The Opioid Abatement Trust Fund holds 85% of New Hampshireâs opioid settlement funds.[1]
In general, and with limited exceptions,[2] Fund monies must only be disbursed to one of the 19 project criteria listed in state law.[3]
Three of these criteria are reimbursement uses: for outpatient and residential treatment services for OUD and co-occurring disorders (inclusive of medications and âabstinence-based treatment,â in addition to treatment for people involved in the criminal legal system);[4] for law enforcement and emergency response services;[5] and for naloxone.[6]
Other approved uses in state law include supports for mobile services, âwithdrawal management,â[7] access to housing, transportation to treatment and other services, employment training, centralized call centers to connect people to supports, improved oversight of methadone treatment programs, scholarships for health providers to work in underserved areas, efforts to prevent over-prescribing, improvements to the prescription drug monitoring program, education for law enforcement on fentanyl, evidence-based âand/or evidence-informedâ prevention, school programs, secondary and tertiary prevention âthrough harm reduction programs,â and addressing the pain management needs of chronic pain patients and/or those in hospital or palliative care.[8]
Disbursements from the Fund must be made âin alignment with relevant state plans.â[9] The Opioid Abatement Advisory Commissionâs contains a non-exhaustive list of strategies that are âin alignment with [state law] ⌠, NHâs SUD Action Plan[,] and the 10-Yr Mental Health Plan.â[10] The Commission's document refers to of the national settlements â which includes prevention, harm reduction, treatment, recovery, and other strategies â as providing a âfurther description of opioid remediation uses.â[11]
Opioid Abatement Advisory Commission decides (with approval from the Governor and New Hampshire Executive Council). The makes decisions on grant funding and other disbursements from this share in coordination with the .[12] The Advisory Commissionâs disbursements must be âin alignment with relevant state plans.â[13]
The Governor and the must approve âall disbursements or grants.â[14] The Department of Health and Human Services (DHHS) is responsible for distributing the monies.[15]
Both governmental entities and non-profit organizations are eligible to receive awards from the Fund.[16] The Commission is required to advise DHHS on the Fundâs administration and approve the agencyâs selection of eligible grant recipients.[17] The Commission and the DHHS Commissioner are both empowered to develop priorities and goals for the Fundâs expenditures and recommend state and local policy changes.[18]
Generally no, supplantation is not prohibited. Like most states, New Hampshire does not prohibit supplantation uses of its opioid settlement funds. This means that the 85% state share may be spent in ways that replace (or âsupplantâ) â rather than supplement â existing resources. However, state law prohibits certain reimbursement uses of funds from the 85% state share where the government entity would have otherwise been reimbursed for such services.[19] This provision effectively operates as a bar against âdouble-dippingâ on funding sources and may limit some, but not most, forms of supplantation.[20]
Eventually (public reporting required). Expenditures for this share will likely be published on the âs website. State law requires the Commission to publish information about its âfunding awardsâ and âreports of funding by recipientsâ online.[21]
Visit OpioidSettlementTracker.comâs for an updated collection of statesâ and localitiesâ available expenditure reports.
Not applicable.
N.H. Rev. Stat. Ann. Sec. 126-A:84(II)(a)-(b). But see 70% regional, 30% non-regional apportionments of Mallinckrodt trust distributions. NOAT II: (January 13, 2023). â
See, e.g., . New Hampshire Attorney General News Release. September 1, 2022. Accessed August 9, 2024. (âUnder the terms of the settlement agreement, Johnson & Johnson will make a single payment of $39.605 million to the State and pay approximately $900,000 in attorneysâ fees to counsel for the counties, cities and towns that filed opioid lawsuits against Johnson & Johnson prior to September 1, 2019â). See also N.H. Rev. Stat. Ann. Sec. 126-A:85(VII) (âThe department of health and human services shall provide administrative support to the advisory commissionâ). â
N.H. Rev. Stat. Ann. Secs. 126-A:83(I) (âAll proceeds received by the state from all consumer protection settlements or judgments against opioid manufacturers or distributors shall be deposited in accordance with RSA 7:6-f. ⌠The state treasurer shall disburse funds from the trust fund solely for the purposes and in the manner set forth in RSA 126-A:84â), 126-A:84(I) (âThe commissioner shall draw from the opioid abatement trust fund for qualifying opioid abatement projects under RSA 126-A:86, I(b)â), and 126-A:86(I)(b)(1)-(17) (listing acceptable project criteria). â
N.H. Rev. Stat. Ann. Sec. 126-A:86(I)(b)(1). â
N.H. Rev. Stat. Ann. Sec. 126-A:86(I)(b)(2). â
N.H. Rev. Stat. Ann. Sec. 126-A:86(I)(b)(5) (âFDA-approved opioid reversal agentsâ). â
N.H. Rev. Stat. Ann. Sec.126-A:86(I)(b)(3)-(4), (6)-(19). The approved criteria regarding pain management were added by legislation enacted in 2024. See 2023 NH HB 1318. â
N.H. Rev. Stat. Sec. 126-A:86(I). â
Guiding Strategies for the Use of Opioid Abatement Funds. Opioid Abatement Advisory Commission (Commission). February 2024. Accessed August 9, 2024. (âUse of these strategies should be determined within the broader context of statewide plans, community feedback, current efforts by non-governmental and governmental entities and anticipated funding reductions (State Opioid Response, COVID relief, etc). This is not an exhaustive list of applicable strategies, but rather, a guiding document to help establish a road map for funding, in alignment with NH statute and opioid settlement agreements (see Exhibit E for further description of opioid remediation usesâ). â
Guiding Strategies for the Use of Opioid Abatement Funds. Opioid Abatement Advisory Commission (Commission). February 2024. Accessed September 1, 2024. (â[The Guiding Strategies] is not an exhaustive list of applicable strategies, but rather, a guiding document to help establish a road map for funding, in alignment with NH statute and opioid settlement agreements (see Exhibit E for further description of opioid remediation uses)â). â
N.H. Rev. Stat. Secs. 126-A:85(I) (âThere is hereby established the New Hampshire opioid abatement advisory commission, which shall consult with and advise the commissioner of the department of health and human services relative to the proper administration and management of the opioid abatement trust fund, as established in RSA 126-A:83, and which shall approve all qualifying grants, loans, and matching funds from that fund under RSA 126-A:86, I(b)â) (emphasis added); N.H. Rev. Stat. Sec. 126-A:86(I)(b) (âThe opioid abatement advisory commission in coordination with the governor's commission on alcohol and other drugs, and in alignment with relevant state plans, shall ⌠[a]ward grants, revolving loan funds, and matching funds to projects from the opioid abatement trust fund under RSA 126-A:83, I, in a manner consistent with the following criteriaâŚâ). â
N.H. Rev. Stat. Sec. 126-A:86(I). The Commissionâs Guiding Strategies for the Use of Opioid Abatement Funds document contains a non-exhaustive list of applicable strategies that are âin alignment with RSA 126-A:86 ⌠, NHâs SUD Action Plan[,] and the 10-Yr Mental Health Plan â
N.H. Rev. Stat. Sec. 126-A:86(I)(b) (âAll disbursements or grants shall require approval of the governor and executive councilâ). The Executive Council works together with the governor to manage state affairs, with a particular emphasis on overseeing government spending. Councilors are directly elected by the people in their districts. See About Us. State of New Hampshire Executive Council. Accessed August 9, 2024. â
N.H. Rev. Stat. Ann. 126-A:84(II)(b) and (III). (âAll remaining funds [after 15% for counties and political subdivisions] shall be deposited into the opioid abatement trust fund as established by RSA 126-A:83, I to be distributed by the commissioner of the department of health and human services, with approval of the opioid abatement advisory commissionâ and â[t]he commissioner of the department of health and human services shall continue to make distributions from the trust fund ⌠for as long as defendants in the opioid litigation make payments to the state or until such time that the funds in the opioid abatement trust fund are exhaustedâ). â
N.H. Rev. Stat. Sec. 126-A:84(II)(b) (âFunds may be awarded to a qualifying governmental entity or program for an approved use under RSA 126-A:86, I(b)â). â
N.H. Rev. Stat. Sec. 126-A:86(I)(a)-(b) (requiring Commission to advise DHHS, approve eligible Fund recipients, and award grants) and 126-A:85(I) (âcommission ⌠shall consult with and advise the commissioner of the department of health and human services relative to the proper administration and management of the opioid abatement trust fund, as established in RSA 126-A:83, and which shall approve all qualifying grants, loans, and matching funds from that fund under RSA 126-A:86, I(b)â). â
N.H. Rev. Stat. Sec. 126-A:86(II) (âThe commission or the commissioner of the department of health and human services may identify additional responsibilities including reporting on projects and programs related to addressing the opioid epidemic, developing priorities, goals and recommendations for spending on such projects and programs, working with state agencies or outside entities to develop measures for projects and programs that address substance use disorders, making recommendations for policy changes on a state and local level, including statutory law and administrative agency regulationsâ). â
N.H. Rev. Stat. Ann. Sec. 126-A:86(I)(b)(1) (imposing such limitations on reimbursement for âcosts related to outpatient and residential opioid use disorder (OUD) and any co-occurring substance use disorder or mental health (SUD/MH) treatment servicesâ). But see N.H. Rev. Stat. Ann. Sec. 126-A:86(I)(b)(2) (not imposing such limitations on reimbursements of costs âfor emergency response services related to OUD and any co-occurring SUD/MH issues provided by law enforcement and first responderâ); (I)(b)(5) (no such limitations on reimbursements âfor emergency response services related to OUD and any co-occurring SUD/MH issues provided by law enforcement and first responderâ). â
For example, the law would prohibit the use of funds from the 85% state share to reimburse the state or local governments for OUD treatment expenses which will be reimbursed by Medicaid but would not prohibit a local government from seeking reimbursement for expenses it otherwise paid for with general revenue funds. See, e.g., Addendum #3 to RGA-2023-DBH-03-OPIOI âOpioid Abatement Programs,â Sec. 1.2.4. New Hampshire Department of Health and Human Services. June 5, 2023. Accessed June 28, 2024 (âApplicants must only request reimbursement for costs not reimbursable by other third-party funding sources and must not request reimbursement for costs that have already been reimbursed by federal, state, or other third-party funding sources. Costs originally paid through county or municipal general funds may be submitted for reimbursement.â) â
N.H. Rev. Stat. Sec. 126-A:86(III) (âThe [Opioid Abatement Advisory] [C]ommission shall create and maintain a website on which it shall publish its minutes, attendance rolls and votes, including records of all votes on funding requests, funding awards, and reports of funding by recipientsâ). See also N.H. Rev. Stat. Sec. 126-A:84(IV) (âOn or before September 1, 2020, each county, city, town or program that receives funds under paragraph II shall annually provide to the department of health and human services and the opioid abatement advisory commission a detailed account of all monies spent on approved uses, including, but limited to, an analysis and evaluation of the projects and programs it has fundedâ) (emphasis added). Note that paragraph II encompasses both the 85% state share and the 15% local share. â
Here are the entities that ultimately decide how each of New Hampshireâs opioid settlement shares are spent:
85% state share: New Hampshire Opioid Abatement Advisory Commission (with approval from Governor and Executive Council)
15% local share: local officials for counties, cities, and towns
New Hampshireâs local government share is distributed to its litigating counties and political subdivisions, the latter of which are defined to include âany village district, school district, town, city, county or unincorporated place in the state.â[1] Each localityâs share is based on population.[2]
In general, and with limited exceptions,[3] New Hampshireâs local share must be spent on uses that align with the 19 project criteria listed in state law.[4]
Three of these criteria are reimbursement uses: for outpatient and residential treatment services for OUD and co-occurring disorders (inclusive of medications and âabstinence-based treatment,â in addition to treatment for people involved in the criminal legal system;[5] for law enforcement and emergency response services;[6] and for naloxone.[7]
Other approved uses in state law include supports for mobile services, âwithdrawal management,â[8] access to housing, transportation to treatment and other services, employment training, centralized call centers to connect people to supports, improved oversight of methadone treatment programs, scholarships for health providers to work in underserved areas, efforts to prevent over-prescribing, improvements to the prescription drug monitoring program, education for law enforcement on fentanyl, evidence-based âand/or evidence-informedâ prevention, school programs, secondary and tertiary prevention âthrough harm reduction programs,â and addressing the pain management needs of chronic pain patients and/or those in hospital or palliative care.[9]
The Opioid Abatement Advisory Commissionâs also contains a non-exhaustive list of strategies that are âin alignment with [state law] ⌠, NHâs SUD Action Plan[,] and the 10-Yr Mental Health Plan.â[10] The Commissionâs document refers to of the national settlements â which includes prevention, harm reduction, treatment, recovery, and other strategies â as providing a âfurther description of opioid remediation uses.â[11]
Local governments decide autonomously. Decisionmakers for the counties and political subdivisions will ultimately decide for themselves how to spend their monies on the 19 project criteria listed state law.[12]
No, supplantation is not prohibited. Like most states, New Hampshire does not explicitly prohibit supplantation uses of its opioid settlement funds. This means that the 15% local share may be spent in ways that replace (or âsupplantâ) â rather than supplement â existing resources.
Yes (public reporting required). View localitiesâ limited annual reporting under âDistribution of Fundsâ . State law requires localities to annually report to the Department of Health and Human Services and the Commission,[13] and the latter must publish funding awards and reports of funding by recipients online.[14]
Visit OpioidSettlementTracker.comâs for an updated collection of statesâ and localitiesâ available expenditure reports.
The New Hampshire Attorney General's office sent a letter to 47 New Hampshire subdivisions encouraging participation in the National Opioid Settlement. Of the 47 subdivisions, only 23 participated.[15]
N.H. Rev. Stat. Secs. 126-A:83(I) (âAll ⌠opioid-related settlement funds or judgments from New Hampshire counties and all political subdivisions shall, likewise, be placed in the trust fundâ),126-A:83(II) (âThe treasurer shall distribute 15 percent of all funds received prior to any deposit in the consumer escrow account or the opioid abatement trust fund to the counties and the political subdivisions that filed lawsuits, on or before September 1, 2019â), and 126-A:84(II)(a) (âFifteen percent of the funds each year shall be distributed to the counties and political subdivisions as identified in RSA 126-A:83, IIâ). See also N.H. Rev. Stat. Sec. 541-B:1(VI) (defining âpolitical subdivisionâ to mean âany village district, school district, town, city, county or unincorporated place in the stateâ). But see 70% regional, 30% non-regional apportionments of Mallinckrodt trust distributions. . National Opioid Abatement Trust II (NOAT II). January 13, 2023. Accessed August 9, 2024. â
N.H. Rev. Stat. Sec. 126-A:83(II) (âThe distribution of funds shall be based on the most recent decennial census population of each qualifying county and political subdivisions. The population of any political subdivision which receives funds under this section shall not be included in the population of the county for determining the distribution to that countyâ). â
See, e.g., Attorney General Reaches $40.5 Million Settlement with Johnson & Johnson to Settle Opioid Claims. New Hampshire Attorney General news release. September 1, 2022. Accessed August 9, 2024. (âUnder the terms of the settlement agreement, Johnson & Johnson will make a single payment of $39.605 million to the State and pay approximately $900,000 in attorneysâ fees to counsel for the counties, cities and towns that filed opioid lawsuits against Johnson & Johnson prior to September 1, 2019â). See also N.H. Rev. Stat. Ann. Sec. 126-A:85(VII) (âThe department of health and human services shall provide administrative support to the advisory commissionâ). â
N.H. Rev. Stat. Sec. 126-A:83(I) (âAll ⌠opioid-related settlement funds or judgments from New Hampshire counties and all political subdivisions shall, likewise, be placed in the trust fund. The state treasurer shall disburse funds from the trust fund solely for the purposes and in the manner set forth in RSA 126-A:84â), Sec. 126-A:84(I) (âThe commissioner shall draw from the opioid abatement trust fund for qualifying opioid abatement projects under RSA 126-A:86, I(b)â), and Sec. 126-A:86(I)(b)(1)-(19) (listing acceptable project criteria). See also City of Nashua: Resolution 21-168 (âFunds will be used in accordance with RSA 126-A:86(I)(b)(1) through (14) [ed. note: now likely âthrough (19)â] for the intervention, treatment, and recovery services related to opioid use disorderâ). September 8, 2021. Accessed August 9, 2024. â
N.H. Rev. Stat. Sec. 126-A:86(I)(b)(1). See, e.g., Belknap County Commissioners, Annual Report on Opioid Abatement Trust Funding (âThis initial check was received by the County and will be used to offset the costs of providing Medically Assisted Treatment (MAT) to inmates of our Corrections Departmentâ). August 25, 2021. Accessed August 9, 2024. â
N.H. Rev. Stat. Sec. 126-A:86(I)(b)(2). â
N.H. Rev. Stat. Sec. 126-A:86(I)(b)(5) (âFDA-approved opioid reversal agentsâ). â
N.H. Rev. Stat. Ann. Sec.126-A:86(I)(b)(3)-(4), (6)-(19). The approved criteria regarding pain management were added by legislation enacted in 2024. See 2023 NH HB 1318. â
Opioid Abatement Advisory Commission (Commission), Guiding Strategies for the Use of Opioid Abatement Funds. February 2024. Accessed August 9, 2024. (âUse of these strategies should be determined within the broader context of statewide plans, community feedback, current efforts by non-governmental and governmental entities and anticipated funding reductions (State Opioid Response, COVID relief, etc). This is not an exhaustive list of applicable strategies, but rather, a guiding document to help establish a road map for funding, in alignment with NH statute and opioid settlement agreements (see Exhibit E for further description of opioid remediation usesâ). â
Guiding Strategies for the Use of Opioid Abatement Funds. Opioid Abatement Advisory Commission (Commission). February 2024. Accessed September 1, 2024. (â[The Guiding Strategies] is not an exhaustive list of applicable strategies, but rather, a guiding document to help establish a road map for funding, in alignment with NH statute and opioid settlement agreements (see Exhibit E for further description of opioid remediation uses)â). â
N.H. Rev. Stat. Ann. Secs. 126-A:83(I) (âAll ⌠opioid-related settlement funds or judgments from New Hampshire counties and all political subdivisions shall, likewise, be placed in the trust fund. The state treasurer shall disburse funds from the trust fund solely for the purposes and in the manner set forth in RSA 126-A:84â), 126-A:84(I) (âThe commissioner shall draw from the opioid abatement trust fund for qualifying opioid abatement projects under RSA 126-A:86, I(b)â), and 126-A:86(I)(b)(1)-(19) (listing acceptable project criteria). See also DHHS, Distribution of Funds generally (linking to documentation of funds distributed to localities, as well as some cities, counties, and townsâ annual spending reports as required by Sec. 126-A:84(IV). Accessed August 9, 2024. The City of Nashua offers an example of a locality applying these requirements. See Resolution 21-168 (âFunds will be used in accordance with RSA 126-A:86(I)(b)(1) through (14) [ed. note: now likely âthrough (19)â] for the intervention, treatment, and recovery services related to opioid use disorderâ). September 8, 2021. Accessed August 9, 2024. â
N.H. Rev. Stat. Sec. 126-A:84(IV) (âOn or before September 1, 2020, each county, city, town or program that receives funds under paragraph II shall annually provide to the department of health and human services and the opioid abatement advisory commission a detailed account of all monies spent on approved uses, including, but limited to, an analysis and evaluation of the projects and programs it has fundedâ) (emphasis added). Note that paragraph II encompasses both the 85% state share and the 15% local share. For information about intrastate reporting submitted by DHHS, see N.H. Rev. Stat. Sec. 126-A:84(VI) (âOn or before November 1, 2020, the commissioner of the department of health and human services shall submit an annual report to the governor and fiscal committee of the general court detailing the activities of the advisory commission, the administration of the opioid abatement trust fund, the amount distributed in the past year, including available measures of success and corresponding data of programs funded, the amount remaining in the trust fund, a summary of how funds were used in the past year, and any recommendations for future legislationâ). Regulations adopted by the Commission make clear the relationship between the reports submitted by localities and DHHS reporting requirements. See N.H. Code R. He-C 1002(11)(f) (âThe department's reporting requirements are governed by RSA 126-A:84, subject to receipt of reporting information from the commission and from counties, cities, towns, or programs that receive funds from the trust fundâ). â
N.H. Rev. Stat. Sec. 126-A:86(III) (âThe [Opioid Abatement Advisory] [C]ommission shall create and maintain a website on which it shall publish its minutes, attendance rolls and votes, including records of all votes on funding requests, funding awards, and reports of funding by recipientsâ). â
Distribution of Funds. DHHS. Accessed September 1, 2024. â