Watchdog Calls for Audits of $2 Billion in Opioid Settlement Spending

A government-transparency group is pressing Pennsylvania, Ohio and West Virginia to submit their opioid settlement accounts to independent audits, arguing that none of the three publishes enough detail for the public to judge whether the money is reducing overdoses.

Rachel O'Brien, deputy public policy editor at Open the Books, presented the findings in an interview with The National News Desk published Friday. Her organization compared county-level settlement spending in Pennsylvania against county overdose deaths and reported no correlation between the two.

"Pennsylvania's got $2 billion," O'Brien said, adding that the state expects another $212 million this year from the Purdue Pharma and Sackler family settlement. Of that total, she said, the state has spent less than $84 million on the categories her group examined: prevention and education, treatment, harm reduction supplies such as naloxone and fentanyl test strips, and programs for incarcerated people.

Vague categories instead of project-level records

According to the investigation, Pennsylvania's settlement administrator has reported roughly $22 million on prevention and education, $15 million on treatment and $18.5 million on programs for people behind bars.

"These are vague categories," O'Brien said. "They don't give specifics, and we still don't know if it's working."

She said the same holds in the other two states her group examined. "Other Rust Belt states we looked at include West Virginia and Ohio," she said. "They also don't release any sort of performance data on whether this money is effective."

The practical consequence, as she described it, is that a county can report a dollar figure for "prevention" without saying which programs received it, how many people they reached, or whether those people stayed in treatment afterward.

From $714 to $42,000 per overdose death

The comparison O'Brien called most striking drew on spending records from 51 of Pennsylvania's 67 counties. For each county, the group calculated settlement dollars spent per overdose death.

"We found it didn't matter if the county spent $714 for every overdose death, like in Lackawanna County, or if they spent over $42,000 for every overdose death in Delaware County," she said. "There was no pattern in the outcomes."

O'Brien said the issue is not whether the programs serve a legitimate purpose, but whether states collect enough information to know. The segment also noted that the comparison cannot by itself show that programs are ineffective, because overdose deaths respond to drug supply, treatment access, population differences and the lag before prevention work shows up in a death count.

A trust that open-records law does not reach

The interview turned on who is supposed to check the numbers. O'Brien said Pennsylvania's auditor general has audited the state's tobacco settlement spending every year but has not audited opioid settlement spending. She also said the trust that decides how the money is allocated is not subject to the state's open-records law.

"The way we got these big categories of how the money was spent was because, like many states, they volunteer it," she said. "But they're not required to go beyond large chunks of money buckets without specifics."

Settlement money flows through a patchwork of state administrators, local governments and private foundations, each with its own reporting standard. O'Brien said many states volunteer the broad figures rather than being required to disclose them. West Virginia redirected future settlement dollars away from its nonprofit foundation toward state and local control, reported in August. In Pennsylvania, Luzerne County's commission advanced three opioid earmarks this week, and the public record of that decision lists recipients and dollar amounts but nothing about what the programs achieve.

Why a missing correlation is not evidence of failure

The measure behind the finding is simple — settlement dollars a county reported, divided by overdose deaths in that county — and simple measures of a slow-moving program tend to cut both ways. Communities with the worst problems also tend to receive the largest allocations, which can make higher spending look associated with worse outcomes, and a real effect could be hidden inside that. O'Brien's answer is that the states should publish measures that do respond within a year: how many people entered treatment, how many received naloxone, how many stayed in care past the first month.

"Before they get more money, the state should know for their own benefit, for the people this is supposed to benefit, if it's working and change course if it's not," she said. "Audits need to happen. We need to see if the money is being spent well."

The segment did not include comment from officials in Pennsylvania, Ohio or West Virginia, and the watchdog's underlying report was not published alongside the interview.