The Relationship Between State Fiscal Capacity and Opioid Settlement Expenditures

Abstract

Introduction: The distribution of funds from national opioid settlements provides a critical opportunity for states to address the ongoing overdose crisis in the US. However, it remains unclear whether these funds have been spent by states with significant fiscal needs, in addition to higher opioid-related needs.

Methods: We used data from KFF Health News to examine per capita opioid settlement spending across states, categorizing them into tertiles. Fiscal need, defined as the ability of governments to fund programs and services, was assessed using US Census of Governments data, and overdose crisis need was measured using Centers for Disease Control and Prevention overdose mortality data. We identified states as "higher overdose need" and "higher fiscal need" and calculated the mean per capita settlement funds spent for each category.

Results: The mean settlement funds spent per capita were $3.45 (SD: 1.75) for tertile 1 (n = 16), $8.11 (SD: 2.04) for tertile 2 (n = 16), and $ 23.69 (SD: 28.12) for tertile 3 (n = 13). Tertile 3 had the highest overdose death rate (23.69, SD: 28.23), while tertile 2 had the highest fiscal need. States categorized as both higher fiscal and overdose need (n = 12) spent a mean of $21.48 (SD: 33.22) per capita, compared to $7.82 (SD: 4.59) in states with lower fiscal and overdose need (n = 21).

Conclusions: States with higher fiscal and overdose needs spent the most settlement funds per capita in 2022-2023, suggesting effective targeting. Future research should examine whether the opioid settlement funds lead to reductions in overdose deaths, particularly in fiscally constrained areas.

Keywords: Opioid epidemic; health policy; overdose; state governments.