In Shell Knob, Missouri, a small town in Barry County where a trip to Walmart can feel like a lifeline, Jason Ponder operates a sober-living facility called Victory House. Men frequently have nothing when they show up at his door. In any case, Ponder takes them shopping. Five hundred dollars, occasionally even more, to begin. No ledger, no questions. “I don’t think money should ever keep someone from experiencing recovery,” he stated. Men who have survived Victory House often recall that initial visit to Walmart. Not out of altruism. as evidence that someone had faith in them before they did.
Thanks in part to a grant linked to Missouri’s portion of the opioid settlement—nearly $900 million the state anticipates receiving through 2038 from lawsuits against pharmaceutical companies like Johnson & Johnson, Cardinal Health, and McKesson—Victory House is currently growing. Businesses that, as the number of overdoses increased, pushed painkillers into communities across the nation for years. Theoretically, the settlement money is the reckoning. Whether it’s being used in ways that truly matter is the question, both in Missouri and nationwide.
| Category | Details |
|---|---|
| State | Missouri |
| Total Expected Settlement Funds | Approx. $894–$900 million through 2038 |
| Amount Received Through 2025 | Over $280 million (state + local governments combined) |
| Amount Spent (as of 2025) | Approx. $108 million (~39% of received funds) |
| Fund Split | 60% state-level / 40% local governments |
| Largest Spending Category | Treatment and recovery (~57%) |
| Law Enforcement Spending | Significant — raising controversy nationally |
| Settlement Sources | Lawsuits against Johnson & Johnson, Cardinal Health, McKesson, others |
| Oversight Body | Missouri Dept. of Mental Health (annual reports); State Auditor |
| Key Challenge | Unspent funds, no enforcement mechanism, rural access gaps |
| Opioid Death Rate (2024) | 14.7 per 100,000 (down from 25.63 in 2021) |
To put it mildly, the situation in Missouri is uneven. Approximately $108 million of the more than $280 million in payouts received by the state through 2025 have been spent. The state and local governments receive 60% and 40% of the fund, respectively, and are free to define “opioid abatement” in their own ways. Some of those choices—such as non-opioid painkillers at Citizens Memorial Hospital in Polk County, medication for pregnant women with opioid use disorder in rural Andrew County, and peer support specialists—are precisely what the funding was intended for. These programs focus on the real, lived experience of addiction—the part that takes place in a county jail, a clinic waiting room, or an Ozark sober-living facility.
Then there are the other choices. After using settlement money to purchase a $30,000 snowplow, the city of Kirkwood came under fire. Even though studies have repeatedly demonstrated that D.A.R.E. has little significant impact on lowering drug use, a number of counties bought D.A.R.E. program vehicles. For the sheriff’s office, Dent County purchased a Flock license plate reader system. Counties in Missouri reported spending money on jail equipment, drug scanners, body scanners, and patrol cars—purchases that are hard to directly link to preventing overdose deaths. The pattern is the same across the country. In 2024 alone, law enforcement purchases received more than $61 million in settlement funds. According to one public health expert, “license plate readers have had any meaningful role in a narcotics investigation” very infrequently. Those who closely examine this spending frequently express that opinion.
The fact that Missouri’s oversight structure is nearly totally voluntary contributes to how annoying it is to watch. No state agency is actually in charge of enforcing a 2023 law that mandates local governments use the funds for opioid-related expenses. Issues have been identified by the state auditor. Tightening accountability has been discussed by lawmakers. Nothing legally binding has been passed. It is difficult to avoid drawing comparisons to the tobacco settlement of the late 1990s: billions promised for public health were dispersed without any real safeguards and absorbed into general government spending patterns rather than the targeted interventions they were intended to fund. The tobacco settlement’s negotiators watched it drift. With few resources, those keeping an eye on the opioid settlement are attempting to stop the same drift.
Another issue is money that is sitting around unused. In 2025, over fifty Missouri counties and cities did not spend any of their settlement funds. Jackson County, a sizable urban county, left almost $4 million untouched; however, context is important because funds from prior years were used to fund a partnership between University Health and a mental health facility. Commissioners in Callaway County are still debating their strategy and discussing calling stakeholders back together. It might be prudent to carefully plan before making purchases. However, it’s also possible that someone is traveling 70 miles to a treatment program for each month those funds sit, compared to an average of 32 miles for urban patients and 70 miles for rural Medicaid enrollees. It is not an abstraction, that gap. It depicts a person attempting to survive while driving on a Missouri highway.
The rate of opioid-related deaths in Missouri has decreased from 25.63 per 100,000 in 2021 to 14.7 in 2024. This is a significant improvement that should be recognized. The availability of naloxone has been helpful. A few of the initial spending choices have been beneficial. However, the money is still coming in, the crisis is not over, and the decisions made now will compound over the next ten years. Jason Ponder is constructing a welding school in Shell Knob so that the men who arrive at his door penniless can leave with a trade. That’s the concept. The funds are present. It remains to be seen if the desire to spend it sensibly will follow.
