The Sangamon County Board approved a resolution last month to settle its 2020 lawsuit against more than three dozen pharmaceutical manufacturers, distributors and retailers for racketeering and corruption in incentivizing the overprescribing of opioids and resulting fatal overdoses. Sangamon County will receive about $620,000 over 15 years from the latest settlement before attorney fees are paid. County officials said those funds are in addition to the roughly $1.3 million the county has already received from other settlements negotiated by the state.
Much like the rest of the country, the annual number of fatal overdoses in Sangamon County far exceeds the annual deaths from homicides and suicides. Sangamon County Coroner Jim Allmon told Illinois Times that 50 people have died of an accidental overdose so far this year in Sangamon County, not accounting for a lag in some toxicology reports.
Drug use is far from exclusive to America or low-income communities but the country’s astronomical overdose rates are uniquely American. The U.S. has both a higher count and rate of deadly overdoses than any other country in the world.
Allmon, who has been county coroner since 2020, explained that overdoses locally have not slowed down despite the Centers for Disease Control and Prevention recently reporting the largest decline of annual overdose deaths the country has ever seen.
“Maybe, like everything else, it takes a little while to get to central Illinois,” Allmon said of reported national declines in overdose deaths. “I know ours are going up, and I tell people that.”
Public health researchers have largely attributed the reduction in deaths to the widespread availability of naloxone, a drug that can be used to reverse overdoses with a simple nasal spray.
With opioid prescriptions on a steep decline, a larger share of overdose deaths have been attributed to unregulated street drugs that, recently, have been laced with fentanyl – typically used in medical sedation – which has become a sticking point in President Donald Trump’s tariff war with countries including Canada and China.
But public health researchers have noted how stopping the sources of illicit fentanyl could just lead to another hazardous additive or chemical agent in a drug supply. Three years ago, Chicago public health workers identified xylazine – a tranquilizer used for animals – in street drugs. Xylazine, which continues to be found in drug supplies across the country, caused harsh, infected wounds where people injected drugs.
At the county board’s Sept. 9 finance committee hearing, officials said they were committed to spending the county’s settlement money on mental health treatment in the Sangamon County Jail. According to the state settlement portal, Sangamon County has spent about 20% of settlement dollars it has received so far. It is unclear whether the city of Springfield has spent any of the almost $712,000 received and whether the city intends to earmark those funds for a specific use, as the county has done.
Tracking settlement spending
How states spend the massive influx of dollars is of concern as overdose deaths still outpace other causes of accidental death. States received billions of dollars from tobacco companies decades ago through similar lawsuits, although not much of it was spent on public health, according to the Bipartisan Policy Center and the Campaign for Tobacco Free Kids.
Consolidated lawsuits from governments across the country have settled for a total of about $50 billion, according to Opioid Settlement Tracker.
Illinois is set to receive almost $1.42 billion of that grand total by the time settlements are fully paid out in 2038, though the state has received more than a third of its total funds already.
Every state had the opportunity to structure its settlement share as it saw fit. Illinois allocated 55% toward a remediation fund that aims to slow the number of overdoses and resulting deaths in the state, 33% to local governments and 12% to the state.
Jonathan Stoltman, director of the national research think tank Opioid Policy Institute, said a good portion of how the state and local governments spend their settlement dollars is, at best, vague. In comparison, the state’s remediation fund is subject to an advisory board consisting of three working groups that each meet quarterly.
“Just back of napkin math, some $600 million doesn’t have that level of oversight. That’s an insane amount of money,” he said.
Almost half of the $1.42 billion the state is going to receive, or about $630 million, will not be subject to the rigorous oversight process of the remediation fund.
Opioid Policy Institute tracks instances of what it calls waste, fraud, abuse and mismanagement of settlement money.
Stoltman said the database tracking those examples and how much governments spent is incomplete but accurate. It lists some Adams County expenses funded by opioid settlement dollars as wasteful – public records show the Adams County Sheriff’s Office paid $50,000 in April for a school police officer to get a new squad car.
While the other portion of Illinois’ settlement money that flows through the remediation fund is supposed to have greater oversight, the information available in the state’s public portal about how the money is being spent has raised some concerns. Stoltman questioned the state spending, to date, more than $7 million on administration of the remediation fund.
“I don’t even know how you get to $7 million that’s basically administrative costs,” he said.
According to the state’s portal, that’s more than the remediation fund expended on any one service program through June of this year.
Illinois Times reviewed almost two dozen vendor payments from the Illinois Department of Human Services to Advocates for Human Potential and found the state paid the consultancy group more than $3.3 million from 2021 through the start of 2025 for administration and professional services related to the state’s overdose action plans.
The Massachusetts-based agency was awarded the Regional Care Coordination Agency grant in 2023 to establish and administer subgrants to social service organizations and nonprofits.
This article appears in October 9-15, 2025.
