Law enforcement capture of opioid settlement funding across Appalachia.

BACKGROUND

National opioid settlements were intended to fund public health remediation, yet early evidence suggests significant institutional capture. In this study I analyze how differing state governance models across 13 Appalachian states shaped resource allocation during the initial disbursement phase.

METHODS

I conducted systematic document analysis of publicly available settlement expenditure records across 13 states in the Appalachia Opioid Remediation Database through July 2025, supplemented by investigative reporting and state transparency portals. I manually coded local, cash-in-hand expenditures into clinical remediation and non-clinical spending categories and calculated weighted capture rates across restrictive and permissive spending frameworks.

RESULTS

The regional weighted mean capture rate for non-clinical law enforcement and administrative purposes was 8.4% ($10.2 million) of documented expenditures. Substantial variation existed across governance models: West Virginia's permissive framework produced a 41.2% verified capture floor, while North Carolina's restrictive model limited non-clinical allocation to 2.6%.

CONCLUSIONS

Discrepancies in state-level oversight have produced significant resource allocation into law enforcement hardware and legacy municipal debts. Permissive spending frameworks appear structurally susceptible to fiscal supplantation. To defend future disbursements, standardized non-supplantation mandates and outcome-based auditing are recommended to prioritize clinical remediation over general infrastructure expansion.