NYC Is Spending Millions in Opioid Settlement Funds. How Exactly Remains a Mystery.

Two years after pharmaceutical money from opioid settlements began pouring into municipalities statewide, New York City can’t say exactly how the more than $60 million it has reported spending thus far has been used, even as overdose deaths continue to rise.

At a quarterly meeting of the New York State Opioid Settlement Fund Advisory Board Wednesday, members railed about the city’s failure to account for its share of the settlement fund.

“I’m concerned on a daily basis with the number of people that are dying,” said board member Joyce Rivera, the executive director of St. Ann’s Corner of Harm Reduction based in the South Bronx, which has the highest rate of overdoses in the state . “Our dollars are not getting to those communities. It is reprehensible.”

Rivera’s frustration was echoed by other members of the board gathered in offices in Albany, Buffalo and New York City. Those concerns came after months of the board unsuccessfully demanding that city officials provide a detailed breakdown of where at least $60 million has been spent over the past two fiscal years.

There’s an initial discrepancy over how much money the city has gotten thus far. Though the state’s budget office says the city has taken in $110 million in direct settlement funding, the city’s own documents say they’ve received just $90 million.

And of the money the city has begun to spend – $60 million overall for the past two fiscal years combined – the city Department of Health, which is tasked with documenting its spending and that of other agencies in quarterly reports, has offered only vague explanations of general initiatives, failing to provide specific amounts or groups the city is contracting with to provide services. The result has mystified advocates on the ground who are anxious to tap into that cash.

Dr. Rebecca Linn-Walton, an assistant commissioner at the city’s Health Department and its designee to the advisory board, said the agency is still working to prepare a presentation on their spending.

“We truly want to be engaged and active and we know that means sharing our plans transparently,” she said at the meeting.

‘Terrible, Terrible Decisions’

Following years of litigation against multiple companies that produced and distributed opioids, New York’s Attorney General Letitia James secured over $286 million in settlements earmarked for New York City, $150 million of which would be handed over in the first five years.

Hoping to keep tabs on all the new money coming in, state lawmakers created a dedicated opioid settlement fund in 2021, meant to go directly to communities for “for treatment, recovery, and prevention efforts,” and created an advisory board tasked with helping to guide that spending.

But frustrations over a lack of transparency have been bubbling for months , even as the opioid crisis rages on, fueled by extremely potent fentanyl and new, deadly adulterants like Xylanxine in the drug supply .

The former president of the advisory board, Avi Israel, head of the Buffalo-based addiction treatment provider Save the Michaels of the World , resigned this spring, citing what he called “lies” and “uncaring answers” from the Hochul administration.

Overdose deaths in New York City have continued climbing dramatically year over year. They were as low as 541 in 2010. In 2019, the year the New York State Attorney General began the lawsuits, they hit 1,497. In 2022, the most recent year data is available, they reached 3,026.

While some states, including North Carolina and Massachusetts , provide detailed dashboards on local and statewide settlement spending, New York thus far has a tracker for just one portion of its spending — the tranche flows through the state’s Office of Addiction Services and Supports.

According to that tracker, that agency has dispersed $353 million across the state, with at least $10 million going to local organizations within New York City.

New York City and counties across the state receive the bulk of their settlement allocation from regional abatements, money that the city departments are responsible for spending.

A spokesperson for the state attorney general didn’t immediately return a request for comment on how much funding it had dispersed to local municipalities thus far, information that isn’t readily available on their website.

“The problem is county executives, county legislatures get to decide how this money is spent. They’re making terrible, terrible decisions,” Alexis Pleus Founder, the Executive Director of Truth Pharm, a grassroots harm reduction organization based in Binghamton, testified during the public comment on Wednesday.

She added that some money had gone to law enforcement agencies or just dropped in the county’s reserves. “The concerns that we have about country level spending are literally endless,” she said at the meeting.

Advocates have raised similar concerns in other states, including Maine and Louisiana , about opioid settlement funds being directed to law enforcement rather than harm reduction and prevention efforts.

‘Basically Tells Us Nothing’

In New York City, funding is allocated to three main agencies according to City Council budget documents . The city’s Health and Hospitals corporation and the Health Department each receive $14.6 million a year, along with $800,000 for the Office of the Chief Medical Examiner. But there’s limited detail about how most of that money is actually being spent.

The most recent quarterly report by the Health Department, in June, said the city had taken in $90 million in settlement funds so far — $20 million less than the $110 million state budget reports detail that the city has received.

The report offered just a vague outline of how it had spent the $60 million it received over the last two years. The city’s Health and Hospital system and Medical Examiner’s office describe several initiatives being undertaken without specifying how much was spent on them or if any outside groups were involved.

Health and Hospitals said funds went toward expanding their street outreach units, emergency unit care and updated workforce training on addiction stigma, among other programs. Its 2024 reports also said settlement funding went to the rollout of its new Virtual ExpressCare program, though it noted just 7% of the 3,106 people treated in the first half of the fiscal year had substance-use disorders, with the majority of the program’s focus on other medical conditions.

The Health Department has offered even fewer specifics for its own spending, with its most quarterly report mentioning only that some of the settlement money went to its contract with OnPoint, the non-profit that runs two safe injection sites in uptown Manhattan.

“This basically tells us nothing. I was frustrated,” said Councilmember Linda Lee, who sponsored the 2022 law that required the city to begin accounting for its share of the opioid settlement funds, of the Health Department’s reports.

Lee, who was quoted in a 2022 press release lauding the city’s outlined priorities, said she still hasn’t seen the receipts.

“It sounds all nice and fluffy,” she said. “Now show us how the money was actually spent.”

“I haven’t seen that information,” she added.

Rachel Vick, a spokesperson for the City’s Health Department, pointed to the June report as evidence of the city’s commitment to transparency on how opioid settlement funds are being spent.

“As a city we have distributed hundreds of thousands of naloxone kits, equipped New Yorkers with fentanyl test strips, launched drug checking services and expanded hospital-based interventions for survivors of overdose,” Vick said. “We look forward to doing even more – with this funding – in the months and years ahead. We’re absolutely committed to transparency.”

The city’s Health and Hospitals system didn’t return a request for comment immediately.

‘The Bronx Is Dying’

Advocates from the Bronx, the county with the state’s highest overdose rate, expressed frustration on Wednesday that the health department hasn’t disclosed any plans for funding community initiatives in the borough.

“We should demand that the mayor respond to this, that the attorney general follows up on this, that the city of New York holds itself transparent to all its citizens,” said Rivera. “The Bronx is dying and it is really unacceptable.”

Though the funds are designated for community relief and services, some at the public comment meeting shared their skepticism that the funds have gone to the community, as the public has no confirmation where millions of dollars in city funding are going.

Bronx resident and advocate Nanette Matthews, 64, who lost her son to fentanyl poisoning, said she was wondering where the funding for housing was, which was supposed to account for 10% of settlement funds according to the advisory board’s guidance. Matthews, who also sits on her local community board, noted many of the people in her area struggling with addiction are also homeless.

“I have gotten absolutely no definitive answer as to where this money is coming from or into,” she said. “I need answers. My son, I can’t resurrect him. I may be able to save somebody else’s life.”

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