A yearlong investigation by KFF Health News, the Johns Hopkins Bloomberg School of Public Health and Shatterproof catalogued roughly 17,500 opioid-settlement expenditures in 2025, offering the most comprehensive national look yet at where the money went—or remained unspent.

State and local governments spent about $3.7 billion last year, as settlements with drug companies are expected to deliver roughly $60 billion over nearly two decades; local decision-makers control nearly half the funds, and national agreements require at least 85% of money distributed to states and local governments to address the epidemic.

About 33% of reported spending—$1.2 billion—was classified as “other,” compared with 21% for warm handoff and recovery services and 14% for treatment.

Much of the spending supported addiction treatment and recovery, but the investigation also found purchases with tenuous or questionable links to the crisis, including streetlights in Camden, New Jersey; surveillance cameras in Carmel, Indiana; routine municipal expenses in Mullens, West Virginia; and a pickleball court in Gilmer County, West Virginia.

The review did not find that any highlighted purchase was illegal; it documented spending whose connection to addiction was weak or unclear, alongside wide differences in oversight.

About 100 localities in 20 states committed $3.7 million to defibrillators, cardiac monitors and related equipment, which officials sometimes viewed as overdose-response tools; emergency responders say overdoses usually require oxygen or naloxone, while defibrillators help only in certain cardiac emergencies.

Syringe service programs and initiatives for babies exposed to drugs in the womb each received less than 1% of settlement spending nationwide, despite being among the core strategies recommended in most agreements.

Housing is an allowed use of settlement funds within the broader recovery-support category, which received more than $786 million, or about 20% of 2025 spending, though housing is not among the core strategies recommended in most agreements.

The analysis covers more than 17,500 documented uses through Dec. 31, 2025, but incomplete reporting means it is not a full accounting; in 12 states, at least 30% of settlement funds could not be tracked through public reports.

Oversight often provides guidance without enforcement: Indiana officials said they lacked authority to enforce local spending rules, even though Spencer County spent about $16,700 on sheriff’s department defibrillators despite the state’s list of unallowable expenses; Iowa collects county reports but does not approve spending.

Advocates say weak oversight makes it hard to track spending and hold agencies accountable, while Elizabeth Burke Beaty argues that people directly affected by addiction should have a central role in decisions; local officials may care deeply but face heavy workloads, budget pressures and limited policy expertise.

Supporters of local control say local governments understand community needs, can respond quickly and test new approaches, while experts caution that the tobacco settlement offers a warning: less than 3% of related revenue went to anti-smoking programs over 20 years, with much of the money filling budget gaps.