Baltimore now has a framework to guide how it will utilize a windfall of funds from opioid settlements — and $20 million will immediately go to the health department to bolster local harm reduction initiatives.
Surrounded by public officials and those working to combat the overdose crisis, Mayor Brandon Scott unveiled the two-pronged plan Thursday at City Hall, signing a comprehensive executive order to create a governance structure for handling hundreds of millions of dollars while providing short-term aid to fuel the health department's ongoing efforts.
"The work ahead to repair the harm done to our communities will be long, and it will be hard, Scott said. "But one thing I know is that we are also resilient, and when we confront something or anything, we always win. This is a fight that we have been fighting for a long, long time — a battle for the health of our neighborhoods, for the lives of our loved ones and for the future of our young people."
City officials said the plans, which mark the beginning of historic investments in harm reduction programs, have been in the works for years.
As the beleaguered city struggles with the highest fatal overdose rate in the nation, it's slated to receive $242.5 million in settlement funds this year alone — providing an unprecedented opportunity to bankroll harm reduction initiatives.
So far, $42 million has been allocated to local organizations and programs, including Tuerk House, Charm City Care Connection and the Law Enforcement Assisted Diversion program. Those grants were stipulated by the settlement agreements, officials have said.
While the additional $20 million in settlement funds are being used to augment the city's remediation efforts in the short term, the executive order provides a roadmap for how the city will decide to allocate the remaining funds down the line.
"This executive order will ensure that restitution funds are governed responsibly, transparently, and effectively in order to support our residents and communities most affected by the epidemic — not just during this administration, but for years to come," Scott said.
The executive order, signed two days before International Overdose Awareness Day, lays out the governance structure in seven phases:
- Establish an opioid restitution fund and outline appropriate uses, which include programs and services that work toward substance abuse prevention; treatment; recovery; and harm reduction.
- Use the funds to establish a trust that will be spent over the period of at least 15 years. A five-person board will oversee the trust, which will be similar to a college endowment fund, and accrued interest must be used for substance use abatement purposes. In addition, at least 5% of the funds must be allocated annually.
- Create "key documentation" to ensure spending is aligned with the interests of the community, including a comprehensive overdose prevention strategy and substance use community needs assessment, which must be updated at least biannually.
- Hire an executive director of overdose response, who reports to the mayor and coordinates with city agencies to lead the city's response to the crisis. The position is expected to be filled by the end of the year.
- Hire an opioid restitution program manager, who reports to the executive director, manages projects and serves as a liaison to the Mayor's Office of Recovery Programs.
- Establish an opioid restitution advisory board, which guides the city's use of settlement funds. Composed of 13 to 17 members, it would include a mix of public officials, health professionals, a member of a local harm reduction organization and city residents who have experienced addiction. Those interested can apply here.
- Have the Mayor's Office of Recovery Programs coordinate and publish notices of funding opportunities. The office will also publish annual financial reports.
Sara Whaley, program manager of the Bloomberg Overdose Prevention Initiative at the Johns Hopkins Bloomberg School of Public Health, said the executive order will ensure that decisions will be made with "community involvement, transparency and accountability."
Whaley is also helping the city decide how to allocate the funds, and she said the strategy is partly based on what she and city officials have witnessed being done in other struggling cities in the U.S.
"Baltimore is fortunate to have the opportunity to learn from their successes and their struggles," she said. "Utilizing that information, and under the leadership at their side, the city has created a governance structure and allocation plan for these dollars, and as someone who has seen a lot of these plans, I'm impressed by it."
Officials have argued that the city's current harm reduction initiatives are battle-tested and effective, but a lack of funding has hindered their ability to save lives.
As roughly three Baltimoreans die of overdoses each day, the city is making it a priority to bolster and expand its current programs.
While the mayor's administration says it supports additional efforts such as overdose prevention centers, its next steps will depend on input from the public and other parties, officials have said.
Bobby Harris, who leads the city's SPOT Mobile Clinic, said the city is facing an "unprecedented" opportunity to expand services, including access to buprenorphine.
"The potential impact of increased access to medication can only be fully realized if implemented with a system of integrated services tailored to provide personalized support for people who often have complex medical and social needs," Harris said. "We have an unprecedented opportunity, as we've seen today, to serve the people of the city."
Scott's administration has emphasized that the city has already received significantly more than if it had joined previous state settlements.
Officials most recently proved the city's decision to pursue independent litigation successful when they reached a $152.5 million settlement with opioid distributor Cardinal Health earlier this month. It was part of a larger settlement the city hopes to secure with a group of opioid manufacturers and distributors.
That lawsuit, which is scheduled to go to trial on Sept. 16 despite attempts to have it thrown out, as reported by The Baltimore Sun, includes Johnson & Johnson; McKesson; Cencora, formerly called AmerisourceBergen; Teva Pharmaceuticals; and Walgreens.
Although the city is on a winning streak, pursuing litigation independently has proven costly. When the city settled with the pharmaceutical giant Allergan earlier this year, nearly half — $20 million in total — was used to pay lawyers representing the city.
It's unclear how much money the city expects to pay in legal fees for the other settlements, but Scott said Thursday the dollar amount would be revealed once litigation has concluded.
The city's announcements touting the settlements and what will be done with the money have provided some of the only public comments from the mayor's administration about the deadly overdose crisis in recent months.
Top officials have remained largely silent about the fentanyl-driven crisis and have canceled public hearings scheduled by city council members, citing a need to protect sensitive information related to ongoing litigation.
For data about the overdose crisis in Baltimore and beyond, check out Mobtown Mag's Overdose Death Data Dashboard here.
Meanwhile, the settlements come as overdose deaths in Maryland dipped in 2023 as a part of a nationwide decline for the first time in five years — but Baltimore's annual death toll continued to climb.
The state saw 2,513 deaths in 2023, a 2.5% decrease from the year prior, but Baltimore had 1,045 deaths, an increase of 5.7%, according to the Maryland Department of Health.
The most recent data shows that Baltimore had a death rate of 146.1 deaths per 100,000 people in the 12-month period ending in July, which more than quadrupled the statewide average and dwarfed the death rates of other counties.
That same data, though, may also show some hope as the city tries to keep drug users alive.
The 12-month total of 856 deaths, for example, is a significant decrease from previous periods, when the numbers often exceeded 1,000 deaths.
There were 2,278 instances of naloxone being administered by emergency service personnel during that period, meaning that, if it weren't for the proliferation of the life-saving drug, the death rate would be significantly higher.
That figure doesn't include naloxone that was administered by other individuals, many of whom have been trained and given the drug as a part of local harm reduction initiatives.
In addition, with 434 overdose deaths so far this year in Baltimore, the city is on track to have fewer than 900 deaths by the end of 2024 — a number that would mark a notable drop but would require the death rate to remain steady, despite an expected increase in fatalities during the winter months.
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