On any given day in Baltimore, an average of three people die of overdoses.
This poignant statistic is front and center this International Overdose Awareness Day, with Baltimore cementing itself as the epicenter of the crisis. As of this year, the city has the highest fatal overdose rate of any city in the U.S.
"The overdose crisis continues to take an overwhelming toll on our communities, with lives being lost at an alarming rate," said Brittney Spencer, director of overdose prevention at the Baltimore City Health Department. "In Baltimore, the number of lives lost is more than three times the number of homicides. These statistics are not just numbers, but real individuals, families and neighbors grappling with the impact of this epidemic."
Spencer spoke at an event celebrating the 30th anniversary of the health department's syringe exchange program, a harm reduction initiative that has been proven to reduce overdose deaths and the risk of diseases such as HIV.
Since 1994, the department has distributed nearly 18 million sterile syringes, interacted with 237,590 drug users, reversed 7,350 overdoses and referred 2,939 individuals to treatment, officials said.
The syringe program is one of numerous harm reduction programs in the city. The department also offers naloxone training and distribution as well as testing kits that detect fentanyl and xylazine, an adulterant that can complicate overdoses.
In an epoch defined by the proliferation of fentanyl, the efforts are invaluable. And Mayor Brandon Scott announced Thursday that the health department would be infused with $20 million to expand its work. Numerous nonprofit organizations already work in tandem with the department to save lives.
Surrounded by public officials and those working to combat the overdose crisis, Scott unveiled a two-pronged plan to combat the overdose crisis. He signed a comprehensive executive order to create a governance structure for handling hundreds of millions of dollars in funds while providing short-term aid to fuel the health department's ongoing efforts.
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.
The governance structure, created to ensure the funds are being managed and spent properly, includes a dedicated opioid restitution fund, an advisory board and a trust to maximize its impact.
"The tragedy of overdose touches each and every one of us," Scott said at the health department's event Thursday. "As someone who has felt the impact myself, I want to extend my condolences to all the families impacted by substance use disorder and overdose. I also want to recognize the friends and families of lost loved ones, the activists fighting for policy reform, the health care advocates here today and those who are out on the street right now. And I encourage you to remember that together we can end overdose."
The executive order and additional funding to the health department are an undeniable win for the city. While Scott's statement was well-intentioned, he got something wrong.
As long as humans exist, people will overdose on drugs.
Fatal overdoses, meanwhile, are entirely preventable. And the work the health department and its partners are doing surely works toward the goal of eliminating them.
Yet even with the windfall of funds to bolster those efforts, something needs to be acknowledged: They might not be enough.
That's why the city must become more ambitious with its harm reduction initiatives, including ones that may seem too radical to be politically viable. That not only means the expansion of all of its current programs, which the mayor's recent announcement will make possible, but the creation of new ones.
Perhaps most importantly, the city must create overdose prevention centers, or OPCs, which have been proven to reduce overdose deaths, lower the risk of HIV and increase access to treatment for substance use disorder.
Bills to create OPCs have been introduced in the state Legislature but have repeatedly died in committee. Therefore, it's likely the city would have to follow the lead of New York City where, in 2021, OnPoint NYC opened the first facility in the country.
While the mayor and his administration have said they support OPCs, there have been no concrete proposals to bring them to Baltimore. Officials say implementing such a program will depend on input from the public and its partners through the newly created governance structure.
However, those who use drugs, whether addicts or not, can't afford to wait.
They have been beaten down by the war on drugs for far too long, with the city's minority community being hit hardest, as evidenced by the concentration of deaths in the city's "Black Butterly."
As long as the status quo remains, organizations such as the Baltimore Harm Reduction Coalition will have to continue holding events such as their annual "Celebration of Life" gathering, which they held last week.
At the event, they built an altar commemorating those who have lost their lives to overdoses. They also staged a mock overdose prevention center, educating attendees about how they work and their benefits.
The organization, despite working tirelessly to help those who are at risk of losing their lives every day, chooses to remain positive – even when talking about those who have died.
"Just because overdose is a part of our life and it’s something that brings grief, doesn’t mean that every time we talk about it, it has to be shrouded in negativity and sadness," said Candy Kerr, the organization's spokesperson. "People that we have lost to overdose are people that we love and are people that have had full lives, and we have great memories of them. The best way to honor them is to get together and have more of an upbeat celebration, but also an opportunity to talk about them, honor them and educate the people who are still here.”
Kerr went on to give the organization's take on the current state of the overdose crisis, echoing the necessity for overdose prevention sites.
“More harm reduction-based programming is needed," Kerr said. "We need more syringe service programs in general; that would be helpful. We are trying to flood the areas with Narcan that we can, but we need more harm reduction spaces in the places where people are using drugs the most – which is not Charles Village, it’s West Baltimore. I think, slowly but surely, politicos are figuring that out. We also need overdose prevention sites. Brandon Scott is on board, but we just need that to happen."
The demands for a more robust harm reduction infrastructure in the city comes as fatal overdose statistics provide both good and bad news.
The state saw 2,513 deaths in 2023, a 2.5% decrease from the year prior, but Baltimore had 1,043 deaths, an increase of 5.5%, 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.
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.
The city cannot afford to delay a more heavy-handed approach to tackling the crisis, as any decline in the death rate is simply hypothetical.
Public officials have offered their support to those who are struggling with substance use and the loved ones of those who have died. They've repeatedly cited their ongoing programs as evidence they are working to put an end to the maelstrom.
However, those people need action – and a lot more of it.
It's estimated that three people will die today. Those individuals could be some of the many Baltimoreans who have been unhoused and struggling with addiction for decades.
They could also be first-time drug users or individuals who have been working to end the crisis and help those in need. Regardless, they are sons, daughters, mothers, fathers and friends.
Their deaths are entirely preventable. And we must ensure their deaths will not be in vain.
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