States are set to receive an estimated $56 billion in funds from litigation against opioid manufacturers, distributors, and pharmacies over the next 18 years. Unlike the big tobacco settlements in the 1990s, which were often spent on items unrelated to tobacco use, guardrails set by the opioid settlements require the majority of the funds will be spent on opioid remediation. Nonetheless, state and local jurisdictions still have wide discretion on the types and quality of programs that they fund. Addiction medicine specialists have several opportunities to utilize their expertise to inform the effective investment of opioid settlement dollars.