or summer. Until then, no Purdue money will flow. Advocates and victims of the opioid crisis gather outside the U.S. Supreme Court on Dec. 4, while the justices hear a case about Purdue Pharmas bankruptcy deal. The protesters urged justices to overturn the deal, which would give the Sackler family immunity against future civil cases related to opioids.(Aneri Pattani/KFF Health News)

2. Most states still arent being transparent about how the money is used.

In March, KFF Health News and Minhee published a comprehensive investigation showing that only 12 states had promised to publicly report how they were using all their settlement dollars.

Since then, that number has inched up to 16.

But 15 states still have not committed to publicly reporting anything at all, and others have promised to publicize only a portion of their spending.

Many people arent happy about the secrecy.

In Ohio, a local advocacy group, Harm Reduction Ohio, sued the OneOhio Recovery Foundation, which controls most of the states settlement dollars, for violating public records and open-meeting laws. Although a judge ruled in favor of the advocacy group, it became a moot point in July, when the state passed a budget that included language exempting the foundation from such requirements.

In Michigan, the Department of Health and Human Services came under fire for not publicly reporting how it was spending upward of $40 million in settlement funds. In October just hours before a legislative subcommittee hearing in which lawmakers asked critical questions about the money the department launched a website, displaying a breakdown of organizations to which it had awarded funds.

At the national level, a dozen Democratic lawmakers have raised concerns about a lack of transparency and oversight via a Sept. 25 letter to the Office of National Drug Control Policy, which is leading the federal governments response to the opioid crisis.

We urge the Biden administration to closely track opioid settlement fund spending, to ensure that populations in need of additional support receive it, the lawmakers wrote.

The Office of National Drug Control Policy responded this month that it did not have the statutory authority from Congress to do so.

Currently, no mechanism exists that would allow ONDCP to require states to disclose their spending, the office wrote in a letter obtained by KFF Health News. ONDCP cannot effectively monitor how states use these funds. Email Sign-Up

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3. Nationwide, money is being spent in several common areas.

Although there is no national data on how settlement dollars are spent, piecemeal tracking by journalists and advocates has surfaced some favorites.

One of the biggest is investing in treatment. Many jurisdictions are building residential rehab facilities or expanding existing ones. Theyre covering the cost of care for uninsured people and trying to increase the number of clinicians prescribing medications for opioid use disorder, which have been shown to save lives.

Another common expense is naloxone, a medication that reverses opioid overdoses. Wisconsin is spending about $8 million on this effort. Kentucky has dedicated $1 million. And many local governments are allocating smaller amounts.

Some other choices have sparked controversies. Share Your Story

Do you have concerns about how your state or locality is using the opioid settlement funds? Are they doing something effective that other places should replicate? Tell us here.Share Your Story

Several governments used settlement dollars to purchase police patrol cars, technology to help officers hack into phones, and body scanners for jails. Supporters say these tools are critical to crack down on drug trafficking, but research suggests law enforcement efforts dont prevent overdoses.

People are also divided over school-based programs to prevent kids from developing addictions. While they agree on the goal, some people favor programs that teach kids about the dangers of drugs like D.A.R.E. in the 80s while others prefer programs focused on improving mental health, resiliency, and communication skills.

Perhaps the most contentious use, though, is shoring up county budgets and paying back old bills. Even if its legal, many people directly affected by the epidemic say this misses the goal of the settlement money, which is to address todays ongoing crisis.

4. The settlements required companies to change problematic business practices, but that has had unintended consequences.

As part of their settlements, manufacturers like Allergan and Johnson & Johnson agreed not to sell opioids for 10 years and curb marketing and promotion activities. Pharmaceutical distributors were required to step up efforts to identify suspicious orders from pharmacies, under the oversight of an independent third-party monitor. Retail pharmacy chains must condct audits and site visits to their pharmacies, as well as share data with state agencies about problematic prescribers.

The goal of these stipulations is to prevent further misuse of prescription opioids. But some people see unintended consequences.

Distributors have placed stricter limits not only on pharmacy orders of opioids, but on many drugs considered potentially addictive, known as controlled substances. As a result, orders for these medications are being canceled more often and some pharmacies are hesitant to fill prescriptions for new patients. That has left people struggling to obtain medications for chronic pain, anxiety, attention-deficit/hyperactivity disorder and, ironically, even medication that treats opioid addiction.

Bayla Ostrach, a researcher in North Carolina who studies substance use and health policy, said buprenorphine, which is considered a gold-standard treatment for opioid use disorder, was already difficult to obtain at many community pharmacies and in rural areas. But the settlements appear to be making it worse.

Instead of increasing access to treatment which is critical to stemming the number of overdoses I really worry the settlements may be having the opposite effect, Ostrach said. Members of the Washington, D.C., Opioid Abatement Advisory Commission, which will advise on the use of more than $80 million, met for the first time and were sworn in on Oct. 25. Like many other jurisdictions, the District of Columbia has yet to spend any of its settlement funds.(Aneri Pattani/KFF Health News)

5. Many places haven’t decided what to do with the money yet.

Several states, including Montana and Hawaii, have yet to spend any of the settlement funds controlled by their state agencies. In Maine and West Virginia, councils overseeing the lions share of funds are still in the process of identifying priorities and developing processes to award grants.

Across the nation, some county officials say they need more guidance on appropriate uses of the money. Others are surveying residents on what they want before making decisions.

The slow pace has frustrated some advocates, who say there should be greater urgency at a time when the drug supply is becoming increasingly deadly. But others say the money will continue arriving through 2038, so setting up thoughtful processes now could pay off for years to come.

Its a trade-off between putting out current fires and preventing future ones, said Shelly Weizman, project director of the addiction and public policy initiative at Georgetown Universitys ONeill Institute. Shes hopeful officials will strike the right balance.

Is there a vision in each state about where were going to be when the settlement monies are done? she said. My hope is that 18 years from now were not still where we are today.

Aneri Pattani: apattani@kff.org, @aneripattani Related Topics Courts Public Health States Investigation Opioid Settlements Opioids Substance Misuse Contact Us Submit a Story Tip

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Keys to ALCS Game 6 (and maybe 7): Superstar dilemmas, secret heroes and numbers to watch

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October 19, 2025

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Keys to ALCS Game 6 (and maybe 7): Superstar dilemmas, secret heroes and numbers to watch

  • David SchoenfieldOct 19, 2025, 07:00 AM ET

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    • Covers MLB for ESPN.com
    • Former deputy editor of Page 2
    • Been with ESPN.com since 1995

Are we having fun yet? Friday was one of the most unforgettable days ever seen in the playoffs, with Eugenio Suarez’s go-ahead grand slam rocking T-Mobile Park and putting the Seattle Mariners one win away from the World Series, and then Shohei Ohtani’s historic three-homer, 10-strikeout performance that goes down as perhaps the single greatest individual performance in postseason history.

Let’s call it a top-five day of all time and add this to our list of future projects to research. Meanwhile, with Ohtani’s Los Angeles Dodgers in the World Series, we’re left with one game Sunday: The Seattle Mariners vs. the Toronto Blue Jays, Game 6 of the ALCS.

Let’s dig into it with some of the keys to watch with the remaining World Series spot at stake.

Guerrero is having a monster postseason, hitting .457/.524/.971 with five home runs. After a hitless first two games of the ALCS, he did his best Roy Hobbs impersonation in Seattle, going 7-for-11 with five extra-base hits. He has just two strikeouts in 42 postseason plate appearances, and he has had 15 balls in play register over 100 mph, including six of his seven hits at T-Mobile.

“He’s a special player, a special talent, an awesome guy to be around,” teammate Ernie Clement said. “He’s earned every bit of success that he’s having, and I couldn’t be happier for him. Just really proud of the work he’s put in. To do it on the biggest stages, it’s a testament to his work.”

In Game 5, the Mariners intentionally walked Guerrero twice, once in the fourth inning with nobody out and a runner on second base — his second intentional walk of the postseason with nobody out, the first time that has happened since 2016 — and then in the seventh with two outs and a runner on second.

The Mariners escaped both jams, but they’re playing with fire — and that’s whether they pitch to him or whether they put him on. It’s certainly not an easy decision for manager Dan Wilson with Guerrero so locked in, but eventually one of those intentional walks is going to backfire and potentially lead to a big inning.

Toronto’s challenge: Getting Cal Raleigh out

Raleigh is following up his historic 60-homer season with an outstanding postseason of his own, hitting .333/.435/.692 with four home runs, the one Mariner who has provided consistent offense. Suarez’s slam was the moment for the history books in Game 5, but that moment might never happen if Raleigh doesn’t first tie the game leading off the eighth inning with his towering home run to left that looked high enough to soar over the Space Needle.

“Oh my god, that ball took forever to get down,” said teammate Bryan Woo. “I can’t say that I’m surprised anymore, but he just continues to impress and show up in big moments.”

The Blue Jays have mostly gone right after Raleigh, who has drawn three walks in five games, one of those intentional. That included the game-tying home run when Brendon Little fell behind 2-0 but came in with a fastball — a little too much down the middle.

“A lot of times I get out there and just start swinging and try to hit something hard,” Raleigh said, “but I was patient waiting for my pitch there and understanding to let the game come to me, try and make solid contact, don’t need a home run, don’t need to try to hit a ball 500 feet, just do something good and adrenaline will usually take over in those moments.”

Toronto’s potential secret hero: Ernie Clement

Following the Blue Jays’ win in Game 3, Clement called himself “probably the worst hitter in baseball” a couple years ago. He was referring to 2022, when he hit .184/.243/.209 in 179 plate appearances with the Guardians and Athletics — which led to the Guardians letting him go, and then the A’s, with the Blue Jays claiming him on waivers during spring training in 2023.

The one-time worst hitter in baseball played 157 games this season, had his best season at the plate with a .277/.313/.398 line and 46 extra-base hits, and is a Gold Glove finalist at two positions — third base (where he started 66 games) and the utility slot (he also started games at second base, shortstop and first base).

He has followed that up with an exceptional postseason, hitting .429 with 15 hits, the most for a player in his first nine career postseason games since Daniel Murphy in 2015. He attributes his success to learning from his failures — “I’ve had quite a few of those,” he said — and understanding that he’s at his best when he’s swinging often, even if that goes against the modern convention of waiting for your pitch.

“I just started to lean into my strength a little bit, which is putting the bat on the ball. I kind of tried to work the count a little bit and maybe try to draw some walks and hit for more power, and that’s just not really my game. Over the last couple years, I’ve learned to just make it hard on the opposing pitchers with my ability to get hits on pitchers’ pitches, and I’ve just really been more aggressive.”

Seattle’s potential secret hero: Bryan Woo

The Mariners’ top starter in the regular season had been sidelined since Sept. 19 due to a right pectoral strain. He wasn’t on the ALDS roster but finally made his postseason debut in Game 5, pitching two innings in relief in Game 5. Alejandro Kirk greeted him with a ringing double and then Clement drove him with an RBI single, although bounced back with a scoreless seventh, getting out of that jam when Kirk tapped back to the mound.

It wasn’t necessarily a stellar effort — he didn’t record a strikeout and had just two swings and misses out of 28 pitches — but it was good enough. He did enjoy running through the “flames” as he left the bullpen for the mound. “Yeah, I told Logan [Gilbert] when he did it the other day, he looked like the coolest he’s ever looked, so I tried to replicate that.”

Woo said he’ll have to wait and see how he feels over the next couple of days, and he isn’t stretched back out to start yet but said “I’d love to contribute the next couple of games.” Given Wilson’s quick hook with Luis Castillo in Game 4 and relatively quick hook with Miller in Game 5, Woo’s potential to throw multiple innings to help bridge the gap to closer Andres Munoz looms large, whether it’s in Game 6 or Game 7.

Key stat to watch: 28 vs. 49

The Blue Jays have struck out just 28 times in the first five games compared to 49 for the Mariners. The Blue Jays had the lowest strikeout rate in the majors in the regular season and have been striking out even less often during the playoffs (just 14.4% of the time in the ALCS). That hasn’t actually produced much more hard contact in this series, however, as the Jays have 53 balls in play classified as hard-hit balls (95-plus mph) while the Mariners have hit 51. The Jays have 14 at 105-plus mph, and the Mariners have 15.

Still, on Friday everything went the Mariners’ way.

“To be honest, we dodged a lot of bullets today,” Raleigh said. There was a the double play on a line drive to first baseman Josh Naylor, Leo Rivas made a nice leaping grab of a line drive up the middle, Raleigh turned Clement’s ball in front of the plate into another double play and Randy Arozarena made a leaping grab at the wall in the eighth to rob Clement of a potential home run.

Over the long haul, swing-and-miss is still a good thing for pitching staffs, and Seattle’s hasn’t generated nearly as much as Toronto’s: The Jays have swung and missed 70 times compared to 102 for the Mariners.

Logan Gilbert, Seattle’s Game 6 starter, was a big swing-and-miss pitcher during the regular season with the third highest strikeout rate among pitchers with at least 100 innings, behind only Zack Wheeler and Chris Sale. He lasted just three innings in his Game 2 start, however, generating just five swinging strikes in 58 pitches. The Mariners will hope that poor effort was a result of starting on two days of rest after pitching two innings in relief in the 15-inning win over Detroit in the ALDS.

Likewise, Trey Yesavage, Toronto’s rookie starter who has pitched just 23.1 innings in the big leagues, will try to find his form from his ALDS start against the Yankees when he struck out 11 in 5.1 hitless innings. The Mariners got to him for five runs in four innings in Game 2 as he walked three, and Julio Rodriguez hit a three-run homer in the first inning.

The key decision: When to go to the bullpens

Both managers have deployed quick hooks with the starters — and both saw those moves backfire in the three games in Seattle. In Game 4, Wilson pulled Luis Castillo in the third inning after just 48 pitches, the shortest start of Castillo’s career, and went early to his high-leverage relievers, but Gabe Speier walked in one of Castillo’s runs, and Matt Brash threw a wild pitch to let in one of the two runs Speier allowed. Wilson doubled in Game 5, pulling Bryce Miller after a leadoff single in the fifth even though he had yet to allow a run. Brash let that inherited runner score, and then Bryan Woo later allowed another run.

Blue Jays manager John Schneider’s decision in Game 5 might have been even more questionable, leaving closer Jeff Hoffman in the pen in the eighth while going first to Brendon Little and then to Seranthony Dominguez, and they combined to allow five runs in blowing the 2-1 lead. Hoffman never got in the game.

Little came on and gave up the home run to Raleigh and then walked the next two batters.

“We talked about it all series,” Schneider said after the game. “Little’s been one of our best pitchers in big spots. Tough guy to elevate. Cal’s a really good hitter. I get it, man. After that, you got to settle down and throw strikes too. So that’s been part of Little’s game. So has strikeouts. Again, I trust every single guy on this roster. It’s hard. No one feels worse than Little, no one feels worse than Ser right now, or me. But I trust every single guy on this roster. Today it didn’t work out, but we’ve won two games in a row a whole lot this year.”

That’s where we’re at: The Blue Jays need to win two to reach their first World Series since 1993. The Mariners need one to reach their first. Ohtani and the Dodgers await. Let’s play some ball.

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Donald Trump mocks ‘No Kings’ protests with AI video of himself dropping brown sludge on protesters from jet

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October 19, 2025

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Donald Trump mocks 'No Kings' protests with AI video of himself dropping brown sludge on protesters from jet

Donald Trump has responded to so-called “No Kings” rallies with an AI video of himself in a fighter jet, pouring brown sludge over protesters.

Millions of people were expected to take part in the demonstrations this weekend – the second such gathering after an initial nationwide day of protest in June coinciding with the US president’s birthday.

The term “No Kings” reflects the belief by some that Mr Trump is behaving like a “king” and some in his administration are depicting him as a monarch.

A protester in costume as Donald Trump presents the president as a prisoner in chains in Seattle. Pic: AP
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A protester in costume as Donald Trump presents the president as a prisoner in chains in Seattle. Pic: AP

One of the rallies in New York. Pic: Reuters
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One of the rallies in New York. Pic: Reuters

On Sunday, the president shared the AI video on his social media platform, Truth Social.

In the clip, an AI-generated version of Mr Trump is wearing a crown and sitting in a jet with “King Trump” written across it, to the soundtrack of Kenny Loggins’ Danger Zone, from the film Top Gun.

The jet then drops thick brown sludge on to AI-generated protesters.

Supporters say the marches are a patriotic defence of free speech, while critics are calling them anti-American.

A large inflatable effigy of Mr Trump in Chicago. Pic: Reuters
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A large inflatable effigy of Mr Trump in Chicago. Pic: Reuters

This protest took place in Washington DC. Pic: AP
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This protest took place in Washington DC. Pic: AP

Mr Trump’s Republican Party has dismissed the demonstrations as “Hate America” rallies.

Many of the events featured marching bands, huge banners and signs, as well as effigies of the president and demonstrators wearing inflatable costumes.

Thousands gathered along the waterfront in Portland, Oregon. Pic: AP
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Thousands gathered along the waterfront in Portland, Oregon. Pic: AP

Protesters at the Wyoming State Capitol got creative with their signs. Pic: Wyoming Tribune Eagle/AP
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Protesters at the Wyoming State Capitol got creative with their signs. Pic: Wyoming Tribune Eagle/AP

The protests follow Mr Trump’s return to the White House and come against the backdrop of a government shutdown which has closed federal programmes and services.

There has also been criticism of what some see as an aggressive executive, confronting Congress and the courts, in ways that protest organisers believe are a slide toward authoritarianism.

This event in San Francisco was among thousands taking place across the US. Pic: Reuters
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This event in San Francisco was among thousands taking place across the US. Pic: Reuters

A 'No Kings' sign, outside City Hall in Los Angeles. Pic: Reuters
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A ‘No Kings’ sign, outside City Hall in Los Angeles. Pic: Reuters

So far, the atmosphere at most of the protests appears to have been largely energetic and upbeat, with protesters calling for accountability and protections for civil liberties.

Organisers said events would be peaceful – a direct response to Republican and Trump administration claims that the protests could be unsafe.

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US airstrike destroyed ‘drug-carrying submarine’, says Trump – as survivors repatriated

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October 19, 2025

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US airstrike destroyed 'drug-carrying submarine', says Trump - as survivors repatriated

Two survivors of a US airstrike, targeting what Donald Trump has described as a “drug-carrying submarine” in the Caribbean, have been repatriated to their home countries.

The US president posted footage of Thursday’s operation, part of a recent military campaign targeting boats transporting drugs to America.

“It was my great honor to destroy a very large DRUG-CARRYING SUBMARINE that was navigating towards the United States on a well known narcotrafficking transit route,” Mr Trump wrote on Truth Social.

“US intelligence confirmed this vessel was loaded up with mostly Fentanyl, and other illegal narcotics,” he added.

The US military staged a helicopter rescue for the survivors on Thursday after the strike on their semi-submersible
vessel, suspected of trafficking illegal narcotics. They were then transported to a US Navy warship.

Two other crew members on board were killed.

The semi-submersible vessel was struck by US forces on Thursday, leaving two dead and two survivors. Pic: @realDonaldTrump/Truth Social
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The semi-submersible vessel was struck by US forces on Thursday, leaving two dead and two survivors. Pic: @realDonaldTrump/Truth Social

President Trump confirmed the survivors would be returned to their home countries of Colombia and Ecuador “for detention and prosecution”. Both countries subsequently confirmed they had been handed over.

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“America will not tolerate narcoterrorists trafficking illegal drugs, by land or by sea,” he added.

On Saturday, Colombian President Gustavo Petro posted on X: “We have received the Colombian detained on the narco submarine, we are happy he is alive and he will be processed according to the law.”

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Trump sends CIA into Venezuela and threatens land attack

Read more from Sky News:
Venezuela’s president pleads for peace
Is Trump planning to attack Venezuela?
Venezuela’s Nobel Peace Prize winner

The Trump administration has said previous strikes in the Caribbean have killed 27 people, raising concerns among some about the legality of the military operations.

The strikes also come against the backdrop of a US military buildup in the Caribbean that includes guided missile destroyers, F-35 fighter jets, a nuclear submarine and around 6,500 troops as the US president escalates a standoff with the Venezuelan government.

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Venezuelan president: ‘We don’t want a war’

On Wednesday, Mr Trump disclosed he had authorised the CIA to conduct covert operations inside Venezuela, adding to speculation in Caracas that the US is attempting to topple Venezuelan President Nicolas Maduro.

Mr Maduro has denied any connection to drug smuggling and claimed the US boat strikes are a pretext for regime change, and violations of sovereignty and international law.

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