Here are the entities that ultimately decide how each of New Hampshire’s opioid settlement shares are spent:
85% state share: New Hampshire Opioid Abatement Advisory Commission (with approval from Governor and Executive Council)
15% local share: local officials for counties, cities, and towns
The Opioid Abatement Trust Fund holds 85% of New Hampshire’s opioid settlement funds.[1]
In general, and with limited exceptions,[2] Fund monies must only be disbursed to one of the 19 project criteria listed in state law.[3]
Three of these criteria are reimbursement uses: for outpatient and residential treatment services for OUD and co-occurring disorders (inclusive of medications and “abstinence-based treatment,” in addition to treatment for people involved in the criminal legal system);[4] for law enforcement and emergency response services;[5] and for naloxone.[6]
Other approved uses in state law include supports for mobile services, “withdrawal management,”[7] access to housing, transportation to treatment and other services, employment training, centralized call centers to connect people to supports, improved oversight of methadone treatment programs, scholarships for health providers to work in underserved areas, efforts to prevent over-prescribing, improvements to the prescription drug monitoring program, education for law enforcement on fentanyl, evidence-based “and/or evidence-informed” prevention, school programs, secondary and tertiary prevention “through harm reduction programs,” and addressing the pain management needs of chronic pain patients and/or those in hospital or palliative care.[8]
Disbursements from the Fund must be made “in alignment with relevant state plans.”[9] The Opioid Abatement Advisory Commission’s contains a non-exhaustive list of strategies that are “in alignment with [state law] … , NH’s SUD Action Plan[,] and the 10-Yr Mental Health Plan.”[10] The Commission's document refers to of the national settlements — which includes prevention, harm reduction, treatment, recovery, and other strategies — as providing a “further description of opioid remediation uses.”[11]
Opioid Abatement Advisory Commission decides (with approval from the Governor and New Hampshire Executive Council). The makes decisions on grant funding and other disbursements from this share in coordination with the .[12] The Advisory Commission’s disbursements must be “in alignment with relevant state plans.”[13]
The Governor and the must approve “all disbursements or grants.”[14] The Department of Health and Human Services (DHHS) is responsible for distributing the monies.[15]
Both governmental entities and non-profit organizations are eligible to receive awards from the Fund.[16] The Commission is required to advise DHHS on the Fund’s administration and approve the agency’s selection of eligible grant recipients.[17] The Commission and the DHHS Commissioner are both empowered to develop priorities and goals for the Fund’s expenditures and recommend state and local policy changes.[18]
Generally no, supplantation is not prohibited. Like most states, New Hampshire does not prohibit supplantation uses of its opioid settlement funds. This means that the 85% state share may be spent in ways that replace (or “supplant”) — rather than supplement — existing resources. However, state law prohibits certain reimbursement uses of funds from the 85% state share where the government entity would have otherwise been reimbursed for such services.[19] This provision effectively operates as a bar against “double-dipping” on funding sources and may limit some, but not most, forms of supplantation.[20]
Not applicable.
N.H. Rev. Stat. Ann. Secs. 126-A:83(I) (“All proceeds received by the state from all consumer protection settlements or judgments against opioid manufacturers or distributors shall be deposited in accordance with RSA 7:6-f. … The state treasurer shall disburse funds from the trust fund solely for the purposes and in the manner set forth in RSA 126-A:84”), 126-A:84(I) (“The commissioner shall draw from the opioid abatement trust fund for qualifying opioid abatement projects under RSA 126-A:86, I(b)”), and 126-A:86(I)(b)(1)-(17) (listing acceptable project criteria). ↑
N.H. Rev. Stat. Ann. Sec. 126-A:86(I)(b)(1). ↑
N.H. Rev. Stat. Ann. Sec. 126-A:86(I)(b)(2). ↑
N.H. Rev. Stat. Ann. Sec. 126-A:86(I)(b)(5) (“FDA-approved opioid reversal agents”). ↑
N.H. Rev. Stat. Sec. 126-A:86(I). ↑
N.H. Rev. Stat. Secs. 126-A:85(I) (“There is hereby established the New Hampshire opioid abatement advisory commission, which shall consult with and advise the commissioner of the department of health and human services relative to the proper administration and management of the opioid abatement trust fund, as established in RSA 126-A:83, and which shall approve all qualifying grants, loans, and matching funds from that fund under RSA 126-A:86, I(b)”) (emphasis added); N.H. Rev. Stat. Sec. 126-A:86(I)(b) (“The opioid abatement advisory commission in coordination with the governor's commission on alcohol and other drugs, and in alignment with relevant state plans, shall … [a]ward grants, revolving loan funds, and matching funds to projects from the opioid abatement trust fund under RSA 126-A:83, I, in a manner consistent with the following criteria…”). ↑
N.H. Rev. Stat. Ann. 126-A:84(II)(b) and (III). (“All remaining funds [after 15% for counties and political subdivisions] shall be deposited into the opioid abatement trust fund as established by RSA 126-A:83, I to be distributed by the commissioner of the department of health and human services, with approval of the opioid abatement advisory commission” and “[t]he commissioner of the department of health and human services shall continue to make distributions from the trust fund … for as long as defendants in the opioid litigation make payments to the state or until such time that the funds in the opioid abatement trust fund are exhausted”). ↑
N.H. Rev. Stat. Sec. 126-A:84(II)(b) (“Funds may be awarded to a qualifying governmental entity or program for an approved use under RSA 126-A:86, I(b)”). ↑
N.H. Rev. Stat. Sec. 126-A:86(I)(a)-(b) (requiring Commission to advise DHHS, approve eligible Fund recipients, and award grants) and 126-A:85(I) (“commission … shall consult with and advise the commissioner of the department of health and human services relative to the proper administration and management of the opioid abatement trust fund, as established in RSA 126-A:83, and which shall approve all qualifying grants, loans, and matching funds from that fund under RSA 126-A:86, I(b)”). ↑
N.H. Rev. Stat. Sec. 126-A:86(II) (“The commission or the commissioner of the department of health and human services may identify additional responsibilities including reporting on projects and programs related to addressing the opioid epidemic, developing priorities, goals and recommendations for spending on such projects and programs, working with state agencies or outside entities to develop measures for projects and programs that address substance use disorders, making recommendations for policy changes on a state and local level, including statutory law and administrative agency regulations”). ↑
N.H. Rev. Stat. Ann. Sec. 126-A:86(I)(b)(1) (imposing such limitations on reimbursement for “costs related to outpatient and residential opioid use disorder (OUD) and any co-occurring substance use disorder or mental health (SUD/MH) treatment services”). But see N.H. Rev. Stat. Ann. Sec. 126-A:86(I)(b)(2) (not imposing such limitations on reimbursements of costs “for emergency response services related to OUD and any co-occurring SUD/MH issues provided by law enforcement and first responder”); (I)(b)(5) (no such limitations on reimbursements “for emergency response services related to OUD and any co-occurring SUD/MH issues provided by law enforcement and first responder”). ↑
N.H. Rev. Stat. Sec. 126-A:86(III) (“The [Opioid Abatement Advisory] [C]ommission shall create and maintain a website on which it shall publish its minutes, attendance rolls and votes, including records of all votes on funding requests, funding awards, and reports of funding by recipients”). See also N.H. Rev. Stat. Sec. 126-A:84(IV) (“On or before September 1, 2020, each county, city, town or program that receives funds under paragraph II shall annually provide to the department of health and human services and the opioid abatement advisory commission a detailed account of all monies spent on approved uses, including, but limited to, an analysis and evaluation of the projects and programs it has funded”) (emphasis added). Note that paragraph II encompasses both the 85% state share and the 15% local share. ↑
Eventually (public reporting required). Expenditures for this share will likely be published on the ’s website. State law requires the Commission to publish information about its “funding awards” and “reports of funding by recipients” online.[21]
Visit OpioidSettlementTracker.com’s for an updated collection of states’ and localities’ available expenditure reports.
N.H. Rev. Stat. Ann. Sec. 126-A:84(II)(a)-(b). But see 70% regional, 30% non-regional apportionments of Mallinckrodt trust distributions. NOAT II: (January 13, 2023). ↑
See, e.g., . New Hampshire Attorney General News Release. September 1, 2022. Accessed August 9, 2024. (“Under the terms of the settlement agreement, Johnson & Johnson will make a single payment of $39.605 million to the State and pay approximately $900,000 in attorneys’ fees to counsel for the counties, cities and towns that filed opioid lawsuits against Johnson & Johnson prior to September 1, 2019”). See also N.H. Rev. Stat. Ann. Sec. 126-A:85(VII) (“The department of health and human services shall provide administrative support to the advisory commission”). ↑
The law originally referred to this as “detoxification.” See 2020 NH . Legislation in 2023 replaced instances of “detoxification” with “withdrawal management.” 2023 NH . ↑
N.H. Rev. Stat. Ann. Sec.126-A:86(I)(b)(3)-(4), (6)-(19). The approved criteria regarding pain management were added by legislation enacted in 2024. See ↑
. Opioid Abatement Advisory Commission (Commission). February 2024. Accessed August 9, 2024. (“Use of these strategies should be determined within the broader context of statewide plans, community feedback, current efforts by non-governmental and governmental entities and anticipated funding reductions (State Opioid Response, COVID relief, etc). This is not an exhaustive list of applicable strategies, but rather, a guiding document to help establish a road map for funding, in alignment with NH statute and opioid settlement agreements (see for further description of opioid remediation uses”). ↑
. Opioid Abatement Advisory Commission (Commission). February 2024. Accessed September 1, 2024. (“[The Guiding Strategies] is not an exhaustive list of applicable strategies, but rather, a guiding document to help establish a road map for funding, in alignment with NH statute and opioid settlement agreements (see Exhibit E for further description of opioid remediation uses)”). ↑
N.H. Rev. Stat. Sec. 126-A:86(I). The Commission’s document contains a non-exhaustive list of applicable strategies that are “in alignment with RSA 126-A:86 … , NH’s SUD Action Plan[,] and the 10-Yr Mental Health Plan ↑
N.H. Rev. Stat. Sec. 126-A:86(I)(b) (“All disbursements or grants shall require approval of the governor and executive council”). The Executive Council works together with the governor to manage state affairs, with a particular emphasis on overseeing government spending. Councilors are directly elected by the people in their districts. See . State of New Hampshire Executive Council. Accessed August 9, 2024. ↑
For example, the law would prohibit the use of funds from the 85% state share to reimburse the state or local governments for OUD treatment expenses which will be reimbursed by Medicaid but would not prohibit a local government from seeking reimbursement for expenses it otherwise paid for with general revenue funds. See, e.g., to RGA-2023-DBH-03-OPIOI “Opioid Abatement Programs,” Sec. 1.2.4. New Hampshire Department of Health and Human Services. June 5, 2023. Accessed June 28, 2024 (“Applicants must only request reimbursement for costs not reimbursable by other third-party funding sources and must not request reimbursement for costs that have already been reimbursed by federal, state, or other third-party funding sources. Costs originally paid through county or municipal general funds may be submitted for reimbursement.”) ↑
New Hampshire’s local government share is distributed to its litigating counties and political subdivisions, the latter of which are defined to include “any village district, school district, town, city, county or unincorporated place in the state.”[1] Each locality’s share is based on population.[2]
In general, and with limited exceptions,[3] New Hampshire’s local share must be spent on uses that align with the 19 project criteria listed in state law.[4]
Three of these criteria are reimbursement uses: for outpatient and residential treatment services for OUD and co-occurring disorders (inclusive of medications and “abstinence-based treatment,” in addition to treatment for people involved in the criminal legal system;[5] for law enforcement and emergency response services;[6] and for naloxone.[7]
Other approved uses in state law include supports for mobile services, “withdrawal management,”[8] access to housing, transportation to treatment and other services, employment training, centralized call centers to connect people to supports, improved oversight of methadone treatment programs, scholarships for health providers to work in underserved areas, efforts to prevent over-prescribing, improvements to the prescription drug monitoring program, education for law enforcement on fentanyl, evidence-based “and/or evidence-informed” prevention, school programs, secondary and tertiary prevention “through harm reduction programs,” and addressing the pain management needs of chronic pain patients and/or those in hospital or palliative care.[9]
The Opioid Abatement Advisory Commission’s Guiding Strategies for the Use of Opioid Abatement Funds also contains a non-exhaustive list of strategies that are “in alignment with [state law] … , NH’s SUD Action Plan[,] and the 10-Yr Mental Health Plan.”[10] The Commission’s document refers to Exhibit E of the national settlements — which includes prevention, harm reduction, treatment, recovery, and other strategies — as providing a “further description of opioid remediation uses.”[11]
Local governments decide autonomously. Decisionmakers for the counties and political subdivisions will ultimately decide for themselves how to spend their monies on the 19 project criteria listed state law.[12]
No, supplantation is not prohibited. Like most states, New Hampshire does not explicitly prohibit supplantation uses of its opioid settlement funds. This means that the 15% local share may be spent in ways that replace (or “supplant”) — rather than supplement — existing resources.
Yes (public reporting required). View localities’ limited annual reporting under “Distribution of Funds” here. State law requires localities to annually report to the Department of Health and Human Services and the Commission,[13] and the latter must publish funding awards and reports of funding by recipients online.[14]
Visit OpioidSettlementTracker.com’s Expenditure Report Tracker for an updated collection of states’ and localities’ available expenditure reports.
The New Hampshire Attorney General's office sent a letter to 47 New Hampshire subdivisions encouraging participation in the National Opioid Settlement. Of the 47 subdivisions, only 23 participated.[15]
N.H. Rev. Stat. Secs. 126-A:83(I) (“All … opioid-related settlement funds or judgments from New Hampshire counties and all political subdivisions shall, likewise, be placed in the trust fund”),126-A:83(II) (“The treasurer shall distribute 15 percent of all funds received prior to any deposit in the consumer escrow account or the opioid abatement trust fund to the counties and the political subdivisions that filed lawsuits, on or before September 1, 2019”), and 126-A:84(II)(a) (“Fifteen percent of the funds each year shall be distributed to the counties and political subdivisions as identified in RSA 126-A:83, II”). See also N.H. Rev. Stat. Sec. 541-B:1(VI) (defining “political subdivision” to mean “any village district, school district, town, city, county or unincorporated place in the state”). But see 70% regional, 30% non-regional apportionments of Mallinckrodt trust distributions. Notice of Abatement Distribution New Hampshire. National Opioid Abatement Trust II (NOAT II). January 13, 2023. Accessed August 9, 2024. ↑
N.H. Rev. Stat. Sec. 126-A:83(II) (“The distribution of funds shall be based on the most recent decennial census population of each qualifying county and political subdivisions. The population of any political subdivision which receives funds under this section shall not be included in the population of the county for determining the distribution to that county”). ↑
See, e.g., Attorney General Reaches $40.5 Million Settlement with Johnson & Johnson to Settle Opioid Claims. New Hampshire Attorney General news release. September 1, 2022. Accessed August 9, 2024. (“Under the terms of the settlement agreement, Johnson & Johnson will make a single payment of $39.605 million to the State and pay approximately $900,000 in attorneys’ fees to counsel for the counties, cities and towns that filed opioid lawsuits against Johnson & Johnson prior to September 1, 2019”). See also N.H. Rev. Stat. Ann. Sec. 126-A:85(VII) (“The department of health and human services shall provide administrative support to the advisory commission”). ↑
N.H. Rev. Stat. Sec. 126-A:83(I) (“All … opioid-related settlement funds or judgments from New Hampshire counties and all political subdivisions shall, likewise, be placed in the trust fund. The state treasurer shall disburse funds from the trust fund solely for the purposes and in the manner set forth in RSA 126-A:84”), Sec. 126-A:84(I) (“The commissioner shall draw from the opioid abatement trust fund for qualifying opioid abatement projects under RSA 126-A:86, I(b)”), and Sec. 126-A:86(I)(b)(1)-(19) (listing acceptable project criteria). See also City of Nashua: Resolution 21-168 (“Funds will be used in accordance with RSA 126-A:86(I)(b)(1) through (14) [ed. note: now likely ‘through (19)’] for the intervention, treatment, and recovery services related to opioid use disorder”). September 8, 2021. Accessed August 9, 2024. ↑
N.H. Rev. Stat. Sec. 126-A:86(I)(b)(1). See, e.g., Belknap County Commissioners, Annual Report on Opioid Abatement Trust Funding (“This initial check was received by the County and will be used to offset the costs of providing Medically Assisted Treatment (MAT) to inmates of our Corrections Department”). August 25, 2021. Accessed August 9, 2024. ↑
N.H. Rev. Stat. Sec. 126-A:86(I)(b)(2). ↑
N.H. Rev. Stat. Sec. 126-A:86(I)(b)(5) (“FDA-approved opioid reversal agents”). ↑
N.H. Rev. Stat. Ann. Sec.126-A:86(I)(b)(3)-(4), (6)-(19). The approved criteria regarding pain management were added by legislation enacted in 2024. See 2023 NH HB 1318. ↑
Opioid Abatement Advisory Commission (Commission), Guiding Strategies for the Use of Opioid Abatement Funds. February 2024. Accessed August 9, 2024. (“Use of these strategies should be determined within the broader context of statewide plans, community feedback, current efforts by non-governmental and governmental entities and anticipated funding reductions (State Opioid Response, COVID relief, etc). This is not an exhaustive list of applicable strategies, but rather, a guiding document to help establish a road map for funding, in alignment with NH statute and opioid settlement agreements (see Exhibit E for further description of opioid remediation uses”). ↑
Guiding Strategies for the Use of Opioid Abatement Funds. Opioid Abatement Advisory Commission (Commission). February 2024. Accessed September 1, 2024. (“[The Guiding Strategies] is not an exhaustive list of applicable strategies, but rather, a guiding document to help establish a road map for funding, in alignment with NH statute and opioid settlement agreements (see Exhibit E for further description of opioid remediation uses)”). ↑
N.H. Rev. Stat. Ann. Secs. 126-A:83(I) (“All … opioid-related settlement funds or judgments from New Hampshire counties and all political subdivisions shall, likewise, be placed in the trust fund. The state treasurer shall disburse funds from the trust fund solely for the purposes and in the manner set forth in RSA 126-A:84”), 126-A:84(I) (“The commissioner shall draw from the opioid abatement trust fund for qualifying opioid abatement projects under RSA 126-A:86, I(b)”), and 126-A:86(I)(b)(1)-(19) (listing acceptable project criteria). See also DHHS, Distribution of Funds generally (linking to documentation of funds distributed to localities, as well as some cities, counties, and towns’ annual spending reports as required by Sec. 126-A:84(IV). Accessed August 9, 2024. The City of Nashua offers an example of a locality applying these requirements. See Resolution 21-168 (“Funds will be used in accordance with RSA 126-A:86(I)(b)(1) through (14) [ed. note: now likely ‘through (19)’] for the intervention, treatment, and recovery services related to opioid use disorder”). September 8, 2021. Accessed August 9, 2024. ↑
N.H. Rev. Stat. Sec. 126-A:84(IV) (“On or before September 1, 2020, each county, city, town or program that receives funds under paragraph II shall annually provide to the department of health and human services and the opioid abatement advisory commission a detailed account of all monies spent on approved uses, including, but limited to, an analysis and evaluation of the projects and programs it has funded”) (emphasis added). Note that paragraph II encompasses both the 85% state share and the 15% local share. For information about intrastate reporting submitted by DHHS, see N.H. Rev. Stat. Sec. 126-A:84(VI) (“On or before November 1, 2020, the commissioner of the department of health and human services shall submit an annual report to the governor and fiscal committee of the general court detailing the activities of the advisory commission, the administration of the opioid abatement trust fund, the amount distributed in the past year, including available measures of success and corresponding data of programs funded, the amount remaining in the trust fund, a summary of how funds were used in the past year, and any recommendations for future legislation”). Regulations adopted by the Commission make clear the relationship between the reports submitted by localities and DHHS reporting requirements. See N.H. Code R. He-C 1002(11)(f) (“The department's reporting requirements are governed by RSA 126-A:84, subject to receipt of reporting information from the commission and from counties, cities, towns, or programs that receive funds from the trust fund”). ↑
N.H. Rev. Stat. Sec. 126-A:86(III) (“The [Opioid Abatement Advisory] [C]ommission shall create and maintain a website on which it shall publish its minutes, attendance rolls and votes, including records of all votes on funding requests, funding awards, and reports of funding by recipients”). ↑
Distribution of Funds. DHHS. Accessed September 1, 2024. ↑