The national opioid settlements negotiated between 2021 and 2022 are now, in mid-2023, beginning to reach state treasuries at scale. The aggregate figure is in the tens of billions, paid out over roughly eighteen years. The headline number is large. The line-item reality is smaller, slower, and considerably more interesting for anyone selling harm reduction supplies.
Three states illustrate how different the first-wave procurement pathways look.
Pennsylvania: the Trust and the counties
Pennsylvania's share flows through the Pennsylvania Opioid Misuse and Addiction Abatement Trust, which governs allocations and sets spending requirements that local governments must follow. Seventy percent of the state's settlement dollars land at the county level. The Trust reviews and approves county plans. Counties, in turn, let their own RFPs.
The practical consequence is that procurement is fast in counties that had existing harm reduction infrastructure (Allegheny, Philadelphia, Montgomery) and slow in counties that did not. Philadelphia's Department of Public Health is already purchasing fentanyl strips at volume through its SUPHR program. Allegheny County is running a rolling RFP that accepts drug-checking-supply bids among other line items. Counties without standing programs are spending the first year of settlement dollars on planning and infrastructure, not on strips.
New York: centralization and scale
New York's model is the opposite of Pennsylvania's. The Office of Addiction Services and Supports (OASAS) coordinates a large share of the state's harm-reduction spending centrally, and the state's Opioid Settlement Fund Advisory Board reviews recommended allocations. The result is a procurement environment where one state-level body can move volume in a single purchase order.
OASAS and partner organizations have distributed millions of fentanyl test strips since the start of the state's harm reduction rollout. The MATTERS Network vending-machine program, supported by Opioid Settlement Fund initiatives in part, is an example of what the centralized model produces: thirty vending machines, tens of thousands of supply orders, and the ability to purchase at a volume that would be hard to replicate through county-by-county purchasing.
Centralized procurement moves faster and buys at volume. County-level procurement is slower but produces programs more closely matched to local need. Both models are now running in parallel.
New Jersey: the hybrid
New Jersey is running a hybrid. The state coordinates policy and high-level allocation. County governments do much of the deployment. The New Jersey Department of Human Services funds Harm Reduction Centers across the state, several of which are operated by community-based organizations that purchase supplies through state contracts.
For a supplier, New Jersey's procurement profile sits between Pennsylvania's and New York's. State contracts exist and can be bid. County RFPs also exist (Hudson, Mercer, and several others have run their own over the past year). A single sales cycle may need to cover both tracks, or at minimum be aware of which is running at a given moment.
What is actually being purchased
In this first wave of settlement-funded procurement, the dominant line items are:
- Fentanyl test strips, by a wide margin.
- Naloxone (still the most-funded harm reduction item overall, though not always within the same procurement cycle as strips).
- Xylazine test strips, now appearing in procurement documents as a secondary line.
- Safer-use supplies (syringes, cookers, sterile water) where state rules permit.
Medetomidine and nitazene strips are not yet widely included in settlement-funded procurements. They will be. The adulterant prevalence data published by Philadelphia and several research groups is moving faster than the procurement language can follow. Our expectation is that the 2024 and 2025 procurement cycles will broaden the portfolio, and that multi-analyte authorization (something like what Ohio might eventually do) will become a procurement accelerator.
The bottleneck is not the money
In nearly every state conversation we have had over the past four months, the constraint has not been dollars. Settlement allocations are ample for the harm reduction line items that match their intended use under the Johns Hopkins Opioid Principles. The constraints are three elsewhere:
- Procurement infrastructure. Some jurisdictions lack the contracting pathway to buy strips at volume, and are building one.
- Legal clarity. Several states still have paraphernalia statutes that read ambiguously against newer strip types.
- Reporting and tracking. Grantees and settlement-fund administrators often require spend documentation that small community-based organizations struggle to produce.
As a supplier, we have learned to expect that the deal cycle for a first-time state purchase is measured in months, not weeks, and that a significant part of the work is helping procurement teams document what they bought, how they tracked it, and what the distribution numbers look like. The money is arriving. The procurement pipes are catching up.