The rise of opioid settlement funding for EMS agencies: A lifeline in crisis response

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By Corey Carlson

As the opioid epidemic continues to devastate communities across the United States, EMS agencies are increasingly finding themselves on the front lines of a public health battle that demands more than just rapid response — it requires sustained investment, specialized training and strategic support. In recent years, a wave of opioid litigation settlements has begun to reshape the funding landscape for EMS, offering new opportunities to bolster overdose response capabilities and community outreach. The original settlement in 2021 was $26.1 billion. Subsequent litigation has brought that amount to $57.1 billion.

In the beginning, opioid settlement funding went primarily to education, Narcan and building projects for rehab facilities. Recent spending trends show that EMS agencies are now emerging as key beneficiaries of this unprecedented financial infusion.

| WATCH NOW: Unlocking opioid settlement funding for public safety agencies

For EMS agencies, this marks a turning point. Historically underfunded and stretched thin, many departments are now eligible for grants and direct allocations to support overdose prevention, patient care, training, harm reduction and first responder wellness. The funding is not only helping EMS teams respond more effectively to opioid emergencies but also enabling them to play a proactive role in community education and recovery support.

Trending uses: training, equipment and outreach

Across the country, EMS agencies are tapping into opioid settlement funds for a variety of high-impact initiatives:

• Paramedic training: In Ravalli County, Montana, Bitterroot Health EMS received $68,000 to help EMTs afford paramedic school. The funding directly addresses workforce shortages and links advanced training to overdose response capabilities.
• Ambulance purchases: Mercer County, West Virginia, awarded $100,000 each to Princeton and Bluefield rescue squads to purchase new ambulances, ensuring faster and more reliable service in overdose-prone areas.
• Mobile harm reduction units: Sonoma County, California, allocated nearly $500,000 to expand its “Wellness on Wheels” program , which includes naloxone distribution, syringe exchanges and school-based prevention education. Sonoma Co.: County Awards $5M In Opioid Settlement Funds To 3 Local Groups
• Community education: Many EMS agencies are using funds to train school staff, community navigators and families on naloxone use and Good Samaritan laws, building a broader safety net around overdose victims.
• Patient care: Multiple agencies across the nation are securing resuscitation equipment (cardiac monitors, AEDs, chest compression devices, airway equipment, narcotic management) to provide a higher level of patient care.

These examples reflect a growing trend: EMS agencies are no longer just reactive responders — they are becoming central players in public health strategy.

Navigating the funding landscape

Accessing opioid settlement funds requires strategic planning and local engagement. Each state has its own administrative structure, often involving an abatement board, attorney general’s office or public health department. Settlement agreements typically divide funds into three categories: state share, local share and statewide abatement funds. EMS agencies may apply directly through local government channels or participate in competitive grant programs.

Key steps for EMS leaders include:

1. Identifying local allocation plans: Review how much funding your city or county is receiving and understand the priorities set by local governance groups.
2. Aligning proposals with core strategies: Most settlement agreements include a “List of Opioid Remediation Uses,” which outlines eligible spending categories (Exhibit E). EMS proposals should emphasize overdose response, naloxone distribution and harm reduction education for the public and personnel. TEVA-Exhibit-E.pdf
3. Collaborating across sectors: Successful applications often involve partnerships with public health departments, schools, mutual aid partners and community organizations.
4. Documenting impact: Funders increasingly require measurable outcomes. EMS agencies should track overdose reversals, training completions and community engagement metrics.

Challenges and opportunities ahead

While the influx of funding is promising, EMS agencies face several hurdles. Navigating bureaucratic processes, meeting reporting requirements and sustaining programs beyond initial grants can be complex. Additionally, some states have yet to finalize their distribution mechanisms, leaving agencies in limbo.

However, the long-term potential is enormous. With payments scheduled through 2038, EMS agencies have a rare opportunity to build lasting infrastructure, invest in workforce development and integrate themselves into broader public health systems. The trend is clear: opioid settlement funding is not just a temporary fix—it’s a catalyst for transformation.

Conclusion: A moment to lead

The opioid epidemic demands a multifaceted response, and EMS agencies are uniquely positioned to lead. With settlement funding now flowing into communities, EMS departments must act decisively to secure their share and deploy it strategically. Whether through training, equipment or outreach, these funds offer a chance to not only save lives but reshape the role of EMS in public health.

EMS agencies must seize this opportunity — not just for their own sustainability but for the communities that depend on them every day.