From Funding to Outcomes: Evaluating Opioid Policy, Spending, and Treatment Access

Session Submission Type: Panel

Abstract

As opioid settlement funds and policy interventions expand across the United States, critical questions remain about how these resources are allocated and whether they effectively improve treatment access and outcomes. This panel brings together four complementary studies that examine opioid policy from the interconnected perspectives of healthcare delivery, state spending, and local public finance. A unifying theme across the panel is the role of innovative policy design, particularly the emergence of opioid settlement funds as a new fiscal instrument, and the central importance of medication for opioid use disorder (MOUD) in addressing the opioid crisis.The first paper evaluates a Massachusetts policy requiring hospitals to initiate MOUD, providing evidence on its effects across stages of treatment among Medicare beneficiaries. This study speaks directly to the importance of expanding access to MOUD within clinical settings and examines whether hospital-based initiation translates into improved treatment engagement and continuity of care.The second paper examines whether opioid settlement revenues constitute a meaningful and stable source of funding for local governments opioid remediation services. The analysis reveals substantial heterogeneity in their fiscal importance, with settlement funds ranging from a negligible share of local health spending to a dominant source of opioid-related resources. This variation highlights the uneven capacity of local governments to rely on this emerging funding stream.Building on this theme, the third paper evaluates how states’ use of opioid settlement funds for treatment programs affects MOUD utilization in substance use treatment centers. The findings show that investments in treatment-oriented programs increase MOUD utilization, particularly in states that restrict supplantation of existing funds. This paper underscores the importance of policy design in ensuring that settlement funds generate new treatment capacity rather than replacing existing expenditures.The fourth paper examines how opioid settlement funds are allocated across law enforcement–related remediation and non-remediation activities. The study finds that jurisdictions with greater reliance on law enforcement–generated revenue and higher policing expenditures are more likely to divert funds away from intended opioid remediation purposes, raising concerns about whether settlement agreements achieve their intended public health goals.Together, these studies highlight how policy design, fiscal incentives, and institutional contexts shape whether opioid-related resources translate into expanded MOUD access and improved treatment outcomes. By integrating evidence across levels of government and stages of care, the panel provides timely insights into how innovative funding mechanisms and treatment policies can be structured to more effectively address the opioid crisis.

Policy Area

• Health Policy

Chair

• Ashley Bradford, Georgia Institute of Technology

Discussants

• Costas Lambros, Indiana University

• Cooper Smiley, University of Georgia

Organizer

• Jiajing Scarlette Shi, Georgia State University

Individual Presentations

• Effects of a State-Level Policy Requiring Hospitals to Provide Treatment for Opioid Use Disorder - Presenting Author: Victoria Elizabeth Bethel, University of Georgia

• When $50 Billion Isn’t $50 Billion: Opioid Settlements in Local Fiscal Context - Presenting Author: Amanda Isabel Mauri, University of Maryland, College Park

• The Effect of Opioid Abatement Funds on Medication-Assisted Treatment Utilizations for Opioid Use Disorder - Presenting Author: Jiajing Scarlette Shi, Georgia State University

• Fiscal Determinants of Local Governments Spending Opioid Settlement Funds on Law Enforcement Activities - Presenting Author: Zoe Lindenfeld, Rutgers University - New Brunswick