Oklahoma's Rural Communities Struggle to Access Opioid Settlement Funds as Metro Areas Capture Majority of Grants

Nearly two years into Oklahoma's effort to distribute opioid settlement funds, a stark geographic divide has emerged. While metropolitan areas and school districts have secured the majority of grants, rural communities—often those hit hardest by the addiction crisis—are struggling to access the resources intended to help them heal.

According to data from the Oklahoma Attorney General's Office, approximately 30 percent of the $30 million awarded in the first two years has flowed to Tulsa and Oklahoma City metro areas. That figure climbs to 38 percent when including cities with populations exceeding 25,000, such as Stillwater, Lawton, Bartlesville, and Muskogee. Meanwhile, rural areas with smaller populations and limited administrative capacity have captured a disproportionately small share of the funding.

The Grant Gap

The Oklahoma Attorney General's Opioid Abatement Board has awarded 129 grants ranging from $19,688 to $1 million since the program's inception. School districts have proven particularly successful, accounting for roughly 37 percent of grantees and securing 23 percent of allocated funds. Their advantage lies in experience: school administrators regularly navigate state and federal grant applications, giving them an edge in meeting the board's requirements for evidence-based proposals and community partnerships.

Rural areas face a different reality. Many lack experienced grant writers capable of crafting sophisticated applications. The data needed to demonstrate the depth of the opioid crisis in their communities may not exist or may be difficult to compile. Community partnerships—another scoring criterion—are harder to forge in sparsely populated regions where organizations are few and far between.

"We found, especially in our first round of funding, the reach was not as far as we had hoped that it could have been because of the lack of capacity and lack of resources," said Jill Nichols, opioid response and grants coordinator for Attorney General Gentner Drummond's office.

A Billion-Dollar Opportunity

The stakes extend far beyond the $30 million already distributed. Nearly $1 billion will flow through Oklahoma's legislative fund over the next 15 years as payments continue from settlements with opioid manufacturers, distributors, and retailers. How that money is distributed will shape the state's response to the addiction crisis for a generation.

Currently, funded projects cluster in three main categories: school-based prevention programs, naloxone distribution and training, and supported housing for people harmed by opioids. These are worthy investments, but the concentration of resources in urban and suburban areas leaves rural Oklahomans with fewer pathways to treatment and recovery.

Building Rural Capacity

State officials recognize the imbalance and are taking steps to address it. For the most recent application cycle, which closed April 1, Oklahoma contracted with grant writers to assist rural applicants. The effort yielded approximately 10 new submissions from communities that might otherwise have been unable to apply.

"There are no guarantees that those will be awarded but just the help received in getting started was huge," Nichols said.

More substantial changes are on the horizon. The Attorney General's Office plans to expand grant-writing support to four staff members positioned across the state's quadrants. These regional coordinators will provide hands-on assistance throughout the entire grant lifecycle—from identifying community needs and writing proposals to coordinating task forces, connecting with local partners, implementing programs, and managing reporting requirements.

"They will be there to support them throughout the process," Nichols explained. "It's going to be really beneficial. We're hanging our hat on this to make the reach."

Structural Barriers

Even with enhanced support, structural challenges remain. The grant program uses population-based tiers that cap funding amounts for smaller communities. While designed to ensure equity, these limits may inadvertently disadvantage rural areas where the per-capita need for addiction services is often higher and the cost of delivering care across vast distances is greater.

"The tiers are meant to be equitable," said Terry Simonson, who served as special counsel in designing the state program. "The problem we are running into is that it's not based on need. The need in a rural area may require more investment than the maximum allowed."

Tulsa City Councilor Carol Bush, who serves on the Opioid Abatement Board, supports rethinking the allocation formula to better serve rural communities.

"Let's keep in mind that if you are a community of 900 and save two lives, that is a huge win," Bush said. "No one size fits all, and maybe we can look to be more flexible in our matrix so it's more personal to a community."

Oklahoma's Late Start

The state's rural challenges are compounded by a delayed start to its opioid settlement program. Former Attorney General Mike Hunter's mid-term resignation in 2021 stalled the process, and it wasn't until Drummond's election in 2022 that the Opioid Abatement Board was established. Other states had already begun distributing funds, giving them a head start in building the infrastructure and relationships that smooth grant administration.

The board is now considering additional reforms, including shifting tier limits or allowing councils of governments to distribute grants more flexibly across multi-county regions. These changes could help rural areas pool resources and build the partnerships necessary to compete for funding.

A National Pattern

Oklahoma's experience reflects a broader national challenge. Across the country, states are grappling with how to ensure opioid settlement funds reach the communities most affected by the crisis. Rural areas consistently face barriers including limited administrative capacity, fewer healthcare providers, transportation challenges, and the geographic isolation that makes service delivery more expensive.

The $50 billion flowing to states from national opioid settlements represents an unprecedented opportunity to build addiction treatment infrastructure. But without intentional efforts to address rural disparities, much of that funding may concentrate in areas that already have more resources—widening rather than closing the gap between urban and rural America.

Oklahoma's emerging model of embedded grant-writing support offers one potential solution. By meeting rural communities where they are and helping them build the capacity to compete for funding, the state may yet ensure that its share of settlement dollars reaches every corner of the state—not just the ones with professional grant writers on staff.

With 15 years of payments remaining, there is time to get the distribution right. For rural Oklahomans struggling with addiction, the question is whether that time will be used to build the bridges they need to access life-saving treatment and support.