How Indiana is spending $980M in opioid settlements

Since late 2022, the state of Indiana and its local communities have received more than $980 million as a result of numerous settlements tied to the nationwide opioid crisis.

These settlements, agreed upon between various states and companies with a hand in opioid manufacturing, distribution, and marketing, seek to reconcile damages brought on by opioid abuse in communities across the United States.

The money comes as a welcome relief for many in the Hoosier state who’ve struggled with the crisis for decades.

The difficulty now comes in deciding how best to spend the money to ease the decimation caused by opioid addiction.

“There’s not a person I know that’s not been touched by addiction, and there are enough needs and gaps in services that need filled,” said Lorra Archibald, executive director of Healthy Communities of Clinton County Coalition.

According to the Indiana Office for the Attorney General, the rate of opioid prescribing peaked in Indiana in 2012, when, on average, there were 112 opioid prescriptions for every 100 residents.

Between 2012 and 2016, 58 counties had an opioid prescribing rate of greater than 100 prescriptions per 100 residents.

Provisional data from the Indiana Department of Health states that 725 people died of a drug overdose in 2024. Despite the high number, this is a nearly 31% decrease compared to 2023, which saw 2, 089 deaths.

Overdose deaths have steadily declined across the state since a peak in 2021.

How funds are distributed

So far, seven national legal disputes have been settled that benefit Indiana, with money coming in each year to support treatment and prevention programs and other efforts in the state.

The state attorney general’s office said it has secured more than $980 million, with more money possible, over the next 18 years.

Funding began making its way to communities in December 2022, said Douglas Huntsinger, executive director for Drug Prevention, Treatment, and Enforcement and chairman of the Indiana Commission to Combat Substance Use Disorder.

The settlements are governed under Indiana Code Section 4-6-15, which states that the money will be split in half between the state and individual cities, counties, and towns.

Among these local jurisdictions, money is divided using a weighted distribution formula which takes into account how many overdoses and overdose deaths a community has faced.

This means that areas with a larger population tend to receive more funding, said Huntsinger. However, community leaders could also offer more information on how the opioid crisis impacted their residents for the chance to receive more funding.

Both the state and local jurisdictions must reserve 35% of their money for restricted abatement use, which includes funding for substance use treatment, education, and prevention, and the other 15% for unrestricted use.

Restricted funds must adhere to Exhibit E, a list of opioid remediation uses approved by the National Opioid Settlement agreement.

These funds can be used on programs like expanded naloxone training, treatment for neonatal abstinence syndrome, and treatment for incarcerated individuals with opioid use disorder.

“There is always the chance that if these funds are not spent properly, that they could be clawed back,” Huntsinger said. “And so I think it’s really important that our locals understand the importance of utilizing these dollars in the way the settlement requires.”

To inform the state’s spending of the settlement money, the Indiana Commission to Combat Substance Use Disorder adopted the Johns Hopkins Bloomberg School of Public Health’s Five Guiding Principles for the Use of Funds from the Opioid Litigation.

The principles, developed by a coalition of organizations with informed knowledge of the opioid crisis, prioritize five goals for how jurisdictions should approach the funds:

• Spend the money to save lives

• Use evidence to guide spending

• Invest in youth prevention

• Focus on racial equity

• Develop a fair and transparent process for deciding where to spend the funds

These guidelines have been incorporated into the settlement spending decisions of 25 states so far.

Indiana started using its statewide settlement funds in 2024, a year after many local governments began. Last year, restricted funds went toward efforts like training at the Indiana Department of Corrections and supporting Hoosiers in recovery.

In November 2024, the commission adopted recommendations for how local communities could spend the money, which includes the Johns Hopkins principles.

Before distributing the money, the recommendations suggest that communities conduct a local needs assessment, based on overdose and mental health data, and establish committees that strategize how the settlement money is handled and distributed.

“What we found was that the 18% of communities that had spent money, they were overwhelmingly in the group that had a committee put together,” said Huntsinger. “So that tells us that communities that are organized, communities that are bringing together cross-sector collaborations are finding success in utilizing this funding.”

Leaders also recommend that these local jurisdictions establish transparency plans to keep residents informed on where the money is going.

Each year, jurisdictions report their spending to the Indiana Family and Social Services Administration, which submits a comprehensive report to the Indiana General Assembly that’s also made publicly available online.

Clinton County’s approach

One local community that’s already using its share of settlement funds to support its community is Clinton County and the city of Frankfort.

In Clinton County, leaders decided to combine the county’s funds with Frankfort’s and work together on spending goals. So far, the entities have received around $946,000 in restricted abatement funds and just under $397,000 in unrestricted funds.

When money began rolling in toward the end of 2022, Archibald, the Healthy Communities director, approached the president of the Clinton County Commissioners to discuss how the county and city would use their share.

From there, Clinton County commissioners established the Opioid Settlement Committee, a group of 10 community members that represent different areas of the community touched by the opioid crisis.

Members include a representative from Clinton County government, Frankfort Mayor Judy Sheets, a member of the Frankfort Police Department, and more. Archibald acts as chairperson.

After forming the committee, the group performed a thorough community needs assessment to determine how to spend the funds.

“We went line by line of this Exhibit E and assessed where we were as a community. Then we decided where our gaps were, and then we decided how we wanted to fill those gaps, and then who would be the responsible organization for doing that,” Archibald said.

While city and county council members ultimately choose how the money is spent, the Opioid Settlement Committee can present different avenues to commissioners before they decide.

Organizations can also apply for some of the settlement money through an online application the county puts out. Each spring and fall, these applications are considered by the committee, which vets the proposals before sending them on to county and city leaders.

“We present all of these at the city and county council meetings and at the county commissioner meetings, which are all open to the public,” Archibald said. “We feel like that’s important for trust, transparency, accountability.”

Since spending began in 2023, Archibald said the money is already making a difference in their community.

Pointing to a support group that was formed with the help of the money, Archibald told the story of how members of the group helped one of their own who is caring for a sick child while in recovery herself.

Archibald said it’s moments like this that show just how important the funding is to the county.

“Those things just touch your heart. And we’ve been able to do a lot of really, really good things with that money, and just seeing the differences that it’s making in the community,” she said. “It’s having a very big, deeply felt impact in our community.” •