When Mayor Brandon Scott signed an executive order creating Baltimore's Opioid Resitution Advisory Board last year, it was hailed as a new chapter in the beleaguered city's fight against a disastrous overdose crisis.
The 20-member board, composed of public health experts and those with lived experience in addiction and drug use, would play a key role in determining how hundreds of millions of dollars from opioid-related lawsuits were spent, Scott said. That money, paired with their input, would allow Baltimore to revolutionize its harm reduction and addiction treatment infrastructure as it reckons with the loss of thousands of residents to overdoses in the last decade.
Yet in the nascent board's first budget cycle, its members may only have a say in allocating a modicum of what would be dispersed from the dedicated restitution fund in the mayor's proposed budget — a shocking revelation to some board members at a Wednesday meeting. Of the $36.7 million that would be used from the fund in the upcoming fiscal year, the board would only have discretion over $2 million, or roughly 5%.
“I have to voice my deep, deep concerns about that,” said board member Meredith Kerr, who provides harm reduction services at the Behavioral Health Leadership Institute and SPARC Women’s Center. “If there’s something that can be changed between now and next week, there’s a role the board can play in that.”
Under the proposed budget, nearly $20 million would head directly to community organizations fighting the unprecedented crisis and working to keep those who use drugs alive.
However, the vast majority of that grant money would be for more than 20 organizations named in settlements reached with opioid manufacturers and distributors last year, leaving the board with only $2 million to consider.
The remainder of the nearly $37 million in restitution funds would be allocated to city agencies — again without the input of board members.
All these financial decisions will be made before the board has had a chance to finalize a strategic plan. Meanwhile, the Board of Estimates may vote on the budget, which would use restitution funds to replace existing funding streams in a controversial practice known as supplantation, as early as next week.
Scott will host a budget town hall at 6 p.m. Tuesday at Coppin State University, with the Board of Estimates slated to consider the proposal at its 9 a.m. meeting Wednesday at City Hall. The budget will then need to be approved by the Baltimore City Council.
"I would really hope that we can influence the budget process for FY27," said board member Crista Taylor, CEO of Behavioral Health Systems Baltimore. " I hear your concern and share your concern, and I have significant concerns about us being able to do anything between now and next week because it's already too far down the process."
"It may be best to make it clear to the public that the resolution board played no role in the process," Taylor added.
The roughly $17.5 million in community grants is just a portion of the total $87 million pre-determined for organizations, all of which is based on five settlement agreements reached last year.
Paul Archibald, a board member and licensed clinical social worker, said every organization should've had to go through the same process to receive funding. That process would include a request for proposals and input from the board, although the mayor would ultimately have the final say in the matter.
"I don't think it's fair," Archibald said.
When factoring in $20 million Scott's administration gave to the health department, $107 million has been earmarked from the restitution fund without any input from the board.
The money for the health department was pitched as an emergency infusion of dollars to combat the overdose crisis last year, announced at the same press conference at which Scott signed the executive order creating the governance structure for restitution funds, which included the board.
Months later, however, Scott has proposed slashing the department's shoestring budget, nearly half of which relies on federal funding that's already under threat.
The two-term Democrat has proposed a $23 million cut to in the upcoming fiscal year, marking a more than 11% decrease from the year prior. Officials attributed this to declining state and federal aid.
Yet the mayor proposed increasing the police department’s budget by $22 million, bringing its total to a whopping $614 million. The health department would receive less than one-third of that at $185 million, even though the overdose crisis's death toll more than tripled the number of homicides in Baltimore last year.
On the other hand, the proposed budget would allocate $9.8 million to such services, an 87% increase over the year prior.
Board members were already on edge about the city's plans for opioid restitution funds. At its first meeting in late March, anxieties quickly arose about the possibility that a windfall of restitution funds could need to be redirected to supplant existing expenditures rather than build up the city's harm reduction and recovery infrastructure.
The concerns were expressed in light of federal funding cuts at the crux of President Donald Trump's austerity measures, including billions of dollars that were meant for local health departments.
Exactly one week later, Scott unveiled his proposed budget — and it did just that.
Money that would specifically be allocated for the city's syringe service program, 911 nurse triage program and population health program would all be taken from the restitution fund rather than the city's general fund, senior officials have said.
That could account for millions of dollars, though the mayor's administration did not provide an exact dollar figure by deadline.
Scott's budget plans to use millions from the fund to supplant money that would normally come from the city's general fund did not account for any of the Trump administration's cost-cutting orders now being challenged in court.
“I would refer to our city council colleagues to ensure that when these budget discussions are happening, and you’re looking at these budgets, that this money — someone at the Tuerk Conference called it ‘blood money’ for people who died for this thing — is not going to something that has already been funded, and we’ve just decided we’ll use this money for that," said board member Carlos Hardy, who spent more than 30 years offering substance use disorder treatment in Baltimore.
"We don't have any say in how these organizations engage with the community, or how the community is going to directly benefit from these grants.
Public health experts overwhelmingly oppose this practice. The Johns Hopkins Bloomberg School of Public Health has also published guiding principles for restitution funds, stating that jurisdictions should "use the dollars to supplement rather than supplant existing funding."
All these financial proposals have been made before the board had a chance to finalize a strategic plan.
In total, the city is slated to receive nearly $670 million from five settlements and a jury verdict late last year in the first phase of an ongoing case against distributors McKessons and Cencora, formerly AmerisourceBergen. About $206 million has already been received, officials have said. Most of the remaining dollars are expected to hit the city's coffers by the end of the year. Meanwhile, Baltimore will learn whether the two massive opioid distributors must cough up $5.2 billion more to fund its comprehensive abatement plan in less than a week. Baltimore City Circuit Court Judge Lawrence P. Fletcher-Hill has said he will rule on the case against McKesson and Cencora, formerly AmerisourceBergen, by May 6.
At the restitution board meeting earlier this week, city officials emphasized that future budgets would be different. The board is still in its infant stage, and as its mission is ironed out, it will have a more active role in decision-making.
Yet the lead-up to this year's budget process, filled with ostentatious press conferences and promises of transparency and change, painted a picture that far from resembles the reality that board members were presented with on PowerPoint slides Wednesday.
The board's inception, along with the hundreds of millions of dollars in restitution funds, offered hope to city residents impacted by the crisis. That included frontline workers serving on the board, who have worked with drug users at the epicenter of the nation's overdose crisis for years.
One could find solace in the fact that officials have promised that the nearly $37 million will fund effective, evidence-based overdose prevention efforts. That could be considered a net positive, even if the vast majority of funding won't be allocated based on the board's input — or if the funding covers the costs of existing programs.
But we can do better. Those who use drugs deserve it, and so do the board members who have dedicated their lives to ensuring they stay alive.
Did you miss my article for the Beat this week? What about last week's newsletter? You'll want to check them out:
For the Beat: "As Baltimore battles overdose crisis and hosts East Coast’s largest addiction conference, harm reduction practices shine"
Roughly 1,500 harm reduction workers, addiction and mental health professionals, and others serving those with substance use disorder gathered in Baltimore on April 29 for the 2025 Tuerk Conference, a gathering meant to highlight the latest developments and brightest minds in addiction treatment.
Despite dozens of abstinence-based treatment programs having booths at the conference, it was harm reduction, a movement championing compassionate care for those actively using drugs, that emerged as key in talks about overdose prevention.
Read my latest piece for the Baltimore Beat here.
Newsletter: "Mayor Scott says the state of the city is strong. Here's where the OD crisis stands"
As Mayor Brandon Scott stood before a packed theater for his State of the City address this week, he extolled his administration's accomplishments before shifting the focus toward Baltimore's future — a speech that included a brief nod to its progress in fighting a devastating overdose crisis.
The two-term Democrat, speaking in front of a massive video display at the France-Merrick Performing Arts Center on Monday, aimed to bestow confidence in his leadership as he helms a city reckoning with the pernicious ripple effects of policies past and present. Yet the event came against a macabre backdrop: Thousands of Baltimoreans have died of overdoses under his leadership, many of whom suffered preventable deaths as his administration remained largely mum on the crisis because of ongoing litigation.
Nevertheless, the public health calamity seems to be losing its steam.
Click here to read last week's newsletter.
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 774 — this is preliminary data that's subject to change as causes of death are determined.
In the 12-month period ending in March, Baltimore saw 679 deaths, a death rate of 115.9 per 100,000 people. Statewide, there were 1,549 deaths, a death rate of 25.1 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.
"Harm Reduction Activists Gather in Bogotá, as World Grows More Hostile," Filter reports:
Around 1,000 people who use drugs, activists, scholars and policymakers have gathered in Bogotá, Colombia, for the 28th annual Harm Reduction International Conference, which opened on April 27. High-profile speakers also include Colombian Minister of Justice Ángela María Buitrago, and United Nations High Commissioner for Human Rights Volker Türk, who sent a video salutation.
“Welcome to the city that represents global change,” stated Harm Reduction International Executive Director Shaun Shelly in his opening speech. “Welcome to the convening of a movement that has never wavered in its pursuit of social justice, restoring dignity to the Global South, and transforming drug policy to one rooted in dignity, health, and rights.”
Delegates from 70 countries are attending the event, which is held every other year. The organizers’ choice of Bogotá for 2025 carries symbolic weight, when Colombia has long been at the epicenter of the drug war. Two years ago, President Gustavo Petro signaled a new direction, launching the National Drug Policy 2023-2033 with the motto, “By sowing life, we banish drug trafficking.” The Petro administration is working toward legalizing cocaine.
Click here to read the full article.
