The opioid settlement is not one deal but a series of agreements, worth a combined $50 to $60 billion, that state and local governments reached with more than two dozen drug distributors, manufacturers, pharmacy chains, and consultants over their roles in the opioid epidemic.1 The money is paid out over periods ranging from a few years to nearly two decades. At least 70% of it is earmarked for addiction treatment, prevention, and recovery, not individual compensation. As of mid-2026, every major settlement is active and payments are flowing; the most recent milestone was the Purdue Pharma and Sackler family deal, which became legally effective on May 1, 2026.
Who Is Paying and How Much
The deals were struck in waves, with the distributors first and the Purdue bankruptcy last.
Drug Distributors
The three largest U.S. drug distributors — McKesson, Cardinal Health, and AmerisourceBergen (now Cencora) — agreed in July 2021 to pay up to $21 billion over 18 years. McKesson’s share is $7.9 billion; Cardinal Health and Cencora each owe $6.4 billion. At least 85% of the money flowing to states and subdivisions must be spent on opioid abatement. The final payout depends on how many local governments signed on. The three companies also had to build a shared clearinghouse that pools their shipping data so states can detect suspicious orders.
Johnson & Johnson
Johnson & Johnson, through its Janssen division, agreed to pay up to $5 billion over nine years, with up to $3.7 billion front-loaded in the first three years. J&J stopped marketing opioids in 2015, stopped selling them in 2020, and is barred from marketing or selling any opioid product, or lobbying on opioid issues, for ten years. The company also has to share clinical trial data through the Yale University Open Data Access Project.
Teva and Allergan
Teva Pharmaceutical agreed to pay roughly $4.25 billion, including an offer of up to $1.2 billion worth of generic Narcan (naloxone); states can take cash instead at 20% of wholesale cost. Allergan’s settlement totals about $2 billion. Both were signed in November 2022. Teva’s payments run through 2035, Allergan’s through 2029.
Pharmacy Chains
CVS, Walgreens, and Walmart reached separate settlements totaling roughly $11.5 billion combined. Walgreens is paying about $4.8 billion through 2036, CVS about $4.3 billion through 2032, and Walmart roughly $2.4 billion through 2028, with most of Walmart’s money front-loaded in the first year. All three must maintain independent compliance departments, conduct site visits and audits, and monitor and report suspicious prescribing. Florida is ineligible under all three deals; West Virginia, New Mexico, and some other states are excluded from, or opted out of, one or more of the pharmacy agreements. Kroger later finalized its own $1.37 billion settlement, with payments beginning in early 2025 and similar reporting duties attached.
Purdue Pharma and the Sacklers
The Purdue deal took the longest and nearly collapsed. In June 2024, the U.S. Supreme Court ruled 5–4 in Harrington v. Purdue Pharma L.P. that the Bankruptcy Code does not allow a reorganization plan to force creditors to release claims against a non-debtor without their consent. Justice Gorsuch, writing for the majority, held that the Code’s catchall provision could not be stretched to extinguish nonconsensual third-party claims, particularly fraud claims that are generally non-dischargeable. The Court noted that the Sacklers had previously taken about $11 billion in distributions from Purdue but were not putting all their assets on the table.
After a court-ordered sixty-day mediation, attorneys general from all 55 states and territories negotiated a revised $7.4 billion settlement, filed in March 2025 and approved on November 18, 2025. The key change: creditors who do not opt into the Sackler releases keep the right to sue the family directly in civil court. The Sacklers are contributing about $6.5 billion; Purdue is paying around $900 million. Initial payments of more than $1.5 billion from the Sacklers and $900 million from Purdue went out when the plan became effective on May 1, 2026, with further installments of roughly $500 million in May 2027 and 2028 and $400 million in May 2029. Creditor payouts are scheduled over 15 years.
The settlement permanently bars the Sacklers from selling opioids in the United States and requires public release of more than 30 million internal documents through an archive at the University of California–San Francisco. Purdue’s manufacturing operations transferred on May 1, 2026, to Knoa Pharma LLC, a 501(c)(4) nonprofit that keeps making OxyContin but cannot market it. Interim CEO Marc Kesselman is Purdue’s former general counsel. Dr. Rahul Gupta, the former White House drug policy director, serves as trustee, and former Montana governor Steve Bullock is the independent monitor.
Other Defendants
Mallinckrodt resolved its claims through bankruptcy for $700 million, all paid to a settlement trust. Amneal Pharmaceuticals settled the bulk of its opioid claims for $88.5 million, with claimants potentially receiving up to $267 million in cash and overdose treatments. McKinsey & Company, which advised Purdue on boosting opioid sales, settled for more than $900 million across state, city, school district, and health plan agreements. Eight generic manufacturers — Alvogen, Amneal, Apotex, Hikma, Indivior, Mylan, Sun, and Zydus — entered a combined settlement framework.
How the Money Reaches States, Counties, and Cities
The national settlement allocates funds to states using a formula built on four factors: overall population, overdose deaths, quantity of opioids delivered, and prevalence of substance use disorder. Within each state, the default split sends 15% to a state-controlled fund, 70% to abatement accounts, and 15% to a subdivision fund for cities and counties.
Most states modified those shares through memoranda of understanding with their local governments. Across the 45 states that published MOUs for the initial $26 billion settlement, the average breakdown is roughly 50% to states, 38% to counties, and 12% to cities. To unlock full payouts, 90% of a state’s cities and counties had to drop individual lawsuits and sign on.
Local arrangements vary. Iowa, New York, and Utah directed no funds to cities. Ohio created a 501(c)(3) foundation to control 55% of its share. Montana placed 70% of its total into a private nonprofit trust. Minnesota sends 75% to cities and counties and keeps 25% at the state. Every state had to set up an Opioid Settlement Remediation Advisory Committee; 14 states gave their committees direct authority to disburse funds or award grants, while 19 use theirs only for non-binding recommendations.
What the Money Can Legally Be Spent On
At least 70% of settlement funds must go toward opioid remediation. The agreements define nine core strategies in a document called Exhibit E, which is substantially identical across the deals:
- Naloxone access, including distribution, training, and bulk purchasing.
- Medication-assisted treatment with buprenorphine, methadone, and naltrexone through emergency departments, mobile units, and low-threshold clinics.
- Pregnancy and postpartum care, including housing, transportation, and childcare for women with opioid use disorder.
- Neonatal withdrawal protocols, early intervention, and family support.
- Warm hand-offs using peer navigators and recovery coaches to connect patients from emergency care to ongoing treatment.
- Treatment in jails and prisons, plus reentry support.
- Prevention: school programs, media campaigns, provider education, drug disposal, and first-responder diversion.
- Harm reduction, including syringe services, fentanyl test strips, and infectious disease testing.
- Data and research, program evaluation, spending dashboards, and workforce development.
Exhibit E also approves recovery housing, employment training, crisis stabilization centers, pre-arrest diversion, and prescription drug monitoring program upgrades. Spending that does not directly address opioid remediation, such as attorney fees or administrative costs, must be reported to the Settlement Fund Administrator. Jurisdictions have wide discretion in how they run programs, but the settlements generally require the money to supplement existing spending rather than replace it. More than 25 states have adopted a set of five guiding principles from Johns Hopkins University that urge governments to save lives, use evidence, invest in youth prevention, focus on racial equity, and allocate funds through fair and transparent processes.
How the Money Is Actually Being Spent
A 2024 database compiled by KFF Health News, Johns Hopkins, and Shatterproof documented more than 10,500 expenditures totaling nearly $2.7 billion. The largest categories were treatment at roughly $615 million, overdose reversal medications and training at $279 million, prevention at about $237 million, and housing programs at $227 million. About 20% of settlement spending remains untrackable through public records.
The same investigation turned up expenditures with little visible connection to addiction. Irvington, New Jersey, spent more than $600,000 on concerts featuring R&B artists, including VIP trailers and popcorn machines; New Jersey’s acting comptroller officially labeled the spending “waste” and a “misuse” of funds. Connecticut towns hosted a 1950s-themed sock hop and a mixed martial arts demonstration. Hardy County, West Virginia, put $60,000 toward repairing a school track. Documented purchases elsewhere included gun silencers, night vision equipment, Tasers, and a children’s book about “Spookley the Square Pumpkin.”
A related concern is supplantation, where governments use settlement dollars to replace money already budgeted rather than expanding services. Scott County, Indiana, used about $191,000 to cover existing EMS salaries, freeing up budget dollars for ambulance loan payments. Blair County, Pennsylvania, used around $320,000 to fund a drug court that had operated for more than two decades on other money. New York State reportedly proposed substituting settlement dollars for part of its addiction agency’s normal budget. As of mid-2026, 13 states and Washington, D.C., have imposed formal restrictions on supplantation.
Can Individuals Get Money from the Opioid Settlement?
In most cases, no. The national settlements with distributors, J&J, pharmacy chains, Kroger, Teva, Allergan, and McKinsey are exclusively for state and local governments. The settlement FAQ states plainly that claims by private individuals, private hospitals, and private insurers are “not included” and are not released by the agreements. If you were personally harmed by prescription opioids and want compensation, those deals offer no path.
The bankruptcies are the exception. Roughly $870 million of the $7.4 billion Purdue plan is set aside for individual victims. To qualify, a claimant had to show they used Purdue opioids before the company filed for bankruptcy on September 15, 2019, meet earlier filing deadlines, and submit supporting evidence by late July 2025. About 140,000 people filed claims, but fewer than half are expected to receive compensation. A previously available option to submit a sworn affidavit in place of medical records was removed during confidential negotiations, which tightened the documentation requirements. Some law firms representing individual claimants are entitled to up to 40% of their clients’ awards.
Endo International, another opioid manufacturer, set up a smaller trust through its own bankruptcy. Endo’s Chapter 11 plan became effective in April 2024, and payouts to individual claimants began in late April 2026 at estimated amounts of roughly $1,950 per claimant before fees and liens. Mallinckrodt’s bankruptcy also included victim funds separate from the governmental settlements.
Tribal Settlements
Native American tribes were explicitly carved out of the state and local government deals. A Tribal Leadership Committee negotiated separate agreements worth more than $1.5 billion with the same defendants, including the distributors, manufacturers, pharmacies, and McKinsey. Participation is open to all 574 federally recognized tribes, whether or not they filed individual suits. The 63 state-recognized tribes that lack federal recognition are not eligible for these funds. Three Native Americans serve as directors of the tribal settlement trust funds, and tribes must file annual reports on how they spend the money. States have no legal obligation under their own settlements to share funds with tribes, though some, including Washington, have voluntarily committed money for tribal opioid response.
What Is Still Being Litigated
Not every claim ended in a check. In January 2025, the Sixth Circuit Court of Appeals vacated a $650 million judgment that a federal district court had entered against CVS, Walgreens, and Walmart based on public nuisance claims brought by Ohio counties. The Ohio Supreme Court had ruled that the state’s Product Liability Act bars common-law public nuisance claims arising from the sale of products in commerce, and the Sixth Circuit applied that ruling to wipe out the judgment.
The next frontier is pharmacy benefit managers. Roughly 80 cases against CVS Caremark, OptumRx, and Express Scripts remain active within the federal multidistrict litigation in the Northern District of Ohio, bogged down in discovery disputes. In October 2025, the City of Philadelphia filed its own suit against the same three PBMs, alleging they conspired with manufacturers to give opioids favorable placement on drug formularies in exchange for rebates. Judge Dan Aaron Polster, who presides over the MDL, denied PBM requests to stall document production in January 2025 and called their emergency appeal to the Sixth Circuit “border[ing] on frivolous.” PBM settlements remain far off, and the MDL continues to accept new cases.