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

• 85% Opioid Settlement Fund share: North Dakota Department of Health and Human Services

• 15% local share: local officials for cities and counties, in collaboration with local public health units

Where do these monies live?

The Opioid Settlement Fund holds the state’s 85% share of opioid settlement funds,[1] plus any local share amounts redirected to the Fund by the local governments.[2] The legislature appropriates funds to the North Dakota Department of Health and Human Services (DHHS), up to a maximum of $8 million in a biennium (i.e., two fiscal years).[3]

What can this share be spent on?

With limited exceptions,[4] this share must be spent on the uses described in the national settlement agreement’s (non-exhaustive) Exhibit E,[5] which includes prevention, harm reduction, treatment, recovery, and other strategies.

DHHS must spend at least 20% of the monies allocated to it from the Fund on opioid use and overdose prevention, including “best practices relating to fentanyl drug overdose” and “workforce development.”[6]

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

Opioid Settlement Advisory Committee recommends, Department of Health and Human Services decides. The North Dakota Department of Health and Human Services (DHHS) ultimately decides specific expenditures for this share after consulting the recommendations of the Opioid Settlement Advisory Committee.[7]

In making its recommendations to DHHS, the Advisory Committee must receive input from localities and the public,[8] as well as consider “cultural practices and alternative best practice treatment methods.”[9] DHHS must develop a process to receive and evaluate the Committee’s spending recommendations,[10] and must implement or assist with the implementation of its spending decisions.[11]

Is this share attached to an explicit bar against supplantation?

No, supplantation is generally not prohibited. Like most states, North Dakota does not explicitly prohibit supplantation uses of its opioid settlement funds. This means that the 85% “Opioid Settlement Fund” share may be spent in ways that replace (or “supplant”) — rather than supplement — existing resources. However, the “Sample Grant Agreement” published as part of a recent state opioid settlement funding opportunity includes language prohibiting the “duplication of funding” and provides that a grantee should use awarded funds “as a payor of last resort.”[12]

Can I see how this share has been spent?

Yes (public reporting not required, only intrastate). DHHS has published a one-time summary of its Opioid Settlement Fund grant awards.[13] State law requires DHHS to annually report Opioid Settlement Fund-related spending decisions to the legislature.[14]

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

What else should I know?

Not applicable.

Citations

1. N.D. Cent. Code Sec. 50-36-02 (“There is created in the state treasury an opioid settlement fund. Moneys recovered by the state as a result of opioid litigation must be deposited in the fund”). Attorney General letter to cities and counties. Undated. Accessed August 13, 2024 (describing AG’s plan to add its 15% State Fund to the 70% Abatement Account Fund). ↑

2. N.D. Cent. Code Sec. 50-36-06(1) (“A political subdivision that recovers moneys as a result of opioid litigation may deposit the moneys in the fund or may retain the moneys and transfer the moneys to the public health unit that provides services to that political subdivision”) and Sec. 50-36-02 (“Moneys recovered by a political subdivision as a result of opioid litigation may be deposited in the fund”). ↑

3. N.D. Cent. Code Sec. 50-36-05(1) (“The department’s spending decisions of the legislatively appropriated funds from the fund for remediating and abating the opioid crisis must include at least twenty percent for opioid use prevention and overdose prevention, including best practices relating to fentanyl drug overdose, and approved use for workforce development)” Sec. 50-36-01(1) (“‘Department’ means the department of health and human services”), and Sec. 50-36-02 (“[L]egislative appropriations from the fund may not exceed eight million dollars in a biennium”). The legislature appropriated $8 million from the Fund to the Department of Health and Human Services for the 2023-2025 biennium. 2023 ND HB 1447 Sec. 5. ↑

4. N.D. Cent. Code Sec. 50-36-02 (“The fund does not include funds not retained by the state pursuant to law or court order”) and Distributor Settlement Agreement I.SS (“Exhibit E provides a non-exhaustive list of expenditures that qualify as being paid for Opioid Remediation. Qualifying expenditures may include reasonable related administrative expenses”). ↑

5. N.D. Cent. Code Sec. 50-36-05 (requiring DHHS to use Fund monies “for remediating and abating the opioid crisis”). North Dakota Opioid Settlement. DHHS website. Accessed August 13, 2024. (“The usage of settlement funds must be used for opioid remediation and align with approved usages as identified in the settlement document Exhibit E”). ↑

6. N.D. Cent. Code Sec. 50-36-05(1). ↑

7. N.D. Cent. Code Sec. 50-36-04(1) (“The department shall develop a process for receiving and evaluating spending recommendations of the committee”) and N Sec. 50-36-05(1) (describing “department’s spending decisions of the legislatively appropriated funds from the [Opioid Settlement] fund”).See also North Dakota Opioid Settlement. DHHS website. Accessed August 13, 2024 (“The Opioid Settlement Advisory Committee will provide input and recommendations to the North Dakota Department of Health and Human Services Behavioral Health Division regarding the spending of funds received by the settlement”). ↑

8. N.D. Cent. Code Sec. 50-36-03(2)(a). ↑

9. N.D. Cent. Code Sec. 50-36-03(2)(c). ↑

10. N.D. Cent. Code Sec. 50-36-04(1). ↑

11. N.D. Cent. Code Sec. 50-36-05(2). ↑

12. See Attachment D, Sample Grant Agreement Sec. 2. North Dakota Department of Health and Human Services, Behavioral Health Division. Accessed September 1, 2024. ↑

13. HHS announces the ND Opioid Settlement Fund Grant awards. HHS press release. January 19, 2024. Accessed September 5, 2024. ↑

14. N.D. Cent. Code Sec. 50-36-04(3). ↑

North Dakota Opioid Settlement

• Opioid Settlement Advisory Committee

• Political Subdivision Allocation Plans

• Advisory Committee Listening Session Summary

North Dakota Department of Health & Human Services: Behavioral Health Division

• Request naloxone

Where do these monies live?

This 15% share is distributed to participating cities and counties, who each then transfer their funds to their local public health unit.[1] Though local governments may keep their shares, all were encouraged to redirect them instead to the state’s Opioid Settlement Fund for uses on “joint opioid abatement strategies and remediation uses statewide.”[2]

What can this share be spent on?

With limited exceptions,[3] this share must be spent on the uses described in the national settlement agreement’s (non- exhaustive) Exhibit E,[4] which includes which includes prevention, harm reduction, treatment, recovery, and other strategies.

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

Local governments decide in collaboration with their local public health units (and must submit plans prior to spend). Decisionmakers for the cities and counties will ultimately decide how to spend their monies on Exhibit E uses in collaboration with their local public health units,[5] and each local government must provide an allocation plan to the DHHS Behavioral Health Division prior to spending its share.[6] DHHS publishes these Political Subdivision Allocation Plans on its website.

Is this share attached to an explicit bar against supplantation?

No, supplantation is not prohibited. Like most states, North Dakota 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.

Can I see how this share has been spent?

Up to each locality (no public reporting required, only intrastate). Opioid settlement expenditures are not officially published in a centralized location for this share. Localities must annually report their spend to DHHS, and DHHS is required to include localities’ expenditures in its annual report to the legislature.[7]

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

What else should I know?

Not applicable.

Citations

1. N.D. Cent. Code Sec. 50-36-06(1) (“A political subdivision that recovers moneys as a result of opioid litigation may deposit the moneys in the fund or may retain the moneys and transfer the moneys to the public health unit that provides services to that political subdivision”). ↑

2. Attorney General letter to cities and counties. Undated. Accessed August 13, 2024 (encouraging localities to “allocate [their] 15% Subdivision Fund under the settlements to be added to the joint Abatement Account Fund and used for joint opioid abatement strategies and remediation uses statewide”). ↑

3. N.D. Cent. Code Sec. 50-36-02 (“The fund does not include funds not retained by the state pursuant to law or court order”) and Distributor Settlement Agreement I.SS (“Exhibit E provides a non-exhaustive list of expenditures that qualify as being paid for Opioid Remediation. Qualifying expenditures may include reasonable related administrative expenses”). ↑

4. N.D. Cent. Code Sec. 50-36-05 (requiring DHHS to use Fund monies “for remediating and abating the opioid crisis”). North Dakota Opioid Settlement. DHHS website. Accessed August 13, 2024. (“The usage of settlement funds must be used for opioid remediation and align with approved usages as identified in the settlement document Exhibit E”). ↑

5. N.D. Cent. Code Sec. 50-36-06(2) (“A political subdivision that recovers and retains moneys as a result of opioid litigation shall collaborate with a public health unit on the use of the moneys for local programs for remediating and abating the opioid crisis. The use of moneys under this subsection must be in compliance with any court-ordered restrictions”). ↑

6. N.D. Cent. Code Sec. 50-36-06(2) (“All political subdivisions shall provide an allocation plan to the behavioral health division prior to expenditure” and the “[t]he political subdivision and public health unit shall work together to ensure all reporting requirements are met”). ↑

7. N.D. Cent. Code Sec. 50-36-04(2). DHHS includes this information in the report that it is required to submit to the legislature under N.D. Cent. Code Sec. 50-36-04(3). ↑

Has the state established an advisory body for settlement funds?

Yes. North Dakota state law establishes the Opioid Settlement Advisory Committee.[1] The Advisory Committee is responsible for providing recommendations to the North Dakota Department of Health and Human Services on uses of legislatively appropriated monies from the state’s Opioid Settlement Fund.[2] The Advisory Committee is required to meet at least four times annually.[3]

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

No. The Advisory Committee is not required to include member(s) with lived and/or living experience.

What is the overall membership of the state advisory body?

The composition of North Dakota’s seven-member (7) Opioid Settlement Advisory Committee is defined by state law to include six voting members and one non-voting member:[4]

• A member of the North Dakota Association of Counties, appointed by the chairman of the Legislative Management

• A member of the North Dakota League of Cities, appointed by the chairman of the Legislative Management

• A member of the North Dakota State Association of City and County Health Officials, appointed by the chairman of the Legislative Management

• A member who represents highway patrol, appointed by the state highway patrol superintendent

• The executive director of the North Dakota Department of Health and Human Services’ Division of Behavioral Health

• The managing director of the Office of Recovery Reinvented

• A member appointed by the governor, who serves as the nonvoting presiding officer of the committee[5]

You can view a list of current Advisory Committee members here (select “Opioid Settlement Advisory Committee”). All members serve two-year terms except for the executive director of the North Dakota Department of Health and Human Services’ Division of Behavioral Health and managing director of the Office of Recovery Reinvented, who serve for as long as they hold their respective positions.[6]

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 North Dakota 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

1. N.D. Cent. Code Sec. 50-36-03(1). ↑

2. N.D. Cent. Code Sec. 50-36-03(2). ↑

3. Select “Opioid Settlement Advisory Committee” on the Official Portal for North Dakota State Government’s Boards website. Accessed September 1, 2024. ↑

4. N.D. Cent. Code Secs. 50-36-03(1)(a)-(g). ↑

5. N.D. Cent. Code Sec. 50-36-03(1)(g). ↑

6. N.D. Cent. Code Secs. 50-36-03(1)(a)-(g). ↑

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

Can I provide input on spending?

• 85% Opioid Settlement Fund share: Yes (required). North Dakota state law requires the to “develop a process for receiving spending recommendation input from political subdivisions and the public,”[1] and the Advisory Committee includes a dedicated public comment period at each of its meetings, typically at the end of each agenda.[2] Visit the Advisory Committee’s to find upcoming meeting dates and agendas, as well as information about past meetings.[3] The Advisory Committee is required to meet at least four times annually.[4]

  • Listening sessions: The Advisory Committee held three listening sessions in 2023,[5] and published a received during those sessions.[6] Stay alert for similar kinds of opportunities in future.

• 15% local share: Up to each locality (not required). Local governments are not required to seek public input on uses of their shares. However, each may choose to seek such input. Watch for opportunities to weigh in on city and county spending decisions, such as city council meetings and town halls.

Can I apply for grants?

Yes. The state has previously posted grant opportunities on this .[7] Local governments 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 Settlement Fund share, visit the website, which includes information about , in addition to summaries of past listening sessions, and grant opportunities.

• For updates on the local share, visit the website’s section and check the websites for your board of county commissioners, city council, or . The website also hosts a list of .

What else should I know?

Anyone seeking more information about the Opioid Settlement Advisory Committee can contact Amy Lies at North Dakota Health and Human Services’ Behavioral Health Division: .[8]

Citations

1. N.D. Cent. Code Sec. 50-36-03(2)(a). The North Dakota Department of Health and Human Services’ also must “develop a process for receiving and evaluating spending recommendations of the committee.” N.D. Cent. Code Sec. 50-36-04(1). ↑

2. See, e.g., . North Dakota Department of Health and Human Services website. Posted July 29, 2024. Accessed September 1, 2024. ↑

3. (see “Committee Meetings”). North Dakota Department of Health and Human Services website. Accessed September 1, 2024. ↑

4. See “Opioid Settlement Advisory Committee” on the Official Portal for North Dakota State Government’s Boards . Accessed September 1, 2024. ↑

5. (see “Committee Meetings”). North Dakota Department of Health and Human Services website. Accessed September 1, 2024. ↑

6. . Opioid Settlement Advisory Committee. North Dakota Department of Health and Human Services website. Accessed September 1, 2024. ↑

7. As of September 1, 2024, the North Dakota Department of Health and Human Services indicated that all available grant funding (approximately $7 million) had been awarded for the 2023-2025 Biennium. These grants must be expended by June 30, 2025 (see “State Opioid Settlement Funding Opportunity”). ↑

8. . North Dakota Department of Health and Human Services website. Posted July 29, 2024. Accessed September 1, 2024. ↑