Opioid Settlement Abatement Fund: Schedule A Uses and 15% Window

Opioid settlement abatement fund uses are governed by a detailed menu called Exhibit E, and the rule is strict: at least 85 percent of a jurisdiction’s settlement money must go toward opioid remediation activities on that list, with a 70 percent floor reserved for a dedicated abatement account. Approved uses include naloxone distribution, medication-assisted treatment, recovery housing, prevention education, treatment for pregnant women and infants with neonatal abstinence syndrome, warm hand-off programs in emergency departments, and treatment for incarcerated people. Up to 15 percent can be spent on unrelated purposes, but general government costs, pension gaps, road repairs, and purely punitive law enforcement spending don’t qualify as abatement.¹

How the Required Spending Is Structured

The settlements set a default three-way split for funds flowing into each state. Seventy percent goes into an Abatement Accounts Fund that must be spent on opioid remediation. Fifteen percent goes to a State Fund controlled by the state government. The remaining 15 percent goes to a Subdivision Fund distributed among counties and cities. States can renegotiate those internal allocations with their subdivisions, but the 70 percent abatement floor is constant across the agreements.¹

Exhibit E itself has two tiers. Schedule A lists “core strategies” that the settlement architects treated as the highest priorities. Schedule B offers a broader menu of approved uses, with more flexibility for jurisdictions choosing among them.²

Core Strategies on Schedule A

Naloxone expansion is the first core strategy. Settlement funds pay to train first responders, school staff, families, and community groups to administer the overdose-reversal medication, and to distribute it to uninsured individuals. Bulk purchasing by governments has made this one of the most scalable uses of settlement dollars.³

Medication-assisted treatment, or MAT, is the second. MAT combines FDA-approved medications like buprenorphine and methadone with behavioral therapy. Approved spending covers distribution to uninsured patients, training for healthcare providers and first responders, and support for programs that integrate medication with counseling and recovery services. MAT has the strongest evidence base for sustained recovery and commands a large share of abatement spending in most jurisdictions.³

Two core strategies focus on pregnant and postpartum women and on infants born with neonatal abstinence syndrome. For mothers, funds cover screening, evidence-based treatment including MAT, and wraparound support such as housing, transportation, and childcare for up to 12 months after delivery. For newborns, the money pays for specialized medical care, ongoing developmental monitoring, and family support.³

The remaining core strategies are warm hand-off programs, which embed navigators and on-call teams in hospital emergency departments to start treatment immediately and move patients into ongoing care, and treatment for incarcerated individuals, which funds evidence-based programs inside jails and during reentry.³

Treatment Capacity, Recovery Housing, and Wraparound Services

Schedule B authorizes a wider range of treatment expansion. Governments can build new inpatient facilities, expand outpatient clinics, and fund residential treatment beds, filling capacity gaps that keep people on waiting lists.⁴

Recovery housing is explicitly listed. Funds can cover both operational costs for sober living environments and housing assistance for residents who can’t afford monthly fees. Peer support specialists, people with lived recovery experience who mentor others through early sobriety, are also an approved expense. Several states have launched dedicated housing programs funded entirely by settlement dollars.⁴

Wraparound services qualify too. Transportation to appointments, employment assistance, childcare, and job training can all be funded on the theory, supported by evidence, that treating addiction in isolation from housing instability, unemployment, and untreated mental health conditions produces weaker outcomes.

Criminal Justice: Treatment Yes, Punishment No

This is the area where readers most often guess wrong. The settlements explicitly allow spending on criminal-justice-adjacent programs, but only when the focus is treatment rather than punishment. Pre-arrest diversion, where police connect someone to care instead of booking them, is listed. So are drug courts, jail-based MAT programs, and reentry support.⁴

The line is specific. Providing buprenorphine to inmates with opioid use disorder qualifies. Building a new jail wing or buying patrol cars does not. Training officers to carry naloxone and respond to overdoses qualifies. Funding a general police academy does not. Jurisdictions that blur that line risk scrutiny.

Prevention and Education

Prevention spending is designed to reduce new cases before they start. Approved uses include school-based curricula on decision-making and the science of addiction, media campaigns modeled on anti-tobacco work, public awareness about safe medication storage and disposal, and drug take-back kiosks for unused prescriptions.³

Professional training also qualifies. First responders learn overdose response and treatment linkage. Healthcare providers get education on prescribing practices. School staff are trained to recognize early signs of substance use. Stigma-reduction campaigns, which research links to higher rates of help-seeking, are an approved expense as well.

What the Abatement Portion Cannot Pay For

The 85 percent remediation portion cannot be used to pay off bonds, fill pension gaps, repave roads, or plug general budget shortfalls. General law enforcement costs, jail construction, and other punitive criminal justice spending without a direct treatment component are off-limits for the remediation portion as well.¹

One widely held assumption is wrong, and it matters: the national settlements do not contain a blanket “anti-supplanting” rule preventing governments from using settlement money to cover programs they were already funding. The agreements themselves generally say nothing about supplantation. Some states have independently enacted laws or policies restricting it, but that varies widely and is not a term of the national agreements.⁵ Public health advocates have flagged this gap because, in theory, a government could redirect its existing addiction-services budget elsewhere and backfill with settlement dollars, leaving total spending on the crisis unchanged.

The 15 Percent Non-Remediation Window

Up to 15 percent of a jurisdiction’s settlement funds can be spent on purposes unrelated to opioids. This flexibility was built in deliberately, to avoid endless disputes over borderline expenditures. A government using this 15 percent to pave a road or repair a building isn’t violating the agreement, though it must publicly report any non-remediation spending, including attorney fees.¹

The 15 percent applies to total allocation. Exceeding it crosses from permissible flexibility into potential misuse that could jeopardize future payments. Jurisdictions that spend the maximum on unrelated projects also face political exposure in communities with high overdose rates.

Oversight and Reporting

Each state must designate an Opioid Settlement Remediation Advisory Committee that provides input on spending decisions and maintains a process for receiving public input.⁶ These committees typically include public health professionals, medical providers, and community representatives. Many states maintain online dashboards tracking allocation and spending, and the agreements require public disclosure of any funds used for non-remediation purposes.¹

The transparency infrastructure is stronger on paper than the enforcement behind it. The agreements do not create a powerful central watchdog with authority to claw back misspent funds. State-level oversight structures and enforcement powers vary considerably, and mechanisms for compelling a jurisdiction to return misused money remain underdeveloped. In practice, the primary tools are public reporting requirements and the implicit threat that future payment installments could be affected. Payments from the major defendants are scheduled to run well into the 2030s, so sustained local attention to advisory committees and public dashboards is the most direct way to keep this money moving where the agreements say it should go.

1
National Opioids Settlement. FAQ
2
National Opioids Settlement. Approved Uses and Core Strategy
3
National Opioid Settlement. Exhibit E – List of Opioid Remediation Uses
4
National Opioid Settlement. Exhibit B – List of Opioid Remediation Uses
5
Network for Public Health Law. Supplantation in the Context of Opioid Settlement Funds
6
Congressional Research Service. National Opioid Litigation: Settlement Agreements as of January 2025