On June 11, 2024, the National Prevention Science Coalition to Improve Lives hosted a briefing to discuss the best strategies for allocating the pharmaceutical settlement dollars to abate the opioid crisis. The crisis of opioid overdose deaths continues to rage, with overdose deaths at an all-time high despite heightened national awareness and more resources than ever dedicated to enforcement, treatment, and overdose prevention. Public health experts and agencies are working to inform the public and eliminate fentanyl from the drug supply; however, misuse of addictive substances and their devastating and costly consequences will not disappear unless we implement a comprehensive, proactive, and sustained approach to substance use and addiction, the most prevalent and preventable health problem the U.S. faces.

There is now an unprecedented opportunity to do this right by smartly allocating the National Prescription Opiate Litigation, which consolidated thousands of lawsuits against some of the companies responsible for the prescription opioid epidemic, as well as other ongoing litigation against responsible parties. Billions of dollars of settlement funds are flowing to states and localities throughout the country. And the substantial body of scientific knowledge and best practices generated to date offer workable solutions.

This briefing featured experts in pathways to substance use and addiction, authors of key recommendations for spending the settlement funds, and public health solutions that hold promise to turn this crisis around by investing in a full spectrum of responses to the crisis, rather than singularly focused approaches (e.g., only interdiction, prescription regulations, or treatment). Addressing adverse experiences and conditions that are harmful to development and health and providing supportive environments can significantly reduce substance use and prevent escalation to addiction and other health and social problems. Investments in this approach are cost-effective, reducing levels of systems involvement and need for substance use treatment, and forestalling the enormous financial, productivity, health, and social costs of untreated addiction.

A scoping landscape analysis of how these monies are currently being allocated across states was presented, along with observations from community stakeholders about whether funds are being used wisely to address their diverse needs. In addition, a technology has been developed to determine the most effective programmatic approaches to quell the crisis using settlement funds. Examples were given, including the Alabama Opioid Model that produced an unexpected policy conclusion.

As Americans grow increasingly attuned to the substance use crisis the country is facing, let’s use the mounds of evidence that have been accumulated to make smart decisions and ensure that settlement funds are being heavily invested in prevention and children’s health and well-being, and not just plugging up holes in the addiction-crisis dam.