Problem Statement: Worldwide, about 60 million people used opioids at least once in 2021. In the United States (US), there has been a 7.5-fold increase in overdose deaths involving synthetic opioids from 2015 to 2022, making up 68% of national drug overdose deaths reported in 2022. To address their role in the US opioid epidemic, a $26 billion USD national settlement agreement with major pharmaceutical manufacturers and distributors was reached. Pennsylvania is to receive nearly $2 billion in settlement funds over a 15 year period, raising important questions about how decisions are made regarding settlement fund resource allocation, including the ultimate public health effectiveness of improving the harm caused by the opioid epidemic.

Description: We collect information on interventions funded from settlement dollars to systematically measure the heterogeneity of funding uses, and the impact of these interventions on key population health outcomes of interest, such as trends in overdose deaths, trends in diagnosis of opioid use disorder, etc.

Lessons Learned: This study uses empirical data to assess the effectiveness of a strategy to allow local autonomy over the decision on interventions to fund from settlement funds in order to reduce the harm caused by opiates. To date over $72M USD has been spent and committed on remediation programs by all 67 counties in Pennsylvania. Our research characterizes the variation in spending by type of intervention (e.g., prevention, acute care treatment, education, provider training, etc.) and the populations targeted by the spending (e.g., criminally justice involved individuals, post-partum women, at risk youth, etc.). We use statistical techniques to associate changes in key population health measures to the interventions, with the goal of assessing real world effectiveness.

Stakeholder Perspective: Our work has implications for how best to structure and allocated damage awards to address important population and public health outcomes.