Josh Stein’s landmark opioids battle

May 13, 2024


  • Two landmark opioid settlements negotiated by Attorney General Josh Stein are bringing over a billion dollars for recovery 
  • The state and local governments are cooperating on use of settlement funds
  • The Stein settlements are a landmark victory in the battle against opioids


In 2021, North Carolina’s Attorney General Josh Stein (now the Democratic nominee for Governor) led a major, multi-state settlement with the pharmaceutical giants responsible for fueling the national opioid epidemic. The $26 billion settlement was eventually joined by a bipartisan group of 46 state attorneys general, but principally negotiated by just a small group – including Attorney General Stein. It was a landmark case in the public interest that drew comparisons to 1998’s Master Settlement Agreement against the tobacco industry.

But winning the settlements is only the first step – the next is to distribute it effectively to those in need of resources to recover from addiction. The framework put in place by Attorney General Stein is, right now, channeling hundreds of millions of dollars into recovery efforts in every county across the state.

The opioid devastation

As we’ve written about before, the opioid epidemic has affected North Carolina deeply:

Like many states, North Carolina has been hard-hit by the national opioid epidemic. Between 2000 and 2020, more than 36,000 North Carolinians died from an opioid overdose – and that is very likely an undercounting. Epidemiologists estimate that more than 600,000 people across the United States and Canada have died of an opioid overdose since 1999, with numbers still rising from “third wave” drug derivatives, like the synthetic opioid fentanyl. (Read: North Carolina’s Opioid Money Grab)

North Carolina is set to receive $750 Million over an 18 year period, and funds have already begun to be distributed to NC county governments for treatment. In addition, Attorney General Stein also negotiated a “second wave” of settlements with companies like CVS, Walgreens and Walmart for their role in the epidemic, resulting in an additional $600 million coming to North Carolina from that $21 Billion dollar settlement. Fiscal year 2024 has seen the largest disbursement of  those settlement funds, with the state and local governments receiving over $200 million dollars already.

Between those two settlements, Attorney General Stein has won total of $1.3 billion in funding for North Carolina to address the opioid crisis. It’s a staggering amount of money, but only until one realizes that it’s compensation paid by corporations responsible for killing tens of thousands of North Carolinians

Getting money where it’s needed

85% of funds received from the opioid settlements is earmarked directly for local county governments across North Carolina. Attorney General Josh Stein’s office helped the state develop the Opioid Action Plan, and coordinated with county and state health officials to develop a Memorandum of Understanding which outlines the specific framework that governs how county governments can choose to spend the funds. It requires, for example, that county officials adopt a  documented spending plan. Some of the strategies require an additional collaborative planning process with the state and the MOA coordination group.  

This approach prioritizes local leadership, voters and decision-making. The state is acting as a partner and coordinator, aligning local responses to an evidence-based strategic plan to ensure funds are spent appropriately, while giving local governments the ability to target their approach to the unique circumstances of their jurisdiction. This approach to state and local partnership has meant that over $300 million in funds North Carolina has received from the settlement just in the last 2 fiscal years is being put to work in a way that is both transparent and effective.

Yet to date, only 60 local governments across North Carolina have developed documented spending plans to claim settlement resources. Many rural counties (often the hardest-hit) have not submitted any, including all 8 counties west of Buncombe and 9 counties in the northeast. 77% of counties have a Medication Assisted Treatment (MAT) which is the “gold standard for treatment” allowing patients’ bodies to reduce and then eliminate its dependency on opioids. The city of Durham and Iredell, Cabarrus and Guilford counties have authorized over $800,000 each for evidence-based addiction treatment. Wake and Mecklenburg have authorized a combined $3.9 million.

In total 29 counties across the state are actively investing money into addiction treatment. 34 counties have spending plans for Naloxone distribution. Naloxone can reverse an opioid overdose in minutes even when expired and is an essential life saving intervention, 94% of overdose patients who receive it will survive. Widespread, free access and education on how to use it has saved thousands of lives in the US.

In all, $1.3 billion dollars has been set aside to help North Carolina recover from the opioid crisis. From the mountains to the sea and from Uptown Charlotte to the rural expanses of Cherokee County, these funds are thin comfort to those who have lost loved ones to opioid addiction, but they will also help save lives and rebuild communities. There’s an evidence-based plan in place and active coordination going on between the state and localities.

North Carolina’s opioid response is a textbook example of government working effectively: obtaining justice for victims of wrongdoing by the powerful, and distributing compensation where it is needed for the common good. For people weary of examples of official corruption, nihilism and failure, the Stein opioid settlement and strategy is a reminder that better is possible – if voters demand it.

Help build progress for North Carolina.
Get in touch
PO Box 452, Carrboro, NC 27510

    Stay updated with us

    Stay Updated

    Receive the latest news from Carolina Forward