MO is projected to receive $894 million in opioid settlement funds through 2038.
National rules require 85% of settlement funds be spent on treatment, prevention, and recovery.
Since 2022, MO has allocated 57% of its settlement expenditures to treatment and recovery services.
Fourteen pharmaceutical companies reached legal settlements with 50 states and over 500 tribal nations following lawsuits regarding opioid distribution and manufacturing (Shen 2025, MO Department of Mental Health (DMH) 2026). The total national settlement currently exceeds $57 billion, to be paid out in annual installments over 18 years. MO is projected to receive approximately $894 million total by 2038 (DMH 2026, DMH 2024). Several major distributors and manufacturers are required to complete their primary contributions within the first five years of the settlement term (Whaley & Sharfstein 2023, Office of the Minnesota Attorney General 2021). Ongoing lawsuits against additional manufacturers and pharmacies may increase this (Shen 2025).
National agreements require at least 85% of settlement funds to be used for approved programs to treat and prevent opioid use, while a maximum of 15% may cover administrative and litigation costs (KFF Health News 2024, National Opioid Settlement n.d.). Approved programs target one of four primary categories: prevention, treatment, recovery, and harm reduction (National Opioid Settlement n.d.).
MO allocates 60% of funds to the state-level Opioid Addiction Treatment and Recovery Fund (OATRF) and 40% directly to settlement-participating local governments (Minhee 2024, RSMo 196.1050 2023). DMH manages the OATRF to support statewide programs and jurisdictions without independent legal claims (DMH 2026). While national agreements include harm reduction as a specific category, MO classifies these as other mitigation strategies (DMH 2025).
All settlement fund recipients must report their spending annually to the Missouri General Assembly to ensure compliance with approved uses (RSMo 196.1050 2023). Since 2022, Missouri has spent $34.2 million in state-share settlement funds, representing the 60% of total funding allocated for statewide use (DMH 2025, Missouri Institute of Mental Health (MIMH) 2025). During this same period, the remaining 40% of funds were distributed directly to participating local governments, which received approximately $90.3 million in combined payments through 2023 (DMH 2025, KFF Health News 2024).
For Fiscal Year 2026, the General Assembly appropriated $79.4 million to the OATRF (DMH 2026). This appropriation increase coincides with the national settlement payments, as several distributors and manufacturers complete their primary contributions within the first five years of the agreement (Whaley & Sharfstein 2023, DMH 2026). Following this initial five-year period, annual payments to states and other plaintiffs will decrease until the fund concludes in 2038.
Expenditures are distributed across four specific categories in MO: treatment and recovery (57% of funds), other crisis mitigation (40%), administration (2%), and prevention (1%). The largest share of funds is used for direct medical help and housing support (Figure 1, DMH 2025, MIMH 2025). Programs by these categories include:
Treatment & ($19.5 million):
Other Crisis Mitigation ($13.7 million):
Administration ($684,813):
Prevention ($342,407):
All state and local expenditure reports are available to the public at moopioidsettlements.dmh.mo.gov.
Figure 1. MO’s State-Share Settlement Expenditures (2022–2024). Of the $34.2M spent, $19.5 million (57%) funded treatment and recovery services for medical care and housing support. $13.7 million (40%) funded other mitigation strategies, including first responder training, court programs, and the distribution of naloxone and fentanyl test strips. Administrative and prevention expenditures each represent 2% or less of total spending and include program support and education and outreach. Adapted from DMH 2025.
References
KFF Health News, Johns Hopkins Bloomberg School of Public Health, Shatterproof (2024) How Are States Spending Opioid Settlement Cash? We Built a Database of Answers. https://kffhealthnews.org/news/article/opioid-settlement-funds-detailed-database-state-county-city-spending/#database
Minhee C (2024) Missouri Opioid Settlements. Opioid Settlement Tracker. https://www.opioidsettlementguides.com/missouri
Missouri Department of Mental Health (2026) State Share of Opioid Settlement Funds – FY 2026 Appropriations to State Agencies. https://dmh.mo.gov/media/pdf/state-share-opioid-settlement-funds-fy-2026
Missouri Department of Mental Health (2025) Second Annual Report to the Missouri General Assembly on Opioid Settlement Funds. https://dmh.mo.gov/media/pdf/second-annual-report-missouri-general-assembly-opioid-settlement-funds
Missouri Department of Mental Health (2024) First Annual Report to the Missouri General Assembly on Opioid Settlement Funds. https://dmh.mo.gov/media/pdf/first-annual-report-march-1-2024
Missouri Institute of Mental Health (MIMH) (2025) 2024 Missouri Statewide Drug Overdose Death Report. Missouri Institute of Mental Health, Department of Psychological Services, University of Missouri St Louis. https://mimhaddisci.org/missouri-statewide-reports
National Opioid Settlement (n.d.) Frequently Asked Questions About the National Opioid Settlement. https://nationalopioidsettlement.com/faq-explanatory-charts/faq/
Office of the Minnesota Attorney General (2021). Minnesota Opioids State-Subdivision Memorandum of Agreement. National Opioids Settlement. https://nationalopioidsettlement.com/wp-content/uploads/2022/02/MN-MOA-EXECUTED-BY-AG.pdf
Revised Missouri Statutes § 196.1050 (2023) https://revisor.mo.gov/main/OneSection.aspx?section=196.1050&bid=54165&hl=
Shen WW (2025) National opioid litigation: Settlement agreements as of January 2025. Congressional Research Service. https://www.congress.gov/crs-product/LSB11270
