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To discover how millions in opioid settlement funds are being spent in Idaho, you can visit 

, which hosts 91 documents from state and local entities getting the money.

What you’ll find is a lot of bureaucratese.

 promising annual reports “specifying the activities and amounts” they have funded.

But many of those reports remain difficult, if not impossible, for the average person to decipher.

It’s a scenario playing out in a host of states. As state and local governments begin spending 

, one of the loudest and most frequent questions from the public has been: Where are the dollars going? Victims of the crisis, advocates, and public policy experts have repeatedly called on governments to transparently report how they’re using these funds, which many consider “blood money.”

, that found 12 states — including Idaho — had made written commitments to publicly report expenditures on 100% of their funds in a way an average person could find and understand. (The other 38 states promised less.)

But there’s a gap between those promises and the follow-through.

This year, KFF Health News and Minhee revisited those 12 states: Arizona, Colorado, Delaware, Idaho, Massachusetts, Minnesota, Missouri, New Hampshire, New Jersey, Oregon, South Carolina, and Utah. From their reports, it became clear that some did not fulfill their promises. And several just squeaked by, meeting the letter of the law but falling far short of communicating to the public in a clear and meaningful manner.

Take Idaho, for instance. Jurisdictions there completed a standard form showing how much money they spent and how it fell under approved uses of the settlement. Sounds great. But in reality, it reads like this: In fiscal year 2023, the city of Chubbuck 

 on Section G, Subsection 9. Public Health District No. 6 

. And even that provides only broad outlines.

G-9 refers to “school-based or youth-focused programs or strategies that have demonstrated effectiveness in preventing drug misuse.” B-2 refers to “the full continuum of care of treatment and recovery services for OUD and any co-occurring SUD/MH conditions,” referring to opioid use disorder and substance use disorder or mental health conditions.

“What does that mean? How exactly are you doing that?” asked 

, a project director at the Network for Public Health Law, when he first saw the Idaho reports.

Does a school-based program involve hiring mental health counselors or holding a one-time assembly? Does treatment and recovery services mean paying for someone’s rehab or building a new recovery house?

Without details on the organizations receiving the money or descriptions of the projects they’re enacting, it’s impossible to know where the funds are going. It’d be similar to saying 20% of your monthly salary goes to food. But does that mean grocery bills, eating out at restaurants, or hiring a cook?

The Idaho attorney general’s office, which oversees the state’s opioid settlement reports, did not respond to requests for comment.

Although Idaho and the other states in this analysis do better than most by having any public reports, Davis said that doesn’t mean they get an automatic gold star.

“I don’t think we should grade them on a curve,” he said. It’s not “a high bar to let the public see at some reasonable level of granularity where their money is going.”

To be sure, many state and local governments are making concerted efforts to be transparent. In fact, seven of the states in this analysis reported 100% of their expenditures in a way that is easy for the public to find and understand. 

 and downloadable spreadsheet clearly list projects, such as Renville County’s use of $100,000 to install “a body scanner in our jail to help staff identify and address hidden drugs inside of inmates.” New Jersey’s annual reports 

 on how counties awarded funds and how they’re tracking success.

 that didn’t originally promise 100% transparency but are now publishing detailed accounts of their expenditures.

However, there are no national requirements for jurisdictions to report money spent on opioid remediation. In states that have not enacted stricter requirements on their own, the public is left in the dark or forced to rely on 

When jurisdictions don’t publicly report their spending — or publish reports without meaningful details — the public is robbed of an opportunity to hold elected officials accountable, said 

, a co-director of East Tennessee State University’s Addiction Science Center and a national expert on addiction issues.

He added: People need to see the names of organizations receiving the money and descriptions of their work to ensure projects are not duplicating efforts or 

“We don’t want to burden the whole thing with too much reporting,” Pack said, acknowledging that small governments run on lean budgets and staff. But organizations typically submit a proposal or project description before governments give them money. “If the information is all in hand, why wouldn’t they share it?”

, a psychiatrist and the director of addiction medicine at St. Luke’s Health System in Idaho, said sharing the information could also foster hope.

“A lot of people simply are just not aware that these funds exist and that these funds are currently being utilized in ways that are helping,” he said. Greater transparency could "help get the message out that treatment works and treatment is available.”

Other states that lacked detail in some of their expenditure reports said further descriptions are available to the public and can be found in other state documents.

In South Carolina, for instance, more information can be found in the 

 of the Opioid Recovery Fund Board, said board chair Eric Bedingfield. He also wrote that, following KFF Health News’ inquiry, staff will create an additional report showing more granular information about the board’s “discretionary subfund” awards.

In Missouri, Department of Mental Health spokesperson Debra Walker said, further project descriptions are available through the state budget process. Anyone with questions is welcome to 

Bottom line: The details are technically publicly available but finding them could require hours of research and wading through budgetary jargon — not exactly a system friendly to the average person.

New Hampshire’s efforts to report its expenditures follow a similar pattern.

Local governments control 15% of the state’s funds and report their expenditures in yearly letters 

. The rest of the state’s settlement funds are controlled by the Department of Health and Human Services, along with an opioid abatement advisory commission and the 

Grant recipients from the larger share explain their projects and the populations they serve on the state’s 

. But the reports lack a key detail: how much money each organization received.

To find those dollar figures, people must search through the opioid abatement advisory commission’s meeting minutes, which date back several years, or search the governor and executive council’s 

 for the proposed contracts. Typing in the search term “opioid settlement” brings up no results, so one must try “opioid” instead, surfacing results about opioid settlements as well as federal opioid grants. The only way to tell which results are relevant is by opening the links one by one.

Davis, from the Network for Public Health Law, called the situation an example of “technical compliance.” He said people in recovery, parents who lost their kids to overdose, and others interested in the money “shouldn’t have to go click through the meeting notes and then control-F and look for opioids.”

James Boffetti, New Hampshire’s deputy attorney general, who helps oversee the opioid settlement funds, agreed that “there’s probably better ways” to share the various documents in one place.

“That doesn't mean they aren’t publicly available and we’re somehow not being transparent,” he said. “We’ve certainly been more than transparent.”

The New Hampshire Department of Health and Human Services said it will be compiling its first comprehensive report on the opioid settlement funds by the end of the year, as 

With opioid settlement funds set to flow for another decade-plus, some jurisdictions are still hoping to improve their public reporting.

 to incentivize local governments to report on their shares. Counties were offered $1,000 to complete 

 about their settlement spending this year, said Laina Stebbins, a spokesperson for the Department of Health and Human Services. Sixty-four counties participated — more than double last year, when there was no financial incentive.

In Maryland, lawmakers took a different approach. They introduced a bill that required each county to post an annual report detailing the use of its settlement funds and imposed specific timelines for the health department to publish decisions on the state’s share of funds.

 about undue administrative burden, the provisions 

, a Democrat representing Baltimore who sponsored the House bill.

Lawmakers have now asked the health department to devise a new plan by Dec. 1 to make local governments’ expenditures public.

Toni Torsch, a Maryland resident whose son Dan 

 at age 24, said she’ll be watching to ensure the public gets a clear picture of settlement spending.

“This is money we got because people’s lives have been destroyed,” she said. “I don’t want to see that money be misused or fill a budget hole.”

, a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at 

 — the independent source for health policy research, polling, and journalism. KFF Health News is the publisher of 

, an editorially independent service of the 

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Aneri Pattani

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Victims of the opioid crisis, health advocates, and  policy experts have called on state and local governments to clearly report how they’re using the funds they are receiving from settlements with opioid companies.

We checked up on the states that promise transparency on opioid settlement funds

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