In a country helmed by plutocrats who yearn for unfettered capitalism, money talks. And though Baltimore's fight against the overdose crisis is a complex public health issue, the means by which it is addressed largely relies on the same thing.
Experts in the field of harm reduction and drug policy largely agree on strategies to prevent overdose deaths, including widespread naloxone distribution, syringe service programs and overdose prevention centers. However, the implementation of holistic, evidence-based drug policy requires more than just political will — it also requires funding. Lots of it. And over the past decade, lawsuits against opioid manufacturers and distributors have been the prime fundraisers.
In a court hearing on Thursday, Sy Polky, an attorney representing Baltimore in a landmark opioid case in which the city is seeking $5.2 billion, laid out why the city needs billions of dollars to save lives amid an unprecedented crisis.
"There are three points that really aren't in dispute: There is an overwhelming opioid public nuisance here in Baltimore, the current efforts to address it are not adequate and the components of the city's plan are the right things to do about it," Polky said.
If the city's successful, the massive sum of money would fund a comprehensive abatement plan created by Susan Sherman, a professor at the Johns Hopkins Bloomberg School of Public Health. She is a leading expert in the area of harm reduction.
The 15-year, five-point abatement plan calls for increased investments in treatment; harm reduction; education; services for special populations, such as during pregnancy; and monitoring and implementation.
The plan includes increasing the city’s treatment capacity, augmenting harm reduction initiatives and, perhaps most notably, opening overdose prevention centers. The city could reduce fatal overdoses by 50% and triple the number of people in treatment, experts have said.
Following the hearing on Thursday, Baltimore City Circuit Court Judge Lawrence P. Fletcher-Hill said he would rule on the historic case within 60 days.
The city is seeking the payout from opioid distributors McKesson and Cencora, formerly AmerisourceBergen. Unsurprisingly, the defense attorneys weren't on board.
Not only do they argue that the abatement plan is deeply flawed; they claim they shouldn't be responsible for funding any of its implementation. They have repeatedly questioned the legitimacy of the city’s statistical model estimating opioid use disorder prevalence, and they've lambasted the city for not conducting a needs assessment for harm reduction and treatment programs.
"[The plaintiffs] have failed to demonstrate that the benefits of the abatement plan outweigh the benefits of continuing the programs and services already in place," said Timothy C. Hester, an attorney for McKesson.
Meanwhile, the defense is also fighting a jury verdict from the first phase of trial in November that ordered the companies to pay $266 million for the public nuisance they allegedly created.
The upshot: The city wants billions to combat the overdose crisis. The massive pharmaceutical companies don't want to pay them a dime.
Prescription opioids' role in the crisis is debatable. The vast majority of those who use drugs do not develop an addiction, though about 80% of heroin or fentanyl users began with prescription opioids. What's often missing from these arguments is that the medications also have a crucial role in the treatment of chronic pain.
What's more clear, however, is that litigation against pharmaceutical companies has become a powerful tool in the arsenals of cash-strapped jurisdictions.
Baltimore is already slated to receive hundreds of millions of dollars from previous settlements reached with opioid distributors and manufacturers by the end of the year, providing an unprecedented opportunity to drive down overdose deaths.
When factoring in the money from the first phase of the trial, the city will have nearly $670 million. As previously mentioned, the amount the city is seeking in the current phase would dwarf that amount.
That's a lot of damn money. But it's necessary, as the city's lawyers have repeatedly argued in court proceedings.
Back in August, Mayor Brandon Scott signed an executive order that created a governance structure to disburse the funds. It included establishing a dedicated opioid restitution fund, an advisory board composed of residents with lived addiction experience and a trust to maximize its impact.
Those things have come to fruition, with the board's members and an executive director of overdose response announced last month. All the funds will now go through the process, which was designed to be transparent and evidence-based.
Even before the executive order, the city allocated a windfall of settlement funds — a total of $107 million for local opioid remediation programs, as stipulated by agreements with five companies. That included $20 million allocated directly to the health department.
More recently, The Baltimore Banner reported Wednesday that the Baltimore City Council's Budget and Appropriations Committee approved more than $14 million for community organizations and city agencies to combat the overdose crisis.
That money will be crucial in driving down overdose deaths through harm reduction, treatment and other services. And it's not unique to Baltimore, though the sheer amount of money the city's receiving is historic.
Nationwide, tens of billions of dollars from opioid lawsuits are flowing into states to save lives, though there have been instances of dollars being misused, according to KFF Health News.
The organization's data shows that Baltimore has easily surpassed the amount of money that Maryland itself is slated to receive; the state has acquired $84.1 million, with an estimated $331.2 million in future payouts.
All this money comes from lawsuits that alleged opioid distributors and manufacturers helped create the overdose crisis by pedaling prescription opioids and deceiving the public about their addictive potential.
It's important to note, though, that prescription opioids are just part of the story. Here's an excerpt from an article I wrote last February that detailed how the city became the epicenter of the nation's overdose crisis — well before other local publications touched the subject:
"America's most significant surge in overdose deaths came during the COVID-19 pandemic, which created a myriad of challenges for Americans. People lost jobs, crimes such as domestic violence increased and isolation exacerbated mental health conditions.
In addition, housing costs went up and access to social services decreased. As COVID-related aid expired, some were forced into homelessness. All of these challenges dealing with what experts call social determinants of health have repeatedly been proven to increase fatal overdose rates.
In a vacuum, all these variables create an environment that fosters chaotic drug use. Yet there are more factors in play. In tandem with an increasingly dangerous drug supply that's become awash with fentanyl and additives such as xylazine, Baltimore and cities throughout the U.S. are reckoning with their history of systemic racism to this day. Factors such as segregation and redlining have created conditions that are detrimental to the health of disadvantaged populations.
The decades-long War on Drugs compounded these issues and, despite what some politicians may say, it's still alive and well. Black and brown Americans are disproportionately impacted by drug criminalization, placing them in a vicious, carceral cycle that keeps them oppressed."
Clearly, there's a lot at play here. However, all of these factors created a recipe for disaster that got us to where we are today — and they will need to be addressed if cities such as Baltimore want to save lives.
And how does a city reckon with this whirlwind of catastrophe and work to repair the damage?
A recognition of wrongdoing and the political will to effect change, surely. However, as previously mentioned, these things take money to address. And lots of it.
It will take money that's handled transparently; money that's allocated with the input of experts and people with lived experience; money that doesn't bear the faces of dead presidents but of the people who such politicians were elected to represent.
Earlier this week, I profiled Sara Whaley, Baltimore's new executive director of overdose response, for Filter.
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.
Read the full article here.
The Maryland Department of Health recently updated its preliminary fatal overdose data:
When the data was first released last month, there were 680 reported fatal overdoses in Baltimore in 2024. That marked a 35% decrease from the year prior, and it was the largest single-year drop on record.
That number has since changed to 714 deaths, as you can see on Mobtown Redux's Overdose Data Dashboard. That's about a 32% decrease from the year prior, and it's still a historic drop. In addition, it's still the lowest death toll the city's seen in nearly a decade; the last time the city saw that few deaths was in 2016, when 694 deaths were reported.
This is why it's important to note that the data in the last few years is preliminary, so it's subject to change. It can take a long time for coroners to determine causes of death, creating a lag in the data.
Regardless, 2024 remains a massive milestone in Baltimore's fight against the overdose crisis.
Check out the harm reduction bills in the General Assembly I'm keeping an eye on; legislation marked with asterisks is unfavorable in the eyes of harm reductionists:
- Senate Bill 83, sponsored by Sen. Shelly Hettleman, D-Baltimore County. This bill would legalize overdose prevention centers (OPCs) in Maryland, allowing for up to six programs statewide. The bill is awaiting a vote in the Senate Finance Committee. Previous iterations of the bill have repeatedly died in committee over the years.
- House Bill 845, sponsored by Del. Joseline Pena-Melnyk, D-Prince George's, and numerous other delegates. This is the companion bill to SB83 and is awaiting a vote in the House Health and Government Operations Committee.
- Senate Bill 370, sponsored by Sen. Cory McCray, D-Baltimore City. This bill would decriminalize drug paraphernalia statewide. Both chambers passed a different iteration of this legislation in 2021 before it was vetoed by failed U.S. Senate candidate and former Gov. Larry Hogan. The new bill is awaiting a vote in the Senate Judicial Proceedings Committee.
- House Bill 556, sponsored by Del. Karen Simpson, D-Frederick, and a few other delegates. This is the companion bill to SB370, and it's awaiting a vote in the House Judiciary Committee.
- *Senate Bill 604, sponsored by Del. Jeff Waldstreicher, D-Montgomery, and Del. Justin Ready, R-Frederick. This bill would create a maximum prison sentence of 20 years for people who distribute fentanyl or heroin resulting in death, also known as "drug-induced homicide." Paired with legislation passed in 2017 that increased the maximum sentence for fentanyl dealers to 30 years, harm reductionists say the bill could lead to sentences as long as half a century. The bill is awaiting a vote in the Senate Judicial Proceedings Committee.
- *House Bill 1398, sponsored by Del. Chris Tomlinson, R-Frederick, and numerous other delegates. This is a companion bill to SB604, and it is awaiting a vote in the House Judiciary Committee.
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