The Relationship Between State Fiscal Capacity and Opioid Settlement Expenditures.

Area of Science:

• Public Health
• Health Economics
• Health Policy

Background:

• National opioid settlements offer funds to combat the US overdose crisis.
• Uncertainty exists regarding whether states with high fiscal and opioid-related needs are prioritizing these funds.

Purpose of the Study:

• To analyze per capita opioid settlement spending across US states.
• To determine if spending aligns with states' fiscal needs and overdose crisis severity.

Main Methods:

• Utilized KFF Health News data for per capita opioid settlement spending.
• Assessed state fiscal need using US Census of Governments data.
• Measured overdose crisis need via CDC overdose mortality data.

Main Results:

• States were categorized into tertiles based on spending, with the highest tertile (n=13) spending $23.69 per capita.
• States with both higher fiscal and overdose needs (n=12) spent $21.48 per capita.
• States with lower needs spent significantly less ($7.82 per capita).

Conclusions:

• States demonstrating higher fiscal and overdose needs allocated the most per capita opioid settlement funds in 2022-2023.
• This indicates potentially effective targeting of settlement funds.
• Further research is needed to confirm if these funds reduce overdose deaths, especially in fiscally challenged regions.