For months, Baltimore had eagerly awaited a ruling by Judge Lawrence P. Fletcher-Hill — one that could have forced opioid distributors to bankroll a multi-billion-dollar abatement plan, allowing the beleaguered city to revolutionize its harm reduction and treatment infrastructure.
Meanwhile, the city's unprecedented overdose crisis raged on. Then Thursday came, and so did his decision: Fletcher-Hill rejected the city's request for $5.2 billion in abatement funds from McKesson and Cencora, formerly AmerisourceBergen. He also wrote that he would allow for a new trial against the two massive opioid distributors from which Baltimore sought the vast sum, reversing a 2024 decision that won the city $266 million.
“The Court finds that the verdict rendered is grossly excessive in light of the evidence and is shocking to the Court,” Fletcher-Hill wrote in his decision.
The case isn't over, but the ruling stung. Facing a crisis that has killed thousands of residents in the last decade, Baltimore needs as large a war chest as possible. The judge's ruling will likely mean the city will have fewer resources to do so.
At the same time, he had a point. The city's argument is flawed, albeit not just for the reasons he cited.
Fletcher-Hill largely argued that the city failed to prove that the two companies created nearly all of its drug problems, nullifying the basis on which the dollar amounts were formulated.
However, the issue is much more complex. And the overarching narrative provided by the city's team — and much of the local media — has been relatively myopic, lacking critical context on the overdose crisis and how we got here.
Opioids have served as a bogeyman for decades, providing fodder for sensationalist takes on the overdose crisis. Yet they exist because they have been proven to be effective for pain management.
The hyper-focus on opioids themselves, therefore, does nothing but perpetuate stigma about those who use them.
The paranoia surrounding opioids dates back to the 1990s, when prescriptions surged as companies such as those named in Baltimore's lawsuit unleashed a wave of marketing campaigns and lied about their addictive potential.
A surge in overdose deaths ensued. Then, just as the drug supply so often does, things shifted. Heroin-related deaths subsequently became the story, followed by fentanyl. Along the way, a fear-mongering narrative parroted by local and national news media permeated throughout American society, feeding the War on Drugs.
In the city's arguments, opioid prescriptions were nonetheless the primary focus. In fact, the city's abatement plan aimed to drastically reduce the amount of opioids prescribed in the city, projecting a 55% decrease.
Filter, an outlet for which I write, has been the only news organization to point out that, while many people who use fentanyl or heroin began with pharmaceutical opioids, the vast majority of people who are prescribed the medications do not develop opioid use disorder.
Rather, it's the non-medical use of these medications that fueled overdoses, whether that be leftover pills that were acquired in some manner by family members, friends or someone on the street.
Bureaucrats have nonetheless cracked down on prescribing opioids over the years. Studies have since shown that such measures have been implicated in driving the overdose crisis to unprecedented levels by pushing people toward an unregulated, lethal drug supply.
The crackdowns have also been hugely detrimental to pain patients, a phenomenon that has spurred lawsuits elsewhere.
The drugs, in other words, are not the problem — but they are a convenient scapegoat that distracts from the real issues at hand.
The real overdose crisis is multifaceted, and it's undeniable that corporate greed at the expense of public health has played a notable role. On the other hand, prohibitionist drug policies implemented under the guise of public safety have worked in tandem with other factors to create a perfect storm.
As a 2019 study published in the Journal of Pain Research notes, "[Overdose deaths] continue to rise even as many patients in chronic pain have seen their medication dosages involuntarily reduced or cut off altogether. Some, in desperation, have sought relief from the black market or even in suicide."
"The current overdose crisis is rooted in the intersection of long-term psychosocial and cultural trends with the lucrative opportunities offered by drug prohibition," the study continues. "Ending drug prohibition will not curb the growing tendency to use drugs nonmedically. However, it will potentially reduce the resulting harm. Short of decriminalization, policymakers should abandon one-size-fits-all intrusions into the clinician–patient relationship."
The study reaffirms what harm reductionists already know. By outlawing or cracking down on certain drugs, the government is feeding an underground market brimming with unregulated substances that are unpredictable and lethal.
As a result, prohibition inherently increases overdose death rates by disrupting the drug supply and pushing drug users toward riskier sources, a phenomenon known as the “Iron Law of Prohibition.”
To clarify, pharmaceutical companies are often malicious, greedy entities that exploit patients in pursuit of capital. Opioids, which they recklessly peddled without regard for patients' safety, can also be highly addictive for some individuals.
But they also serve a purpose. And as a regulated substance, they are significantly safer than what's sold on the streets.
Baltimore's lawsuit largely disregarded this and the myriad other elements that have contributed to the overdose crisis. The litigation also shifts the spotlight away from policies that, unlike the lawsuit itself, the city has control over.
The city's arguments have largely ignored factors that can serve as root causes of drug use and addiction. Known as social determinants of health, these include poverty, housing instability, lack of health care and poor education.
Such systemic problems can, and should, be attributed to policy failures. And those failures foster environments that can lead to drug use and poor health outcomes, including fatal overdoses.
A city can crack down on drugs or chase after companies for billions of dollars all it wants. Yet as long as these deeply rooted afflictions exist — all of which have festered alongside racial inequality and other forms of oppression — so will dangerous substances and those who use them to cope with such plagues.
Nonetheless, Baltimore officials continue to argue that the companies must be held accountable. And the abatement plan, drafted by experts in the field of harm reduction, included a comprehensive list of priorities that would undoubtedly save lives, most notably the establishment of overdose prevention centers.
Baltimore has been hit harder by the overdose crisis than any other city in the nation, witnesses testified during the trial, and such a severe crisis necessitates an equally ambitious response.
They're not wrong. However, placing all the blame on Big Pharma also removes the city of any culpability.
In reality, Baltimore is so heavily reliant upon these funds for overdose prevention efforts because the city has failed to sufficiently invest in harm reduction and treatment programs as the overdose crisis has raged on for years.
Take Mayor Brandon Scott's latest proposed budget, for example, which is awaiting consideration by the Baltimore City Council.
Scott has called for an 87% increase in substance use disorder and mental health funding. In that same budget, he's suggested millions of dollars in additional funding to the police department while cutting funding to the department that oversees government-led harm reduction initiatives.
The proposal includes a 3.5% cut to the health department's budget, or a more than $7 million decrease. Meanwhile, the BPD would see a $22 million increase to its budget, marking a whopping $614 million.
Health officials have expressed fears about their budget, regardless of what the city allocates. With half of their money coming from federal funds, their finances could be upended by President Donald Trump and his allies as they propose slashing billions in public health spending.
As their initiatives could be crippled, the BPD is likely posed to once again successfully argue for an increase in funding, capitalizing on city officials' inability to reform its punitive approach to drug policy.
At a budget hearing last week, police officials touted an 11% increase in felony drug arrests and a 28% increase in misdemeanor arrests since last year. Police Commissioner Richard Worley said the BPD must crack down even harder.
In light of the city's budget, the restitution funds would at best provide only a temporary boost to harm reduction initiatives, without an actual shift in priorities.
In response to Fletcher-Hill's ruling this week, the city must decide by July 7 if it will accept a massive cut to $266 million it won in a jury verdict in the first phase of the trial to avoid re-litigating the matter.
The judge proposed that the two defendants pay just under $52 million, and any money for abatement would be re-evaluated afterward.
“We must not lose sight of the heart of this effort. We stood tall to say Baltimore deserved more, that the families destroyed by these companies deserved better," Scott said in a statement following the judge's ruling.
"As a result, we secured a historic amount of funding to bolster our work tackling the opioid crisis in our city. Even with today’s decision, the settlements we’ve reached through this process far exceed what our city would have gained through the global settlement — making it clear that we made the right decision to continue this fight alone."
The mayor is correct; the city is still slated to receive a large sum of money, regardless of the outcome in the ongoing trial. Yet, as it now stands, it is only guaranteed just more than $400 million in restitution funds, all of which stem from settlements reached with companies that did not want to go to trial.
That's significantly less than the BPD's annual budget — and those funds are supposed to be spread out over 15 years.
As Baltimore officials settle on a course of action in response to the judge's ruling, they would be prescient to re-evaluate their priorities. As Fletcher-Hill wrote in his ruling, their argument is flawed. But so is their approach to drug policy, and the city's current trajectory is untenable as the overdose crisis rages on.
Hundreds of Baltimoreans continue to die each year. And despite harm reductionists' calls for reform, the only thing that is changing is the drug supply — and that's a turn for the worse.
This situation has brought about an odd sense of déjà vu; I think it stems from the fact that I've admittedly spent quite a bit of time in abstinence-based treatment programs.
In those rooms, people are often told that the drugs aren't the problem. Rather, they're a perceived solution to a more serious underlying issue. Instead of focusing on the drug, individuals are encouraged to perform some introspection in therapy to find the root cause of their substance use.
Such self-reflection is something the city could benefit from.
Miss my latest article for Filter or last week's newsletter? You'll want to check them out:
Filter: "Judge Rejects Baltimore’s $5.2 Billion Lawsuit Request to Address OD Crisis"
A judge has rejected Baltimore’s request for $5.2 billion in abatement money in a long-running opioid lawsuit — dealing a major blow to its ambitious plan to address the overdose crisis. The June 12 ruling will also allow for a new trial against the two opioid distributors from which Baltimore sought the vast sum, reversing a 2024 decision that won the city $266 million.
Baltimore City Circuit Court Judge Lawrence P. Fletcher-Hill said the city failed to prove that it needed McKesson and Cencora (formerly AmerisourceBergen), to pay $5.2 billion to cover the costs of redressing the damages they allegedly caused.
The city had previously argued that it needed the money because the pharmaceutical giants recklessly peddled prescription opioids and misled the public about their addictive potential, leaving Baltimore with a growing addiction and overdose crisis that has claimed thousands of lives.
Newsletter: "BPD pleads for money to fuel drug-war policing as health department faces budget cuts"
As the War on Drugs carries on in tandem with Baltimore's overdose crisis, the city's perennial dilemma of whether to throw more money at the cops or fund life-saving harm reduction initiatives returned to the spotlight this week.
At a Tuesday evening budget hearing, the Baltimore Police Department pleaded for additional money to cover the overtime costs accrued by officers enforcing prohibition, with the top brass touting an increase in drug arrests this year. Health department officials then picked up the mic on Wednesday morning, warning that their budget could be upended on the heels of a historic decline in overdose deaths.
Public "safety" and public health had once again come to a head.
Mobtown Redux's Overdose Data Dashboard is frequently updated with the latest local, state and national data:
Baltimore's overdose death toll in 2024 has increased to 775 — this is preliminary data that's subject to change as causes of death are determined. That marks a nearly 26% decrease from the year prior.
In the 12-month period ending in April, Baltimore saw 651 deaths, a death rate of 111.1 per 100,000 people. Statewide, there were 1,504 deaths, a death rate of 24.3 per 100,000 people.
Neighborhoods in West Baltimore saw the most deaths, an unfortunate pattern in this data.
Check out Mobtown Redux's Overdose Data Dashboard here.
Click here to learn more about harm reduction resources in the Baltimore area.
The Associated Press: "Music festivals have become more open to harm reduction initiatives. How far will it go?"
NEW YORK (AP) — The sounds of muffled percussion and audience cheers reverberate throughout the grounds. Brand activations, makeshift bars and restaurant pop-ups control traffic as a sea of bodies move from set to set. Sandwiched between is a row of nonprofits across familiar causes: hunger, housing and voter registration.
It’s a common music festival scene, until closer inspection. There is a new table, This Must Be the Place. The Ohio-based nonprofit offers attendees free opioid overdose reversal treatment and training on how to use it, an education acquired in under two minutes. Just a few years ago, their inclusion might’ve been unthinkable amid murky regulations and a lack of public awareness surrounding harm reduction.
Advocates say drugs are commonly consumed at music festivals, making them ideal locations for harm reduction activities. While more music festivals are allowing such activities, activists are pushing for expanded efforts as some festivals remain cautious.
Click here to read the full article.
