People who use drugs in Baltimore, overwhelmingly support prescribed safe supply programs, according to new research. Published in the International Journal of Drug Policy in October, the study highlighted how the most vulnerable respondents were the most supportive of the idea—and dug into the specifics of what people want.
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.
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.
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.
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.
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