The Relationship Between Receipt of Opioid Settlement Funds and Reductions in Opioid Overdose Deaths in the United States

Introduction

The ongoing distribution of funds from the national settlement agreements with opioid distributors and manufacturers presents a unique opportunity to mitigate the morbidity and mortality associated with opioid use. We examine whether larger per capita settlement disbursements correspond to greater reductions in opioid-related overdose deaths since, and the extent to which states with higher baseline opioid-related overdose death rates received greater per capita settlement disbursements.

Methods

Using national data on opioid settlement disbursements from Kaiser Family Foundation and overdose deaths from the CDC, we estimated an event study using a Poisson regression to compare trends in overdose deaths during the pre-disbursement period (2017-2021) to those observed in the post-disbursement period (2022-2023). We then quantified the magnitude of settlement disbursements in 2022-2023 relative to opioid-related overdose death rates in the five preceding years.

Results

Each additional per-capita dollar of settlement funds was associated with a 0.99% larger decline in opioid-related overdose deaths in 2022 (95%CI: -1.90%, -0.08%; p=0.03) and a 2.46% decline in 2023 (95%CI: -4.17%, -0.75%; p=0.01). We also found a significant association between opioid-related overdose death rates in the five years prior to disbursements and the magnitude of per capita disbursements (2022-2023). Each additional opioid-related overdose death per 100,000 residents was associated with a $0.87 greater per-capita disbursement (95%CI: $0.43, $1.31; p<0.001).

Conclusions

This study provides valuable initial evidence that settlement disbursements are being directed towards states with higher baseline opioid-related overdose death rates, and the size of disbursements are associated with early reductions in these death rates.