The opioid crisis remains one of the most devastating public health and security challenges in the United States. While a recent decline in opioid overdose deaths—down 17% between July 2023 and July 2024—offers hope, the threat posed by illicit synthetic opioids such as fentanyl is far from over. In this context, the $26 billion national opioid settlement, finalized in February 2022, provides an unprecedented opportunity for states and local governments to invest in life-saving strategies.
However, this opportunity is being undermined by the misuse and misallocation of funds. Transparent, strategic, and accountable spending should align with the core goal of opioid abatement.
The Scope of the Crisis
Since the onset of the opioid epidemic, over 600,000 Americans have died from drug overdoses. In recent years, the crisis has entered its most dangerous phase, driven primarily by illicitly manufactured fentanyl and synthetic opioids:
- In 2020, synthetic opioids accounted for over 82% of all opioid-related deaths.
- In 2021, fentanyl alone caused 71,238 deaths, up 23% from the previous year.
- By 2022, the DEA had seized over 379 million lethal doses of fentanyl—enough to kill every American.
- DEA data shows that 6 out of 10 counterfeit pills seized in 2022 contained potentially fatal doses of fentanyl.
Youth are increasingly affected. Fentanyl is now responsible for 94% of pediatric opioid deaths, and overdose deaths among children aged 12–17 have more than doubled since the pandemic.
Meanwhile, new substances such as nitazenes (up to ten times more potent than fentanyl) and xylazine (an animal tranquilizer that resists naloxone reversal) are rapidly emerging in the illicit supply.
The Settlement Opportunity
The $26 billion settlement from opioid manufacturers and distributors offers a unique window for impact. In total:
- New Mexico will receive approximately $884 million over 15 years.
- 50% of that total will go directly to local governments.
- Funds are legally restricted to be used for opioid abatement—i.e., prevention, treatment, recovery, and harm reduction.
When spent correctly, this funding can bolster law enforcement, expand treatment infrastructure, enhance crisis intervention, and reduce future overdose deaths.
What’s Working: Models of Effective Use
Several states and localities have implemented exemplary, evidence-based strategies:
- Spokane County, WA invested $7.2 million in expanding its regional crisis stabilization center, treatment beds, and support for parents of affected infants.
- Snohomish County, WA launched a mobile methadone van and expanded naloxone distribution through its “Leave-Behind” program.
- Clark County, WA is directing nearly $1 million to community-based prevention and treatment programs, including jail-based MAT (medication-assisted treatment).
- Louisiana earmarked 20% of its $325 million for sheriffs to focus on treatment-based diversion rather than incarceration.
- Wisconsin is competitively distributing $3 million to rural law enforcement for drug disposal, jail-based treatment, and community education.
Innovative co-responder programs are also gaining traction. In cities like Eugene, OR (CAHOOTS), San Antonio, TX, Miami-Dade, FL, and Mount Pleasant, SC, law enforcement is partnering with mental health professionals to deescalate crises and connect individuals to care—reducing ER visits, arrests, and municipal costs.
New Mexico’s Progress
New Mexico has taken commendable steps to prioritize collaboration and community input:
- Albuquerque and Bernalillo County are sharing funds and holding public meetings to identify strategic priorities.
- Las Cruces and Doña Ana County have narrowed focus to four core areas: MAT, recovery services, prevention, and data-driven planning.
- Seven rural counties have joined together in a regional Opioid Remediation Collaborative, focusing on expanding access to MAT and wraparound services.
- Top priorities statewide include detox capacity, treatment coordination, harm reduction, housing access, and real-time resource mapping.
These approaches emphasize local control, evidence-based planning, and transparency—setting a model for other states in the Southwest.
Where It’s Going Wrong
Despite these successes, a significant number of jurisdictions are using—or planning to use—settlement funds on unrelated expenses. A 2023 investigation by KFF Health News and Johns Hopkins University uncovered examples such as:
- Flint, MI: $10,000 spent on a building sign
- Oregon City, OR: $30,000 on first responder heart screenings
- Robeson County, NC: $10,000 on a toy robot ambulance
These expenditures do little or nothing to address the opioid epidemic. Worse, they may violate settlement terms, risk future disbursements, and weaken public trust.
Policy Recommendations
- Enforce Clear Spending Guidelines
Ensure all expenditures meet the legal definition of opioid abatement as outlined in settlement agreements. - Prioritize Evidence-Based Interventions
Fund programs that are backed by data, such as MAT, harm reduction, jail-based treatment, and mobile crisis response. - Promote Transparency and Public Input
Require regular reporting, open allocation meetings, and clear publication of how funds are spent. - Encourage Regional Collaboration
Small and rural communities can benefit from pooled resources and shared services to increase impact. - Protect Against Future Threats
Invest in flexible infrastructure to address emerging drugs like nitazenes and xylazine, and prepare law enforcement and public health teams for evolving threats.
Conclusion
The opioid crisis is evolving, not ending. The arrival of fentanyl, and now nitazenes and xylazine, has turned a public health emergency into a national security concern. The $26 billion opioid settlement is a powerful tool, but only if it is used with intention, integrity, and urgency.
New Mexico is showing promising leadership. Other states should take note. Communities must stay focused on the core goal: saving lives, reducing harm, and building a sustainable recovery infrastructure for the future.
Anything less is a wasted opportunity we cannot afford to squander.