The Year in Opioid Settlements: 5 Things You Need to Know

Published

2 years ago

December 21, 2023

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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

Sports

Cal Raleigh Home Run Watch: After two more on Tuesday, will the Big Dumper hit 60?

Published

13 mins ago

September 17, 2025

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Cal Raleigh Home Run Watch: After two more on Tuesday, will the Big Dumper hit 60?

Sep 12, 2025, 12:00 PM ET

The Big Dumper just left the yard again!

In what has become a regular occurrence during Cal Raleigh‘s incredible 2025 season, the Seattle Mariners catcher added two more home runs to his historic total Tuesday — and passed another MLB legend in the process.

Raleigh has already surpassed the record for home runs by a catcher and by a switch-hitter and joined the prestigious 50-homer club, and who could forget his Home Run Derby triumph earlier this summer?

What record could Raleigh set next, how many home runs will he finish with and just how impressive is his season? We’ve got it all covered.

Raleigh must-reads: Raleigh’s road to homer history | Surprising 50-HR seasons | Best power half-seasons in MLB history

Raleigh’s current pace

Raleigh is now at 56 home runs and on pace for 60 with 11 games left.

The American League record is 62, set by Aaron Judge in 2022, and there have been only nine 60-home run seasons in MLB history.

Who Raleigh passed with his latest home run

With his 55th and 56th home runs Tuesday, Raleigh passed Mickey Mantle (yes, you read that right: The Mick himself) for the most in a season by a switch-hitter.

Raleigh and Mantle (who reached the mark twice) are the only switch-hitters in MLB history with 50 long balls in a single season — well ahead of Lance Berkman and Chipper Jones, who each hit 45 in their most prolific home run season.

Who Raleigh can catch with his next home run

The next milestone up for Raleigh is passing Ken Griffey Jr.’s Mariners franchise record of 56, which Raleigh tied with his two-homer effort Tuesday. That’s a number Griffey reached twice — in the 1997 and 1998 seasons.

Raleigh has already joined Griffey as the only Mariners with 50 home runs (or even 45) in a season. Raleigh is also the first Seattle slugger with 40 homers in a season since Nelson Cruz in 2016.

Raleigh’s 5 most impressive feats of 2025

Most home runs in a season by a switch-hitter

With his 55th home run, Raleigh knocked Mickey Mantle, who hit 54 in 1961, from the top spot. Breaking Salvador Perez‘s record of 48 home runs by a primary catcher understandably got a lot of attention, but beating Mantle’s mark is arguably more impressive given how long the record stood and the Hall of Famer’s stature.

One of the best months ever for a catcher

In May, Raleigh hit .304/.430/.739 with 12 home runs and 26 RBIs. Only four catchers have hit more home runs in a calendar month and only eight with at least 100 plate appearances produced a higher slugging percentage. Raleigh was almost as good in June, hitting .300/.398/.690 with 11 home runs and 27 RBIs, giving him two-month totals of .302/.414/.714 with 23 home runs and 53 RBIs. In one blazing 24-game stretch from May 12 to June 7, Raleigh hit .319 with 14 home runs.

Reaching 100 runs and 100 RBIs

Raleigh is sitting on 101 runs scored while leading the American League with 115 RBIs. Only eight other primary catchers have reached 100 in both categories in the same season — Mike Piazza did it twice, in 1997 and 1999, and he and Ivan Rodriguez were the last catchers to do it in ’99. Of the other catchers, seven are in the Hall of Fame (Piazza, Rodriguez, Mickey Cochrane, Yogi Berra, Roy Campanella, Johnny Bench and Carlton Fisk). The lone exception is Darrell Porter, who reached the milestone with the Royals in 1979.

Tying Ken Griffey Jr.’s club record for home runs

Griffey hit 56 home runs for the Mariners in 1997 and 1998, leading the AL both seasons and winning the MVP Award in 1997 (he and Ichiro Suzuki in 2001 are Seattle’s two MVP winners). Griffey had the advantage of playing in the cozy confines of the Kingdome in those years, although his home/road splits were fairly even. Raleigh, however, has had to play in a tough park to hit in, with 30 of his 56 home runs coming on the road, where his OPS is about 100 points higher. That marks only the 19th time a player has reached 30 road homers (by contrast, 30 homers at home has been accomplished 37 times).

An outside shot at most total bases by a catcher

With 317 total bases, Raleigh’s 2025 campaign is already one of only 20 catcher seasons with 300 total bases (yes, time at DH has helped him here). The record is 355, shared by Piazza in 1997 and Bench in 1970 (both played 150-plus games in those seasons). Raleigh would need a strong finish to get there but could at least move into third place ahead of Perez’s 337 total bases in 2021. Not counted in Raleigh’s total bases: his 14 stolen bases!

UK

Trump will be treated to full pomp and pageantry – and no one does it better than Britain

Published

13 mins ago

September 17, 2025

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Trump will be treated to full pomp and pageantry - and no one does it better than Britain

While the nature of Donald Trump’s second state visit is indeed unusual, from the moment Sir Keir Starmer delivered the gold-edged invitation it began a process steeped in tradition.

State visits are usually reserved to one per head of state, with Trump last hosted by Queen Elizabeth II in 2019.

Typically, second-term US presidents are offered a shorter visit, perhaps tea or lunch with the monarch at Windsor Castle. But the red carpet is literally being rolled out once again, with Trump receiving a second full state visit, with all the pomp and pageantry it entails.

An indication was given early on in Trump’s second term that he’d be receptive to a second state visit, and so – on perhaps the advice of the new prime minister – the King issued a second invitation.

The greatest form of tradition is one that always evolves, and so this may now set a new precedent for presidents who are voted out but then return to serve a second term.

Any nation can hold a state visit, but what is unique about Britain remains our internationally respected pageantry.

Even down to the very invitation – there is a very precise format for inviting someone on a state visit.

An invite must be issued, established by international law. Written on a special gold-edged paper, embossed with a golden coat of arms that is issued, it forms part of a historic archive.

Breaches of protocol

Much has been made in the past about moments where protocol was breached – Michelle Obama famously put her arm around Queen Elizabeth in 2011, but, in all honesty, I doubt very much the Queen was upset by this.

The fuss was not made by the late monarch, who accepted that what mattered was that Americans should be made very welcome on behalf of the UK.

And then criticism emerged against Trump, who appeared to make the Queen change places when the Guard of Honour was to be inspected.

But, in truth, it was Elizabeth II who had to correct herself because, in her long life as sovereign, she never escorted a visiting president.

The escort should stand further from the troops and her self-correction was misinterpreted as his error.

Trump’s visit this time will likely generate just as many headlines, but I don’t think there will be critical moments where a breach occurs.

What will happen today?

The Prince and Princess of Wales will greet the president and his wife in the grounds of the Windsor estate in the morning, before accompanying them to meet the King and Queen for an open-air greeting.

Mr and Mrs Trump, the King, Camilla, William, and Kate will then take part in a carriage procession through the estate to the castle, with the carriage ride joined by the Household Cavalry Mounted Regiment, which will provide a Sovereign’s Escort, as well as members of the armed forces and three military bands.

A ceremonial welcome with a guard of honour will be staged in the quadrangle of the castle, as is customary, followed by lunch with the royal family and a visit to see a Royal Collection exhibition within the castle.

The president and his wife will then visit St George’s Chapel privately on Wednesday afternoon to lay a wreath on the tomb of Queen Elizabeth II, whom they both met on their first state visit.

They will then be treated to a flypast by the Red Arrows alongside UK and US F-35 military jets on the east lawn at Windsor Castle, as well as a special Beating Retreat military ceremony.

The traditional grand state banquet is set to follow in the castle’s St George’s Hall in the evening, with both Mr Trump and the King to give speeches as the event gets underway.

What it means for Trump – and is it worth it?

Trump’s mother would cut out and keep in a scrapbook containing pictures of the young Princess Elizabeth and her sister, Margaret Rose. It was an era before endless celebrity news, a time when public life revolved around the royals, the war, and survival.

And the president loved his mother, like many men do, so these things mean an enormous amount to him.

When the horses go back to the stables and the carriages are put away, the impact of this visit will remain fresh in the mind of a president who may feel his nation – and maybe even he himself – have been affirmed by their ally.

Quite apart from the politics, although much will be said and written on that, there is one great hope for any state visit: that the country so many (myself included) have fought for can be safer and more successful as a result of the pomp and pageantry on display.

UK

Why UK’s undersea cables are vulnerable – and Putin has ‘pretty good map’ of where they are

Published

13 mins ago

September 17, 2025

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Why UK's undersea cables are vulnerable - and Putin has 'pretty good map' of where they are

Russia has a “pretty good map” of Britain’s crucial network of undersea cables, experts have warned – potentially presenting Vladimir Putin with a “vulnerable soft underbelly” to attack.

While separated by 21 miles of water, a web of cables and pipelines nonetheless connects the UK and Europe.

These lines carry critical civilian and military communications, electricity and gas – things that underpin the fabric of our society.

But it’s hard to constantly keep an eye on hundreds of miles of subsea cables, leaving them vulnerable to sabotage.

After damage to undersea cables in the Red Sea caused internet disruption in Asia and the Middle East, Sky News looks at what subsea cables are and what damage to one or more of them – accidental or otherwise – could mean for the UK.

A Russian ‘spy’ ship in English waters

When the Yantar research vessel sailed through the English Channel earlier this year, she was followed closely by HMS Somerset.

At first glance, it might be odd for a Royal Navy warship to be asked to shadow a civilian boat. But Britain doesn’t believe the Yantar is a civilian vessel, it believes it is used for Russian surveillance.

Defence Secretary John Healey spelled it out in parliament, saying: “Let me be clear, this is a Russian spy ship used for gathering intelligence and mapping the UK’s critical underwater infrastructure.”

The Yantar complied with international rules of navigation, Mr Healey said. But this was not the first time it had been detected near Britain’s subsea installations, he added.

What are undersea cables?

There are around 60 sets of undersea cables branching out from the UK, Dr Sidharth Kaushal, an expert in maritime technology, told Sky News.

They are fairly wide, he says, and usually encased in a metal sheath. Closer to shore, they are often buried under concrete to further protect them. There are also pipelines which carry gas from the continent.

Some cables are in relatively shallow waters and are relatively easy to repair – they are often damaged unintentionally by commercial activity – while others are in deeper waters and require specialist equipment to fix if a problem arises.

A recent report from the IISS thinktank (the International Institute for Strategic Studies) highlighted the extent to which the European and global economies relies on them.

“Cables transmit around 95% of global data flows and underpin an estimated $10trn in financial transactions every day,” it said.

Making a map?

Experts believe Russia has spent recent years covertly mapping undersea cables in the West – some of which are military and whose locations are not public knowledge.

“We have seen an uptick in activity of Russian surveillance,” said RUSI thinktank expert Dr Kaushal.

Surface vessels have been gathering intelligence, but there have also been reports of Russian uncrewed submersibles being operated near undersea cables, he added.

“Given that this has been a persistent activity in an area on which they have placed some importance for quite some time… one would expect they have a pretty good map.”

What does sabotage look like?

Severing undersea cables can have a detrimental impact on the countries they serve.

“There’s quite a bit of redundancy in the cable networks running across the Atlantic and indeed the cable networks that service the UK,” Dr Kaushal said. “It certainly would not be very easy to sabotage cables… in a way that would be impactful.”

While it might be easy for a hostile state to deny cutting one or two cables, a systematic effort to affect the UK by cutting enough to have an impact would be harder to disavow, he added.

This is particularly the case with cables that are in deeper water, reachable only by a handful of states.

Recent disruption to undersea cables has been blamed on “anchor-dragging by Russia’s shadow fleet”, the IISS said in its report.

In December, Finland seized the Eagle S oil ship which had been carrying Russian oil and was suspected of damaging the Estlink 2 undersea power cable in the Baltic Sea by dragging its anchor across it.

Russia has previously denied damaging undersea infrastructure.

Does the UK need to prepare?

Faced with an increasingly fraught international picture as the war in Ukraine grinds on, the UK parliament’s National Security Strategy committee launched an inquiry into undersea cables earlier this year.

It is examining how well the UK is able to defend its undersea infrastructure – and how resilient the nation would be in the event of a major, protracted disruption to our internet connection.

“Our internet cable network looks like an increasingly vulnerable soft underbelly,” chairman Matt Western MP said as the inquiry began.

“There is no need for panic – we have a good degree of resilience, and awareness of the challenge is growing. But we must be clear-eyed about the risks and consequences: an attack of this nature would hit us hard.”

Dr Kaushal argued that while there is a degree of redundancy in the undersea cables that serve the UK, the pipelines that bring gas to British homes are perhaps more vulnerable.

“I think in some ways the pipeline network is far more fragile because there we are more reliant on a handful of critical pipelines,” he said.