Opioid Settlement Navigator
North Carolina will receive about $1.6 billion from national opioid settlements through 2041. Learn how the money flows, what it can pay for, and how your organization can partner with your county to put it to work.
The basics
The settlement at a glance
Between 2021 and 2025, the NC Department of Justice helped negotiate more than $55 billion in national settlements and bankruptcy resolutions with companies that made, distributed, and sold opioids. The companies include the distributors McKesson, Cardinal Health, and Cencora (formerly AmerisourceBergen); Johnson & Johnson; the pharmacy chains CVS, Walgreens, Walmart, and Kroger; the drug makers Teva, Allergan, and eight secondary manufacturers; and the Purdue Pharma and Sackler bankruptcy plan.
In North Carolina, every dollar is governed by one agreement between the State and local governments: the NC Memorandum of Agreement (MOA) and its supplements. The MOA decides who receives money, what it can pay for, and how it must be reported. Payments arrive every year, so new funding decisions happen every budget cycle.
The bottom line for organizations: you do not apply to the settlement itself. Counties and cities receive the money, choose approved strategies, and contract with organizations like yours to deliver them.
Where the money goes
From the courtroom to your community
Who receives local funds
All 100 counties receive payments. Seventeen municipalities were also entitled to direct payments; eight of them (Canton, Cary, Charlotte, Concord, Gastonia, Greenville, Raleigh, and Wilmington) send their share to their county instead. The cities still receiving their own payments are Asheville, Durham, Fayetteville, Greensboro, Henderson, Hickory, High Point, Jacksonville, and Winston-Salem.
Option A or Option B
Option A
The county funds one or more of the 12 high-impact strategies in Exhibit A. No special planning process is required.
Option B
The county first completes a collaborative strategic planning process (Exhibit C), presents a report to its board, and files it with CORE-NC. It can then fund the much longer Exhibit B list as well.
Whichever option your county uses determines what it is allowed to buy from you. See each county's spending plan.
What the money can pay for
The 12 high-impact strategies
Counties may only spend settlement funds on approved strategies. These are the 12 on the Option A list, in plain language. Always use the official wording and number when you write to your county. Read Exhibit A.
Strategy 1: Collaborative strategic planning
Staff time, facilitation, and community planning that decide how settlement dollars are used, including any activity in Exhibit C.
Often delivered by: Coalitions, networks, and conveners
Strong fit for faith-based recoveryStrategy 2: Evidence-based addiction treatment
Treatment consistent with national ASAM guidelines, including any FDA-approved medication for opioid use disorder. Can include capital costs for treatment facilities, on a pro rata basis.
Often delivered by: Licensed clinical providers, opioid treatment programs, health centers
Strategy 3: Recovery support services
Peer support specialists and care navigators, including those based in community organizations, who help people in treatment or recovery reach treatment, housing, healthcare, and other support.
Often delivered by: Recovery ministries and community organizations with peer staff
Strong fit for faith-based recoveryStrategy 4: Recovery housing support
Help with rent, move-in deposits, or utilities for people in treatment or recovery, or recovery housing programs that house people receiving medication for opioid use disorder.
Often delivered by: Recovery homes and residential programs
Strong fit for faith-based recoveryStrategy 5: Employment-related services
Job training, job skills, placement, interview coaching, resume help, work attire, community college or vocational courses, and transportation to make it possible.
Often delivered by: Work programs, social enterprises, life-skills programs
Strong fit for faith-based recoveryStrategy 6: Early intervention
Programs and training that identify and help young people under 26 who are struggling, or at risk of struggling, with drugs or mental health. General prevention aimed at everyone does not qualify here.
Often delivered by: Youth ministries, schools, family programs
Strategy 7: Naloxone distribution
Getting naloxone to people at risk of overdose and the people around them, including through community organizations that serve people who use drugs.
Often delivered by: Outreach teams, shelters, community organizations
Strategy 8: Post-overdose response teams
Teams that reach people after a non-fatal overdose and connect them to treatment, recovery support, healthcare, and other services.
Often delivered by: Partners of EMS, health departments, hospitals
Strategy 9: Syringe service programs
Registered programs under N.C.G.S. 90-113.27 that provide supplies and safe disposal and connect people to care.
Often delivered by: Registered harm reduction programs
Strategy 10: Criminal justice diversion programs
Pre-arrest, post-arrest, and pre-trial programs that connect people involved, or at risk of involvement, in the justice system to treatment, recovery support, and other services.
Often delivered by: Programs partnering with courts, sheriffs, and police
Strong fit for faith-based recoveryStrategy 11: Addiction treatment for incarcerated persons
Evidence-based treatment for people in jail or prison, including at least one FDA-approved opioid agonist medication.
Often delivered by: Clinical providers serving jails
Strategy 12: Reentry programs
Programs that connect people leaving jail or prison to treatment, recovery support, healthcare, and other services, or provide those services directly.
Often delivered by: Reentry ministries, transitional programs
Strong fit for faith-based recoveryThe broader Exhibit B list (Option B counties only)
Exhibit B groups many more strategies under these headings: treating opioid use disorder; supporting people in treatment and recovery; connecting people to care; criminal-justice-involved persons; pregnant and parenting women and their families; preventing over-prescribing; preventing misuse; harm reduction; first responders; leadership and planning; training; and research.
Three Exhibit B strategies name faith communities directly: B.10 (engage non-profits, faith-based communities, and coalitions to support people in recovery and their families), C.15 (engage non-profits and the faith community to support outreach for treatment), and G.7 (engage non-profits and faith-based communities to support prevention). Read Exhibit B in full.
For faith-based programs
Three things counties will ask about
Faith-based programs are eligible partners. Counties will ask about the same three things, so have clear answers ready.
Medications for opioid use disorder
Treatment funded under Strategy 2 must follow ASAM guidelines, which include buprenorphine, methadone, and naltrexone. Under Strategy 4, counties can fund rent and utility help for people in recovery, or recovery housing programs that house people receiving these medications. The NC Department of Justice reminds counties that any program they fund must follow the Americans with Disabilities Act and the Fair Housing Act. Programs with a clear, welcoming medication policy are easier for counties to fund.
Keep funded services distinct
Settlement dollars are public funds. As is standard practice for public funding, budget the funded service (peer support, housing help, job training) separately from worship and religious instruction, and make participation in religious activities voluntary for people served with these funds. Ask your county how it applies this locally.
Show your evidence and results
The ASAM definition of recovery that the State relies on addresses the "biological, psychological, social, and spiritual" parts of addiction. Your whole-person model fits that definition. Back it with data: people served, retention, housing, employment, and progress on tools such as the Aspire stoplight assessment.
Interactive tool
Find your funding path
Answer four quick questions to see which strategies match your work, what to watch out for, and where to start in your county. Nothing you enter leaves this page.
Roadmap
Seven steps to settlement funding
Learn your county's plan
Open the official Local Progress and Spending Plans dashboards and select your county. Note which strategies it has already funded, how much is authorized, and which option (A or B) it is using. Find the name of the staff member who coordinates opioid settlement work; it is often in the county manager's office or the health department.
Match your program to a strategy
Counties can only pay for strategies listed in Exhibit A, or in Exhibit B if they have completed the Option B planning process. Describe your work using the exact strategy name and number, for example "Exhibit A, Strategy 3: Recovery support services." Use the path finder above to see where you fit.
Get to the table
Every county that receives funds must hold at least one public meeting a year on how the money is used. Attend it. Ask to join the county's opioid advisory group or strategic planning process, and speak during public comment at a commissioners' meeting. Relationships formed here usually come before any funding.
Watch for funding opportunities
Most counties award funds through a request for proposals, a grant round, or a contract with a provider already doing the work. Sign up for county procurement notices and health department updates. The state's 15 percent share is appropriated by the General Assembly, and some of it reaches community organizations through state agency grants, so watch NCDHHS announcements too.
Write a proposal the county can approve
Before spending, a county must pass a resolution naming each strategy, the amount, and the time period. Make that easy: show local need with data, name the strategy number, give a line-item budget and cost per person served, list your measures, and explain how the work continues after the grant.
Be ready for contract compliance
When a county contracts with you, it must hold you to the same rules it follows. Expect a written agreement tied to the authorized strategy, monitoring visits, procurement standards, conflict-of-interest rules, and regular reports on spending and the people you serve.
Report results and renew
Counties file an annual financial report and an annual impact report with CORE-NC within 90 days after each fiscal year ends on June 30. The data you provide goes into those public reports. Organizations that report clearly and on time are the ones counties renew.
Get ready
Funding readiness checklist
Work through this list before you approach your county. Your progress is saved in this browser so you can come back to it.
0 of 16 complete
Make contact
Outreach letter builder
Your first contact with the county should be short, specific, and tied to an approved strategy. Fill in a few details and we will draft an introduction email you can send to your county's opioid settlement coordinator.
Questions
Frequently asked questions
Can our organization apply directly to the opioid settlement?
No. National settlement administrators pay the State and eligible local governments directly. Community organizations receive settlement dollars through contracts or grants from a county or city, or through programs funded with the State's share. Your path runs through your local government.
Can faith-based organizations receive settlement funds?
Yes. The NC Memorandum of Agreement lets counties and cities contract with nonprofits, charities, and other entities to carry out approved strategies. The broader Exhibit B list names faith-based communities directly in strategies B.10, C.15, and G.7. You will need to follow the county's procurement process and the rules for the strategy you are funded under.
Can a county give us a grant and let us decide how to spend it?
No. Local governments may not hand over responsibility for funding decisions. Your agreement will be tied to the specific strategies and amounts the county authorized by resolution, and the county must monitor how the money is used.
Does our program have to allow medications for opioid use disorder?
It depends on the strategy. Evidence-based treatment (Strategy 2) must follow ASAM guidelines, which include all FDA-approved medications. Recovery housing (Strategy 4) can fund rent and utility help for people in recovery, or recovery housing programs that house people receiving medication. The NC Department of Justice notes that counties and the organizations they fund must comply with anti-discrimination laws such as the Americans with Disabilities Act and the Fair Housing Act. Review your admission policy with legal counsel before you apply.
What happens to the State's 15 percent?
The NC General Assembly decides how to spend it, and it must still address the opioid epidemic. Much of it is distributed through state agencies such as NCDHHS, which sometimes run competitive grants open to community organizations. See the official state spending page.
Is there a matching requirement?
No. The MOA does not require a match. Settlement funds can be combined with other funding as long as the project fits an authorized strategy, and showing other support strengthens a proposal.
Can settlement funds pay for buildings or vehicles?
Strategy 2 explicitly allows capital spending on facilities that provide evidence-based treatment (only the treatment portion, on a pro rata basis). Other purchases must fit the authorized strategy and the county's resolution, and follow the county's procurement and capital rules. Ask your county before you budget for them.
When do counties make funding decisions?
North Carolina local governments run on a July 1 to June 30 fiscal year and adopt budgets in late spring. A county must authorize settlement spending by resolution before any money is spent. Reaching your county in the fall and winter gives your proposal the best chance to be included in the next cycle.
How long will the money keep coming?
Payments are scheduled through 2041. Different settlements run on 18-, 15-, and 11-year schedules. Payments from the Purdue Pharma and Sackler bankruptcy plan (about $150 million for North Carolina) and the secondary opioid manufacturer settlement begin in 2026. Check the official NC payment schedule for each local government's projected amounts.
Official sources
Where to read more
- NC Opioid Settlements (CORE-NC), the official state portal
- How settlement funds are allocated
- About the national settlements
- Local Progress dashboard: what each county is doing
- Local spending plans
- NC payment schedule by local government
- Use and reporting of funds
- Full text of the NC Memorandum of Agreement (PDF)
- Exhibit A: Option A strategies (PDF)
- Exhibit B: Option B strategies (PDF)
- Exhibit C: Collaborative strategic planning (PDF)
- FAQ on Option A strategies, NC Department of Justice (PDF)
- FAQ on the Memorandum of Agreement, NC Department of Justice (PDF)
- Strategy resources and toolkits
- NC Association of County Commissioners: Opioid Settlements Assistance
- Naloxone Saves NC: how organizations can distribute naloxone
- National Opioid Settlement administrator
This navigator is a plain-language guide, not legal advice. Facts were checked against official North Carolina sources on October 14, 2026. If anything here differs from the MOA, its supplements, or the national settlement documents, the legal documents take precedence. Confirm requirements with your county before you apply.