Here are the entities that ultimately decide how each of Alabama’s opioid settlement shares are spent:

• 50% state share: Alabama state legislature

• 50% local share: decisionmakers for municipalities, counties, and governmental public health entities (i.e., public hospitals, county health departments, boards of health)

Has the state established an advisory body for settlement funds?

Yes.

• The Oversight Commission on Alabama Opioid Settlement Funds was established by joint legislative resolution (2023 AL HJR 204) in 2023. The Commission is responsible for developing “a statewide plan for the investment and use of opioid settlement funds” and reviewing settlement fund expenditures.[1]

• The Alabama Opioid Overdose and Addiction Council was established by Executive Order 708 in 2017. This body was responsible for developing and submitting a "strategic action plan” on combating the state’s overdose crisis to the governor, which they may periodically update as necessary.[2] The Council is also responsible for annually reporting “a detailed evaluation of … initiatives undertaken to combat Alabama’s opioid-use epidemic.”[3] While some prior reports of the Council have made detailed recommendations around the use of opioid settlement funds, this body has a broader focus than strictly opioid settlement funds.[4]

Is the state advisory body required to include member(s) with lived and/or living experience?

It depends. Alabama House Joint Resolution 204 does not require the Oversight Commission on Alabama Opioid Settlement Funds to include a member with lived and/or living experience. However, the Alabama Opioid Overdose and Addiction Council is required to include two individuals “in recovery from opioid addiction” appointed by the Recovery Organization of Support Specialists.[5] It must also include two family members of “people who are or have been addicted to opioids” appointed by the Council on Substance Abuse – NCADD.[6]

What is the overall membership of the state advisory body?

The Oversight Commission on Alabama Opioid Settlement Fund has 16 members and is intended to “be inclusive and reflect the racial, gender, geographic, urban, rural, and economic diversity of the state.”[7] Members include:

• Commissioner of the Department of Mental Health or their designee

• Direction of the Board of Pardons and Paroles or their designee

• The State Health Officer or their designee

• The Director of Finance or their designee

• Three experts in “programs and services for opioid treatment and abatement,” appointed by the Attorney General, the Governor, and the Lieutenant Governor, respectively[8]

• An expert in programs and services for opioid treatment and abatement for veterans, appointed by the Commissioner of the Department of Veterans Affairs

• Six members of the state legislature, including legislative leadership and their legislator-appointees[9]

The Alabama Opioid Overdose and Addiction Council has over 50 members with a wide range of focus areas and expertise.[10] Numerous state agencies are represented on the Council, as well as legislators and professional associations such as the Alabama Pharmacy Association and the Alabama District Attorneys’ Association.[11] The Governor may also add members “as deemed appropriate.”[12] Review the Council’s 2023 membership in its 2023 Annual Report.

Are local governments required to establish a settlement advisory body? If so, are local advisory bodies required to include member(s) with lived and/or living experience?

No (up to each locality). Local governments in Alabama are not required to establish opioid settlement advisory bodies to inform spending of the 50% local share. However, localities may choose to establish advisory councils that include members with lived and/or living experience to help ensure that settlement spending reflects community priorities.

What else should I know?

Not applicable.

Citations

1. 2023 AL House Joint Resolution 204, Preamble. ↑

2. Alabama Exec. Or. No. 708, Secs. 2-3. ↑

3. Alabama Exec. Or. No. 708, Sec. 3. ↑

4. See, e.g., the Alabama Opioid Overdose and Addiction Council’s 2023 Annual Report and 2022 Annual Report. ↑

5. Alabama Exec. Or. No. 708, Sec. 4(z). ↑

6. Alabama Exec. Or. No. 708, Sec. 4(aa). ↑

7. 2023 AL House Joint Resolution 204, Sec. (b). ↑

8. 2023 AL House Joint Resolution 204, Secs. (a)(5)-(7). ↑

9. The Speaker of the House of Representatives or their designee; the President Pro Tempore of the Senate or their designee; the Chair of the Senate Finance and Taxation-General Fund Committee or their designee; the Chair of the House Ways and Means-General Fund Committee or their designee; two members of the House of Representatives appointed by the Speaker of the House; and two members of the Senate, appointed by the President Pro Tempore of the Senate. 2023 AL House Joint Resolution 204, Secs. (a)(9)-(14). ↑

10. See Alabama Exec. Or. No. 708, Sec. 4(a)-(aa). ↑

11. Alabama Exec. Or. No. 708, Sec. 4. ↑

12. Alabama Exec. Or. No. 708, Sec. 4(bb). For example, the most current membership of the Council also includes representation from, e.g., March of Dimes, Blue Cross Blue Shield, and the University of Alabama at Birmingham. See Council’s 2023 Annual Report. ↑

This Community Guide will describe how Alabama is spending its opioid settlements and whether Alabama is working to ensure community access to opioid settlement funds. Last revised September 1, 2024.

Where do these monies live?

Alabama’s local share is distributed to its local governments and governmental public health units.[1]

• For Alabama’s settlement with McKesson and Janssen, 40% is allocated to and 10% is allocated to (i.e., public hospitals, county health departments, boards of health).[2]

• For Alabama’s settlement with Endo, 40% is allocated to litigating political subdivisions.[3]

• For Alabama’s opioid-related bankruptcy settlements, 50% is allocated to political subdivisions.[4]

• According to a presentation from the Office of the Alabama Attorney General, 50% of the state’s settlements with Teva, Allergan, CVS, and Walgreens will “go[] to local entities.”[5]

• Local governments also received funds from a settlement with Walmart, negotiated by the Alabama Attorney General on behalf of Alabama cities and counties.[6]

What can this share be spent on?

With limited exceptions,[7] this share must be spent on uses consistent with the national settlement agreement’s (non-exhaustive) ,[8] which includes prevention, harm reduction, treatment, recovery, and other strategies.

Who ultimately decides how to spend this share (and how)?

Local governments and governmental public health entities decide autonomously. Decisionmakers for the local governments and governmental public health entities will decide autonomously how to spend their share of opioid settlement funds on approved uses (e.g., uses).[9]

Are supplantation uses prohibited for this share?

No, supplantation is discouraged but not prohibited. Like most states, Alabama does not explicitly prohibit supplantation uses of its opioid settlement funds. This means that the 50% local share may be spent in ways that replace (or “supplant”) – rather than supplement – existing resources.

However, in its annual reports, the has described a “shared commitment to using abatement funds recovered from statewide opioid settlements to supplement and strengthen resources available to Alabama communities and families for substance use disorder prevention, harm reduction, treatment, and recovery.”[10]

Can I see how this share has been spent?

Up to each locality (neither public nor intrastate reporting required). Opioid settlement expenditures are not officially published in a centralized location for this share.

What else should I know?

Unlike most states, Alabama chose not to participate in some of the national settlement agreements.[11] Pursuing individual settlement agreements with the companies involved in the opioid litigation means that Alabama’s opioid settlement scheme is not automatically subject to all the features (and protections) of the “national” settlement agreements’ opioid remediation-related terms. For example, Alabama’s McKesson and Janssen settlement agreements do not specify any amount that must be used exclusively towards forward-looking abatement strategies.[12]

Citations

2. McKesson Special Master Report 1 (“Pursuant to Sec. B. l of the McKesson and Janssen Opioid Settlement Allocation Agreement, "The State, Political Subdivisions [Litigating Local Governments] and Litigating Governmental Public Health Entities … shall divide all Settlement Funds with 50% going to the State, 40% going to the Political Subdivisions [Litigating Local Governments], and 10% going to the Litigating Governmental Public Health Entities”). ↑

3. Endo’s allocation departs from Alabama’s general 50% state, 50% local rule to allocate 60% to the state and 40% to political subdivisions. Alabama Endo Settlement Sign-on Sec. B.1. ↑

7. See, e.g., McKesson Special Master Report (describing special master fees and attorneys’ fees). ↑

12. See Section V.D.1 of the Distributor and Janssen agreements (requiring states to spend 70% of their opioid settlements on “future opioid remediation”). ↑

Alabama Department of Mental Health

• (behavioral health services and treatment finder, including naloxone)

Community Education Group

Can I provide input on spending?

• 50% state share: Depends on future programming (not required). Though the Oversight Commission on Alabama Opioid Settlement Funds has held public hearings in the past, the state government has not established recurring opportunities for the public to provide input on uses of its 50% share.[1]

  • Public hearings. The Oversight Commission on Alabama Opioid Settlement Funds held four public hearings in late 2023 and early 2024 to hear presentations from organizations making recommendations on the use of funds and/or directly seeking funds from the 50% state share.[2] Since the submission of its for the investment and use of settlement funds, it is unclear if this Commission will continue to hold hearings or otherwise seek community input.[3]

  • “Community engagement.” The is generally responsible for studying the state’s opioid overdose crisis and identifying strategies to reduce death and other harms, including through the submission of annual reports to the governor.[4] These reports, which refer to a standing Community Engagement Committee,[5] mentions the Council’s “deep community engagement” but do not describe public input opportunities.[6]

• 50% local share: Up to each locality (not required). Local governments are not required to seek public input on spending their share of settlement funds. However, each may choose to seek such input. See, e.g., Walker County’s , which is “intended to provide input to public officials for the opioid settlement fund.”[7] Watch for other opportunities to weigh in on city and county spending decisions, such as city council meetings and town halls.

Can I apply for grants?

Yes. State agencies have established their own grant programs,[8] but there is no settlement-specific grant portal. Local governments also may create grant programs to distribute their share of funds.[9] The existence, parameters, and processes for local settlement grant programs will vary by locality, so stay alert for new opportunities. Visit the (OpioidSettlementTracker.com and Legal Action Center) for the most up-to-date information on settlement grant opportunities for community organizations.

Where do I go for updates?

• For updates on the state share, visit the Alabama Opioid Overdose and Addiction Council’s .

• To find updates on the local share, a good starting point is to check the websites for your county commission, city council, or local health department.

• You can also check for updates on Community Education Group’s , which tracks information about the 13 states of Appalachia.

What else should I know?

The authorizing resolution for the Oversight Commission on Alabama Opioid Settlement Funds requires the Commission to provide a notice of all meetings, a copy of its findings, and any other documents produced by the Commission to the Secretary of State.[10] The Alabama Secretary of State is required by state law to post these materials and other key information on its website; as of September 1, 2024, it has yet to do so.[11] Keep an eye out for this required information.

Citations

11. Ala. Code Secs. 36-14-17.1(b)(1)(a)-(e). This is a requirement that applies to any temporary task force, not just the Commission. ↑

Where do these monies live?

Alabama’s 50% state share is held in the state’s Opioid Treatment and Abatement Fund.[1]

What can this share be spent on?

With limited exceptions,[2] this share must be spent on uses consistent with the national settlement agreements’ (non-exhaustive) Exhibit E.[3] The Alabama Opioid Overdose and Addiction Council’s eight priorities, which “align” with Exhibit E,[4] further identify a subset of its many interventions it thinks “would assist in changing the trajectory of the opioid crisis in Alabama.”[5]

Who ultimately decides how to spend this share (and how)?

Oversight Commission on Alabama Opioid Settlement Funds recommends, Opioid Overdose and Addiction Council guides, state legislature decides. The Alabama state legislature ultimately decides via appropriation how to spend funds from this share after consulting with the Oversight Commission on Alabama Opioid Settlement Funds (Commission) and Opioid Overdose and Addiction Council (Council).[6],[7]

• The Commission, created in 2023, is specifically tasked to “develop a statewide plan for the investment and use of opioid settlement funds and review the expenditure of funds appropriated to agencies and entities.”[8]

• The Council, created in 2017,[9] is generally responsible for assisting the governor in developing a statewide response to the overdose crisis and identifying spending priorities that reflect the state’s needs.[10]

Are supplantation uses prohibited for this share?

No, supplantation is discouraged but not prohibited. Like most states, Alabama does not explicitly prohibit supplantation uses of its opioid settlement funds. This means that the 50% state share may be spent in ways that replace (or “supplant”) – rather than supplement – existing resources.

However, in its annual reports, the Alabama Opioid Overdose and Addiction Council has described a “shared commitment to using abatement funds recovered from statewide opioid settlements to supplement and strengthen resources available to Alabama communities and families for substance use disorder prevention, harm reduction, treatment, and recovery.”[11]

Can I see how this share has been spent?

No (neither public nor intrastate reporting required). Opioid settlement expenditures are not officially published in a centralized location for this share.

Visit OpioidSettlementTracker.com’s Expenditure Report Tracker for an updated collection of states’ and localities’ available expenditure reports.

What else should I know?

Unlike most states, Alabama chose not to participate in some of the national settlement agreements.[12] Pursuing individual settlement agreements with the companies involved in the opioid litigation means that Alabama’s opioid settlement scheme is not automatically subject to all the features (and protections) of the “national” settlement agreements’ opioid remediation-related terms. For example, Alabama’s McKesson and Janssen settlement agreements do not specify any amount that must be used exclusively towards forward-looking abatement strategies.[13]

Citations

1. See 2024 AL House Bill 479 (appropriating settlement funds from the “Opioid Treatment and Abatement Fund”). But see Alabama Attorney General Marshall Finalizes $220 Million Settlement with Two Opioid Distributors. Alabama Attorney General Office press release. March 4, 2024. Accessed August 6, 2024 (“The State’s share of the settlement funds will be deposited directly into the State’s General Fund”). ↑

2. See, e.g., McKesson Special Master Report (describing special master fees and attorneys’ fees). ↑

3. See 2022 Annual Report. Alabama Opioid Overdose and Addiction Council. December 31, 2022 (describing Exhibit E’s “core strategies” list under “Approved State Use of Abatement Funds” and stating that “[t]he agreement reached by the State of Alabama with various parties restricts the use of any settlement funds to abatement strategies only. The priorities recommended by the Council align with the approved strategies”). Note that the state’s Janssen (Johnson & Johnson) settlement includes its own approved use exhibit with a non-exhaustive list of opioid remediation strategies that is similar but not identical to the national settlement agreements’ Exhibit E. The Janssen approved uses exhibit’s list of opioid remediation strategies are grouped into three categories: Opioid Community Innovation & Recovery (e.g., treatment, prevention, and harm reduction), Opioid Statewide Innovation & Recovery (e.g., resources for dashboards and stigma reduction training), and Opioid Recovery Sustainability (e.g., funding for child and family supports and syringe service programs). Johnson & Johnson Sign-On Exhibit A. ↑

4. See 2022 Annual Report. Alabama Opioid Overdose and Addiction Council. December 31, 2022 (“Approved State Use of Abatement Funds”). See also 2023 Annual Report. Alabama Opioid Overdose and Addiction Council. December 31, 2023 (“The Council supports ongoing recommendations as outlined in the previous year’s report,” which are “in keeping with the State Opioid Plan” established by the Oversight Commission on Alabama Opioid Settlement Funds). ↑

5. Id. See also Opioid Bankruptcy Case Allocation Agreement Exhibit A (describing a state-specific abatement plan with “three main components” to “complement … all other state and local government opioid plans”). ↑

6. See, e.g., 2024 AL House Bill 479, 2023 AL House Bill 465. ↑

7. See 2023 Annual Report. Alabama Opioid Overdose and Addiction Council. December 31, 2023 (“The Council looks forward to continued collaboration with the Oversight Commission on Alabama Opioid Settlement Funds providing lawmakers with the information they need to make data-driven and impactful decisions, based on guidance found in the 2022 Alabama Opioid Overdose and Addiction Council Report to the Governor.”) ↑

8. 2023 AL House Joint Resolution 204. ↑

9. Alabama Executive Order No. 708 (Aug. 8, 2017). ↑

10. See Alabama Attorney General Marshall Finalizes $220 Million Settlement with Two Opioid Distributors. Alabama Attorney General Office press release. March 4, 2024 (“As the Alabama Legislature works to determine the best uses of this funding, appropriators will have the benefit of reviewing two-and-a-half years of diligent work by the Alabama Opioid Overdose and Addiction Council to determine the State’s greatest needs”). ↑

11. Alabama Opioid Overdose and Addiction Council, 2023 Annual Report and 2022 Annual Report. ↑

12. See OpioidSettlementTracker.com’s “Global Settlement Tracker.” ↑

13. See Section V.D.1 of the Distributor and Janssen agreements (requiring states to devote 70% of their opioid settlements to future opioid remediation). ↑