The “Advancing Cross-Cutting Engagement and Service Strategies for People who Use Drugs” program, known as ACCESS, made history in 2020 as the first in the state to provide funding directly to harm reduction organizations.

Years later, as President Donald Trump’s administration ramps up its drug war and slashes funding that’s crucial to prevent overdose deaths, the latest request for applications (RFA) from the Maryland health department’s Office of Harm Reduction—which gives little time for organizations to adjust their own language when they apply—has dropped the name of the movement from which the office takes its title.

This follows open hostility to harm reduction from the Trump administration, as demonstrated by a July “Dear Colleague” letter, which stated that Substance Abuse and Mental Health Services Administration (SAMHSA) funds “will no longer be used to support poorly defined so-called ‘harm reduction’ activities.”

“I think these are unspoken messages about what their leadership’s opinion is on harm reduction.”

“In my opinion, Maryland is taking [federal guidance] to an extreme,” Erin Russell, a harm reduction consultant who started the ACCESS program while chief of the former Center for Harm Reduction Services, told Filter.

“I think these are unspoken messages about what their leadership’s opinion is on harm reduction,” she said of the Maryland administration. “They’re not being transparent about the funding amount, and they’re not supporting the team by producing a transparent and normal RFA process. The scrubbing of harm reduction is not coming from the harm reduction team themselves, so we can only assume that someone higher up is parsing this change.”

Funding for ACCESS grants has been made up of both state and federal dollars. A state health department spokesperson told Filter that the program allocated a total of $26 million in the most recent fiscal year, but declined to comment when asked about the next budget allocation and whether there would be cuts.

The program has been responsible for allocating millions to local harm reduction organizations annually, and there are fears that there will be a significant decline in grant funding for the upcoming fiscal year.

The ACCESS RFA opened on December 22, and will close on January 22. The state health department says the timeframe exceeds the three-week minimum for notices required under state law. But Russell called the timeframe “absurd.”

The request was issued over the holiday season, she noted, giving organizations even less time to apply for funds when they will likely have to modify their application language to do so.

“I don’t think the work will continue at the same volume … It hurts people, and more people will die with the system as it’s been redefined.”

The terminology change in the RFA, which replaces “harm reduction” with phrases such as “services designed to reduce morbidity and mortality among people who use drugs,” isn’t in and of itself the problem, Russel said. Regardless of what compassionate care for people who use drugs is called, the movement will go on, and life-saving services will continue.

However, the move, combined with actions at the federal level, has negative implications for local harm reduction initiatives. Not only could they receive less aid because the grant program itself is underfunded, but they could be pushed further underground.

“I don’t think the work will continue at the same volume that it is now, or has been,” Russell said. “There are plenty of programs that were maybe renting space and offering drop-in services that are not going to move back to the trunk of someone’s car. Or places that were going to buy mobile vans are now not going to do that level of expansion.”

“It hurts people,” Russell said, “and more people will die with the system as it’s been redefined.”

In July, Trump signed an executive order in July to criminalize homelessness, ramp up forced institutionalization of people with mental illnesses and substance use disorders, and defund life-saving harm reduction programs. The SAMHSA letter, stating that certain harm reduction programs  “only facilitate illegal drug use and its attendant harm,” followed days later.

“It’s very frustrating … but in the end, I think this is a compromise that they may need to make to be able to provide services that really do save people’s lives.”

Dr. Joshua Sharfstein, professor at the Johns Hopkins Bloomberg School of Public Health, told Filter that a shift in how the Maryland government speaks about harm reduction may be a necessary hardship under the Trump administration.

“For people who understand and practice [harm reduction], hearing the words vilified is unpleasant—that’s the minimum,” Sharfstein said. “It’s very frustrating. It’s unfortunate, but in the end, I think this is a compromise that they may need to make to be able to provide services that really do save people’s lives.”

It’s unclear what policy impact these changes will have, he added, as the federal government seems to have thus far equated harm reduction with programs such as overdose prevention centers, of which there are only three sanctioned examples in the country.

In Baltimore, where OPC have been debated for years as the city’s fatal overdose rate climbed to the highest in the nation, the federal guidance has already been felt on that front.

In October, Baltimore Health Commissioner Dr. Michelle Taylor told Filter that the city wouldn’t pursue these life-saving spaces because of fears of losing federal funding.

More recently, Mayor Brandon Scott (D) removed OPC from his list of legislative priorities. And members of the state’s Harm Reduction Standing Advisory Committee announced in December that OPC legislation wouldn’t be introduced in the upcoming state General Assembly session, as they will instead channel their energy into decriminalizing drug “paraphernalia.”

“[The department] remains focused on protecting the health and safety of our communities, which includes addressing the health, well being and mortality of Marylanders who use drugs.”

Still, state officials have insisted that existing programming will not suffer. Health Department spokesperson David McCallister told Filter that the agency is simply adjusting its language to abide by guidance from the Trump administration.

“This funding, along with state funds and other federal grants, is critical to our mission of continuing life-saving, evidence-based interventions for Marylanders who use drugs,” he said. “The Maryland Department of Health remains focused on protecting the health and safety of our communities, which includes addressing the health, well being and mortality of Marylanders who use drugs.”

The state likely cannot afford to have its harm reduction efforts take a hit. Its overdose prevention initiatives have contributed to a notable decline in deaths statewide. In Baltimore, which has by far the highest fatal overdose rate in the state, there were 777 overdose deaths in 2024, a historic 25.5-percent decrease from the year prior, according to preliminary data.

In the 12-month period ending in October, the most recent data available, Baltimore saw 560 deaths, indicating that the trend continued into much of 2025.

Update, January 13: This article was updated to reflect information about the last ACCESS budget allocation, received from the Maryland Department of Health after publication time.

Image by Filter

The post Maryland Scrubs the Term “Harm Reduction” From Key Grant Program appeared first on Filter.

Researchers based in Baltimore and Canada surveyed 300 city residents who had injected drugs in the past year, most of whom continued to do so. They found that 87 percent would support programs providing access to regulated drugs, in order to protect participants from the adulterated street supply.

“The health impacts of the drug supply are just horrific,” lead researcher Dr. Danielle German, associate professor of health, behavior and society at the Johns Hopkins Bloomberg School of Public Health, told Filter. “The range of responses and things that are on the table don’t actually explicitly address the exposure to the toxicity in the drug supply.”

Of the survey participants who supported safe supply in Baltimore, 62 percent had been unhoused in the past 12 months, and 69 percent were 40 or older. This, the researchers say, suggests heightened support among demographics most in need of protection.

Those who were interested “went far beyond” what was asked of them,  keenly aware of what they’d like in a safe supply program and how it could benefit their lives.

While there are no locally available data on a correlation between lack of housing and overdose deaths, this association is broadly established, with growing evidence of a causal relationship.

Meanwhile, overdose deaths disproportionately impact Black residents of majority-Black Baltimore—most of the survey participants were also Black—and are concentrated in the 50-69 age range. Data from the Maryland Department of Health show that fatal overdose rates among older Black men, the most vulnerable demographic, have more than doubled those of their white counterparts in recent years.

The study comes amid a housing crisis in Baltimore—and renewed attention on the consequences of the toxic drug supply, in a jurisdiction that’s had higher overdose rates than any other major city in the United States.

Dozens of people in Baltimore’s Penn North neighborhood have been impacted by three separate mass-overdose incidents in 2025. The first event in July, which hospitalized nearly 30 people, involved N-methylclonazepam, a rare and potent benzodiazepine. The third and most recent incident involved medetomidine, a veterinary sedative.

Despite this, local officials have done little to address the root causes of changes in the drug supply. The police department has ramped up crackdowns on people who use and sell drugs, and city leaders have refused to adopt certain evidence-based measures such as overdose prevention centers because of possible pushback from higher levels of government.

As local media and officials hyperfocus on abstinence-based treatment or punitive drug policy, the responses of people who use drugs suggest a greater concern for what they need to survive.

The study authors are clear that safe supply is another commonsense overdose prevention strategy.

“It is building on the evidence and support that we have had in this country for prescribed methadone and buprenorphine,” German said; “the sort of [medications for opioid use disorder] model that builds on the recognition that providing substances that meet people’s needs is an important part of being able to support people’s overall well-being.”

“We only have a couple of those options, and we know they can be really effective for the people they work for,” she continued. “A substantial proportion of them continue to use and remain at risk of the unregulated drug supply; there’s a whole range of people who either aren’t ready or it’s not a great fit for them. I just see this is broadening what could be available to support the range of people [with what] they need to be safe. I think ideally, we would consider a continuum of resources and services and support for people—really meeting them where they’re at.”

As local media and public officials hyperfocus on abstinence-based treatment or punitive drug policy, the responses of people who use drugs suggest a greater concern for what they need to survive.

Their demand for a regulated drug supply was not necessarily surprising, German said. And notably, some participants who weren’t interested in the program were not opposed to the idea itself, but simply believed it wouldn’t be the right fit for them.

In addition, those who were interested “went far beyond” what was asked of them in their responses, she said, as they were keenly aware of what they’d like in a safe supply program and how it could benefit their lives.

Participants expressed great interest in having wrap-around services as part of the hypothetical safe supply program. In addition, the overwhelming majority of those who were interested—more than 96 percent—expressed willingness to discuss their drug use openly and honestly with a doctor as part of the program. This might be seen as surprising, given widespread stigma against people who use drugs in health care settings.

“What’s so valuable about studies like this is that it’s actually making sure the people who may access programs are the ones who are having a say in the evidence.”

Among other preferences for a Baltimore safe supply program, 91 percent of survey participants wanted it to offer somewhere safe to keep drugs. And despite the unwelcoming attitudes of some pharmacists,  93 percent stated that they’d be comfortable getting the drugs from a pharmacy.

Participants also expressed notable interest in having input on dosages, routes of administration, timing of use and the ability to have take-home doses—all of which were directly connected to how willing individuals would be to participate in a program, German said.

About half of opioid users reported that they’d prefer pharmaceutical heroin as the drug dispensed by the program, while 38 percent of non-opioid users said that they’d prefer crack cocaine—just slightly more than those who would prefer powder cocaine.

“What’s so valuable about studies like this is that it’s actually making sure that the voices of people who may access programs are the ones who are having a say in the evidence that is being generated,” Zach Kosinski, who served as a community advisor on the new research, told Filter.

“That informs further research,” he said, “which informs policy recommendations, which informs what those programs actually end up looking like when we get there one day.”

While the published study does not explicitly call for the widespread adoption of safe supply programs, it cites “strong acceptability of prescribed safer supply” to address factors “including overdose, violence, and associated healthcare costs,” as a reason to further research safe supply and launch pilot programs.

As city officials push back on more ambitious overdose-prevention proposals amid a hostile national climate for harm reduction, those who worked on the study believe it lays a solid foundation to further explore the efficacy and feasibility of safe supply in Baltimore.

Photograph by Serkan Yildiz via Unsplash

The post Baltimore Drug Users Want Safe Supply, Know How It Should Look appeared first on Filter.

Mayor Brandon Scott (D) appointed Taylor—the former director of the Shelby County Health Department in her home state—as Baltimore’s top health official in August, and she was confirmed by the City Council on September 15.

She’s taken the reins as President Donald Trump targets harm reduction initiatives nationwide and slashes public health funding. Locally, a string of mass overdose events in Baltimore’s Penn North neighborhood has struck fear into the community, and police have cracked down harder on people who use drugs.

At a time when public health faces an uncertain future and fear is being weaponized to fan the flames of the drug war, Taylor says she is forced to be realistic.

“We always have to be cognizant of who’s in office right now.”

That includes taking a step back regarding overdose prevention centers (OPC) in Baltimore. Taylor is a vocal advocate for the facilities, and harm reductionists have ramped up demands for city-sanctioned sites in response to a spate of overdoses and repeated failures to legalize them at the state level. 

“While local public health would love to do everything that could potentially fit under our umbrella, we always have to be cognizant of who’s in office right now, not only federally [but] at the state level and city level,” Taylor told Filter during a sit-down interview.

“I want to be compassionate,” she continued. “But does being compassionate mean that we are not going to be able to maintain our levels of federal funding, where we need to do all of the other services that we need to do?”

Taylor’s concerns over potential retaliation if the city were to press forward unilaterally with OPC stem from the fact that nearly half of Baltimore City Health Department’s $201 million budget comes from federal funding.

Nonetheless, she asserted that the city has “all the pieces it needs” to turn the tide of the overdose crisis, though the federal government’s position impedes the efforts of some City Council members to push for more tools to save lives.

Even without the issue of a hostile White House, Taylor’s department must also operate on $7.3 million less in funding than in 2024.

Baltimore’s most recent budget entails a 3.5 percent cut to the health department funding due to a decrease in state and federal aid. Yet its police budget has been boosted by $22 million. That increase comes as officers have targeted people who use and sell drugs under the guise of violence prevention.

The tension between policing and harm reduction has been an ongoing problem in Baltimore.

As of September, there was a 21 percent increase in misdemeanor drug arrests compared to the January-September period of 2024, and some police districts have seen drug-related arrests double. Baltimore Police Commissioner Richard Worley told a September public hearing “there’s no way around” targeting drug users for arrest.

Asked about the impact of drug-war policing on public health efforts—studies have shown that crackdowns can increase fatal overdoses and violence—Taylor would not directly answer the question.

Although she said there are cases when the police and public health officials “shouldn’t meet in the middle,” she asserted that public safety and public health are still “inextricably linked.”

“There are times when public health should be the focus. But at the same time, we know when police should be the focus,” Taylor said. “The question is, how do we get to a place in our community where the police get to do the work they’re supposed to do, and public health can continue to save lives in every way we can?”

The tension between policing and harm reduction has been an ongoing problem in Baltimore.

It was on display after July saw the first of a series of mass overdose events in the city, which was attributed to a mix of fentanyl and a rare, potent benzodiazepine. Nearly 30 people were hospitalized, though a cadre of harm reduction workers were on the scene to prevent deaths and conduct outreach.

Shortly afterward, police raided the neighborhood and arrested five people.

Since then, two additional mass overdose events have occurred, the most recent on October 8. Each time, city officials attempted to emphasize a public health-focused response—while police officials assured residents they would crack down on those involved.

“The city is being very intentional about investments. In Memphis-Shelby County, I had to beg for half a million dollars for naloxone and test strips.”

To Taylor, who said her department is now drafting a mass-overdose response protocol, there’s evidence that the city prioritizes public health over interdiction. Despite cuts to the health department, $9.8 million was allocated to mental health and substance use programs in the most recent budget—more than quadrupling expenditure in those areas from a decade ago.

“While it’s not perfect, the proof is in the investments being made,” Taylor said. “And the investments are truly being made in public health. You can’t argue with that. And now it’s up to us to really use those investments in such a way that not only are we going to be able to save more lives, and we think we’re already starting to do that, but we can work on all these other issues that come with it.”

The total health department budget is still dwarfed by the police department’s budget of over $600 million, however.

Despite the precarity of public health funding, Baltimore is in a unique position to ramp up investments in harm reduction and treatment initiatives.

After years of litigation, the city is slated to receive roughly $580 million from lawsuits against opioid distributors and manufacturers over the city’s overdose crisis.

A significant portion—more than $100 million—must be used to cover legal fees. And one of two distributors that a judge ordered to pay Baltimore $150 million in an August decision has appealed, making that award uncertain.

Still, the city has already received nearly $240 million after accounting for fees. The money is slated to be allocated over 15 years, and none of it can be used for “punitive” programs, officials have said.

Taylor acknowledged the money isn’t as much as it seems when spread out over that period, but she is confident the city will use it wisely and be proactive about planning for funding sources further down the line.

“The city is being very intentional about investments,” Taylor said. “They’ve made a $20 million investment over five years in the health department. That’s huge for a health department. In Memphis-Shelby County, I had to beg for half a million dollars for naloxone and test strips.”

“It’s really about showing people you do care—that you’re showing up, that you at some level know what they’re dealing with.”

In the current budget, Baltimore earmarked nearly $37 million for harm reduction and treatment initiatives. Of that, the city’s new Restitution Advisory Board only has discretion over $2 million, and that money is now being advertised to community-based organizations through a competitive application process.

Whatever the amount, those dollars could be crucial in the city’s efforts to combat the overdose crisis. Although fatal overdose rates have dropped significantly in the past year, Baltimore has continued to see the highest overdose deaths per capita of any major city in the United States.

The numbers further demonstrate that Taylor has taken over as health commissioner amid myriad unknowns.

It’s unclear if that downward trend will hold, and she’s helming the health department of a city that’s already in the federal government’s crosshairs. Heavy-handed policing, an increasingly unpredictable drug supply and the threats to federal funds combine to imperil efforts to keep people who use drugs alive.

Yet the new health commissioner was drawn to Baltimore in part because of its rich harm reduction history, with its syringe service program dating back to 1994, and she intends to maintain that image.

Harm reduction advocates have fought for more, including OPC and “paraphernalia” decriminalization. But even if those things don’t come soon, Taylor said the city has the most important tool: compassion.

“It’s really about showing people you do care—that you’re showing up, that you at some level know what they’re dealing with,” she said. “And if you don’t know, at least we are empathetic to what you have to deal with. That alone gives people hope that we can get to the other side. It took time to get to this point, and it’s going to take time to get out of it. But it means we have to show up.”

Photograph of Baltimore City Health Commissioner Dr. Michelle Taylor by Logan Hullinger

The post Baltimore’s New Health Commissioner Wrestles With OD Crisis—and Trump appeared first on Filter.

The Baltimore City Council Public Safety Committee’s September 9 hearing involved little discussion of harm reduction—even though it was advertised as a top issue on the meeting’s agenda. Instead, it immediately devolved into back-and-forths on how to further crack down on “open-air drug markets,” with police boasting “significant” increases in drug-related arrests.

Though some city council members argued their efforts didn’t go far enough, police officials insisted the city’s drug-war policing has intensified.

“The way we get to the dealers is by arresting the users. There’s no way around it.”

“We want to ultimately get to the supplier of drugs,” Commissioner Richard Worley said. “The way we get to the supplier of drugs is by arresting dealers. The way we get to the dealers is by arresting the users. There’s no way around it.”

The strategy depicted by Worley runs contrary to a consensus among public health experts and harm reduction advocates. For decades, they’ve warned that targeting drug users is futile and potentially deadly.

City health officials have echoed those sentiments, and even the commissioner seemed to undermine his plan when he admitted, “we’re not going to arrest our way out of” the city’s overdose crisis.

That didn’t stop police officials from touting an increase in drug arrests while lamenting the years under former State’s Attorney Marilyn Mosby, who implemented a de facto decriminalization policy in 2020 that discouraged low-level drug arrests because the suspects wouldn’t be prosecuted.

There had been 1,450 drug-related arrests in 2025 as of August 30, a 16 percent increase on the equivalent period in 2024, according to data presented by police officials. The resulting charges included over 61 percent that were felonies, and 150 marijuana charges.

In June, a Baltimore Beat investigation found that drug charges plummeted over the last decade before ticking up under current State’s Attorney Ivan Bates, who scrapped Mosby’s nonprosecution policy. People arrested on drug charges are almost exclusively Black, as was the case with 92.5 percent of such arrests in 2024.

Baltimore’s Black community has also been hit hardest by the overdose crisis, with rates among older Black men, in particular, at times doubling that of their white counterparts.

Police officials cited multiple strategies to crack down on drug markets at the hearing, including surveillance, plainclothes District Action Teams and the Group Violence Reduction Strategy. City officials have most frequently praised GVRS, describing it as a successful program connecting those at risk of violent crimes to social services. In practice, however, it has led to widespread drug busts under the guise of violence prevention.

Councilman Mark Conway (D), chair of the Public Safety Committee, called the police department’s plan “insufficient.”

Studies have shown that such drug enforcement strategies can increase overdose death rates by disrupting the drug supply and pushing drug users toward riskier sources. They have also been found in some cases to increase violence among those in the drug trade.

Although Worley called the department’s strategies “comprehensive,” Councilman Mark Conway (D), chair of the Public Safety Committee, was unsatisfied. Conway, who commandeered much of the hearing, called the department’s plan “insufficient.”

“We still need to tie our decisions to outcomes and determine whether or not they’re actually working,” he said. “And I don’t think they’re working yet.”

Councilman Mark Conway (left)

Conway, who has attempted to position himself as a leader in overdose crisis talks but has repeatedly demanded heavier-handed police action, called for a more detailed plan from the police to address drug markets and drug use—yet even he conceded the limited impact of arresting people who sell drugs.

“There will be 50 [people] behind them indefinitely until we figure out how to address the demand for drugs in that area,” he said, adding that he has demanded a comprehensive, written plan to tackle drug markets and drug use for nearly a year.

Despite the problematic nature of the city’s drug enforcement strategies and a nearly $613 million police budget, police officials also cited insufficient staffing and a need to recruit more officers for drug enforcement.

The hearing served as an illustration of the city’s ongoing inability to live up to promises to focus on compassionate care for people who use drugs.

Maryland Governor Wes Moore (D) and Baltimore Mayor Brandon Scott (D) have just set out a joint plan to boost policing in the city.

On September 5, the leaders announced the reinstatement of a city-state policing partnership, the first such initiative since 2020. Maryland State Police and Maryland Transportation Authority Police will now be on call to deploy to the city if requested by local police, including for drug enforcement.

“Both agencies have pledged their full support, in partnership with other local and state resources, to prevent and investigate crime and if needed, to assist with the response to calls for service in Baltimore,” state police spokesperson Elena Russo told Filter.

The announcement came amid ongoing hostilities between the governor and President Donald Trump, who threatened to deploy the National Guard to Baltimore after signing an executive order that aimed to criminalize homelessness, ramp up forced institutionalization of those with mental illnesses and substance use disorders, and defund life-saving harm reduction programs.

Scott opposed this, citing historic drops in homicides and other crimes.

With its discussion of providing even more police resources, the hearing served as an illustration of the city’s ongoing inability to live up to promises to focus on compassionate care for people who use drugs.

It wasn’t until halfway through a hearing of over two hours that the subject moved on from enforcement.

In a shift in tone, Conway asserted the city must invest in neighborhoods and provide job training and other services for residents experiencing substance use disorder, noting the city already has agencies tasked with such programs.

He also questioned whether the city health department was taking the overdose crisis seriously enough, citing its struggles to curb overdose deaths during the height of the COVID-19 pandemic.

“If this is the highest priority for the city, it’d be really hard to tell from the outside,” Conway said.

“Being arrested never helped me. We need peers. We need client-based care, we need to meet people where they are.”

In response to questions on how to address the crisis, Councilman Zac Blanchard (D) suggested that the city consider opening an overdose prevention center (OPC) in downtown’s Westside, allowing residents to use drugs under the supervision of medical professionals.

Local harm reduction organizations have long demanded the centers and, more recently, Councilman Ryan Dorsey (D) has become more vocal in his support.

Blanchard’s suggestion provided brief insight into what the city could do to ramp up its harm reduction infrastructure and utilize programs that are proven to save lives and connect people to vital services. The mayor, who has the authority to unilaterally permit OPC to open, has thus far resisted doing so.

That focus on compassionate care for those in need has been sorely missing, said Karl Green, a local harm reduction worker and member of the city’s Restitution Advisory Board who spoke during the hearing’s public comment period.

“Being arrested never helped me,” Green said. “Harm reduction peers and people that don’t necessarily work in recovery but have been through it and show you can overcome it and believe in you… I believe this has been missing. We need peers. We need client-based care, we need to meet people where they are.”

Photographs, including top photograph of Commissioner Richard Worley, by Logan Hullinger

The post Baltimore Overdose-Crisis Hearing Hosts Plan to Arrest More Drug Users appeared first on Filter.

On August 14, the city accepted an offer from Baltimore City Circuit Court Judge Lawrence P. Fletcher-Hill in a landmark case that will leave it with $152 million in its lawsuit against opioid distributors McKesson and Cencora (formerly AmerisourceBergen), though appeals are still possible. The city had initially sought billions of dollars to fund a comprehensive abatement plan.

“This award still dwarfs the original amount the City would have received, had we not brought this separate litigation on behalf of our city,” Mayor Brandon Scott (D) said in a statement. “This is also the only successful jury verdict and the only successful judgment against either of these companies.”

Baltimore officials took the deal quickly; they had until August 22 to make a decision.

The mayor’s office did not respond to Filter’s questions about the deal’s potential impact on overdose prevention plans, but they will undoubtedly take a hit. The mayor instead focused on the smaller windfall the city did manage to secure.

“Generations of Baltimoreans have lost loved ones to substance use as a direct result of the opioids that Big Pharma pushed on our neighborhoods,” he said. “While no amount of money can ever undo that harm, this award will help us expand our recovery programs, prevent future overdose deaths, and finally break the cycle of substance abuse in Baltimore.”

The deal reached by Fletcher-Hill and the city came from a ruling on August 8, when the judge offered the city just $100 million of the $5.2 billion in abatement funds it had hoped for. He also reversed a $266 million jury verdict for “public nuisance” damages last year, leaving only $52 million of that on the table.

At issue, the judge said, was that the city failed to prove that the two opioid distributors were responsible for 97 percent of the opioid-related damages Baltimore had experienced, which was at the crux of its lawyers’ arguments in court.

Baltimore officials took the deal quickly; they had until August 22 to make a decision.

“There isn’t any amount of money that can give us back those we’ve lost … But this money, if put into the right hands, can bring significant changes to the communities most affected.”

Candy Kerr, spokesperson for the Baltimore Harm Reduction Coalition, also took an optimistic tone after the city announced it had accepted the judge’s offer, asserting that adding “any
substantial amount of money” to the city’s war chest was a “win.”

“I’m relieved for this to be the end of one chapter and the beginning of another,” Kerr told Filter. “To be clear: There isn’t any amount of money that can give us back those we’ve lost, and without systemic change, no amount of money will end the racist War on Drugs. But this money, if put into the right hands, can bring significant changes to the communities most affected.”

The case, which began in 2018, has dragged on with multiple delays. It all stems from the city’s risky decision to pursue litigation independently rather than join statewide lawsuits.

The city put together a comprehensive abatement plan, based on billions in additional funding, that called for increasing investments in its harm reduction and treatment infrastructure—including implementing overdose prevention centers (OPC), something organizations such as the Baltimore Harm Reduction Coalition have demanded for years.

The city could reduce fatal overdoses by 50 percent under the plan, expert witnesses said, as well as tripling the number of people in treatment.

Lawyers for the city had argued that the plan was necessary because McKesson and Cencora recklessly peddled prescription opioids and misled the public about their addictive potential for years, which created an addiction and overdose crisis that Baltimore has struggled to deal with to this day.

The city has seemingly already scaled down its goals for redressing the overdose crisis compared to what was laid out in the abatement plan.

Even though the city has recently seen record declines in overdose deaths, like elsewhere in the United States, it has still struggled with the highest fatal overdose rate of any major US city, with thousands dying in the past decade.

As that decline in deaths continues, the city has seemingly already scaled down its goals for redressing the overdose crisis compared to what was laid out in the abatement plan.

Earlier this in August, the mayor’s new Office of Overdose Response wrapped up a campaign that entailed going into the community to garner input on its draft strategic plan to address the overdose crisis, which has proven to be less ambitious than the abatement plan introduced in court.

The new plan aims to reduce fatal overdoses by just 40 percent by 2040, without explicitly calling for OPC but potentially allowing for their implementation.

Whatever the contents of the plan, the harsh truth is it will have significantly less money to fund it than was once anticipated.

When factoring in a handful of settlements with other opioid manufacturers and distributors reached in 2024, the city’s total earnings from opioid-related lawsuits have reached nearly $580 million.

Issues may also arise over whether the funds will be used for supplantation, which would entail using the funds to replace existing expenditures rather than for new programs.

That may seem like a game-changing sum, but that is to be placed into a trust and allocated over 15 years. For comparison, that’s less than the annual budget for the Baltimore Police Department. Attorneys’ fees will also likely take a chunk out of the total.

Issues may also arise over whether the funds will be used for supplantation, which would entail using the funds to replace existing expenditures rather than for new programs. The practice could become more likely if President Donald Trump succeeds in slashing funding for local health departments. Nearly half of the Baltimore City Health Department’s funding comes from the federal government.

Concerns about supplantation already raised red flags among some Opioid Restitution Advisory Board members earlier in 2025, when the city used $3.3 million of the roughly $37 million in funds earmarked for the overdose crisis in the fiscal year budget to cover the costs of health department programs that had typically been bankrolled by general fund dollars.

Public health experts overwhelmingly oppose this practice, and the Johns Hopkins Bloomberg School of Public Health has also published guiding principles for restitution funds, stating that jurisdictions should “use the dollars to supplement rather than supplant existing funding.”

Additional concerns surfaced over just how much power the advisory board has. Though the board was touted as an imperative part of a new chapter in the city’s response to the overdose crisis, decisions about how money is allocated are ultimately left up to the mayor.

Under the current fiscal year budget, nearly $20 million went directly to community organizations that provide harm reduction and addiction treatment services. Yet the vast majority of that grant money was for 22 organizations named in settlements reached with opioid manufacturers and distributors in 2024, leaving the advisory board with just $2 million to allocate at its discretion.

The remainder of the nearly $37 million would be allocated to city agencies—again without the input of board members.

Photograph of the Baltimore City Circuit Court Elijah E. Cummings Courthouse by Logan Hullinger

The post Baltimore Accepts Offer for Fraction of the Opioid Settlement It Sought appeared first on Filter.

The August 8 decision was not a complete surprise. In a June ruling, Baltimore City Circuit Court Judge Lawrence P. Fletcher-Hill had indicated the city would not receive nearly as much as it had hoped. He found the city’s lawyers failed to prove their claim that opioid distributors McKesson and Cencora (formerly AmerisourceBergen) were responsible for 97 percent of opioid-related damages the city has experienced. In that ruling, Fletcher-Hill rejected the city’s $5.2 billion request for abatement and said he would allow for a new trial, effectively reversing a 2024 jury verdict that won the city $266 million for “public nuisance” damages.

Under an arrangement between the judge and the city, Baltimore now has until August 22 to decide whether to accept the proposed abatement award in addition to watered-down public nuisance damages, or opt for a new trial completely. If the city takes the deal, it will walk away with a total of about $152 million.

“The Court concluded … that these two Defendants were responsible, at most, for just under 20% of the total amount of past and future damages claimed by the City.”

“The Court concluded, based on the evidence presented to the jury, that the largest verdict that would not be considered legally excessive would be premised on a conclusion that these two Defendants were responsible, at most, for just under 20% of the total amount of past and future damages claimed by the City,” Fletcher-Hill wrote in his August 8 ruling.

It is not immediately clear whether the city plans to challenge the abatement ruling. Regardless of the outcome, Baltimore is still guaranteed to receive hundreds of millions of dollars from previous opioid settlements and the ongoing case.

“We have received the court’s abatement ruling and are considering all options at this time,” the office of Mayor Brandon Scott (D) said in a statement. “We remain committed to securing justice for all Baltimore residents disproportionately impacted by the opioid crisis. We will respond in due time in the appropriate judicial forum.”

The city has argued that the pharmaceutical giants recklessly peddled prescription opioids and misled the public about their addictive potential, leaving Baltimore with a growing addiction and overdose crisis that has claimed thousands of lives, at a rate higher than any other major city in the United States.

The projected abatement funds have been the cornerstone of the city’s plans to address the crisis. Officials put together a 15-year, five-point plan to use billions of dollars to bolster Baltimore’s harm reduction and treatment infrastructure—including by opening overdose prevention centers (OPC).

“If the City believes this [OPC] approach is valuable, it is up to City leaders both to resolve the legal issues … and to convince the community that these sites are valuable and appropriate.”

In the August 8 ruling, Fletcher-Hill directly addressed the city’s plans for the facilities, noting the fact that they remain illegal under state law after numerous failed attempts to pass legislation legalizing the sites in the General Assembly in recent years.

“The concept is extremely controversial. Defendants even argue that this feature could not be ordered by the Court because the sites are not legal under Maryland law,” Fletcher-Hill wrote.

“Without making any determination whether this strategy is valuable from a public health perspective, the Court will not require this feature in the abatement plan,” he continued. “If the City believes this approach is valuable, it is up to City leaders both to resolve the legal issues with this type of site and to convince the community that these sites are valuable and appropriate.”

Baltimore already has numerous harm reduction and treatment programs, but expert witnesses who testified at trial said the current level of services is inadequate and must be expanded. The model used by the city estimates that more than 32,500 residents at any given time have opioid use disorder.

Under the plan, the city could reduce overdoses by 50 percent and triple the number of people in treatment, witnesses said.

In the month leading up to the judge’s latest ruling, officials held numerous public hearings and listening sessions about the overdose crisis.

The city’s aim to reduce opioid prescriptions by 55 percent is controversial, however—given damaging implications for pain patients, and the relationship between a national crackdown on opioid prescribing and the overdose crisis reaching unprecedented levels. Some advocates argue that opioid lawsuits themselves contribute to a harmful chilling effect on prescribing.

In the month leading up to the judge’s latest ruling, officials held numerous public hearings and listening sessions about the overdose crisis. This ended more than a year of relative silence on the issue, as the mayor’s administration had argued that public discourse might jeopardize the litigation.

Public hearings were held by Baltimore City Council members, while the mayor’s new Office of Overdose Response held four community listening sessions specifically to garner feedback on its draft strategic plan to address the crisis. That sweeping plan has proved to be less ambitious than the abatement plan presented in court; it aims to reduce fatal overdoses 40 percent by 2040, without explicitly calling for OPC.

At least one Council member has recently reiterated his support of city-sanctioned OPC—the kind of step taken by New York City—when efforts seeking state authorization have repeatedly failed. But the plan makes no mention of the facilities. To date, the mayor has refused to use his powers to unilaterally open the sites.

The plan does, however, state that one of the city’s priorities is to “increase access to a full array of low-barrier harm reduction services (including naloxone distribution, drug checking, syringe service programs, and other evidence-based strategies.” The latter phrase might include OPC.

It’s unclear just how much the judge’s ruling on the case, which dates back to 2018 and has faced numerous delays, will impact the city’s overdose prevention plans—though city officials have conceded it will make things significantly more difficult.

Baltimore will likely have to adjust its plans to operate on almost $215 million less, depending on whether it accepts the judge’s proposal or opts for a new trial.

After the $266 million jury verdict in November, based on the “public nuisance” caused by the companies’ practices, the city had expected its overdose prevention war chest to come to nearly $670 million, excluding any abatement dollars. Now, Baltimore will likely have to adjust its plans to operate on almost $215 million less, depending on whether it accepts the judge’s proposal or opts for a new trial.

The city asserted in court that the overdose crisis was largely caused by “pill mills” dishing out opioids they received from companies like Cencora and McKesson. But defense attorneys said the city failed to identify faults in the companies’ practices. They also questioned the legitimacy of the city’s statistical model estimating OUD prevalence, which underpins the cost estimates for its abatement plan, and suggested the plan did not factor in existing overdose prevention programs that may already be funded.

The city’s witnesses responded that funding for existing programs will run out, while the plan focused on fully funding initiatives over 15 years by putting the funds in a trust that accrues interest. They dismissed concerns regarding the statistical model and emphasized that the severity of the crisis demands a response of equivalent ambition.

Though Baltimore’s fatal overdose rate remains the highest in the nation, according to city officials, the number of deaths in the city has continued to decline, in line with trends seen nationwide.

Preliminary data recently published by the Maryland Department of Health showed the city recorded 777 deaths in 2024, a fall of nearly 26 percent from 2023. Subsequent monthly data suggest the downward trend has continued, with fewer than 600 deaths in the 12-month period ending in June.

While the trajectory is positive, the crisis continues to have a disproportionate impact on older Black men, and people living in areas such as West Baltimore.

Photograph of Baltimore City Circuit Court Elijah E. Cummings Courthouse by Logan Hullinger

The post Judge Offers Baltimore $100 million for OD Crisis—Far Less Than City Sought appeared first on Filter.

Baltimore City Circuit Court Judge Lawrence P. Fletcher-Hill said the city failed to prove that it needed McKesson and Cencora (formerly AmerisourceBergen), to pay $5.2 billion to cover the costs of redressing the damages they allegedly caused.

The city had previously argued that it needed the money because the pharmaceutical giants recklessly peddled prescription opioids and misled the public about their addictive potential, leaving Baltimore with a growing addiction and overdose crisis that has claimed thousands of lives.

“The court is struck by the fact that the City did not present any evidence of any unreasonable conduct by either Defendant after about 2019,” Fletcher-Hill wrote in the ruling. “The City also chose not to ask for an injunctive relief to change the practices of either Defendant in the future. Rather, any abatement remedy will be to deal only with the ongoing effects of Defendants’ conduct in the past.”

While the judge rejected the sum the city requested for abatement, his ruling indicates that the court will still make a decision on the final amount. But first, the city must decide by July 7 if it will accept or contest a massive cut to $266 million it won in a jury verdict in the first phase of the trial.

“The Court finds that the verdict rendered is grossly excessive in light of the evidence and is shocking to the Court.”

Fletcher-Hill wrote that the jury’s decision was predicated on the flawed assertion that 97 percent of opioid-related damages were caused by the two companies. In light of that, he instead proposed that the two defendants pay just under $52 million. McKesson would pay the bulk of that, at $37.4 million.

“The Court finds that the verdict rendered is grossly excessive in light of the evidence and is shocking to the Court,” Fletcher-Hill wrote.

Fletcher-Hill’s much-anticipated ruling came after lawyers for the city and companies wrapped up their arguments in the second phase of the trial in December; he delayed his decision twice in recent months.

In November, in the first phase of the trial, a jury ordered the companies to pay the city more than $266 for the “public nuisance” caused by their practices. That brought the city’s anticipated litigation-funded overdose prevention war chest to nearly $670 million, but the city will now likely have to adjust its plans to operate on roughly $200 million less.

“This decision is disappointing to say the least. We are evaluating the decision and considering all of our options,” Baltimore Mayor Brandon Scott said in a statement. “Even with today’s decision, the settlements we’ve reached through this process far exceed what our city would have gained through the global settlement—making it clear that we made the right decision to continue this fight alone.”

The plan entails increasing the city’s treatment capacity, augmenting harm reduction initiatives and opening overdose prevention centers.

The city had hoped the $5.2 billion would fund a 15-year, five-point abatement plan, which calls for increased investments in treatment; harm reduction; education; services for special populations such as pregnant women; and monitoring and implementation.

The plan entails increasing the city’s treatment capacity, augmenting harm reduction initiatives and opening overdose prevention centers, which advocates have said are long overdue.

Baltimore already has numerous harm reduction and treatment programs, but those who testified said the current level of services is inadequate and must be expanded. The model used by the city estimates that more than 32,500 people at any given time have opioid use disorder.

The city could reduce overdoses by 50 percent and triple the number of people in treatment under the plan, witnesses said.

However, the city’s aim to reduce opioid prescriptions by 55 percent is deeply controversial—part of what some advocates say is a chilling effect that’s exacerbated by opioid lawsuits themselves.

While many people who use fentanyl or heroin began with pharmaceutical opioids, the vast majority of people who are prescribed opioids do not develop opioid use disorder (OUD). Nationally, a crackdown on opioid prescribing has been implicated in driving the overdose crisis to unprecedented levels. It has also been hugely detrimental to pain patients—a phenomenon that has spurred lawsuits elsewhere.

The city predicated much of its legal argument on the assertion that the overdose crisis was largely caused by “pill mills” that dished out millions of opioids they received from companies such as Cencora and McKesson.

The ruling comes on the heels of a historic drop in overdose deaths in Baltimore, which has been the worst-impacted major city in the United States.

Defense attorneys, however, said that the abatement plan failed to identify any faults in the companies’ practices. They also questioned the legitimacy of the city’s statistical model that estimated OUD prevalence, which is largely what its cost estimates are based on, and why the plan did not factor in existing overdose prevention programs that may already be funded.

The city’s witnesses grew impatient with the defense, persistently arguing that funding for existing programs will run out, and that the plan focuses on fully funding initiatives over 15 years by putting the funds in a trust that accrues interest. Those on the stand dismissed concerns regarding the statistical model, and emphasized that the severity of the crisis requires an equally ambitious plan to address it.

With the final outcome of the case yet to be determined, it’s unclear to what extent the June 12 decision will impact the city’s overdose prevention initiatives. But funding for those initiatives looks certain to be far less than the city had hoped.

The ruling comes on the heels of a historic drop in overdose deaths in Baltimore, which has been the worst-impacted major city in the United States.

Data recently published by the Maryland Department of Health showed the city recorded 775 deaths in 2024, a decrease of nearly 26 percent from the year prior. Subsequent monthly data seem to indicate that the downward trend has continued.

The last time Baltimore saw fewer than 800 overdose deaths was in 2017. Though the numbers are preliminary and subject to change, the decline has prompted both newfound optimism and a recognition that more work must be done—above all in marginalized populations where the crisis remains at a devastating level.

Photograph of the Baltimore City Circuit Court Elijah E. Cummings Courthouse by Logan Hullinger

The post Judge Rejects Baltimore’s $5.2 Billion Lawsuit Request to Address OD Crisis appeared first on Filter.

March 17 was “Crossover Day” in Maryland—the date by which bills must pass one chamber of the General Assembly in order to be guaranteed a vote in the other by the end of the legislative session in April. As lawmakers rushed to pass numerous bills, those cross-filed in both chambers that would legalize overdose prevention centers (OPC) and decriminalize drug “paraphernalia” languished in committee. 

When the deadline passed at midnight, neither had proceeded to a floor vote. 

“There doesn’t seem to be the will to pass either of these bills,” Dan Rabbitt, policy director at Behavioral Health System Baltimore, told Filter before the deadline had passed. “It’s unfortunate. Our top priority as a state and city should be preventing overdoses, and both of these measures would help advance efforts to prevent overdoses. We’re disappointed.”

The bills have failed to gain traction in the Democrat-controlled legislature despite ardent support from public health experts and Baltimore Mayor Brandon Scott (D), who declared both proposals “legislative priorities” this session. During hearings, advocates passionately urged lawmakers to help combat an overdose crisis that has devastated Baltimore, in particular.

“Every year since this bill was introduced, countless lives have been lost from drug overdoses. These deaths are preventable.”

The OPC legislation would allow six centers to open throughout the state in areas with high rates of overdose deaths. It is sponsored by Senator Shelly Hettleman (D-Baltimore County) in the Senate and Delegate Joseline Peña-Melnyk (D-Anne Arundel County) in the House, who have asserted that myriad evidence shows their efficacy in saving lives.

“I and the many co-sponsors of House Bill 845 will continue to fight for the bill in the event that the bill does not move forward this session,” said Del.Peña-Melnyk, who chairs the Health and Government Operations Committee, in a statement. “Every year since this bill was introduced, countless lives have been lost from drug overdoses. These deaths are preventable.”

Sen. Pamela Beidle (D-Anne Arundel County), chair of the Senate Finance Committee, confirmed to Filter that there was not enough support to justify putting the bill to a vote. Sen. Hettleman noted the OPC issue has been “politicized so much over the years,” adding she will reevaluate before determining whether she’ll push for the bill in future sessions.

Meanwhile, legislation to decriminalize drug “paraphernalia” has had a mixed past in the General Assembly. It cleared both chambers in 2021 before being vetoed by former Governor Larry Hogan (R). This session, it’s sponsored by Sen. Cory McCray (D-Baltimore City) and Del. Karen Simpson, (D-Frederick County). Its key purpose, supporters say, is to allow people to utilize syringe service programs without fear they could be arrested for possessing the supplies they receive.

“There is no data indicating this decades[-long] ‘war on drugs’ law has ever reduced use or crime,” Simpson said in a statement. “However, this law is an obstacle to the workers and volunteers who are trying to save lives amid our overdose crisis. I will reintroduce [the bill] until this antiquated obstacle to health and safety is repealed.”

Over the years, harm reduction advocates and sponsors have described multiple obstacles preventing the bills from becoming law. This time around, House members indicated to Filter that they believed they had the votes to pass the OPC legislation, but a lack of support in the Senate dissuaded them from pushing it to a floor vote.

“I do think that some of it is a racist idea of, ‘Whatever happens to that community happens to that community.’”

This may reflect an ideological gulf between the two chambers. Despite a Democratic trifecta in the state, lawmakers in the upper chamber are seen as having a more conservative bent. For example, sources told Filter that Senate leadership had the votes to override Hogan’s veto of the decriminalization legislation in 2021, but chose not to.

Catherine Tomko, a harm reduction advocate and a social scientist focusing on substance use and mental health at the Johns Hopkins Bloomberg School of Public Health, suggested a troubling factor at play.

“So many of the overdoses and drug harms that are happening [in Maryland]  happen in Baltimore City, which is a majority-Black city,” she told Filter. “So I do think that some of it is a racist idea of, ‘Whatever happens to that community happens to that community,’ so there isn’t as much of a political will and urgency.”  

With the bills now expected to once again die in committee, the spotlight may shift toward Baltimore’s mayor—who leads a city which has had the highest fatal overdose rate in the nation—and the possibility of unilateral implementation at the city level.

Mayor Scott’s office has repeatedly dodged questions about OPC, refusing to say whether he would take matters into his own hands, as New York City did in 2021, rather than rely on state-sanctioned sites. 

In a statement on March 17, the mayor only said he would “evaluate every option” going forward.

“It is extremely disappointing that these life-saving measures once again face a roadblock due to the General Assembly’s failure to advance them,” Scott said. “We have taken every opportunity to bring attention to how these strategies can save lives as part of a comprehensive approach to tackling overdose and substance use disorder in cities like ours, and we will continue to advocate for them at every turn. As we regroup after this disappointing setback, we will evaluate every option and tool at our disposal to ensure we’re putting forth the most robust overdose response possible.”

In February, Scott appointed Baltimore’s first-ever executive director of overdose response, Sara Whaley, who endorsed OPC and safe supply programs in principle in a recent interview with Filter.

Crossover Day was not a total defeat for harm reduction advocates: It appears that drug-induced homicide legislation will also die in committee.

Despite the setbacks, Crossover Day was not a total defeat for harm reduction advocates: It appears that drug-induced homicide legislation will also die in committee. The bill is just one of many iterations of legislation at the state and national level to punish people who supply drugs involved in an overdose death more harshly. 

Advocates condemn such legislation as an escalation of the drug war. They point out that many people charged under these laws are friends or family members of the person who died, who had been sharing drugs that both were using.

Maryland’s bill would create a maximum prison sentence of 20 years for people distributing fentanyl that results in death. Paired with legislation passed in 2017 which increased the maximum sentence for selling fentanyl to 30 years, opponents of the bill say it could lead to prison sentences as long as half a century, deterring people from reporting overdoses in which they could be found complicit.

Maryland’s legislative session ends April 7. Barring any last-minute pushes, the bills will all die in committee. But those on the frontlines of the overdose crisis say they’ll fight on.

“With these [OPC and decriminalization] bills, we’ll fundamentally save lives and improve the health of the people of Baltimore,” Rabbitt said. “It’s the right thing to do. The fact there isn’t political support in the legislature or among leadership today doesn’t mean there never will be. The political whims change.”

Photograph of Maryland State House by Logan Hullinger

The post OPC and “Paraphernalia” Decrim Bills Miss Key Deadline in Maryland appeared first on Filter.

Whaley, previously the top public health advisor to Mayor Brandon Scott (D) and program director of the Bloomberg Overdose Prevention Initiative, was named Baltimore’s first-ever executive director of overdose response on February 12. In an exclusive interview with Filter on March 3—weeks before a ruling in a landmark opioid lawsuit is expected to drop—she made her support for harm reduction plain.

Whaley praised the important work being done by the city’s existing harm reduction infrastructure. However, she emphasized there is more to be done to save lives.

“I see my role as bringing us together so that we’re all working toward the same goals and objectives,” she said. “The other role is overseeing restitution funds, and I think these two roles work really well together because the city’s response is going to be holistic. The restitution funds are just one piece of a big pie.”

While her role will inevitably be limited by state and federal laws, Whaley herself backs key harm reduction measures that are missing from the overdose prevention plans of many cities in the United States—including Baltimore.

“OPC can work really well. If our end goal is to save lives, the number one thing we can do is provide a space where people will not die of an overdose.”

These include both overdose prevention centers (OPC) and safe supply programs—initiatives that are mostly seen in other countries but have been proven to prevent overdose deaths. She wants decriminalization of drug “paraphernalia,” too.

Mayor Scott has vocally supported current state bills to legalize OPC and decriminalize paraphernalia across Maryland. However, OPC legislation has repeatedly died in committee in recent years, and former Governor Larry Hogan (R) vetoed a previous iteration of the paraphernalia bill in 2021. Lawmakers have held committee meetings on both bills this legislative session, but it’s unclear whether they’ll advance to floor votes.

“We’ve seen [OPC] can work really well,” Whaley said. “If our end goal is to save lives, the number one thing we can do is provide a space where people will not die of an overdose. And the way that we do that is by having folks who are readily available to reverse that overdose.”

Similarly, when asked about safe supply programs, Whaley said: “If we want to keep people alive, like, if that is the end goal and we have a chaotic drug market that is contaminated with really deadly and dangerous things, regulate it. We’ve done it with other substances like alcohol, marijuana and psilocybin.”

City officials have been mum, however, about whether they’ll unilaterally push for OPC at the city level (the approach taken in New York City), instead emphasizing their support for state-sanctioned facilities. Such a move would ultimately be the mayor’s decision. When asked about the possibility of local OPC and safe supply programs, both Whaley and a member of the mayor’s administration who was sitting in on the interview declined to comment, instead reiterating the mayor’s current goals.

As part of Baltimore’s ramped-up efforts to combat the overdose crisis, the mayor also appointed Whaley as one of three non-voting members of a new 20-person Opioid Restitution Advisory Board, tasked with advising the city on how to spend restitution funds. She’s additionally a member of the mayor’s Overdose Cabinet.

“Baltimore has an immense opportunity.”

Whaley has entered the role at a crucial juncture in the city’s overdose crisis. Data released by the Maryland Department of Health in February showed that Baltimore recorded 680 lives lost to overdose in 2024—a 35 percent decrease from the year prior. That’s still 680 preventable deaths. But it was the largest single-year drop on record, and the toll was the lowest in nearly a decade.

Meanwhile, the city is slated to receive hundreds of millions of dollars from litigation against opioid distributors and manufacturers by the end of 2025, representing a big chance to drive deaths down further.

When combining the money from five settlements reached in 2024 and the money awarded by a jury in the first phase of an ongoing trial against two opioid distributors in November, the city should have nearly $670 million to put into a trust from which dollars will be distributed over the next 15 years.

The city could receive an additional boon if it’s successful in the second phase of the ongoing litigation, where it’s seeking $5.2 billion to fund its abatement plan. A ruling is expected in the coming weeks.

“Baltimore has an immense opportunity,” Whaley said.

The new data and incoming funds offer a glimpse of hope to the beleaguered city, which is still reeling from the impacts of a national public health catastrophe. Most of the thousands of Baltimoreans who have died in the past decade were among the city’s most vulnerable people, with older Black men worst impacted.

“I think there is a mistrust in white institutions. That’s a valid concern, which is why I think harm reduction is so beautiful: It tears down walls and meets people where they are.”

Whaley attributed both the surge in overdose deaths during the COVID-19 pandemic and the recent decline to a variety of factors, stressing that the issues are multi-faceted. Along with an increasingly dangerous drug supply contaminated with substances such as xylazine and medetomidine, the pandemic worsened existing inequalities stemming from systemic racism, she said.

That significantly impacted social determinants of health, with drug users experiencing more severe isolation and economic hardships, Whaley said. All of this is exacerbated by government agencies and other programs not having earned the full trust of the city’s majority-Black population.

“I think in general there is a mistrust in white institutions,” Whaley said. “That’s a valid concern, which is why I think harm reduction is so beautiful: It tears down those academic or institutional walls and meets people where they are.”

“We talk about social determinants of health, poverty, lack of opportunities, racism and redlining,” she continued. “All of those things have contributed to communities that are disenfranchised, and when there is a lack of opportunity and trauma, I understand why communities might be distrustful of these institutions.”

Those factors—working in tandem with the criminalization of drug use and fears of police-led responses—helped propel Baltimore’s fatal overdose rate to the highest of any major US city.

“All the harm reduction tools, building relationships with people. All of those initiatives are key.”

However, the recent decline in deaths indicates the city is catching up with trends seen nationwide, albeit late. Whaley repeatedly emphasized Baltimore’s unique, robust harm reduction infrastructure and peer community when discussing how the city has made headway.

“I think there are a lot of factors, and to point out a single one is foolish,” she said. “Access to low-barrier treatment for those who are ready. A big one is harm reduction. Getting naloxone into the hands of folks who need it is one of the biggest factors contributing to our decrease in overdose deaths. All the harm reduction tools, building relationships with people. All of those initiatives are key. One we don’t talk about as much is that we are finally leveling out after COVID, so I think there are some environmental factors as well.”

Roadblocks to further progress abound. To the problems posed by existing federal laws, we must now add President Donald Trump, who is striking fear into harm reduction organizations with promises to slash federal funding and redouble the drug war.

The times are “unprecedented,” Whaley said, and the uncertainty among officials and harm reduction advocates is immense.

“The sense of community here is beautiful, and it’s something that is really, really special about this city.”

However, what’s also unprecedented is Baltimore’s opportunity to effect change through a historic windfall of funds to combat the overdose crisis—funds that she will oversee.

Even prior to Whaley’s appointment, the city had earmarked millions from opioid settlements to support local harm reduction initiatives. The entities standing to benefit offer critical services such as naloxone distribution, syringe service programs, testing strips and drug treatment coordination. Under Whaley’s leadership, such initiatives are expected to receive an even larger infusion of funds.

But at the heart of the city’s response to the crisis, she emphasized, is not money, but compassion and collective resiliency.

“I didn’t necessarily want to stay here after school,” she said of Baltimore. “But the sense of community that is here is beautiful, and it’s something that is really, really special about this city. We often talk about resilience at the individual level; putting everything on the individual to get better or be resilient in the face of adversity. But resiliency really is the community coming together to offer resources and support.”

Photograph courtesy of Sara Whaley

The post Baltimore’s First Overdose Response Chief Endorses OPC and Safe Supply appeared first on Filter.

On January 8, state Senator Shelly Hettleman (D-Baltimore County) reintroduced a bill that would permit six OPC in places with high rates of overdose deaths. Although OPC have been proven to prevent deaths and bring many other public health benefits, previous iterations of the bill have repeatedly died in committee over the years.

“I really believe what we are doing with regard to substance use disorder is not enough,” Sen. Hettleman told Filter. “It is one additional tool that we could employ to build trust among users and provide services to save lives. Bottom line for me, this is about saving lives.”

The bill will soon be scheduled for a hearing in the Senate Finance Committee, and a companion bill will be introduced in the House.

Maryland has seen a long battle over OPC. Activists and public health experts have fought hard to get the legislature to act over the years, but OPC bills haven’t gained support as easily as other harm reduction efforts. For example, legislation to decriminalize drug “paraphernalia” cleared both chambers in the General Assembly, though it was vetoed by former Governor Larry Hogan (R) in 2021 (a new bill is back on the table this legislative session).

Baltimore Mayor Brandon Scott, recently sworn in for his second term, named OPC as a “legislative priority” on the same day the bill was introduced.

The OPC bill does not mandate the creation of the sites, which Hettleman said could be a source of misunderstanding. Rather, it permits municipalities to work with community partners to introduce them, subject to approval from the state health department.

What may be most important this time around, Hettleman said, is that Baltimore Mayor Brandon Scott (D), recently sworn in for his second term, named OPC as a “legislative priority” on the same day the bill was introduced.

Scott has voiced support for OPC for years. But his recent comments may signify a more urgent wish to bring them to Baltimore, which has the highest fatal overdose rate of any major city in the United States.

OPC “are associated with reduced overdoses, decreased public drug use, reduced syringe litter, increased access to addiction treatment, increased engagement in health services, and reduced strain on emergency medical services,” Scott said. “As Maryland sees an influx of opioid restitution funds, we have an unprecedented opportunity to address substance use disorder and the overdose crisis—I’m calling on our state legislators to take bold, evidence-based action.”

Scott’s office did not respond to Filter’s requests for comment on why Baltimore has not followed the lead of New York City in establishing OPC without state authorization. Researchers have suggested that Baltimore could accomplish this by issuing an emergency declaration.

OPC in Maryland would not only save lives but address the racist impact of the drug war, said Candy Kerr of the Baltimore Harm Reduction Coalition.

Despite overdose deaths reaching unprecedented levels in recent years, only three states have legalized the sites. Rhode Island opened the first state-sanctioned OPC in December. New York City’s two sites opened in 2021; they have averted almost 1,700 overdoses since then, and have been visited by local lawmakers.

OPC in Maryland would not only save lives but address the racist impact of the drug war, said Candy Kerr, spokesperson for the Baltimore Harm Reduction Coalition. The nonprofit is part of the BRIDGES Coalition, a group of more than 30 Maryland organizations advocating for OPC.

“Baltimore City has a long history of predominantly Black communities being hit the hardest by drugs and criminalization of [drug use], and opening OPCs in said communities [is] one small piece to combatting this continued harm,” Kerr told Filter.

Research has found that a majority of business owners in Baltimore City and Baltimore County support the idea of having OPC in their neighborhoods. One study found that OPC in Baltimore could save the city $6 million in annual health care costs.

State lawmakers, however, have other financial concerns on their minds.

Maryland is currently reckoning with an anticipated $2.7 billion budget deficit, and lawmakers are focused on hashing out deals to fill the gap. Advocates fear this could dominate the legislature’s attention, leaving the OPC bill sidelined once again.

In 2020, Scott, then serving as city council president, announced a resolution to hold informational hearings on OPC. “There’s nothing that says we can’t do it,” he told Filter at the time.

The resolution passed and gave hope to advocates, yet years went by without any legislative action to implement OPC in the city. Any prospect of opening the sites could also hinge on a landmark trial in which the city is seeking $5.2 billion from opioid distributors McKesson and Cencora to combat the overdose crisis. In the second phase of the trial in December, the city’s expert witnesses testified that investments in OPC, in addition to a myriad of other harm reduction initiatives, are crucial to the city’s 15-year abatement plan.

Authorization through state law is preferable because it would provide stronger legal protections, Sherman said.

Susan Sherman, a professor at the Johns Hopkins Bloomberg School of Public Health who created the city’s abatement plan, has studied and advocated for OPC for years. She views the sites as a holistic, evidence-based approach to public health, but she recognizes the roadblocks.

“It’s hard to stomach the fact that it flies in the face of what people think helps people who use drugs, period,” Sherman told Filter. “It challenges you on a deep level.”

While Baltimore’s power to implement the sites unilaterally may be up for debate, she added, authorization through state law is preferable because it would provide stronger legal protections.

Leadership of Maryland’s Democrat-controlled House and Senate leadership did not respond to Filter’s requests for comment. The office of Governor Wes Moore (D) declined to comment on specific legislation.

“I think politicians are concerned that their constituents won't support them if they vote for something so controversial,” Kerr said. “So our job should be easy, right? OPCs actively save lives in the short term and give people access to supplies and resources that can help them in the long term, and we have scientific evidence to prove it, so why wouldn't people be on board?”

“Because we still see drug use as a moral issue in this country, and a lot of people have experiences with drug use or people who use drugs that may be less desirable,” she concluded. “Does that mean we'll stop educating? No. But it does mean it takes time.”

Photograph of a window in Baltimore’s Charles Village neighborhood, displaying a sign advocating for OPC, by Logan Hullinger

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