Fatal overdoses plummeted in Baltimore last year, marking the lowest death toll in nearly a decade — but the crisis's disproportionate impact on Black residents remains a harsh reality.
Data released by the Maryland Department of Health last week showed Baltimore recorded 680 deaths in 2024, a 35% decrease from the year prior. Though the numbers are subject to change because they are preliminary, the significance of the decline has prompted both newfound optimism and a recognition that more work must be done amid a devastating, decades-long crisis.
“It’s great news; it’s great to see that,” said Danielle German, associate professor of health, behavior and society at the Johns Hopkins Bloomberg School of Public Health. “It’s not surprising to me given the amount of frontline work and harm reduction in particular that has taken place over these last several years, especially post-pandemic. The investment that has happened locally in these efforts that directly support people who are using drugs to stay safe have an impact.”
In part thanks to Baltimore’s unique, robust harm reduction infrastructure, the numbers may indicate Baltimore is turning a corner after establishing itself as the city with the highest fatal overdose rate in the nation. Experts have said that the city benefits from a large number of harm reduction organizations and a wide array of services for those who use drugs.
The last time Baltimore saw fewer than 700 overdose deaths was in 2016, when 694 deaths were recorded. That year marked the beginning of a massive surge in fatalities, with just 393 overdose deaths recorded in the year prior, according to state health department data.
“That’s an enormous decrease, and that’s a lot of lives that were saved,” said Dr. Eric Weintraub, a psychiatrist specializing in addiction who serves as associate director of the Kahlert Institute for Addiction Medicine at the University of Maryland School of Medicine. "I felt good because a lot of us who have been doing work in this area felt like we've been helping out but the numbers weren't budging. We sort of rationalized it like it would be a lot worse if we weren't doing what we were doing. To see a decrease like this makes us feel good about the work we're doing, and that we're contributing to this decrease we're seeing."
Both the city and state outpaced the decline seen nationally, where a decrease of 22% was reported in the 12-month period ending in August, according to the Centers for Disease Control and Prevention.
The dramatic decrease in deaths also comes with a notable decline in naloxone administered by EMS, which fell by nearly 28% in Baltimore last year. It’s unclear why Baltimore saw that decrease, but it could indicate that either nonfatal overdoses are also decreasing or the life-saving medication could just be so widespread that emergency personnel are only carrying out a fraction of total revivals, experts said.
Last year’s decline in deaths, the most significant drop in more than a decade, has been encouraging to experts. However, the data also underscores that Black Baltimoreans, specifically men, are hit hardest by the crisis — a manifestation of the impact of systemic racism and the decades-long drug war.
Black residents comprised 65% of all overdose deaths in 2024, according to the data. Black men specifically accounted for nearly half of all deaths, with those 55 years old or older being at the highest risk. The highest concentration of fatalities occurred in the city’s Black Butterfly.
Studies have shown that Black men are significantly more likely to die of overdoses, with fatal overdoses among the demographic increasing fourfold over the past decade nationally.
"I think the short answer is racism," German said. “If we within the city and within the country care about keeping people safe from fentanyl, we need to do that in a way that recognizes people’s current realities — and in a way their current realities are impacted by the historical legacies of structural violence and such. It’s scary to imagine we might be walking down a road where we wouldn’t take that into account.”
Minorities' lived experiences can impact their ability to get help as well, Weintraub said.
“I think there’s a couple things,” Weintraub said. “One is a lack of trust from patients on whether the current care system is going to treat them fairly. And I think there’s a lot of stigmatization within certain communities against certain types of treatment.”
Weintraub added that other factors could be at play, such as whether certain communities have less access to treatment such as buprenorphine and methadone or are being treated differently by providers. He emphasized that there needs to be concerted efforts to bridge any gaps in treatment access and engage communities directly.
The existing health disparities remain a concern despite the decrease in overdose deaths. Experts also emphasize, however, that those who have fought to save lives amid the crisis cannot afford to get complacent.
The numbers being preliminary means that the actual death toll could be higher, as it can take months for causes of death to be determined by coroners. While Weintraub said he doesn't expect any significant increases in the finalized data, Baltimore's overdose death rate remains alarmingly high.
Baltimore's 2024 death rate was 116.1 deaths per 100,000 people when using 2020 U.S. Census data, dwarfing that of other counties and the statewide average, which came out to 25.1 per 100,000.
“The decrease in fatal overdoses that we’re seeing in Maryland is historic, and it’s proof that our investments in behavioral health and substance use care and the incredible efforts of people all around our state are paying off,” Governor Wes Moore said in a statement. “However, we still have work to do. We are still losing far too many of our loved ones and neighbors to preventable overdoses, and we will not let up in our efforts to meet people where they are and make connections to care.”
Experts have said for months they were cautiously optimistic about the trend of fatal overdoses, as prior data indicated Baltimore was beginning to follow the decline seen nationally. Overdose deaths decreased for the first time in five years in 2023, which many have at least partially attributed to ramped-up harm reduction efforts.
The Baltimore City Health Department, however, remains skeptical of the recent data as the city pursues litigation against opioid distributors to fund initiatives to tackle the overdose crisis.
“While these latest numbers showing a decrease in overdose deaths are incredibly encouraging, it is important to recognize both the fact that this is preliminary data and the complexity of the factors driving short-term changes,” department spokesperson Blair Adams said in a statement. “We will continue to acknowledge the progress being made and, just as they have tirelessly done on a daily basis, Health Department staff, Baltimore’s first-responders, and our community health providers and partners will continue their daily efforts to save lives. Given the ongoing litigation, we will reserve any additional comments for the appropriate judicial form.”
The ongoing lawsuit against McKesson and Cencora, formerly called AmerisourceBergen, could bring in as much as $5.2 billion to fund the city’s abatement plan to combat the overdose crisis. The plan includes increasing the city’s treatment capacity, augmenting harm reduction initiatives and, perhaps most notably, opening overdose prevention centers.
Baltimore City Circuit Court Judge Lawrence P. Fletcher-Hill is expected to soon issue a ruling on whether the companies must cover the full costs of the city’s abatement plan. Even if they are ordered to pay the city, it may not be for the full $5.2 billion its lawyers have requested.
Baltimore is already slated to receive nearly $670 million over the next 15 years from various settlements with opioid distributors and manufacturers. Officials and public health experts alike hope the money could bolster local harm reduction efforts.
That money could be crucial, as local harm reduction organizations have expressed fear that funding cuts and punitive drug policies under President Donald Trump could hinder their ability to continue fighting the crisis.
Trump recently struck fear into such nonprofits after ordering a federal funding freeze on grants and loans, a maneuver meant to force organizations to adhere to the nascent administration’s far-right doctrines.
The Republican has also promised to ramp up law enforcement efforts to crack down on drugs and those who use them — an indicator he plans to escalate a drug war that has historically targeted Black Americans.
Editor's note: This article was published in partnership with the Baltimore Beat. Check it out on the Beat's website here.
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