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The opioid settlement funds present a key opportunity for communities to address the current opioid epidemic and prevent future addiction crises. Many leaders recognize the importance of prevention, but effective prevention strategies remain misunderstood and underutilized.
This report aims to help guide opioid settlement spending decisions, showing how communities can use the funds to strengthen substance use prevention efforts, reduce risk factors, and promote long-term health and well-being.
Background
Through settlement agreements with opioid manufacturers, distributors, pharmacies, and other companies involved in making and distributing opioids, states and localities are receiving over $50 billion to address harms from the opioid crisis. These opioid settlement funds present an unprecedented opportunity to both address the current opioid epidemic and prevent future addiction crises.
The settlement funds provide communities with access to significant new resources, but many decision-makers are unsure how to invest these funds most effectively to reduce youth substance use, prevent substance use disorder, and promote long-term well-being. While there is broad agreement that prevention is key, prevention strategies are often underutilized, misunderstood, or underfunded, despite a strong evidence base demonstrating their effectiveness.
Purpose of the Guide
To help bridge this gap, this guide aims to support communities and leaders deciding how to spend opioid settlement funds in making informed, evidence-based funding decisions that prioritize primary prevention.
This guide:
- Summarizes the research supporting a primary prevention framework to reduce youth substance use;
- Identifies strategies (at the family-, school-, health care-, community-, and government-levels) that reduce risk factors and strengthen protective factors for substance use;
- Outlines approved uses in the Settlement Agreement (Exhibit E) that align with primary prevention;
- Highlights examples from states and communities already investing in strategies aligned with primary prevention; and
- Offers practical steps for assessing community needs and evaluating outcomes.
Policymakers, advocates, and other community members can use this guide to help ensure that these funds are used strategically to help prevent addiction and the continuation of the addiction crisis.
Published
October 2025