Between 2022 and 2040, states, counties and cities expect to receive over $50 billion in payments from the national opioid settlements. As settlement payments are disbursed in the coming years, continued state-local coordination is key to ensuring that these resources are effectively invested. Ongoing communication and information sharing at the state and local levels can improve alignment of efforts and resources, reduce duplication and ensure that settlement funds are directed to the areas of greatest need. 

To highlight state and local collaboration on settlement spending, the National Association of Counties (NACo) and the National Academy for State Health Policy (NASHP) partnered to develop case studies in five geographically and politically diverse states that have demonstrated innovative approaches to collaboration within their own unique settlement structures. Through key informant interviews with state officials, county officials and county association leaders, NACo and NASHP identified examples of intergovernmental coordination across four domains:

  • Sharing resources, expertise and learnings across jurisdictions
  • Aligning settlement funding to address common priorities
  • Developing mechanisms for ongoing coordination and communication, and
  • Promoting transparency of funding decisions.

Through this process, NACo and NASHP identified examples of successful state-local coordination in opioid settlement administration as defined by state and local stakeholders. This resource contains case studies describing five unique state contexts and two key strategies supporting state-local coordination within each state. An overview of the strategies described in each case study is provided below.

Colorado
  • Regional councils align funding priorities between cities and counties in each region.
  • Regional and state councils communicate through monthly calls and annual conference.
Indiana
  • A grant matching program aligns funding priorities between state and local governments.
  • An annual financial report provides transparency on all state and local expenditures, including expenditures by more than 600 units of local government.
Minnesota
  • Required annual meetings between counties and adjacent cities promotes alignment of funding priorities.
  • A public dashboard provides transparency on state and local government expenditures.
North Carolina
  • An intergovernmental technical assistance team facilitates resource sharing between state and local governments.
  • A public dashboard provides transparency on state and local government expenditures.
Virginia
  • A state council communicates with local governments through multiple engagement mechanisms, including trainings, webinars, conferences and individualized outreach.
  • The state council utilizes financial incentives to promote alignment of funding priorities with local governments.

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  2. Drug Overdose Mortality by State. U.S. Centers for Disease Control and Prevention. Updated March 1, 2022. Accessed March 11, 2024. https://www.cdc.gov/nchs/pressroom/sosmap/drug_poisoning_mortality/drug_poisoning.htm#print
  3. Colorado Opioids Settlement Memorandum of Understanding (“MOU”). Office of the Colorado Attorney General; 2021. https://coag.gov/app/uploads/2021/10/1-Colorado-Opioid-MOU.pdf
  4. Colorado: Guide for Community Advocates on the Opioid Settlement. Vital Strategies and OpioidSettlementTracker.com; 2023. https://www.vitalstrategies.org/wp-content/uploads/Colorado-Opioid-Settlement-Fact-Sheet-V2.pdf
  5. 2023 Colorado Opioid Abatement Council Roster. Office of the Colorado Attorney General; n.d. https://coag.gov/app/uploads/2023/05/COAC-Roster-4.1.23.pdf
  6. House Enrolled Act No. 1001. General Assembly of the State of Indiana; 2023. https://www.in.gov/sba/files/HB1001.06.ENRS.pdf.
  7. Indiana: Guide for Community Advocates on the Opioid Settlement. Vital Strategies and OpioidSettlementTracker.com; 2023. https://www.vitalstrategies.org/wp-content/uploads/Indiana-Opioid-Settlement-Fact-Sheet-V2.pdf
  8. Opioid settlement match grant awardee overview. Indiana Family and Social Services Administration; n.d. https://www.in.gov/fssa/files/Opioid-Match-Grant-Awardee-Overview.pdf
  9. Local JRAC. IN.gov. n.d. Accessed March 11, 2024. https://www.in.gov/justice/local-jrac/
  10. National opioid settlement plan. Indiana Family and Social Services Administration; n.d. https://www.in.gov/recovery/files/National-Opioid-Settlement-Indiana-Plan.pdf
  11. H.F. No. 400. State of Minnesota House of Representatives; 2019. https://wdoc.house.leg.state.mn.us/leg/LS91/HF0400.6.pdf
  12. Amended Minnesota opioids state-subdivision memorandum of agreement. The Office of the Minnesota Attorney General; n.d. https://www.ag.state.mn.us/opioids/docs/MN_MoA.pdf
  13. Opioid Epidemic Response Advisory Council. Minnesota Department of Human Services. n.d. Accessed March 11, 2024. https://mn.gov/dhs/opioids/oer-advisory-council.jsp
  14. Minnesota: Guide for Community Advocates on the Opioid Settlement. Vital Strategies and OpioidSettlementTracker.com; 2023. https://www.vitalstrategies.org/wp-content/uploads/Minnesota-Opioid-Settlement-Fact-Sheet.pdf
  15. Opioid Epidemic Response Advisory Council: Grant Award Update & Evidence-Based Analysis of Opioid Legislative Appropriations. Minnesota Department of Human Services, n.d. Accessed March 11, 2024. https://www.lrl.mn.gov/docs/2022/mandated/220696.pdf
  16. Memorandum of agreement between the State of North Carolina and local governments on proceeds relating to the settlement of opioid litigation. More Powerful NC; n.d. https://www.morepowerfulnc.org/wp-content/uploads/2023/07/Final-Opioid-MOA-rev-July-2023-re-Ex-E-and-F.pdf
  17. North Carolina: Guide for Community Advocates on the Opioid Settlement. Vital Strategies and OpioidSettlementTracker.com; 2023. https://www.vitalstrategies.org/wp-content/uploads/Virginia-Opioid-Settlement-Fact-Sheet-V2.pdf
  18. Opioid settlement assistance. North Carolina Association of County Commissioners; n.d. Accessed March 11, 2024. https://www.ncacc.org/services-for-counties/ncacc-strategic-member-services/opioid-settlements-assistance/
  19. A State-by-State Look at the 1998 Tobacco Settlement 25 Years Later. Campaign for Tobacco-Free Kids; 2018. https://www.tobaccofreekids.org/what-we-do/us/statereport
  20. Virginia opioid abatement fund and settlement allocation memorandum of understanding. NationalOpioidSettlement.com; n.d. https://nationalopioidsettlement.com/wp-content/uploads/2021/10/VA-Opioid-Abatement-Fund-and-Settlement-Allocation-MOU1.pdf
  21. Virginia: Guide for Community Advocates on the Opioid Settlement. Vital Strategies and OpioidSettlementTracker.com; 2023. https://www.vitalstrategies.org/wp-content/uploads/Virginia-Opioid-Settlement-Fact-Sheet-V2.pdf
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