Addressing Overdose Through Collaboration and Opioid Settlement Funds

May 11, 2026 | JoAnne Deehr, Christina Severin

Drug overdose remains a leading cause of preventable death in the United States. While the most recent CDC data shows a nearly 16% decline in overdose deaths from December 2024 to November 2025, not all populations or jurisdictions are seeing the same levels of reduction — indicating significant, enduring needs among certain groups and areas of the country.

As jurisdictions continue to respond to the overdose crisis, policymakers are focused on strengthening cross-agency coordination and infrastructure alongside improving the governance and strategic use of opioid settlement funds.

Formalizing Collaboration Through Legislation

Collaboration among agencies and interested parties is key to driving comprehensive overdose prevention and treatment strategies. Several states have recently enacted legislation formalizing this multi-sector collaboration to improve overdose response and public health outcomes.

• Georgia updated its Behavioral Health Reform and Innovation Commission with the enactment of SB 233, in 2025. Initially established to review the state’s behavioral health system, the bill creates several subcommittees, including a newly revised subcommittee on addictive diseases. It also expands the commission’s membership to include a certified addiction recovery specialist and a family member who has experienced a loss due to overdose.
• Texas enacted HB 4783, also in 2025, which requires a biannual report evaluating opioid antagonist distribution practices in the state. In preparing this report, the Texas Health and Human Services Commission must work with each state agency and institution of higher education that receives funding or resources from the health agency’s opioid antagonist distribution program.
• Virginia enacted HB 794 during the most recent legislative sessions, requiring the department of health to develop a strategic plan to reduce overdose in coordination with the secretaries of health and human resources, education, public safety, and homeland security.

Many jurisdictions also formalize collaboration through overdose fatality review teams. These multidisciplinary teams review data and share information to identify opportunities for improvements that may reduce overdoses. As of 2025, at least 18 states have laws establishing overdose fatality review teams, although jurisdictions may initiate a fatality review process through existing authority and without a specific enabling statute. Wisconsin recently enacted AB 192, which formally establishes fatality review teams and specifies that overdose is a reviewable event. Meanwhile, Maryland enacted HB 1012, authorizing local suicide fatality review teams and requiring coordination with other local fatality review teams, including those focused on child fatalities and overdoses.

Employing Other Policy Levers to Reduce Overdose

Legislation isn’t the only option for jurisdictions interested in pursuing policy changes to increase collaboration, reduce overdose, and promote access to lifesaving measures. Policy tools like executive orders and rulemaking can also support a jurisdiction’s health policy efforts. For example, Rhode Island used an executive order in 2015 to create the Governor’s Overdose Task Force, a multidisciplinary body charged to develop a plan and recommendations for addressing addiction, treatment, and prevention. Subsequent executive orders modified the task force and its focus, including an expansion of membership and specific staffing requirements in 2022. The task force recently achieved 10 years of supporting the state’s strategic plan development and efforts to reduce drug overdose deaths.

Ohio has also used multiple policy levers to address overdose priorities in the last year. While state law authorized the use of fentanyl test strips, other drugs were contributing to overdose deaths. In the summer of 2025, Ohio enacted HB 96, which amended the state’s drug paraphernalia law and authorized the state board of pharmacy to adopt rules that authorize the use of products and other equipment to detect compounds other than fentanyl. That fall, the Governor signed an executive order allowing the state to immediately adopt other authorized exemptions to the state’s drug paraphernalia law via rule and allow the use of test strips to detect additional substances (i.e., xylazine, medetomidine, nitazenes, and benzodiazepines).

Opioid Settlement Funds

Spending Authority and Governance

Opioid settlement funds represent a significant, time-limited opportunity for states and territories to address the overdose crisis through prevention, treatment, and recovery. Since 2022, nearly all jurisdictions have established formal governance structures to guide allocation and spending of the over $50 billion in nationwide funds. While most states distribute funds across local, state, and statewide abatement components, there is increased interest in aligning settlement investments with existing priorities, incorporating public input, and strengthening coordination across agencies.

As attention shifts from initial allocation to long-term stewardship, states are advancing policies to improve transparency, accountability, and strategic use of funds. Several states have enacted legislation formalizing oversight structures and ensuring funds are used for intended public health purposes. For example, in 2025 Mississippi enacted SB 2767, establishing an Opioid Settlement Fund Advisory Council to review grant applications and recommend allocations, with the legislature responsible for final approval or rejection. This year, the state enacted SB 2726 to strengthen oversight, standardize the grantmaking process through clearer criteria and third-party input, and enhance reporting/evaluation. While this legislation emphasizes directing funds towards abatement and public health purposes, it also expands legislative authority over funding decisions, reflecting a shift in how recommendations are considered within the overall allocation process.

In addition, Iowa enacted HF 1038 in 2025, creating an investment and allocation framework for the state portion of settlement funds, with funding distributed through competitive grants to support prevention, treatment, recovery, and overdose response efforts. Other states are integrating settlement funds into broader public health systems. Michigan, for instance, has taken a statewide budgeting approach, allocating more than $130 million through its fiscal year 2026 budget and positioning the state health department as a key partner in aligning investments with statewide opioid response strategies.

States are also refining allowable uses of settlement funds to reflect evolving priorities. In 2025, Maryland enacted two bills expanding the use of their opioid settlement funds:

• SB 594 expands and clarifies how funds can be used to support prevention, treatment, and recovery, while also updating the health department’s overdose response training curriculum.
• SB 495/HB 728 authorizes the use of funds to support operations of the Attorney General’s Opioids Enforcement Unit and requires reporting on those activities to strengthen oversight.

Accountability and Innovation

Building on these governance efforts, states are also advancing policies to improve transparency and explore targeted, innovative uses of settlement funds. Several states have focused on strengthening reporting requirements. In 2025, Delaware enacted SB 169 revising the operations of its Behavioral Health Consortium, which ensures the delivery of quality care by providing oversight of the state’s public and private entities involved in behavioral health and substance use treatment. The law also clarifies the authority of the state’s settlement distribution commission to improve coordination, distribution, and oversight of funds. Also in 2025, New York (S 3007) and Maine (LD 110) enacted legislation requiring local governments to publicly report how settlement funds are used, increasing visibility into spending decisions and outcomes.

At the same time, states are using settlement funds to support targeted investments and strengthen service delivery across the continuum of care. In 2025:

• Vermont passed H 218, allocating nearly $10 million in FY2026 opioid settlement funds for prevention, treatment, recovery, and overdose prevention initiatives, with the Department of Health overseeing program implementation.
• Maryland enacted HB 1131, creating a Buprenorphine Training Grant Program to support paramedics in administering medication for opioid use disorder, expanding access to treatment in emergency settings. The bill requires a minimum $50,000 annual appropriation from the state’s Opioid Restitution Fund to support the program and directs the Maryland Office of Overdose Response to convene a workgroup to assess access to buprenorphine statewide.

Conclusion

As jurisdictions continue to address the overdose epidemic, strengthening cross-agency coordination and deploying opioid settlement funds strategically will be critical — helping to advance targeted and sustainable prevention, treatment, and recovery efforts. ASTHO will continue to monitor these policies.