Continued Blaming of Purdue Pharma Won’t Solve the Opioid Crisis

By Lynn R. Webster, MD

On July 15, The Washington Post published an editorial urging states to use opioid settlement funds to expand naloxone access and addiction treatment programs.

These are sound public health goals. But the editorial’s framing — tying these investments to reparations for damage attributed to Purdue Pharma — rests on an oversimplified and misleading narrative that has shaped policy and public opinion for over a decade.

Purdue Pharma aggressively market OxyContin and contributed to early overprescribing. However, it was never the dominant supplier of prescription opioids. Analyses of pill counts, morphine milligram equivalents, and regional variation show that Purdue’s market share was often far less than one-third. While its actions were consequential, the disproportionate focus on Purdue distracts from the broader, ongoing drivers of the crisis.

Addiction is not caused by the availability of opioids alone, but also by the conditions that make people vulnerable: poverty, trauma, housing instability, and untreated mental illness. By fixating on corporate actors, we risk mistaking the spark for the fire — and neglecting the deeper issues that sustain the epidemic.

The editorial also perpetuates confusion between physical dependence and addiction. The former is a predictable response to long-term opioid use; the latter involves compulsive behavior and impairment. Blurring the two has led to harmful policies, including forced opioid tapers and abandonment of stable pain patients.

These policies have not reduced deaths. As prescription opioids became harder to obtain — often due to regulatory pressure — some patients turned to illicit alternatives; not to get high, but to avoid withdrawal or manage pain. This shift laid the groundwork for the explosion of heroin and illicit fentanyl use. Today, illicit synthetic opioids are involved in more than 70% of overdose deaths.

Framing settlement spending as payback reinforces a punitive narrative rather than advancing evidence-based solutions. Naloxone, youth prevention, and addiction treatment should be pursued because they work — not because they symbolize restitution.

The real challenge lies in addressing the conditions that lead to substance use in the first place. Reforming housing policy, expanding mental health care, and ensuring access to meaningful employment are more difficult— but are far more essential — than litigating against a defunct company.

We should also be asking why the healthcare system permitted aggressive opioid marketing, why insurers incentivized pill volume over outcomes, and why evidence-based addiction care and harm reduction remain chronically underfunded.

Managing the crisis requires more than blame. It requires accurate explanations, structural change, and sustained investment in public health — rather than narratives that feel satisfying but obscure the truth.

Lynn R. Webster, MD, is a pain and addiction medicine specialist, and serves as Executive Vice President of scientific affairs at Dr. Vince Clinical Research, where he consults with pharmaceutical companies.

Dr. Webster is the author of the forthcoming book, “Deconstructing Toxic Narratives – Data, Disparities, and a New Path Forward in the Opioid Crisis,” to be published by Springer Nature.

‘This Is Blood Money’: Who Is Policing How Opioid Settlement Funds Are Spent?

By Aneri Pattani, KFF Health News

After years of legal battles, state attorneys general won billions of dollars in opioid settlements from drug companies accused of fueling the addiction crisis. They declared victory at press conferences, and some touted the deals during their gubernatorial campaigns.

But now that the windfall is being spent, are attorneys general doing enough to ensure it’s used for the intended purposes?

No, say many families affected by the overdose crisis, recovery and harm reduction advocates, policy experts, and researchers following the cash.

“This is blood money,” said Toni Torsch, a Maryland resident whose son Dan died of an overdose at age 24. It can’t make up for the lives lost, but “we do want to make sure that it’s going to count.”

Torsch and others affected by the crisis are increasingly worried that no one seems to be guarding the opioid settlement cash while elected officials eye it hungrily. With the Trump administration slashing federal funding for addiction and Congress approving massive reductions to Medicaid — the largest payer for addiction care nationwide — people fear state legislators will use the settlements as a grab bag to fill budget shortfalls.

In the face of these concerns, two research and advocacy organizations are proposing a solution: a crowdsourced database to identify potential examples of misuse and prompt attorneys general to investigate.

The Opioid Policy Institute and Popular Democracy launched a website that allows members of the public to submit alleged cases of waste, fraud, abuse, and mismanagement of opioid settlement funds. Submissions are reviewed by Jonathan Stoltman, director of the Opioid Policy Institute, and then posted with details such as how much money was spent, what was purchased, who made the decision, and links to relevant news articles or budget documents.

The database, shared first with KFF Health News, includes about 150 examples to start, including $2,362 awarded by a Missouri county to its roads and bridge department and $375,600 spent on a body scanner for a Michigan county jail. The initial examples were sourced from people in recovery, advocates, and others Stoltman and his team asked to test the project. Stoltman acknowledged he’ll face criticism as the primary arbiter of what qualifies as misuse for the database, but said he’ll use research studies to defend his decisions.

The website also shows people how to file complaints with their state attorney general and ask the office to develop a formal process for receiving and investigating such complaints.

“I hope this is a wake-up call for state AGs that their work on this project is not done,” said Frank Kearl, who co-led the effort with Stoltman and is working as an attorney at Popular Democracy until July 14. “We still have time” to make changes to ensure we “spend this money in a way that actually responds to the harm that was caused.”

The website’s launch comes just over a week after New Jersey lawmakers passed a budget that gave health systems $45 million in settlement funds despite the state attorney general’s opposition. Legislators said it would shield hospitals from the blow of federal Medicaid cuts, but harm-reduction advocates said it gives short shrift to people with substance use disorders, whom the money was meant to serve.

Lawmakers in North Carolina and Washington, D.C., are also considering using settlement funds to plug gaps, and Connecticut and Nevada have discussed it too.

“That’s not what it’s there for,” said Torsch, who runs a nonprofit dedicated to addiction recovery in her son’s honor. “We want to make sure that money is being spent in the most responsible and effective way to help people that are still struggling.”

Last year, when Torsch heard that a western Maryland county spent some of its settlement money on guns, she reached out to her state attorney general to complain. The office said it wasn’t its responsibility, Torsch said, and told her to contact the health department.

She was confused.

The attorney general’s office is supposed to represent “the top cops,” Torsch told KFF Health News.

The Maryland attorney general’s office declined to answer KFF Health News’ questions about how it handles opioid settlement complaints.

Few States Monitor Spending

About a dozen companies are expected to pay state and local governments more than $50 billion in opioid settlements over nearly two decades. Purdue Pharma’s case, the most well known, is still wending its way through court. But other companies, including Johnson & Johnson, CVS Health, and Walgreens, have begun paying.

Although the specifics of each settlement deal vary, most require states to use at least 85% of the money on efforts related to the opioid crisis. But enforcement is left to the companies that paid out the money. And legal experts are skeptical that the companies are monitoring state spending.

Attorneys general should be enforcing that standard too, said Stoltman, of the Opioid Policy Institute. “If you’re going to bang your chest about how much money you got for your state for opioids,” he said, “what are you doing to make sure that it’s actually being spent well?”

Stoltman’s and Kearl’s teams surveyed attorneys general offices in 56 states and territories to see if each office had a complaint form specific to this pot of money, explained the details needed to report misuse, and allowed submitters to track their complaints. They also searched websites of state auditors, comptrollers, and similar entities for complaint forms or procedures.

Their findings? Only three states mentioned specific processes for reporting misuse of opioid settlement money.

South Carolina and New Jersey had links on settlement-related websites that directed people to general complaint forms. Oklahoma was the only state to have an opioid settlement-specific form.

Jill Nichols, opioid response and grant coordinator in the Oklahoma Office of Attorney General, said it was created in April in response to the researchers’ inquiry. As of late June, she’d received one complaint, which was found to be without merit.

Stoltman and Kearl said they hope the crowdsourced database will encourage more attorneys general to take an active oversight role by illustrating how much potential misuse is occurring.

The Michigan attorney general’s office said it plans to publish a settlement-specific complaint form this year.

But some attorneys general told KFF Health News it wasn’t their job to track how the money is spent.

Brett Hambright, a spokesperson for Pennsylvania Attorney General David Sunday, said the state created an opioid settlement council to take on that responsibility.

In North Carolina, Attorney General Jeff Jackson’s office said, settlement funds are controlled by the state legislature and local governments. “Our office does not administer the funds nor do we have the power to withhold them,” spokesperson Ben Conroy said.

Even when attorneys general watch the money closely, their power may be limited. For example, Arizona Attorney General Kris Mayes went to court last year to stop the state legislature from giving $115 million in settlement funds to the Department of Corrections. But a judge ruled against her.

Maryland Attorney General Anthony Brown’s office directed KFF Health News’ questions to other state agencies.

Michael Coury, a spokesperson for Maryland’s Office of Overdose Response, said members of the public can email the office with complaints. If the office agrees misuse has occurred, it will bring the complaint to the attorney general, who — per the state’s agreement with local governments — “may” take action.

As of this year, the attorney general’s office will receive $1.5 million of Maryland’s opioid settlement funds annually to cover personnel and administration costs related to opioid-related lawsuits. This may involve suing more companies for future settlement deals.

Torsch, the Maryland mom, said she wishes the focus wasn’t just on winning more money but also ensuring that existing settlement dollars are spent well.

“We owe it to all the families that have been destroyed and suffered great losses,” she said.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — an independent source of health policy research, polling, and journalism. Learn more about KFF.

New Jersey Town ‘Wasted’ Opioid Settlement Money on Concerts

By Crystal Lindell

A town in New Jersey used its opioid settlement money for two concerts costing more than $632,000 – and a large sum of that money was used for six-figure contracts for a town employee's family businesses. 

That’s according to a scathing report by New Jersey’s Office of State Comptroller (OSC), which details the ways the township of Irvington misused the money, 

According to the OSC report, Irvington “wasted and misspent” opioid settlement money on two “Opioid Awareness Day” concerts in 2023 and 2024. A substantial portion of the money – $368,500 – was paid to Irvington employee Antoine “DJ Qua” Richardson and his wife, who were hired to book musical performers and deejay the event. 

However, the state said Irvington officials do not know — and never asked — how Richardson actually spent the hundreds of thousands of dollars he received.

“In interviews with OSC, Richardson’s wife refused to account for the money, while Richardson claimed not to know or recall how the money was spent,” the OSC said.

State investigators determined that Irvington spent more than $200,000 on billboards and other promotional materials advertising the concerts, including $34,445 on t-shirts and $16,000 for mobile billboards, which prominently featured Irvington Mayor Tony Vauss. 

Irvington also used settlement money to pay nearly $13,000 to rent luxury trailers for the performers, and $29,000 to purchase power generators and food supplies like popcorn machines, cotton candy, and shaved ice.

Irvington police officers were paid over $17,000 in overtime to provide security at the two concerts.

State investigators say “none of the billboards, promotional materials, or t-shirts that Irvington provided to OSC included information about obtaining treatment or avoiding abuse of opioids — they simply promoted the concerts.” 

The organizers made only a “superficial effort” to raise awareness about opioid abuse in the town of 61,000 people, according to the report. Most of the concert material promoted the performers, the mayor, and the concerts themselves.

The stage display also made no mention of opioids. In fact, the only message displayed on stage was an ad for a “Yacht Party Cruise Around Manhattan” hosted by Richardson.

The township also didn’t allocate any of the settlement money to pay for the overdose reversal drug Narcan that was handed out at one concert.

IRVINGTON TOWNSHIP IMAGE

Instead, concert organizers requested donations for Narcan, “even though this life-saving drug was the only clearly effective measure at one of the concerts that could directly address the crisis and potentially save lives,” the OSC said.

“These funds are meant to address an ongoing public health emergency that continues to claim lives. When municipalities like Irvington fail to meet that duty, they not only waste resources but erode public trust and betray the communities most in need of support.”

Irvington officials dispute many details in the OSC report, and even went to court to block the report’s release. Mayor Vauss released a lengthy response to the report and said the township would proceed with a defamation lawsuit against acting State Comptroller Kevin Walsh and the OSC.

Walsh’s investigation wasn’t fair, according to attorney Christopher Kinum, who represents Irvington. He said state guidance on how to spend opioid settlement money was vague.

“Every municipality is using the funds for a different reason. These funds were disbursed before there was guidance. All there was, was some term — ‘evidence-based methods to combat the opioid crisis,’” Kinum told the New Jersey Monitor.

‘A Grave Misuse of Funds’

The use of billions of dollars in opioid settlement money is an issue around the country. Over $10 billion has been handed to state and local governments in recent years, and billions more are expected over the next decade. New Jersey alone has been provided over $120 million in opioid funding, with another $520 million in future payouts.

New Jersey recently diverted $45 million in settlement money to four cash-strapped hospitals to offset federal cuts in Medicaid funding. Harm reduction advocates called that a “raid of opioid settlement funds” and want the money returned.

Nevada and Connecticut also want to use settlement money to shore up social service programs hurt by federal funding cuts; while Arizona transferred $115 million in settlement money to the state prison system to help close a budget deficit.

“I have a very high level of fear that states are going to be tapping into these settlement dollars in every creative way they can to fill some of these budget shortfalls,” national recovery advocate Ryan Hampton told KFF Health News. “It’s a grave misuse of funds and one that is going to have dire consequences.”

If you want to see how your state and local government is spending opioid settlement money, you can visit a KFF Health News database or the Opioid Settlement Tracker.