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

• 60% Opioid Addiction Treatment and Recovery Fund share: Missouri General Assembly

• 40% local share: local officials for cities, counties, and political subdivisions

Has the state established an advisory body for settlement funds?

No. Missouri has not established an advisory body to inform spending of opioid settlement funds.

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

Not applicable.

What is the overall membership of the state advisory body?

Not applicable.

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 Missouri are not required to establish opioid settlement advisory bodies. 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

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

Missouri Department of Mental Health (DMH)

• Opioid Settlement Reporting Website

  • (March 1, 2024)

• ,

Other

Can I provide input on spending?

• 60% Opioid Addiction Treatment and Recovery Fund share: Depends on future programming (not required). The state has not established recurring opportunities for the public to provide input on uses of its 60% share.[1] However, the Missouri Department of Mental Health and the Department of Health and Senior Services have previously sought “local-level feedback to guide state-level overdose prevention and response efforts” via regional listening sessions and input surveys in Kansas City, St. Louis, and Poplar Bluff.[2],[3]

Where do these monies live?

The Opioid Addiction Treatment and Recovery Fund holds the state’s share of opioid settlement funds.[1] The Fund holds monies from the local share that local governments can choose to direct to the Fund.[2]

Note: This 60% allocation to the state applies to the grand majority, but not all, of Missouri’s opioid settlements.[3]

What can this share be spent on?

In general, and with limited exceptions, the state must spend its share on the uses described in the national settlement agreement’s (non-exhaustive) Exhibit E, (“Approved Uses”),[4] which includes prevention, harm reduction, treatment, recovery, and other strategies.

The Fund must also be specifically spent only to “pay for opioid addiction treatment and prevention services,” including their related “health care and law enforcement costs.”[5]

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

General Assembly decides. The appropriates Fund monies to state agencies and departments for uses on opioid use disorder treatment and prevention:[6]

• (DMH), which has received the majority of monies appropriated from the Fund in past years[7]

• (DOH)[8]

• [9]

In 2022-23, the legislature appropriated Fund monies to DMH, DOH, and the Office of Administration.[14] In 2024, the Department of Mental Health continued to be a major recipient of Fund appropriations.[15] As in many other states, the Missouri Governor has line-item veto authority over specific appropriations.

Is this share attached to an explicit bar against supplantation?

No, supplantation is not prohibited. Like most states, Missouri does not explicitly prohibit supplantation uses of its opioid settlement funds. This means that the 60% Opioid Addiction Treatment and Recovery Fund share may be spent in ways that replace (or “supplant”) — rather than supplement — existing resources.

Can I see how this share has been spent?

Yes (public reporting required). View annual reports on the Department of Mental Health’s .[16] DMH is required to annually report to the legislature, and this report must be published online.[17] The drop-down feature also links to expenditure reports for specific categories of recipients.

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

What else should I know?

Missouri’s non-litigating subdivisions’ amounts are distributed directly to them from the state’s share of funds, not the local share, and according to of the national settlements.[18]

Citations

1. Mo. Rev. Stat. Sec. 196.1050(2)(1) (establishing the Opioid Addiction Treatment and Recovery Fund); (“60% [Opioid Settlement Funds (applying to funds from the Janssen and Distributor settlements only)] to the State Share”); and and (“All Opioid Settlement Funds [and all Bankruptcy Settlement Funds] allocated to the State Share shall be deposited into the Opioid Addiction Treatment and Recovery Fund”). ↑

2. (“Any Political Subdivision that cannot use its Opioid Settlement Funds for Approved Uses as required by this MOU may remit their allocated share of Opioid Settlement Funds to the State to be deposited in the Opioid Addiction Treatment and Recovery Fund”). See also . Missouri Department of Mental Health (DMH). Accessed September 1, 2024 (describing the state’s share of funds as also containing “[r]estitution payments (state only) to compensate states that did not use outside counsel”). ↑

Where do these monies live?

This share is distributed to Missouri’s 106 participating counties, 66 participating cities, and three political subdivisions according to Exhibit G of the national settlements.[1] (Missouri’s non-litigating subdivisions receive their amounts directly from the state’s share of funds, and also according to Exhibit G.[2]) Localities may each may opt to direct their shares to the state’s Opioid Addiction Treatment and Recovery Fund.[3]

Note: This 40% allocation applies to the grand majority, but not all, of Missouri’s opioid settlements.[4]

What can this share be spent on?

With limited exceptions,[5] this share must be spent on the uses described in the national settlement agreement’s (non-exhaustive) Exhibit E, (“Approved Uses”) which includes prevention, harm reduction, treatment, recovery, and other strategies.[6]

is also incorporated into the Department of Health’s (see “”).

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

Local governments and subdivisions decide autonomously (but must report uses). Though decisionmakers for the counties, cities, and subdivisions will ultimately decide for themselves how to spend their monies on approved uses,[7] each must annually report their expenditures to the Department of Mental Health’s .[8]

The local governments are also encouraged to form partnerships with the , , and to spend their shares.[9]

Are supplantation uses prohibited for this share?

No, supplantation is not prohibited. Like most states, Missouri does not explicitly prohibit supplantation uses of its opioid settlement funds. This means that the 40% local share may be spent in ways that replace (or “supplant”) — rather than supplement — existing resources.

Can I see how this share has been spent?

Yes (public reporting required). View annual reports on the Department of Mental Health’s .[10] DMH is required to annually report to the legislature, and this report must be published online.[11] This also links to expenditure reports for specific categories of recipients.

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

What else should I know?

Missouri’s local governments are still building their track record of opioid settlement spend. According to the Department of Mental Health’s most recent annual report, “[t]he 2022 payments to local governments were made in the final two weeks of the calendar year,” and “68% of local governments (99 out of 146) did not spend opioid settlement funds during 2023.”[12]

Citations

1. (“40% [Opioid Settlement Funds (applying to funds from the Janssen and Distributor settlements only)] to the Litigating Subdivisions Share”), (defining “Litigating Subdivisions Share” to mean “the amount of the Settlement Funds allocated to Litigating Subdivisions”), and B.20 (defining “Litigating Subdivisions” to mean those that filed their opioid litigation complaints by January 1, 2021). See also . Missouri Department of Mental Health (DMH). Accessed September 1, 2024 (describing “93 participating counties” and “50 participating cities” prior to 2024). As of 2024, the are the City of Bolivar’s Citizens Memorial Hospital District and St. Louis County’s Kinloch Fire Protection District and Northeast Ambulance and Fire Protection District. ↑

2. (defining “Non-Litigating Subdivisions” to mean “Political Subdivisions with a population of 10,000 or more individuals … that did not initiate opioid-related litigation on or before January 1, 2021” and “Political subdivisions” to mean “all political subdivisions of the State of Missouri”) and (“The Non-Litigating Subdivisions Share of the Opioid Settlement Funds shall be deducted from the State Share; it shall not be deducted from the Litigating Subdivisions Share. The Non-Litigating Subdivisions Share shall be paid directly to them by the national administrator and shall not be deposited into accounts for the State of Missouri”).