In the 1990s, health care professionals began prescribing opioid pain medications with false reassurance from pharmaceutical companies that the opioids were not habit-forming. The resulting misuse, addiction, and overdoses have been devastating—841,000 deaths from drug overdoses since 1999—two-thirds from opioids. Prevention and treatment services are essential in addressing this public health crisis. This toolkit is designed to help community-based organizations understand how to access the funds available for prevention and remediation through recent settlements with pharmaceutical companies, manufacturers, and retailers.

States, localities, and tribes have reached numerous settlements with opioid manufacturers, pharmaceutical distributors, and pharmacies over the last few years. The 2021 settlement, frequently called the “global settlement,” 1 between 47 states and the distributors McKesson, Amerisource-Bergen, and Cardinal Health and drugmaker Johnson and Johnson totaled $26 billion, to be disbursed over 18 years and frontloaded at the beginning. In 2022, the “big three pharmacies,” 2 CVS, Walgreens, and Walmart, reached settlements of $5 billion over 10 years, $5.7 billion over 15 years, and $3 billion up front, respectively. After a federal judge held up an earlier deal, Purdue Pharma3 agreed to a higher settlement of $5.5 billion, with another $500,000 contingent on selling their pharmaceutical companies. Numerous other smaller settlements have been reached with other entities, including Mallinckrodt ($1.7 billion), Teva ($4.25 billion), AbbVie’s Allergan unit ($2.37 billion), and Endo ($450 million). In total, $50.07 billion4 has been awarded through settlements with opioid corporations.

The settlement funds will go to states and localities to address the opioid epidemic. The “global settlement,” in particular, requires that at least 85% of the funds go to opioid remediation activities. As funds flow to entities nationwide, community-based organizations must have a seat at the table when decisions are made about how these funds are spent locally. These will be significant investments in the kinds of services our sector provides. The profound impact of the opioid epidemic has made it clear that a considerable part of the solution will be strengthening communities with upstream resources and support.

This guide offers tools and resources to help community-based organizations navigate the complex legal and legislative process and to implement lessons learned from past settlements, like with tobacco companies. Organizations should reach out to relevant stakeholders immediately, as these decisions are being made now in many states.