New Report Calls for Course Correction for New York Opioid Settlement Fund Distribution

Report calls on state lawmakers and oversight leaders to redirect settlement dollars toward community-based, lived-experience solutions and require real transparency

NEW YORK STATE (02/04/2026) (readMedia)-- Today, an independent report, "Community Solutions, State Exclusions: The Misalignment of New York's Opioid Settlement Funds" analyzing New York State's Opioid Settlement Fund (OSF) spending was released by Truth Pharm. The report shows the current approach is structurally shutting out the community-based organizations most connected to the overdose crisis and calls for corrective action.

Overdose deaths continue to climb even after years of system expansion. The report notes that overdose fatality rates are now roughly three times higher than in 2011 and that more than 70,000 New Yorkers have died of an overdose since 2000, including 4,567 lives lost in 2024 alone despite a 70% increase in funding over the same period of time. Opioid settlement funds offer a time-limited opportunity to change the trajectory of the overdose crisis, but New York's spending patterns are reinforcing the same system failures that have not delivered better outcomes.

"This is an ambitious and sorely needed report by Truth Pharm; it puts laser focus on the problems that the State must correct to ensure that opioid settlement funds actually reach the people and communities where they're needed the most." Stated Tracie Gardner, Executive Director, National Black Harm Reduction Network.

"Settlement funds were supposed to repair harm, not reinforce the status quo," said Chelsea Pickett, team lead, co-author of the report, and doctoral student at CUNY. "Our analysis shows New York's settlement spending is being routed through structures that favor large institutions by design, while the community-led organizations that have proven they can reach people most impacted are left fighting for scraps. That is not an effective strategy."

What the report found

Using publicly available funding and financial data, the authors analyzed OSF allocations for Funding Year 2023 as reported by the State's OSF tracker, and categorized recipients by annual operating budget using GuideStar size classifications.

The report documents a clear imbalance:

  • Organizations with operating budgets over $5 million received 84.7% of OSF dollars, compared with 15.3% received by community-based organizations (CBOs).
  • CBOs and grassroots organizations received fewer awards and smaller grants on average, with awards for organizations under $5 million averaging about $179,553 while larger organizations received awards nearly four times larger.
  • CBOs were eligible to apply for only two of sixteen state-issued RFAs in FY 2023, one of which capped awards at $9,500.
  • None of the OSF was spent on programs to support families impacted by the opioid crisis, not even for the children left behind after the loss of a parent(s).
  • The report warns of potential supplantation risk, citing OSF awards to state university degree programs despite separate tuition and workforce development initiatives announced in 2025 and funds flowing to large nonprofit corporations already able to bill for their services and sitting on $3.3 billion in cash reserves
  • Executive compensation patterns reinforce inequity, with average executive director compensation in this category exceeding $650,000.

"This is not just about fairness," said Maci Johnson, co-author of the report, and graduate student at Binghamton University. "When the state builds eligibility rules that effectively block community-based applicants, it cuts off the very models that tend to engage marginalized people more effectively, operate with fewer barriers, and innovate faster. You cannot 'abate the crisis' while starving the closest responders."

Transparency problems and accountability gaps

The report also flags ongoing problems with public reporting and the state's OSF tracker. The authors document instances where reported totals, award counts, and initiative details are inconsistent, and argue that tracker updates have not clearly explained what changed, when, or why.

Tricia Christensen, MPP, report reviewer said, "This report makes one thing clear: New York's approach to spending these funds is both opaque and misaligned with community needs. The lack of transparency is a red flag, creating space for decisions to be made behind closed doors that steer public dollars toward large institutions and hospital executives, while grassroots community-based organizations doing the most lifesaving work are left underfunded and sidelined."

Ella Dailey, co-author of the report, and an undergraduate student at Binghamton University, said the data issues were not an academic footnote, but a public accountability failure. "We used the state's publicly available information," Dailey said. "But when award details are incomplete or revised without explanation, it becomes harder for policymakers and the public to verify how dollars are being used and whether the spending matches settlement intent."

The report notes that the Opioid Settlement Fund Advisory Board has repeatedly raised the need to create opportunities forCommunity Based Organizations, but that recommendations have not translated into accessible funding opportunities.

What the authors are calling for

The report urges state leaders to treat opioid settlement funds as a finite, time-limited opportunity and to stop routing them through systems that inherently exclude community-based care. Nationally, opioid settlements total about $57.7 billion, with more than $2.8 billion allocated to New York State and only 15% spent to date.

Key recommendations include:

  • Move administration of the state share of OSF to the AIDS Institute within the New York State Department of Health to better support community partnership and innovation.
  • Redesign OSF distribution to prioritize CBOs and low-barrier services, fund community-developed innovations, and establish a lived-experience advisory body.
  • Provide stronger oversight and transparency through the New York State Attorney General and New York State Comptroller, including a comprehensive audit of allocation, reporting, and compliance.

"This isn't abstract. It's people," said Alexis Pleus, Founder and Executive Director of Truth Pharm. "Every time funds bypass grassroots and lived-experience organizations, the state is choosing bureaucracy over reach, and comfort over impact. Families have risen up through their grief to build resources, because they had to. It's long past time to support them. I have faith State leaders will recognize the value of this report to inform a corrective path forward."

Context and alignment with national reporting

The authors note that their findings align with concerns raised publicly across the state. In November 2025, Drug Policy Alliance published an independent analysis of 140 public testimonies submitted between 2022 and 2024, documenting widespread concern that settlement dollars were flowing disproportionately to large institutions while smaller community organizations struggled to access resources.

How to get the report

A copy of the complete report can be found online here: https://truthpharm.org/opioid-settlement-fund/#