Opioid Settlement Funds

Settlement Funds in Marin County 

Oversight & Management

Opioid settlement funds (OSF) received by Marin County are allocated for activities that align with specified opioid abatement goals. These activities include prevention education, awareness building, harm reduction, treatment services, and recovery support. The funds support various initiatives across the county to reduce the impact of opioid use. County of Marin Department of Health and Human Services (HHS) oversees these efforts through its Public Health (PH) and Behavioral Health and Recovery Services (BHRS) divisions, working with community-based providers through a formal RFP and contracting process. To date, more than 70% of OSF spending has been allocated to fund work led by community partners while less than 30% of OSF spending has funded County-led services and programs. These efforts have been designed to align with Allowable Expenditures and High Impact Abatement Activities (HIAA) as specified in Exhibit E to satisfy the terms of each settlement agreement.  California has named the Department of Health Care Services (DHCS) as the oversight and monitoring entity for OSF recipient counties, including Marin, who are required to submit annual reports to DHCS.

The Allocation Process

The allocation of OSF in Marin County is guided by the Core Strategies and Approved Uses which are specified in the state-specific settlement agreements and address how funding can be used to accomplish opioid remediation in each county in accordance with the terms of the settlement agreements. Though legally local governments are not required to seek public input about the allocation decisions related to opioid settlement spending, Marin County has both welcomed public commentary during Board of Supervisors (BOS) public meetings and has created concerted opportunities to educate and elicit community members’ input on priority setting for OSF allocations in Marin, as outlined in the Community Involvement section below.

Proposed allocations of OSF awarded to Marin County, are developed by the leadership of HHS, inclusive of the Public Health Officer, the Director of BHRS and the Division Directors from both Public Health and BHRS divisions of HHS.  These proposals are brought before the Marin County Board of Supervisors, in the form of Spending Plans (often covering multiple years of spending), for review, discussion, modification, and approval by the BOS. 

Once a spending plan has been formally approved by the BOS, the relevant HHS division is able to solicit requests for proposals (RFPs) from community-based organizations, contractors, and local providers who can conduct the identified opioid remediation initiative. It is through the RFP and contracting process that the majority of opioid remediation activities in Marin are implemented. 

Key Dates

Sources & Amounts

Allocated Settlements

Community Involvement

The County of Marin values and relies upon community involvement to effectively respond to the health and wellness needs of residents. This is clearly reflected in the number of cross-sector partnerships, collaboratives, and coalitions that operate throughout the County to address complex health issues more effectively.  Related to prioritizing the allocations of opioid settlement funds, even though community involvement is not a legal requirement, the Department of Health and Human Services has sought the input of key stakeholders, in a variety of ways.  Stakeholder input has been and will continue to be influential in helping to shape the priorities and decisions related to County allocations of opioid settlements funds. Following are some examples of recent outreach.

Outreach

In December of 2024 and throughout January of 2025, HHS engaged in a variety of concerted outreach and educational efforts designed to invite the public to provide feedback for those interested in helping shape how OSF are allocated in Marin County. Twenty-two separate outreach initiatives were undertaken in this recent effort, including hosting a listening session for youth, developing a dedicated OSF webpage, making available a downloadable presentation about OSF priorities, presenting the OSF overview and answering question for nine community stakeholder groups (presentations were in person and virtual), inserting announcements into local newsletters with links to the OSF resources, emailing HHS’ and partner listservs inviting engagement, and releasing an online community survey that was live for five weeks and available in three languages.

Insight

As a direct result of the outreach efforts described above, over 33,800 people (13.53% of Marin County’s population) were contacted and invited to explore the new OSF Webpage, review the new OSF Community Presentation, and asked to take a linked survey (that is no longer live). One hundred and twenty-four surveys were received by HHS, representing a 13% participation rate given a total of 954 individuals who attended live presentations, opened the related OD Free Marin newsletter, or visited the OSF Webpage during the timeframe when the survey was live (reflecting a 2.8% conversation rate of the total number of people contacted and those who opted to engage proactively).  

The findings shared below, reflect the preferences and priorities of the individuals who submitted the OSF Community Survey. Demographics of respondents are as follow, 74% white, 12% Multiracial, 6% Black/African American, 5% Asian, 2% Latino. This compares to the current population of Marin, which is: 66% White, 18% Hispanic, 6.2% Asian, 5.5% Multiracial, 2.3% Black, 1.2% Native American/other. Irrespective of race, 20% of our survey respondents’ identity as Hispanic or Latino. 

Survey Results

Each respondent who participated in the 2024-2025 OSF Community Survey, was asked to review and rank order a list of high-impact opioid abatement activities designed to expand the County’s capacity to support the following priority initiatives. The order of the list below reflects the priority ranking of survey respondents: 

1. Expand youth prevention, engagement coordination, and education 
2. Support program coordination of outreach to overdose survivors 
3. Widen Naloxone distribution and community engagement 
4. Support overdose and suicide prevention program coordination 
5. Increase substance use disorder-related crisis response services

Priority Strategies 

Community survey respondents were asked to select two priority activities (from a list of four or more priority activities) for each of the four core abatement strategies shared.  The top two activities selected by the majority of respondents are listed below:

Core Abatement Strategies

Core Strategy One: Expand the substance use disorder treatment infrastructure and support for people in treatment and in recovery.

1. Drug addiction prevention for vulnerable youth
2. Expand availability of culturally and linguistically responsive treatment for persons with opioid use disorder

Core Strategy Two: Increase diversion (from the justice systems to treatment) for people with substance use disorder 

1. Support treatment and recovery courts that provide evidence-based options for persons with opioid use disorder and any co-occurring substance use/mental health conditions
2. Implement best practices for outreach, diversion, employability, restorative justice, and harm reduction

Core Strategy Three: Utilize harm-reduction to prevent overdose deaths and other harms

1. Provide training in harm reduction strategies to health care providers, students, peer recovery coaches, etc.
2. Increase the availability and distribution of naloxone (Narcan)

Core Strategy Four: Expand programs to prevent opioid use

1. Employ strategies to address mental health needs of young people 
2. Implement school-based strategies, including substance use curricula

Priority Populations

Community survey respondents were asked to identify the top three priority populations for prevention and treatment initiatives in Marin County.  The following graph reflects their selections: (Scroll your cursor over each section of the pie chart to see percentages)

Priority Activities

In addition to selecting multiple choice answers, community members were invited to provide their own input about OSF allocation priorities through open-ended responses.  From the 45 comments submitted, five priority areas emerged that were raised by three or more individuals.  The list below reflects the OSF allocation priorities from community respondents:

• Great geographical coverage/West Marin access 
• School and community-based youth education and campaigns 
• Increase availability of outpatient and residential recovery services in county
• Support for youth going through recovery (e.g. support groups) 
• Increase access to mental health services at the school level 

Get Involved: Join OD Free Marin

OD Free Marin has an ad-hoc task force of its steering committee that engages in OSF allocation priority-setting on behalf of community and serves as a thought-partner to HHS, as invited to do so.  Learn more and consider joining OD Free Marin. Sign up for an Action Team. 

Settlement Funds in California

Approved Uses

Pursuant to the California State-Subdivision Agreements, funds must be used for opioid remediation  (defined in the National Opioid Settlement Agreements, as the “care, treatment, and other programs and expenditures designed to (1) address the misuse and abuse of opioid products, (2) treat or mitigate opioid use or related disorders, or (3) mitigate other alleged effects of, including on those injured as a result of, the opioid crisis.”). These funds must support approved activities utilizing “core strategies” (referred to as abatement strategies) outlined in each settlement’s Exhibit E. Additional provisions or limitations vary by state and are detailed in each state’s memoranda of understanding. Examples for California are available here. In California, the DHCS is responsible to oversee how these funds are used.

• DHCS California Opioid Settlements
• California Opioid Settlements Frequently Asked Questions
• Office of the Attorney | National Opioids Settlements
• CDPH Opioid Settlements
• Community Access | Guide for Opioid Settlement

Acronym Key

This webpage, updated quarterly, is designed to provide the community greater understanding about opioid settlement funds in Marin County. To learn more, please use the links above. 
Questions? email: info@odfreemarin.org