ResearchPosted on rand.org Mar 18, 2026Published in: Health Services Research, Volume 61, Issue 2, e70094 (April 2026). DOI: 10.1111/1475-6773.70094
To assess the potential of opioid settlement dollars disbursed to state and local governments to replace or supplement federal substance use disorder (SUD) funding.
For each state, we calculated the percentage of Substance Use and Mental Health Services Administration (SAMHSA) SUD funding for each state that can be offset by settlement funds.
We estimated annual opioid settlement distributions (2022-2038) from KFF Health News and SAMHSA-funded SUD awards (2024) from SAMHSA's website and the Tracking Accountability in Government Grants System.
Across states, the mean difference between SAMHSA SUD funds and settlement funds was $56.83 (SD: $53.76) per capita, and the mean percentage of SAMHSA SUD funding that could be replaced by settlement funds was 51.16 (SD: 28.46) per capita. Oregon was the only state where settlement disbursements exceeded SAMHSA SUD funding.
Substantial gaps remain between current federal SUD funding and what opioid settlement funds can offset. Our findings underscore that opioid settlement funds are not a viable replacement for federal funding, both because they were never intended to serve this purpose, and because they are insufficient in scale.
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