AMNA NAWAZ: The settlement money from several companies that made, distributed and sold opioid painkillers is starting to flow in.

More than $50 billion will be paid out over the next 18 years to state and local governments across the country.

But the debate around exactly how this money should be spent is just beginning.

In the first of two reports, special correspondent Cat Wise and producer Mike Fritz traveled to North Carolina, where overdose deaths have spiked by more than 70 percent since 2019.

It's part of our ongoing series America Addicted.

CAT WISE: In Troy, North Carolina, Chrystal Weatherly's new job starts early.

As a peer support specialist her first task is often gathering up boxes of the overdose-reversal drug Narcan from the Montgomery County Health Department.

CHRYSTAL WEATHERLY, Peer Support Specialist: OK. CAT WISE: She then heads to the local jail, where she works with inmates battling addiction.

CHRYSTAL WEATHERLY: Hey, it's Chrystal.

CAT WISE: By afternoon, she's driving across this rural section of the state with her friend and volunteer, Jamal Moore (ph).

CHRYSTAL WEATHERLY: Which one, this one or that one?

JAMAL MOORE, Friend: Let's check this house, I think.

CHRYSTAL WEATHERLY: OK. CAT WISE: They talk to residents, hand out Narcan, and provide information about treatment options.

CHRYSTAL WEATHERLY: My name is Chrystal.

OK, I'm a peer support specialist.

And I'm in the county working with folks that have addiction issues.

CAT WISE: Home to just 25,000 people, Montgomery County's overdose death rate is nearly double that of North Carolina statewide rate.

CHRYSTAL WEATHERLY: I'm in recovery.

So I know what it's like to struggle in that in that way.

So I'm here to help people.

CAT WISE: After battling alcohol and drug addictions for 30 years, Weatherly says it's work that's deeply personal.

She's been in recovery since 2015.

CHRYSTAL WEATHERLY: People in this community that need help are more likely to talk to me because they know that I'm in recovery and I understand what it's like to struggle and have no hope.

And so that's what I want to do is offer people hope that they don't have to live that way.

CAT WISE: Few resources have been available to address the opioid crisis here in Montgomery County until now.

CHRYSTAL WEATHERLY: Do you know anybody that might need some Narcan?

CAT WISE: Weatherly's job, which she began in May, and the Narcan she distributes are both funded by opioid settlement payments now coming into North Carolina, a state that is expected to receive about $1.5 billion over the next 18 years.

CHRYSTAL WEATHERLY: People need support.

And people need to know that the stigma that is typically attached to substance use is not viewed that way by everybody.

CAT WISE: The stakes for Weatherly and others on the front lines of North Carolina's opioid epidemic are high.

JOSH STEIN (D), North Carolina Attorney General: The opioid crisis has been absolutely devastating.

It is the deadliest drug epidemic in American history.

And, tragically, we're at the deadliest moment.

CAT WISE: North Carolina's Attorney General Josh Stein led negotiations for national settlements against companies that included Johnson & Johnson, CVS, Walgreens and several others.

In all, these settlements have netted roughly $54 billion.

Is it enough money to actually make an impact?

JOSH STEIN: It is absolutely enough money to make an impact.

It's not enough money to end addiction.

But what I am 100 percent certain is that there will be many, many more people who are alive, healthy and happy because of these funds and the important programs they're going to fund than otherwise would be.

CAT WISE: Stein says the goal of most of these settlements was to give states flexibility in determining how best to spend their money, but to also require them to use at least 85 percent of that funding on addiction treatment and prevention.

Those requirements were put in place because of what happened during the 1990s after states won more than $240 billion from cigarette companies.

JOSH STEIN: We all watched what happened with the tobacco settlement.

Here in North Carolina, that money just goes straight into the general fund and is used for whatever.

It's not helping people who are struggling with nicotine addiction.

What we want is for this money to go to help people who are struggling with opioid addiction.

So, the money is required to go to that purpose.

CAT WISE: But across the nation, how those spending requirements will be enforced remains a big question, says Aneri Pattani of KFF Health News.

She has been tracking how opioid settlement money is being spent.

ANERI PATTANI, KFF Health News: What's literally in the settlement documents is the idea that, if states don't use at least 85 percent of their funds on the epidemic, then the companies, meaning Johnson & Johnson, AmerisourceBergen, et cetera, the companies that settled, would be the ones to sort of hold the states accountable and say hey, you didn't meet this 85 percent number, we're going to take you to court, and we're going to reduce our future payments to you.

CAT WISE: So far, more than $3 billion has gone out to state and local governments.

The amount of money each state will receive is based on several factors, including the percentage they contribute to the country's total number of overdose deaths, the number of people with opioid use disorder, and the total population of the state.

ANERI PATTANI: Fifty billion dollars is a lot of money.

But you think about it being spread over 18 years and across 12 different companies, a lot of these pharmaceutical companies are bringing in profits in the tens of billions.

You take Johnson & Johnson, for example, they're going to be paying out $5 billion in the opioid settlement funds in total.

But they last year made profits around $95 billion.

So, a lot of people are looking at that and thinking, you know, this is not that much coming from the companies.

CAT WISE: But it's money that many hope will make a difference.

In North Carolina, 85 percent of settlement funds will go directly to counties and the rest to the state's legislature.

JOHN SHAW, Montgomery County, North Carolina, Commissioner: To have this additional funding really is our first step towards getting -- getting our community back.

CAT WISE: Forty-three-year-old John Shaw never imagined he'd get into politics, but, last year, he became a Montgomery County commissioner, in large part because of what opioids have done to his community.

JOHN SHAW: In the last five years, personally, I have known five people to pass away, in this past one in January, my best friend in life.

And he struggled for quite some time.

CAT WISE: Shaw's best friend, Chris Goodwin (ph), loved music and his community.

He died from a fentanyl overdose in his home earlier this year.

While Shaw hopes there will one day be enough funding to open a residential treatment facility, he's now focused on saving lives.

JOHN SHAW: We haven't engaged this issue, not just here, but across this country.

And it's seeped into every household and one way or another.

And we have got to get proactive to provide recovery treatment options for those who want it.

CAT WISE: That's why he pushed to spend Montgomery County's first settlement payments, about $70,000 so far, on more Narcan and hiring Chrystal Weatherly.

JOHN SHAW: Within 72 hours of an overdose, we want to have her engaging with that individual.

After that -- after that experience, it's a great time to talk to somebody about possibly making different life choices.

CAT WISE: But for those who lost loved ones to opioids, this settlement money remains largely out of reach.

RITA RUSSELL, Mother: Without them, we're lost.

And now, without anything, we're lost.

CAT WISE: Rita Russell has lost two children, her daughter Alicia and her son Whitley, to overdoses in the last four years.

She and her son John sat down with me in Fayetteville.

RITA RUSSELL: There's a lot of parents that lost their children.

There's children that lost their mother and fathers.

I hope, as a survivor, along with all other survivors, that we get some compensation.

JOHN RUSSELL, Community Activist: Yes, it was people dying back there.

CAT WISE: John, who is a community activist, says he was angry when he learned none of the state's money would be going to families like his.

He's been traveling to settlement funding meetings across North Carolina.

JOHN RUSSELL: A lot of times, I sit there in rooms, and I'm like, I wonder how many people here have a love -- have a lost one?

How many individuals in this room with me have lost one?

It's a different complexity when you got somebody that you really love die from it.

You see things a lot differently.

CAT WISE: Russell says his sister, who died in 2019, was outside a gas station when she overdosed.

Those around her weren't able to help.

JOHN RUSSELL: If she would have had Narcan, it might have helped you.

So, then I said, well, why don't we just normalize this and put it inside stores?

CAT WISE: He's now hoping to apply for some of the state's settlement funding for a new nonprofit that aims to help people find Narcan via an app he is developing.

JOHN RUSSELL: Yes, this goes for the store.

So, that way, if anybody comes in, and they have a overdose in the store, you got something to work with them with.

If we're dealing with an epidemic, and you're calling for individuals to step up to the plate, there's a lot of individuals that will step up to the plate that are doing things.

CHRYSTAL WEATHERLY: It's this one right down here.

CAT WISE: For Chrystal Weatherly, she knows her work is just beginning, that even the most difficult cases represent an opportunity.

CHRYSTAL WEATHERLY: I think it's critical to reach them, and that it doesn't matter to me how many times they have overdosed.

There's always hope.

And as long as they're still here, I see someone with potential.

I see somebody that can have a different life.

CAT WISE: A glimmer of hope, finally, for a state that is now losing more than 4,000 people to overdoses a year.

For the "PBS NewsHour," I'm Cat Wise in Montgomery County, North Carolina.

AMNA NAWAZ: And, tomorrow night, we will travel to Ohio, where the debate around opioid settlement money has led to a legal battle.