Using Opioid Settlement Proceeds for Public Health: Lessons from the Tobacco Experience

State, county, and city governments across the country have filed hundreds of lawsuits against opioid manufacturers, distributors, and retailers. The odds are high that these lawsuits will culminate in a “global settlement agreement” that requires the defendants to pay billions of dollars to states and localities that have been harmed by the opioid epidemic. Though much of that money will—and should—be spent to reimburse communities for opioid-related costs they have already incurred, such a settlement would also provide a tremendous opportunity to strengthen the nation’s public health system infrastructure in order to better protect against future public health challenges. The experience of the 1998 Master Settlement Agreement (MSA) with the major tobacco companies, however, suggests that setting aside funds for public health will not be easy. This article reviews the history of how states spent their MSA funds, with a focus on the efforts of public health advocates to ensure that some portion of the funds were spent on tobacco prevention and cessation. These efforts were, in many cases, successful in the short term, but they were not sustained over time. This article will summarize lessons learned from the MSA experience that can be applied to a potential opioid settlement agreement.