Where San Diego's opioid settlement money actually went

If you or someone you know uses drugs: free naloxone is available countywide. In a crisis, call or text 988, or San Diego's Access & Crisis Line at (888) 724-7240, 24/7.

When San Diego County's Board of Supervisors unanimously adopted its Opioid Settlement Framework on October 25, 2022, the money on the table was described as up to roughly $100-118 million over 18 years: San Diego's share of national settlements from which California expects up to approximately 9.92% of funds, an estimated ~$2.05 billion to the state over the settlement horizon. The first payment, $4,202,515.15, arrived in November 2022.

Settlement dollars come with public accounting: every participating county files an annual expenditure report with the state. Two years of San Diego's reports are now public, and they tell a clean two-act story.

Year one (SFY 2022-23): the money arrived faster than the programs

• Received: $13,619,614.32 (Distributors + Janssen payments, both funds), plus $80,647 interest.
• Spent: $1,542,615.33. About 11%. Administrative costs: $9,317.
• Year-end balance: $12.15 million.

An 11% first-year spend rate looks bad in isolation and isn't: the county spent year one building programs rather than pushing money out the door, a deliberate framework the September 2023 Board update laid out in detail.

Year two (SFY 2023-24): full throttle

• Abatement-account received: $6,976,349.92. Spent: $6,915,316.77: about 99%.
• For comparison, California's participating cities and counties collectively spent about 33% of what they received that year. San Diego County spent its abatement receipts at three times the statewide pace.
• (The county's separate CA Subdivision Fund received $1.41M and spent $34.8K; the Mallinckrodt bankruptcy added $652K, unspent. Those funds permit reimbursement of past expenses and lag by design.)

What the money bought

The framework's three components, with the programs the filings and Board updates name:

Healthcare integration: San Diego Relay (24/7 peer response to nonfatal overdoses in emergency departments; 150, 138, and 131 engagements at its three live EDs per 2025 reporting); an EMS buprenorphine field-induction pilot (paramedics starting medication treatment at the scene of withdrawal); and the Overdose Surveillance and Response (OSAR) unit, including drug-testing of seized substances and decedent cases with the Medical Examiner.

Harm reduction and prevention: naloxone at scale: 55,000+ kits allocated to distribution partners and ~30,050 distributed to community members by mid-2023, including 12 vending machines, with settlement funds adding ~21,000 kits a year on top of the state's ~32,000; drug-checking services; a mobile harm reduction services program; school-based prevention (Project Alert, extended through June 2027); and prescription disposal bags targeted to post-surgical patients in the Central and East regions.

Social supports: peer workforce integration across the funded programs.

Settlement money is also now visible outside HHSA: the county's FY 25-26 first-quarter budget adjustments moved $500,000 of Opioid Settlement Funds to the Sheriff's Office Opioid Enforcement Program, shifting it off general-purpose revenue.

The accountability hook

The Board directed the CAO to report annually, by memo, on the settlement budget plan, and the DHCS expenditure reports publish county by county. Between the two, this is among the most auditable money in local government. This page will be updated as each year's filings post. The results those dollars are chasing are tracked in part 9: overdose deaths fell 21% in 2024 and kept falling into 2025.