Under the nationwide legal settlements with major opioid manufacturers and distributors, the state of Wisconsin and its local governments will be receiving a total of $780 million by 2038. Of that total, 30 percent is set aside for the state government while the remainder goes to 71 counties and 16 municipalities. But critically, how has it been allocated and how will it be spent?
Wisconsin state law ring-fences what governments can spend the money on: It’s meant to be for an approved use related to reducing opioid-related harms. But despite records requests from reporters, governments have failed to provide accurate information when asked, or have delayed doing so, reports Wisconsin Watch.
Reporting levels vary. Milwaukee County, for instance, published 30 pages of data when reporting its opioid spending to the state. But multiple county and municipal governments have shared few details, published information years after state deadlines, or released nothing until they were forced to by journalists. According to the state Department of Justice, it reviews and monitors local governments’ opioid settlement spending, but has no enforcement mechanism. The legislature’s Joint Finance Committee is also responsible for reviewing the spending.
“One of the important parts of effective spending is transparency on how decisions are made.”
Advocates want more transparency, given the widely varying known uses of the money Wisconsin governments have already spent—ranging from jail recovery programs to law enforcement—and the fact that this is just a fraction of the money so far received, with another $400 million incoming.
Adrienne Hurst is the senior technical advisor and Wisconsin team lead for the Vital Strategies Overdose Prevention Program, which conducts policy work and research in the state.
“Wisconsin has posted annually their spend plans and reports for the 30 percent of funding that goes to [the state health department],” she told Filter. “The other 70 percent goes to [counties and cities]. Counties are required to post the activities they fund, and largely they have through the Wisconsin Counties Association. There is a public database [available]. One of the important parts of effective spending is transparency on how decisions are made.”
The Wisconsin Department of Health Services has an online tracker indicating how governments have spent money on different priorities. Here’s what it shows for 2025:
* $6 million for tribal nation abatement, for prevention, harm reduction, treatment and recovery services for the state’s different Indigenous nations.
* $6 million overall for harm reduction including naloxone, fentanyl test strips, and peer support services. The purchased naloxone is for community organizations and public health departments statewide, to be given away free to people in need. $300,000 of this money was used to purchase electronic lockboxes for drug storage in prisons.
* $7.7 million in capital expenditures, or building and renovations, for treatment and other services. This money has paid for a residential drug treatment facility in Appleton to expand to a 70-bed facility; and for a new, 16-bed residential treatment center in Milwaukee.
* $1 million for school based prevention in K-12 schools, and $1 million for after-school programs including a grant to the Boys and Girls Club.
* $1.5 million for community-based prevention programs to nonprofit and faith-based organizations.
* $3 million for medications for opioid use disorder. The state prison department has received half of this money to increase medication treatment to people in residential services and community supervision statewide.
* $2.75 million to pay for room and board for Medicaid recipients in residential drug treatment. By law, Medicaid cannot reimburse for housing costs for patients in these programs.
* $3 million for law enforcement agencies, for stated purposes including drug disposal, keeping opioid users out of jail, staff and training on medications for opioid use disorder, and opioid treatment in jails.
“Wisconsin has dedicated a good chunk of its funding to things like naloxone, fentanyl and xylazine test strips, and providing technical assistance,” Hurst said, detailing the investments in harm reduction. “Obviously the state not only invested in harm reduction, but also treatment interventions.”
“We focus on medication for opioid use disorder because it is life-saving,” she continued. However, “There is investment in less effective interventions like naltrexone which has an inferior outcome.”
“There have also been interventions in things like police-driven harm reduction … We say those are less effective.”
Settlement money going to law enforcement is particularly objectionable to many harm reduction advocates.
“There have also been interventions in things like police-driven harm reduction and naloxone, [which they sometimes] leave behind or carry,” Hurst said. “We say those are less effective at investing in communities worst affected by the War on Drugs and overdose.”
Wisconsin saw a significant reduction in overdose deaths of at least 35 percent in 2024, according to provisional data from the CDC, in a better trajectory than the nationwide trend of a fall of almost 27 percent. But the pain of the ongoing crisis is felt unevenly, and Wisconsin’s allocation of settlement money—which was determined by a formula intended to factor in population and impacts—doesn’t always reflect that.
State health data show that counties with the highest opioid-involved overdose rates from 2014-2023 are scattered throughout the state, from the more populous eastern and southern regions to northern counties bordering Michigan.
Milwaukee County, home to the state’s largest city, had the second highest rate, with 38.9 deaths per 100,000 population, and has received the highest percentage of settlement dollars, just over 25 percent. Up north, Menominee County, home to the Menominee Indian Reservation, has the highest rate—a devastating 76.8 deaths per 100,000 people—but receives a tiny 0.08 percent of settlement dollars.
“In Wisconsin, one third of all overdose deaths happened in Milwaukee County,” Hurst said. “You would expect resources would be heavily focused there. At the same time, sparsely populated communities like Menominee and more rural counties, even though the absolute number of deaths are small year after year, they can have a profound impact on that community. Absolutely you want to invest where most overdoses are happening, but you also want to … safeguard [rural] communities.”
“I think we need to better focus on a strategy to not just prevent overdose deaths, but get to the root.”
Glaring racial disparities are another feature of Wisconsin’s overdose crisis. Black residents have suffered the highest overdose death rate, at 79 deaths per 100,000 population, followed by Indigenous residents at 76 deaths per 100,000. White residents have had a far lower rate of 20 deaths per 100,000, illustrating how economic and social inequalities contribute to and exacerbate overdose deaths.
Alan C. Robinson, president of the Herbal Aspect cannabis brand in Madison and director of a proposed drug checking initiative in the city, urges that people directly impacted by the overdose crisis should be involved in decision-making and allocation of funds.
“Overdose prevention and harm reduction in general is really intersectional with other challenges and disparities people face in everyday life,” he told Filter. “Being unhoused, jobless, [lower] education. There’s a convergence of life stresses that sometimes drive people to self-medicate and use substances. Without a robust and holistic approach—providing housing security and food security—you’re not attacking the root of the problem of substance use. I think we need to better focus on a strategy to not just prevent overdose deaths, but get to the root.”
Image used via Flickr/Creative Commons 2.0
