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

• 60% Opioid Recovery and Remediation Fund share: Massachusetts Executive Office of Health and Human Services

• 40% municipal share: decisionmakers for towns, cities, and counties

Where do these monies live?

This share is distributed to the Commonwealth’s participating towns, cities, and counties according to the percentages listed here.[1]

What can this share be spent on?

This share must be spent on the strategies described in the “Municipal Use of Abatement Funds” section of the Massachusetts Abatement Terms,[2] which provides seven categories of interventions:[3]

• Opioid use disorder treatment

• Support people in treatment and recovery

• Connections to care

• Harm reduction

• Address the needs of criminal-justice-involved persons

• Support pregnant or parenting women and their families, including babies with neonatal abstinence syndrome

• Prevent misuse of opioids and implement prevention education

Municipalities are prohibited from using their shares to fund care reimbursed by the state.[4] The Massachusetts Abatement Terms also describe a “shared commitment” to use settlement funds in ways that reflects in the input of communities, addresses disparities, addresses co-occurring disorders, leverages existing programs, and encourages innovation.[5]

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

Localities decide autonomously. Decisionmakers for the towns, cities, and counties will ultimately decide for themselves how to spend their monies on abatement uses,[6] and each are able to engage in grantmaking with nonprofit organizations.[7] Municipalities are encouraged to enter into agreements amongst themselves to pool their funds and collaborate on abatement efforts,[8] and each locality may opt to reallocate its shares to the Opioid Recovery and Remediation Fund (ORRF).[9]

Localities also may optionally tap into resources created by the Commonwealth to support local opioid abatement efforts. The Department of Public Health’s Bureau of Substance Addiction Services’ Guidance for Municipalities Utilizing Opioid Settlement Abatement Payments, for example, refers to:

• The Department of Public Health’s Office of Local and Regional Health’s Shared Service Infrastructure

• The Office of the Inspector General’s Chapter 30B team (technical assistance on public procurement)[10]

• Strategic guidance and technical assistance from the John Snow Research and Training Institute[11]

Are supplantation uses prohibited for this share?

Yes, supplantation is prohibited. Massachusetts’ state-subdivision agreement explicitly requires the state’s abatement funds to be used “solely to supplement and strengthen, rather than supplant, resources for prevention, harm reduction, treatment, and recovery, in accordance with the … Massachusetts Abatement Terms.”[12] This includes, but is not limited to, a specific prohibition on municipalities using their shares to “fund care reimbursed by the state,” including by Medicaid (MassHealth) or the Massachusetts Bureau of Substance Addiction Services.[13]

Can I see how this share has been spent?

Yes (public reporting required). View Care Massachusetts’ Municipal Opioid Abatement Funds Data Dashboard. Localities that receive $35,000 or more in annual settlement funds, whether individually or pooled with other localities, must submit annual expenditure reports to the Massachusetts Executive Office of Health and Human Services (EOHHS), and all localities are asked to submit such reports.[14] EOHHS has committed to making these reports publicly available.[15]

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

What else should I know?

In response to community feedback, Boston established a novel $250,000 Family Overdose Support Fund to provide “financial support to Boston families who have lost a loved one to opioid overdose. … Families can use the funds to cover funeral expenses, therapy, legal services, childcare, and other financial burdens.”[16]

Citations

1. Massachusetts State-Subdivision Agreement for Statewide Opioid Settlements, Sec. C. Non-participating subdivisions’ amounts are reallocated to the ORRF. See Massachusetts State-Subdivision Agreement for Statewide Opioid Settlements, Sec. D(b); Frequently Asked Questions About the AG's Statewide Opioid Settlements. Massachusetts Office of the Attorney General website. Accessed August 15, 2024 (“Distributions allocated to municipalities that do not participate in a particular statewide opioid settlement (i.e., municipalities that do not sign settlement Participation Forms for one or more of the settlements) will be directed to the Opioid Recovery and Remediation Fund”). ↑

2. Massachusetts State-Subdivision Agreement for Statewide Opioid Settlements, Sec. C; Massachusetts Abatement Terms, Sec. III. ↑

3. Massachusetts Abatement Terms, Sec. III (“Municipal Use of Abatement Funds”). ↑

4. Massachusetts Abatement Terms, Sec. III (“Municipal abatement funds shall not be used to fund care reimbursed by the state, including through MassHealth and BSAS, although local or area agencies or programs that provide state-reimbursed services can be supported financially in other ways that help meet the needs of their participants”). But see Bill Zito. Ludlow CARES seeks reimbursement from opioid funds. The Reminder. May 14, 2024. Accessed August 16, 2024 (reporting on the Ludlow CARES Coalition’s request to the Town of Ludlow’s Board of Selectman for reimbursement using the town’s opioid settlement funds. It is unclear whether the requested reimbursement would qualify as “care reimbursed by the state”). ↑

5. See Massachusetts Abatement Terms, Sec. I (“Statewide Commitment to Abatement”). This opening section of the Massachusetts Abatement Terms merely expresses the Commonwealth’s and its municipalities’ “shared commitment” to using funds in certain ways; subsequent sections do contain hard-and-fast rules for each of the shares. ↑

6. See Massachusetts State-Subdivision Agreement for Statewide Opioid Settlements, Sec. C; Guidance for Municipalities Utilizing Opioid Settlement Abatement Payments. Department of Public Health’s Bureau of Substance Addiction Services website. Accessed August 16, 2024 (“Municipalities are encouraged to innovate and collaborate in developing opioid abatement fund strategies”). See also Alexa Lewis. Easthampton creates fund to receive estimated $1M in opioid settlement money over next 10-15 years. Daily Hampshire Gazette. June 12, 2024. Accessed August 16, 2024 (reporting on both Easthampton and Westhampton as having established accounts to receive settlement funds, and that Westhampton’s “Board of Health is in discussion with local organizations and other municipalities to determine the best uses for the funds”). ↑

7. Frequently Asked Questions About the AG's Statewide Opioid Settlements. Massachusetts Office of the Attorney General website. Accessed August 15, 2024 (“state procurement laws apply to expenditure of municipal abatement funds, subject to certain permitted exceptions and exemptions. Exceptions and exemptions that may be relevant to municipalities seeking to expend abatement funds include, for example, an exception for grant agreements between municipalities and nonprofit entities for a public purpose, and an exemption for contracts or agreements entered into by a municipal hospital or a municipal department of health”). ↑

8. Massachusetts State-Subdivision Agreement for Statewide Opioid Settlements, Sec. C; Massachusetts Abatement Terms, Sec. III (“Municipalities are encouraged to pool abatement funds to increase their impact, including by utilizing the Office of Local and Regional Health’s Shared Service Infrastructure”). See Marcia Testa. Statewide Opioid Settlement Funds Templates and Webinars. Massachusetts Association of Health Boards website. August 10, 2022. Accessed August 16, 2024; Guidance for Municipalities Utilizing Opioid Settlement Abatement Payments. Department of Public Health’s Bureau of Substance Addiction Services website. Accessed August 16, 2024 (“Inter-municipal agreements allow municipalities to pool funds to build shared abatement programs and services”). ↑

9. Massachusetts State-Subdivision Agreement for Statewide Opioid Settlements, Sec. C. ↑

10. Frequently Asked Questions About the AG's Statewide Opioid Settlements. Massachusetts Office of the Attorney General website. Accessed August 15, 2024 (“The Office of the Inspector General (OIG) has published answers to frequently asked questions about use of municipal abatement funds here. In addition, the OIG's Chapter 30B Manual provides helpful guidance on the state laws governing municipal procurement of supplies, services, real property. The OIG has a Chapter 30B team trained in public procurement that can provide you with technical guidance and answer your questions. To speak with someone on the OIG’s procurement team, call 617-722-8838 or email 30BHotline@mass.gov”). ↑

11. Guidance for Municipalities Utilizing Opioid Settlement Abatement Payments. Department of Public Health’s Bureau of Substance Addiction Services website. Accessed August 16, 2024 (“Municipalities can access support from John Snow Research and Training Institute (JSI) at www.caremass.org and fill out the Request Help form or by emailing abate@jsi.com or by phone (617-385-3655). The team at JSI can provide technical assistance and training related to using these funds in compliance with the State-Subdivision Agreement”). ↑

12. Massachusetts State-Subdivision Agreement for Statewide Opioid Settlements, Sec. B. See also Massachusetts Abatement Terms, Secs. I (“a shared commitment to using abatement funds recovered from statewide opioid settlements to supplement and strengthen resources”), II (“Abatement funds directed to the state shall be deposited into the statewide Opioid Recovery and Remediation Fund to supplement prevention, harm reduction, treatment, and recovery programs throughout Massachusetts”). ↑

13. Massachusetts Abatement Terms, Sec. III (“[A]lthough local or area agencies or programs that provide state-reimbursed services can be supported financially in other ways that help meet the needs of their participants”). ↑

14. Massachusetts Abatement Terms, Sec. V(B) (“The reports shall include, but not be limited to: municipal abatement funds received; an itemized list of the funds expended for abatement and administrative costs, if applicable; the unexpended balance; a brief description of the funded abatement strategies and efforts to direct resources to vulnerable and under-served

    Communities”). See also Guidance for Municipalities Utilizing Opioid Settlement Abatement Payments. Department of Public Health’s Bureau of Substance Addiction Services website. Accessed August 16, 2024 (“Starting in August 2023, all participating municipalities will be asked to submit an annual report on their FY23 Opioid Abatement Fund planning process, strategies selected, and expenditures. Those municipalities that received $35,000.00 or more in FY23 are required to submit a report.”) ↑

15. Guidance for Municipalities Utilizing Opioid Settlement Abatement Payments. Department of Public Health’s Bureau of Substance Addiction Services website. Accessed August 16, 2024 (“In order to support full transparency of the use of the opioid abatement funds, and in accordance with the State-Subdivision Agreement l [], all reports will be made public”). ↑

16. Family Overdose Support Fund to Assist Families Who Lost Loved Ones to Overdose. City of Boston press release. May 1, 2024. Accessed August 16, 2024. ↑

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

Massachusetts Executive Office of Health and Human Services

Massachusetts Attorney General’s Office

Massachusetts Attorney General’s Office, Department of Revenue, and Department of Public Health

• (March 2023)

Has the state established an advisory body for settlement funds?

Yes. The (Council) was created by state law to make recommendations to and consult with the on Opioid Recovery and Remediation Fund expenditures.[1] The Council is required to hold public meetings at least every quarter and recommendations are approved by majority vote.[2]

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

Yes. At least two members of the Council must be “qualified by experience with opioid use disorder, either first-hand or as a family of an individual with an opioid use disorder.”[3] More broadly, the Council’s appointing authorities — which include legislative leaders, the Governor, the state Attorney General, and the Massachusetts Municipal Association — must ensure the inclusion of “members with personal experience with opioid use disorder.”[4]

What is the overall membership of the state advisory body?

The current membership is listed . State law requires its 20 members to be appointed by the following state and local leaders:[5]

• Four (4) members appointed by majority and minority leadership in each legislative chamber[6]

• Three (3) members appointed by the Governor, at least one of whom must have experience with opioid use disorder (first-hand or as a family member)

• Three (3) members appointed by the Attorney General, at least one of whom must have experience with opioid use disorder (first-hand or as a family member)

• Ten (10) local government officials appointed by the Massachusetts Municipal Association, none from the same county, and at least two (2) from a “gateway municipality”[7]

Appointing authorities must ensure that the Council includes members that:

• Represent racially and socioeconomically diverse communities[8]

• Have public health expertise related to opioid use disorder[9]

• Have personal experience with opioid use disorder[10]

• Will “contribute to reducing disparities in health outcomes for underserved communities experiencing opioid use disorder”[11]

Appointing authorities also must "consider having racially diverse representation on the council.”[12]

The Secretary of Health and Human Services serves as a non-voting chair and provides administrative support to the Council.[13] Members serve two-year terms and are not explicitly limited in how many terms they serve, but any member can be removed by their appointing authority.[14]

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?

What else should I know?

Not applicable.

Citations

3. Mass. Ann. Laws ch. 10, Sec. 35OOO(b). ↑

4. Mass. Ann. Laws ch. 10, Sec. 35OOO(b)(iii). ↑

5. Mass. Ann. Laws ch. 10, Sec. 35OOO(b). ↑

6. The state’s Senate President, Senate Minority Leader, Speaker of the House, and Minority Leader of the House all appoint one member. Mass. Ann. Laws ch. 10, Sec. 35OOO(b). ↑

7. Mass. Ann. Laws ch. 23A, Sec. 3A(b) (defining “gateway municipality” as “a municipality with a population greater than 35,000 and less than 250,000 with a median household income below the commonwealth’s average and a rate of educational attainment of a bachelor’s degree or above that is below the commonwealth’s average”). ↑

8. Mass. Ann. Laws ch. 10, Sec. 35OOO(b)(i). ↑

10. Mass. Ann. Laws ch. 10, Sec. 35OOO(b)(iii). ↑

11. Mass. Ann. Laws ch. 10, Sec. 35OOO(b)(iv). ↑

12. Mass. Ann. Laws ch. 10, Sec. 35OOO(b) (emphasis added). ↑

13. Mass. Ann. Laws ch. 10, Sec. 35OOO(b). ↑

14. Mass. Ann. Laws ch. 10, Sec. 35OOO(b). ↑

Can I provide input on spending?

The express the Commonwealth’s and its municipalities’ general commitment to using settlement funds in a way that “reflects the input of [their] communities” and of “people who have personal experience with the opioid crisis.”[1]

• 60% Opioid Recovery and Remediation Fund share: No opportunities available (not required). The (Council), which must meet at least quarterly, is subject to the state’s .[2] However, this state law does not require the Council to allow public comment during its meetings.[3] Minutes from do not show dedicated space for public input, although anyone can submit general comments or questions to the Council via email: .

• 40% municipal share: Up to each municipality (not required). Though municipalities are not required to seek public input on uses of its share, those receiving more than $35,000 in settlement funds in a given year are required to their “efforts to solicit community input regarding how abatement funds should be spent from local stakeholders,” including people with lived experience.[4] Examples of municipalities’ input opportunities:

  • “Between May 30, 2023 and October 13, 2023, the Boston Public Health Commission Office of Recovery Services gathered feedback from Boston residents through community and provider listening sessions, surveys released in multiple languages, and a longform Request for Information.”[5] Themes from data collected from this outreach are summarized .

  • Several other localities have launched online surveys to collect public feedback on opioid settlement-related spend (e.g., , , , , , and ).

Can I apply for grants?

Yes. Massachusetts has established specific settlement-funded grant opportunities for community organizations. Visit RIZE Massachusetts’ “” page to view current funding opportunities. Local governments also may create grant programs to distribute their share of funds. 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 Opioid Recovery and Remediation Fund share, visit the Opioid Recovery and Remediation Fund Advisory Council’s , which includes details on upcoming meetings.

• To find updates on the local share, a good starting point is to check the websites for your municipality’s governing body, local board of health, or local health department (e.g., , , , , and ).

What else should I know?

Not applicable.

Citations

2. Mass. Ann. Laws ch. 10, Sec. 35OOO(b) ("The council shall hold no fewer than 4 meetings annually and the council shall make its recommendations upon a majority vote. The council shall be subject to sections 18 to 25, inclusive, of chapter 30A”); Mass. Ann. Laws ch. 30A, Sec. 20(a) (“Except as provided in section 21, all meetings of a public body shall be open to the public”). ↑

Where do these monies live?

The Opioid Recovery and Remediation Fund (ORRF) holds 60% of Massachusetts’ opioid settlement funds,[1] as well as amounts allocated to non-participating subdivisions.[2]

What can this share be spent on?

With limited exceptions,[3] monies in the Opioid Recovery and Remediation Fund (ORRF) must be spent “to mitigate the impacts of the opioid epidemic in the commonwealth, including, but not limited to, expanding access to opioid use disorder prevention, intervention, treatment and recovery options,”[4] and to “supplement harm reduction, treatment, and recovery programs.”[5] The also describe a “shared commitment” to use settlement funds in ways that reflects in the input of communities, addresses disparities, addresses co-occurring disorders, leverages existing programs, and encourages innovation.[6]

The state’s Opioid Recovery and Remediation Fund Advisory Council’s additionally identifies , , and specific initiatives.[7]

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

Opioid Recovery and Remediation Fund Advisory Council recommends, Executive Office of Health and Human Services decides and administers. The administers and ultimately decides specific expenditures from the ORRF after consulting the recommendations of the (Council),[8] which identifies priorities and has developed a strategic framework (“”).[9]

Are supplantation uses prohibited for this share?

Yes, supplantation is prohibited. Massachusetts’ explicitly requires the state’s abatement funds to be used “solely to supplement and strengthen, rather than supplant, resources for prevention, harm reduction, treatment, and recovery, in accordance with the … .”[10]

Can I see how this share has been spent?

Yes (public reporting required). View the Opioid Recovery and Remediation Fund’s annual reports . Massachusetts state law requires the state Secretary of Health and Human Services to publish on its website an annual report detailing ORRF expenditures from the prior year.[11]

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

What else should I know?

• Expansion of harm reduction services

• Increased access to medication for OUD

• Workforce

• Expansion of supportive housing programs

• Community outreach and engagement

Citations

11. Mass. Ann. Laws ch. 10, Sec. 35OOO(c) (“Annually, not later than October 1, the secretary of health and human services shall file a report on the activity, revenue and expenditures to and from the fund in the prior fiscal year with the clerks of the senate and the house of representatives, the house and senate committees on ways and means and the joint committee on mental health, substance use and recovery and made available on the executive office of health and human services’ public website. The report shall include, but not be limited to: (i) the revenue credited to the fund; (ii) the amount of expenditures attributable to the administrative costs of the executive office; (iii) an itemized list of the funds expended from the fund; and (iv) data and an assessment of how well resources have been directed to vulnerable and under-served communities”). ↑