Courts are no longer just resolving claims — they are shaping how opioid abatement is funded, distributed, and monitored.

Having matured from a battle-like phase defined by sweeping complaints and massive bellwether trials, opioid litigation now operates through coordinated MDL case management, state and tribal abatement structures, national settlement frameworks with strict reporting requirements, and bankruptcy plans designed to navigate the Supreme Court’s constraints on mass-tort reorganizations.

The Congressional Research Service’s 2025 analysis of national opioid settlements observes that more than a million Americans have died of opioid-involved overdoses since 1999, and governmental plaintiffs have increasingly relied on litigation recoveries to fund prevention, treatment, and recovery programs. The National Opioid Settlements’ executive summary underscores how abatement-only spending mandates and long-tail payment schedules have become core components of the litigation resolution landscape.

When it comes to opioid response and treatment programs, however, the Trump administration has proposed and implemented deep funding cuts. As a result, these life-saving programs have entered a period of instability that could put the nation back on track toward rising overdose deaths like those reported by the Congressional Research Service.

MDL 2804: The Central Coordinating Spine

MDL No. 2804 — In re National Prescription Opiate Litigation — remains the heart of federal opioid litigation. The Northern District of Ohio explains that plaintiffs allege manufacturers misrepresented addiction risks associated with long-term opioid use and distributors failed to monitor suspicious orders—conduct that contributed to the epidemic.

Even after large national settlements, docket activity continues, as reflected in aggregated reporting sources like CourtListener, where thousands of related filings persist. The MDL docket reflects not only unsettled claims but ongoing disputes over allocation, administration, and settlement implementation.

National Opioid Settlements: Long-Horizon Abatement Funding

The National Opioid Settlements — Executive Summary outlines coordinated agreements across distributors, manufacturers, and pharmacy chains. The 2021 agreements require the “Big Three” distributors—McKesson, Cardinal Health, and AmerisourceBergen—to pay up to $21 billion over 18 years. Johnson & Johnson (Janssen) contributes up to $5 billion over nine years.

Later settlements with CVS, Walgreens, Walmart, Teva, and Allergan expanded total abatement funding while implementing operational reforms. Crucially, under both the 2021 and 2022 frameworks, states and their subdivisions must use at least 85% of funds for opioid abatement—an intentional structure turning settlement payouts into a form of restricted public health funding. CRS simultaneously documents how states have relied on these distributions to fill gaps in treatment and harm-reduction systems.

Purdue, Bankruptcy, and the Supreme Court’s Harrington Decision

A pivotal shift occurred when the U.S. Supreme Court decided Harrington v. Purdue Pharma L.P. on June 27, 2024. The Court held that the Bankruptcy Code does not permit a Chapter 11 plan to release claims against non-debtors—such as Sackler family members—without creditors’ consent. This ruling struck at the core of the nonconsensual third-party release model often used to resolve mass-harm cases through bankruptcy courts.

In response, Purdue Pharma announced in November 2025 that the bankruptcy court indicated it would approve a reorganization plan structured around creditor choice. The plan preserves a distribution of more than $7.4 billion in abatement and compensation funds while giving creditors the option to grant or withhold releases of their direct claims—aligning with Harrington’s requirements.

Plan materials and confirmation documents are publicly accessible through the Kroll Restructuring Administration’s Purdue case site.

Tribal Nations: A Parallel, Sovereign Settlement System

Tribal Nations participate in opioid litigation through a distinct sovereign framework. The Tribal Opioid Settlements Official Portal documents tribal litigation across the opioid supply chain, from manufacturers and distributors to pharmacies and consultants. Settlements require that funds be used exclusively for opioid abatement in Indian Country, and Tribal Nations must file periodic abatement-use reports to maintain eligibility for future distributions.

A defining component of tribal settlement administration is the intertribal allocation methodology. The Intertribal Allocation page describes how allocation formulas—originally developed for the Purdue bankruptcy—distribute funds according to relative harm suffered and were subsequently adopted in the Mallinckrodt bankruptcy tribal settlement structure.

To support ongoing tribal settlements, the MDL court established a Qualified Settlement Fund (QSF) framework in March 2025, as detailed in a comprehensive order relating to “All MDL Tribal Cases.” This QSF structure enables coordinated distribution of settlement proceeds for additional defendants resolving claims with Tribal Nations.

Tribal Nations now operate within a parallel, sovereign settlement system with their own allocation formulas and reporting structures.

Enforcement Trends: Misbranding, Dispensing Failures, and Corporate Conduct

McKinsey & Company

The U.S. Department of Justice’s December 13, 2024 press release announced a landmark resolution of criminal and civil investigations into McKinsey’s work advising Purdue on OxyContin sales strategies. McKinsey agreed to pay $650 million, adopt compliance reforms, and cease consulting on controlled substances for a limited period. The firm’s own documentation appears on the McKinsey — Opioid Facts portal.

Endo Health Solutions (Opana ER)

On February 29, 2024, DOJ announced a global resolution with Endo, including a misdemeanor FDCA plea. Under the bankruptcy agreement, Endo will pay up to $464.9 million over ten years, subject to approval by the Southern District of New York bankruptcy court. DOJ’s Endo announcement explains how its marketing of Opana ER violated federal law.

Pharmacies (Walgreens and Others)

Pharmacy dispensing practices remain an enforcement priority. DOJ’s April 21, 2025 Walgreens announcement outlines allegations that Walgreens violated the Controlled Substances Act by filling millions of invalid opioid prescriptions and violated the False Claims Act by billing federal healthcare programs for them. CRS contextualizes such actions within the broader national opioid response framework.

Abatement Governance: The Future of Opioid Litigation

The next decade of opioid litigation will be dominated by governance, not liability. National settlement agreements require abatement-only spending and extensive reporting, while tribal agreements require detailed abatement-use submissions to remain eligible for distributions.
The federal government has traditionally been a major source of funding for opioid response efforts. On Sept. 22, 2025, HHS (via SAMHSA) announced more than $1.5 billion in continuation awards under the State Opioid Response and Tribal Opioid Response programs.
However, the September 2025 SAMHSA awards were part of the last intact cycle of preapproved federal opioid response funding. Shortly afterward, the federal government began backing away from funding commitments, threatening the stability of addiction treatment and overdose prevention programs nationwide.

While settlement funding becomes more structured and long-term, federal opioid-response funding has grown increasingly unstable.

Federal Opioid Response Funding Under the Trump Administration: Cuts, Delays, and Uncertainty

While litigation-driven abatement funding has become more structured and long-horizon, the federal government’s parallel role in funding opioid response programs has entered a period of instability. Independent investigations and watchdog analyses show that, throughout 2025 and into early 2026, the Trump administration implemented or proposed significant cuts, delays, and disruptions affecting overdose prevention and addiction treatment programs nationwide.

In July 2025, NPR reported that the administration withheld roughly $140 million in fentanyl response grants allocated through the CDC’s Overdose Data to Action (OD2A) program. By late 2025, analyses showed deep cuts to SAMHSA, including staff reductions exceeding 50 percent and elimination of $1.7 billion in block grants. In January 2026, outlets confirmed cancellation of up to $1.9 billion in substance use and mental health funding affecting thousands of grantees.

Additional reports revealed draft budget proposals recommending elimination of naloxone distribution programs. Watchdog organizations warned these shifts risk reversing gains in overdose death reductions and destabilizing already strained public health systems.

Taken together, these developments show that federal opioid response funding remains uncertain. As states, counties, and Tribal Nations build long-term abatement programs funded through settlements and bankruptcy plans, federal policy volatility creates ongoing risk for the treatment and prevention infrastructure those programs depend on.