With a historic drop in overdose deaths and hundreds of millions of opioid settlement dollars heading to the city’s coffers, Baltimore has entered a new chapter in its overdose crisis response. And Sara Whaley has been tasked with leading it.
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 that can 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.
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 No. 1 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’d 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.
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 an unprecedented opportunity 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.
Whaley attributed both the surge in overdose deaths during the COVID-19 pandemic and the recent decline to a variety of factors, emphasizing 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.
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.
However, what’s also unprecedented is the city’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.”
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