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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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Bottom 10: Where the teams aren’t hot, but the coaches’ seats are

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September 17, 2025

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Bottom 10: Where the teams aren't hot, but the coaches' seats are

  • Ryan McGeeSep 17, 2025, 07:00 AM ET

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    • Senior writer for ESPN The Magazine and ESPN.com
    • 2-time Sports Emmy winner
    • 2010, 2014 NMPA Writer of the Year

Inspirational thought of the week:

Time everlasting
Time to play B sides
Time ain’t on my side
Time I’ll never know

Burn out the day
Burn out the night
I’m not the one to tell you what’s wrong or what’s right
I’ve seen suns that were freezing and lives that were through
But I’m burning, I’m burning, I’m burning for you

— “Burnin’ For You,” Blue Oyster Cult

Here at Bottom 10 Headquarters, currently located behind the huge pile of to-go containers that Jess Sims brings home from all of her “College GameDay” road eats segments, we know that where there is smoke, there is also fire. And barbecue. And ash. But hopefully no ash on the barbecue.

There are a lot of chairs being barbecued in college football these days. Hot seats that became kindling, and way too early for an October fall harvest bonfire. UCLA and Virginia Tech became the first FBS teams to part ways in-season with their head coaches, one a legendary former player and the other a legendary former assistant coach. And that has led to a hunka hunka burning “Who’s Next?” hot seat lists.

It’s enough to make one, well, take a seat, and pause to contemplate their place in this world. Might one day we wake up to find an athletic director standing in the door of our office with a pink slip? Or a booster who sells cars and thinks he’s an expert on the spread offense standing in our door with a buyout check? Or Lane Kiffin standing in the door of our kitchen with a tape measure and fabric samples? And … wait … as we sit here … did someone spill some Tabasco on this chair or did we accidentally get some muscle rub in our drawers?

With apologies to Navy O-lineman Connor Heater, Ole Miss D-tackle Jon Seaton and Steve Harvey, here are the post-Week 3 Bottom 10 rankings.

The Amherst Amblers fell to 0-3 via a 47-7 loss at Iowa, which was also Kirk Ferentz’s 206th victory, making him the winningest coach in Big Ten Conference history. It was a fitting coincidence considering that Ferentz took the Hawkeyes job while the original Minutemen were still in Massachusetts.

The Bearkats kouldn’t enjoy the bye week on their kalendar bekause they still kouldn’t kover the spread against Open Date U. Now they will kombat Texas and kuarterbacking konundrum Arch Manning.

There are currently 11 0-and-something teams in the FBS, and five reside in #MACtion. Sources have told Bottom 10 JortsCenter that those teams have all asked Ohio if they can have the contact info for West Virginia’s scheduling guy.

In related news, sources are also telling us that after firing head coach DeShaun Foster, UCLA officials attempted to see if the NCAA would let them return to the Pac-2, but their calls kept getting kicked to voicemail because the NCAA lines were tied up with all of the UCLA players ringing the transfer portal hotline.

Since their dramatic run to the College Football Playoff national title game, the Irish are 0-3. It’s not an ugly 0-3. It’s 0-3 against three ranked teams by a combined 15 points — and the two losses this season are by a combined four points. But with no conference championship at their disposal and only one ranked opponent remaining on their schedule, the Irish CFP safety net is thinner than the margin of whether Rudy was or wasn’t offside.

Virginia Tech spent the offseason having its roster raided like a rum runner boat boarded by Jack Sparrow, lost a game to the son of its legendary coach, got run over by Vandy, got blown out by supposed little brother in-state school Old Dominion and fired its head coach so early in the season that the players who were left from the first transfer portal raid could start their own transfer portal exit if they wanted. My pal Marty Smith hasn’t been this upset since I accidentally spilled Swiss Miss on his white Air Jordan Dior’s.

7. Oregon Trail State (You have died of dysentery) (0-3)

Full disclosure: I am currently writing this in a hotel room in Corvallis, where I’m working on a “College GameDay” feature about the platypus trophy that the Beavers and Ducks will play for this weekend. I am … pretty … sure … they’re … messing … wItH … THEE … hOtEl … WHYFY … 2 … kEEp … mE … frum … FY-LING … this … STorY …

I don’t want y’all to get too excited, but I am looking at the schedule and on back-to-back Tuesday nights in November, Weeks 12 and 13, Akron hosts UMess and State of Kent. That rapid clicking you heard was me checking on hotels and flights and then emailing the GameDay honchos to try to convince them to do shows from Akron with me for seven straight days. That one solitary click you heard was them hanging up on me.

The Golden Flashes in the Pan lived up to that name, constructing a NSFW 21-play, 93-yard, 12-plus-minute drive to take a 28-24 lead over the Buffalo Bulls Not Bills with 2:38 remaining … and then surrendering 76 yards on eight plays in 1:29 to lose their 24th straight FBS game, 17th straight MAC game and 11th straight conference game at home. That’s not NSFW, that’s NC-17. Shoutout to a year ago, when the Flashes’ upcoming visit to Florida State would have been the Pillow Fight of the Week.

Speaking of NC-17, have y’all peeped Florida’s schedule? It’s the scariest thing I’ve seen since that time my family visited a Florida truck stop and my daughter bought what she thought was a souvenir rubber alligator, but then a few miles down the road it bit the dog.

Waiting list: Do You Know The Way to San Jose State, Northworstern, My Hammy of Ohio, Western Not Eastern or Central Michigan, Kennesaw Mountain Landis State, No-vada, the team that barely beat No-vada, Baller State, We’re Not In Kansas State Anymore, replay reviews that make on-field refs quit.

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Dabo defends record following 1-2 start, poll exit

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September 17, 2025

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Dabo defends record following 1-2 start, poll exit

  • Andrea AdelsonSep 16, 2025, 04:41 PM ET

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    • ACC reporter.
    • Joined ESPN.com in 2010.
    • Graduate of the University of Florida.

Dabo Swinney defended his program, which has started 1-2, during a fiery news conference Tuesday, saying, in part, that if Clemson was tired of winning “they can send me on my way.”

The Tigers started the season ranked No. 4 with College Football Playoff hopes but fell out of the Top 25 this week after losing to Georgia Tech 24-21. They opened the year with a 17-10 home loss to LSU and trailed Troy at halftime in Week 2, also at home, before rallying to win.

“Hey, listen, if Clemson’s tired of winning, they can send me on my way,” Swinney said. “But I’m gonna go somewhere else and coach. I ain’t going to the beach. Hell, I’m 55. I’ve got a long way to go. Y’all are gonna have to deal with me for a while.”

Clemson has not been in sync on offense, with third-year starting quarterback Cade Klubnik struggling to find rhythm and consistency, and the defense is still learning to adapt to new defensive coordinator Tom Allen.

Swinney said Tuesday that he was confident his team would respond, starting Saturday against Syracuse, because that is what his program has done during hard moments. But he also had a message to critics who have questioned where Clemson goes from here after two tough losses.

“I would just say, if you don’t believe in us because we’ve lost two games down to the last play and we’re 1-2? You didn’t believe in us anyways, so it don’t matter,” Swinney said. “You weren’t all-in anyway.”

Swinney pointed out that in his 17 years as head coach at Clemson, he has had one bad season — going 6-7 in 2010. In 13 of the last 14 years, Clemson has won 10 or more games. That lone season without 10 wins came in 2023, when Clemson started 4-4 but wound up winning five straight to finish 9-4.

“All we’ve done is win,” Swinney said. “We’ve won this league eight out of the last 10 years. Is that not good? I’m just asking. Is that good? To win your league eight out of 10 years, to go to the playoffs seven out of 10 years, be in four national championships, win it twice. Yeah, we’re a little down right now. Take your shots. I’ve got a long memory. We’ll be all right. We’ll bounce back.”

Swinney pointed out all the other times Clemson has rebounded from difficult losses — including 2021, after losing to Georgia to open the season, and last season — winning the ACC title and making the 12-team CFP after losing to South Carolina in the regular-season finale.

Clemson lost to Texas in the first round of the playoff 38-24, but the bulk of its team returned for 2025, making the Tigers the heavy favorite to repeat as ACC champions. Instead, the season has not started the way anybody expected.

“If we stink because we haven’t played for the national championship since January of ’20, well, I guess we stink,” Swinney said. “But why are we held to a different standard from all these other teams out there who ain’t ever won nothing?”

Swinney has had to fight off questions about his program nearly every year since it last made the playoff in 2020.

In 2023, Swinney made similar comments about leaving Clemson after “Tyler from Spartanburg” called into his radio show and wondered why the school paid over $10 million to go 4-4.

“I work for the board of trustees, the president and the AD, and if they’re tired of me leading this program, all they got to do is let me know. I’ll go somewhere else where there is an appreciation,” Swinney said at the time. “I don’t know if it’ll be here, but it’ll be somewhere.”

On Tuesday, Swinney returned to the missed plays his team made in the two losses that could have made a difference and said he continues to have “faith in the storm.”

“We’re not perfect, and we may suck this year,” Swinney said. “We may lay a freaking egg and go 6-6. But I don’t think so. I know that’s going to disappoint a lot of people, but I don’t think so. The reason we are the best program in college football is because we’ve always battled. We’ve always responded.

“Let’s respond like we always have and let the story be written.”

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Mateer, Beck take over as Heisman favorites

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September 17, 2025

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Mateer, Beck take over as Heisman favorites

Three weeks of college football down, and the race for the Heisman Trophy is even more wide open than it was at the start of the season, according to oddsmakers.

Oklahoma quarterback John Mateer is the new favorite for the award at several sportsbooks, with ESPN BET showing +850 odds as of Tuesday afternoon. At some other shops, though, Miami QB Carson Beck is the favorite, getting as short marketwide as +700 at BetMGM.

Either way, it’s the longest odds for a Heisman favorite at this point in the season since at least 2012, according to data compiled by ESPN Research from SportsOddsHistory.com; the previous longest favorite was LSU running back Leonard Fournette at +500 heading into Week 4. It’s largely in line with how bookmakers saw the Heisman race playing out, as Texas QB Arch Manning was the longest preseason favorite in over 15 years at +650.

Manning’s odds to win the trophy have fallen precipitously amid struggles in his first three weeks as the full-time Longhorns starter, as he currently ranks tied for 15th on the board at +3000, per ESPN BET. Due to his name recognition and overall popularity, he is still the most-bet player in the market by tickets and handle at BetMGM and DraftKings, making him a liability with the books.

South Carolina QB LaNorris Sellers also was a popular play for bettors before the season and is “currently our biggest liability for the Heisman market,” according to ESPN BET senior trading director Adrian Horton. After he was injured in the Gamecocks’ 31-7 loss against Vanderbilt, Sellers’ odds have lengthened all the way to +5000 from +1400 before the season. Cade Klubnik, who was the second favorite (+900) coming into the campaign, has seen his odds fall all the way to 100-1 amid poor play and a 1-2 record for his Clemson Tigers.

Aside from LSU QB Garrett Nussmeier, who moved from last week’s favorite to tied for third on the board at +1300, the new crop of favorites features somewhat less liability for sportsbooks. Mateer, Beck and Oregon QB Dante Moore (also +1300) were not overly popular preseason plays and have not picked up a ton of momentum with bettors despite strong starts to the season. Moore, for example, is the 10th-most-bet player by handle at ESPN BET but does not even crack the top 10 at either BetMGM or DraftKings.

There are, however, two names to watch outside of the quarterback position as the Heisman race heats up. Ohio State wide receiver Jeremiah Smith (+1800) and Notre Dame RB Jeremiyah Love (+6000) are both listed as significant liabilities at BetMGM, and Love, in particular, has gotten significant action at ESPN BET. “That will have us keeping a close eye on the Irish running back,” Horton said.

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