How will NC spend its opioid settlement money?

man stands by a podium, gesturing with his hands, speaking to an unseen audience at the opioid summit


The state of North Carolina reached an agreement with its counties about how it would spend potential settlement money coming from massive multi-state lawsuits against opioid distributors and manufacturers for their alleged role in the opioid epidemic.

By Taylor Knopf

A windfall of cash could be headed to North Carolina if multi-state settlement agreements are reached with opioid distributors and manufacturers for their alleged roles in fueling the opioid epidemic.

The total of these settlements with drug distributors Cardinal, McKesson, and AmerisourceBergen, along with opioid manufacturers Johnson & Johnson and Purdue Pharma, could be as high as $26 billion. North Carolina could receive as much as $850 million over an 18-year period.

In anticipation of these funds, the N.C. Attorney General’s Office reached an agreement last week with the N.C. Association of County Commissioners about how to spend the money.

“This is an agreement that essentially says, if there is money coming from the national level, what happens to it in North Carolina,” Steve Mange, Senior Policy & Strategy Counsel to North Carolina Attorney General, told attendees of the Opioid Misuse & Overdose Prevention Summit on Tuesday.

“The first and most important and newsworthy theme is that all of the money — 100 percent of any money coming into North Carolina from the national opioid settlement or bankruptcy resolution — will be spent on evidence-informed strategies to address the epidemic,” he said.

There won’t be a repeat of the tobacco master settlement agreement where little of the money went toward tobacco cessation or public health efforts, Mange added.

This agreement comes as opioid overdose deaths are at an all-time high. Pandemic-related stressors have fueled overdoses. The prevalence of contaminated street drugs has made those overdoses more deadly.

In 2019, even before the pandemic struck, an average of six North Carolinians died each day from drug overdoses. Illegal opioids such as fentanyl and heroin made up 78 percent of overdoses in that year.

According to North Carolina’s agreement with the counties, 80 percent of any settlement money will go to the counties and local governments. Fifteen percent will be appropriated by the General Assembly to address the opioid epidemic. And the remaining 5 percent will go toward an incentive fund to encourage counties to sign on to this agreement, the Attorney General’s office outlined in a recent press release.

Currently, the state of North Carolina, 76 counties and eight municipalities have sued opioid manufacturers and distributors over the opioid epidemic. However, all of the state’s counties and municipalities have the opportunity to sign this spending agreement with the state, according to the Attorney General’s office.

“The opioid epidemic, in recent years, has taken the lives of more than 16,000 North Carolinians, torn families apart, and ravaged communities from the mountains to the coast,” said Attorney General Josh Stein in a press release.

“These companies helped to create and fuel this epidemic with irresponsible marketing and a lack of oversight – and they must be held accountable to help clean up this mess,” he said. “Should we prevail, today’s agreement between the counties and the state is an important step toward getting much-needed resources to communities across North Carolina as they work to address the epidemic and its aftermath.”

Details about options for how counties could proceed and how the money would be spent and publicly reported include:

  • Under Option A, a local government may fund one or more strategies from a shorter list of evidence-based, high-impact strategies to address the epidemic. Under Option A, local governments may use opioid settlement proceeds to fund: 
    • Collaborative strategic planning 
    • Evidence-based addiction treatment 
    • Recovery support services 
    • Recovery housing support 
    • Employment-related services 
    • Early intervention programs 
    • Naloxone distribution 
    • Post-overdose response teams 
    • Syringe service programs 
    • Criminal justice diversion programs 
    • Addiction treatment for incarcerated persons 
    • Reentry programs for recently incarcerated persons
  • Under Option B, a local government may fund one or more strategies from a longer list of strategies after engaging in a collaborative strategic planning process involving a diverse array of stakeholders at the local level. This includes an array of strategies that: 
    • Treat Opioid Use Disorder (OUD) 
    • Support people in treatment and recovery 
    • Provide connections to care 
    • Address the needs of criminal-justice-involved persons with OUD 
    • Address the needs of pregnant or parenting women and their families 
    • Prevent over-prescribing of opioids 
    • Prevent misuse of opioids 
    • Prevent overdose deaths and other harms (harm reduction) 
    • Support first responders 
    • Promote leadership, planning, and coordination 
    • Fund relevant training and research
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