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
This share is distributed to the Commonwealth’s participating towns, cities, and counties according to the percentages listed here.[1]
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]
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]
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]
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.
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]
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”). ↑
Massachusetts Abatement Terms, Sec. III (“Municipal Use of Abatement Funds”). ↑
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”). ↑
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. ↑
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”). ↑
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”). ↑
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”). ↑
Massachusetts State-Subdivision Agreement for Statewide Opioid Settlements, Sec. C. ↑
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”). ↑
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”). ↑
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”). ↑
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”). ↑
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.”) ↑
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”). ↑
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. ↑
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]
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]
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]
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]
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.
Expansion of harm reduction services
Increased access to medication for OUD
Workforce
Expansion of supportive housing programs
Community outreach and engagement
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”). ↑
In 2023, the Council used their to recommend the creation of a multi-year and municipal grant program (i.e., the Department of Public Health’s )[12] and identified additional spending priorities for 2024.[13] It also allocated monies across five initiatives:[14]
Massachusetts State-Subdivision Agreement for Statewide Opioid Settlements, ; Mass. Ann. Laws ch. 10, Sec. 35OOO(a). ↑
Massachusetts State-Subdivision Agreement for Statewide Opioid Settlements, (“amounts allocated to Subdivisions that are Non-Participating Subdivisions as of a Payment Date”). ↑
Mass. Ann. Laws ch. 10, Secs. 35OOO(b) (providing that “[t]he secretary of health and human services shall provide administrative support to the council”), 35OOO(c) (referring to “the administrative costs of the executive office” as an expenditure of the ORRF). See also . Massachusetts Office of the Attorney General website. Accessed August 15, 2024 (providing that no settlements funds will be used “to pay any state lawyers”). ↑
Mass. Ann. Laws ch. 10, Sec. 35OOO(a). See also Massachusetts Abatement Terms, (“It is also understood that OUD is often accompanied by co-occurring substance use disorder or mental health conditions, and it is intended that the strategies in this document will support persons with OUD and any co-occurring SUD and mental health conditions”). ↑
Massachusetts Abatement Terms, (“State Use of Abatement Funds”). See also Massachusetts State-Subdivision Agreement for Statewide Opioid Settlements, . ↑
See Massachusetts Abatement Terms, (“Statewide Commitment to Abatement”). This opening section of the Massachusetts Abatement Terms expresses the Commonwealth’s and its municipalities’ non-binding “shared commitment” to using funds in certain ways; subsequent sections contain hard-and-fast rules for each of the shares. ↑
. Opioid Recovery and Remediation fund. December 6, 2022. Accessed August 15, 2024. A specifically linked to this presentation from December 6, 2022 when referring to the “ORRF Strategic Framework.” See also . Kate Walsh, Executive Office of Health & Human Services, on behalf of the Opioid Recovery and Remediation Fund Advisory Council. October 1, 2023. Accessed August 15, 2024 (“The ORRF strategic framework prioritizes the investment of funds to address racial and geographic disparities in [OUD], with a goal of creating a full continuum of prevention, harm reduction, treatment, services, and supports for an individual’s recovery from opioid addiction and in support of their loved ones”). ↑
Mass. Ann. Laws ch. 10, Secs. 35OOO(a) (“Expenditures from the fund shall be made by the executive office of health and human services, without further appropriation and consistent with the terms of settlements made in connection with claims arising from the manufacture, marketing, distribution or dispensing of opioids, as applicable. The secretary of health and human services, in consultation with the Opioid Recovery and Remediation Fund advisory council … shall administer the fund”), 35OOO(b) (“There shall be an Opioid Recovery and Remediation Fund advisory council regarding the expenditures from the fund”); Massachusetts State-Subdivision Agreement for Statewide Opioid Settlements, (describing ORRF as administered by EOHHS “in consultation with” the Council). ↑
Massachusetts Abatement Terms, . See . Executive Office of Health and Human Services. March 6, 2024. Accessed August 15, 2024 (announcing additional strategic priorities and specifically linking to a when referring to the “ORRF Strategic Framework”). ↑
Massachusetts State-Subdivision Agreement for Statewide Opioid Settlements, Sec. . See also Massachusetts Abatement Terms, Secs. (“a shared commitment to using abatement funds recovered from statewide opioid settlements to supplement and strengthen resources”), (“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”). ↑
See, . RIZE Massachusetts press release. May 15, 2024. Accessed August 15, 2024 (“DPH’s Bureau of Substance Addiction Services (BSAS) contracted RIZE to develop and implement a community grantmaking program that would create a pathway of access for municipalities and nonprofit organizations to apply for Opioid Recovery & Remediation Fund (ORRF) funding … The Community-based Opioid Response Efforts (CORE) grant, the first round of grants through Mosaic, will fund community-based organizations that are working to reduce the harms caused by the opioid epidemic”). ↑
. Executive Office of Health and Human Services. March 6, 2024. Accessed August 15, 2024 (see “”). ↑
. Kate Walsh, Executive Office of Health & Human Services, on behalf of the Opioid Recovery and Remediation Fund Advisory Council. October 1, 2023. Accessed August 15, 2024. ↑