Advocates Say Opioid Settlement Funds in New York Are Still Too Slow to Arrive – and Hard to Track

This is the second story from Health on the Margins, a limited investigative series exploring the Catskills region’s fragile healthcare systems.

The year was 1996. Nintendo 64 debuted its video games in America. Bill Clinton was re-elected president of the United States. And the pharmaceutical giant Purdue Pharma released OxyContin, a powerful opioid prescribed to treat severe pain.

After Purdue Pharma released OxyContin, they aggressively marketed to care providers nationwide. In just four years, its sales grew from $48 million in 1996 to almost $1.1 billion in 2000. The pharmaceutical company also distributed 15,000 copies of an educational video to physicians without FDA approval in 1998 and asked doctors to show the video to patients.

“Once you found the right doctor and you told him or her, don’t be afraid to take what they give you,” said the video narrator. “Some patients may be afraid of taking opioids because they’re perceived as too strong or addictive but that is far from actual fact.”

The marketing video is not only misleading, it’s also not true. As many as one in four people receiving prescription opioids in long-term care settings struggles with opioid addiction, according to the U.S. Department of Labor.

Over the past two decades, opioid-related overdoses have surged across the country. While overdose deaths have significantly declined in the last two years, the devastating toll it has left on communities remains.

By 2021, lawmakers, families, and health advocates had reached a breaking point.

New York enacted legislation that year to establish a dedicated opioid settlement fund with money states secured from various settlements with opioid manufacturers and distributors. To date, the state has secured more than $2.5 billion, says New York’s Office of Addiction Services and Supports (OASAS) spokesperson Evan Frost.

But some health experts have criticized New York for being too slow to move the money to local communities – and keep track of how the funds are used.

“ It seems to have been lost on folks that the government’s really the fiduciary of this money. It wasn’t their money. They got it because people’s kids and loved ones died from opioids,” said Rob Kent, former general counsel for the Biden administration’s White House of National Drug Control Policy and former general counsel for OASAS.

Kent and other health leaders say too much red tape is slowing down the distribution of funds, while the public remains relatively in the dark on where the money is being spent. In October, New York earned $35 million in interest from opioid settlement dollars just sitting, meaning millions of designated dollars remained unspent.

Understanding local dollars

New York’s OASAS distributes money to local counties and governments primarily through two avenues: regional abatement and direct share funds.

Local governments who receive regional abatement dollars must report to OASAS and use the funds based on the state’s approved uses, such as increasing access to MAT and supportive housing.

But direct share dollars are largely unrestricted and OASAS has no oversight over – something that Kent worries will have long-term implications.

“It’s the same bad path that the tobacco settlements followed, which is most of the money was not used for its intended purpose,” said Kent.

Radio Catskill reached out to Sullivan, Orange, and Ulster counties to learn how counties spent their funds. While Sullivan and Ulster counties shared their 2024 spending totals, Orange County did not respond to our questions before this article was published.

Sullivan County reported spending more than $346,000 in opioid settlement funds between July 2024 and June 2025. In 2024, the smallest share of major spending went to treatment programs, while all unrestricted funds – about $37,000 – were directed to law enforcement.

Geographic disparities can be astronomical. Although Sullivan and Rockland counties are only about an hour apart, Sullivan prescribed opioids at nearly three times the rate of Rockland County in 2023. Sullivan County also has the third-highest per capita overdose death rate in the state.

As of October 6, Sullivan County still had more than $1.7 million in settlement funds remaining, while additional funding is expected to trickle in following Purdue Pharma’s $7.4 billion opioid settlement in June.

READ: 2024 spending reports from Sullivan County, Orange County, and Ulster County

Tracie Gardner, Executive Director of the National Black Harm Reduction Network and New York Opioid Settlement Fund Advisory Board member, worries that distribution is not happening equitably nor with community voice in mind.

“This is happening across the country that we’re seeing numbers diminishing in terms of overdose deaths. It’s just not happening equally or uniformly, right?” said Gardner.

While overdose deaths among white people have fallen, for Black and Indigenous Americans, overdose rates have skyrocketed nationwide. Black New Yorkers are less likely to have access to treatment care and lifesaving measures like Narcan and more likely to be criminalized for drug-related offences.

Gardner says anti-Black racism was embedded in fueling the opioid crisis from the beginning.

“These doctors were saying to people, ‘You won’t get addicted like those people. You can take these pills, you’re not gonna get addicted,’” said Gardner. “That is in the heads of people, that they so associate Black and brown people with addiction, that [this] was easily embraced rather than the science of the addictive nature of opioids.”

While Gardner is an advisory board member to OASAS, she says she and other members can only recommend how opioid settlement dollars are spent. “We cannot force the agency that administers the dollars… we can’t compel them.”

How other states spend opioid settlement dollars

Like Sullivan County in New York, Nash County in North Carolina is a smaller, rural area of the state with between 80,000 to 100,000 residents.

“Overcoming stigma is a big thing in all communities, but definitely in smaller communities where everybody really knows their neighbor,” said Tia Foula, assistant county manager and opioid settlement manager for Nash County.

North Carolina is slated to receive $750 million over the next 18 years – less than a third of what New York is anticipating. But the southern state has been touted as a blueprint for something New York has struggled with: transparency and community planning.

CORE-NC, a partnership of several North Carolina agencies, designed its website for anyone to view and compare how the state’s 98 local governments have spent its dollars so far. The website also shows overall spending trends, including top strategies local counties have invested in, and where exactly counties are in their implementation journey.

For Foula, that level of transparency feels reassuring. It helps her see what other agencies are up to and reminds her she’s not alone.

“It can feel overwhelming to try to solve an opioid crisis in your community. Sometimes you need to talk to some partners to keep you focused or to resolve issues,” she said.

As part of its opioid settlement planning, Nash County hosted five community town halls to shape their spending plans. “I think it’s very important that there’s sufficient planning and collaboration because in 2038, when the money stops coming, there’s still gonna be a community in need,” said Foula.

Sullivan County Health & Human Services Commissioner John Liddle says the county will be rolling out a new committee focused on hearing directly from people with lived experience that he’s excited about.

While Nash County is still in its early stages of implementation, she’s hopeful other states can learn how more transparency and community decision-making can make a big difference.

“It feels like just an overall effort to make sure that the communities are better off,” said Foula. “I really do feel like we have the resources and the partnership for all local governments in North Carolina to be successful.”

Image: New York Attorney General Letitia James and health leaders outside The Recovery Station in New York with an opioid settlement fund award (Photo Credit: Office of the New York State Attorney General)