In less than three weeks, Baltimore will learn whether two massive opioid distributors must cough up billions of dollars to fund its comprehensive abatement plan — a decision that could revolutionize harm reduction in the epicenter of the nation's overdose crisis.
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 a hearing last month, he set the self-imposed deadline after attorneys made post-trial arguments in a case predicated on allegations that they were largely responsible for the city's swelling death toll by recklessly peddling prescription opioids.
To abate the damage caused by the companies, the city needs a whopping $5.2 billion, attorneys and expert witnesses argued late last year.
“The goal isn’t just for people not to die from overdose and to be in a treatment program, it’s for people to be able to do the things they want to do in their life — to get their house back, their kids back and to be productive members of society,” said Dr. Joshua Sharfstein, an expert witness helping guide the city’s overdose response who also serves as director of the Bloomberg American Health Initiative.
The city had initially sought up to $11 billion. It later amended the lawsuit, tailoring its plan to focus on only those who have struggled with pharmaceutical opioids or have opioid use disorder.
The money will help fund a 15-year, five-point abatement plan, which calls for increased investments in treatment; harm reduction; education; services for special populations such as pregnant women; and monitoring and implementation.
The plan entails increasing the city’s treatment capacity, augmenting existing harm reduction initiatives and opening overdose prevention centers, the last of which is considered a linchpin of life-saving drug policy.
Baltimore already has numerous harm reduction and treatment programs, but those who testified said the current level of services is inadequate and must be expanded. The model used by the city estimates that more than 32,500 people at any given time have opioid use disorder.
The city could triple the number of individuals in treatment and reduce overdoses by 50% under the plan, witnesses said. However, in a controversial move, it also aims to reduce opioid prescriptions by 55% — a goal some studies say would increase fatal overdose rates and hurt pain patients.
The city has based much of its legal argument on the assertion that the overdose crisis was largely caused by “pill mills” that distributed millions of opioids they received from companies such as Cencora and McKesson. Their addictive potential, meanwhile, was completely disregarded, lawyers have alleged.
The defense’s attorneys, however, have noted that the abatement plan fails to identify any faults in the companies’ practices. They also questioned the legitimacy of the city’s statistical model that estimated the OUD population, which is largely what its cost estimates are based on, and why the plan did not factor in existing programs in the city that may already be funded.
Not only do the companies not want to pay the city a dime, but they're also seeking to nullify a jury trial verdict last year and potentially schedule a new one.
The judge has heard all of these arguments. And in the coming days or weeks, the lawsuit's fate will be decided. Appeals are very likely in any scenario.
The decision could be transformative for two reasons: The windfall of funds could significantly expand overdose prevention efforts if used correctly, and it could usher in a new era of transparency about drugs and overdose deaths in Baltimore.
The latter has long been a point of contention. It's been more than a year since officials largely stopped responding to requests for comment on matters related to the overdose crisis, citing ongoing litigation. Since then, there have only been a few occasions when the mayor or other officials spoke in detail about the matter.
The silence has caused flare-ups in City Hall, too.
In February, Councilman Mark Conway announced public hearings on the overdose crisis last week for a second time. They were subsequently canceled in response to pressure from Mayor Brandon Scott's administration. It marked the second time the councilman and mayor butted heads over whether to open up public discourse amid ongoing litigation against opioid distributors, the first of which resulted in protests outside of City Hall.
However, despite the potential for good news regarding overdose prevention and transparency, the decision may come with some caveats.
First, it could kick-start a very lengthy appeals process, which city officials may end up citing as a reason to remain largely mum about a crisis that has killed thousands of Baltimoreans over the past decade.
In addition, there are ongoing concerns about how the funds will be used.
At the first meeting held by the city's new Opioid Restitution Advisory Board last month, members expressed fears that federal funding cuts at the crux of President Donald Trump's austerity measures could lead the city to use restitution dollars to supplant funding for existing programs rather than creating new ones.
As evidenced by Scott's budget proposal unveiled earlier this month, that's already happening — even without accounting for any of the Trump administration's cost-cutting orders that are now being challenged in court.
The proposed budget suggests using more than $37 million from the fund. The 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 accounts for millions of dollars.
Thirteen states and Washington, D.C., have restricted the use of restitution dollars to replace existing funds, according to KFF Health News. Maryland is one of those states, though it has no control over the funds Baltimore receives through independent litigation.
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."
The money from opioid lawsuits is placed in the city's Opioid Restitution Fund. Like the board, it was created by an executive order signed by Scott last year, and the governance structure mandates that the money be placed into a trust and distributed over 15 years.
This is the first year the city's budget stands to benefit from the fund, the requirements for which exclude any grants that were allocated before its creation because of settlement agreements.
The city is already slated to receive nearly $670 million from five settlements and a jury verdict late last year in the first phase of the ongoing trial, about $200 million of which has already been received, officials have said.
Regardless of the judge's looming decision, these are historic times in Baltimore's fight against an unprecedented overdose crisis. A decade of surging death tolls has led to the city having the highest fatal overdose rate of any major city in the U.S.
It wasn't until last year that the city saw a glimmer of hope: Overdose deaths dropped 25.8%, marking the lowest death toll in years. Deaths nationwide have also been on the decline.
Those who use drugs continue to die of overdoses at astronomical rates, and all of those deaths are preventable. Yet 2024 demonstrated that harm reduction works, and efforts should be expanded and funded as much as possible.
It is still early in the city's budget process, so it's not too late to ensure that restitution funds are used to augment the city's harm reduction infrastructure rather than maintaining the status quo.
Perhaps most importantly, Baltimore must adopt more ambitious programs such as city-sanctioned OPCs. These facilities are proven to prevent overdose deaths, yet the mayor has only supported them via state legislation — an effort that has repeatedly failed in the General Assembly.
As a senior official said last month, "We're trying to move forward; I don't want to just hold the dam."
One can hope that city officials embody that mindset upon the conclusion of this trial and channel it into progressive drug policy reform. The lives of those who use drugs depend on it, and the city cannot afford to regress amid an unprecedented overdose crisis.
Miss last week's newsletter? You'll want to check it out:
Flanked by a cadre of cops and city officials, Mayor Brandon Scott on Wednesday announced the takedown of a drug trafficking organization in Curtis Bay — yet the aftermath of these coveted busts can be deadly for drug users.
The joint operation, conducted by law enforcement agencies at every level of government, yielded 11 arrests and was touted as a valiant effort under the city's Group Violence Reduction Strategy during a press conference at the Curtis Bay Recreation Center. Officials made it clear that drug dealing and the violence it's associated with have no place in Baltimore, issuing a stern warning to those who continue despite offers to divert them from the lifestyle.
"In order for the strategy to work, we have to hold those who choose to engage in behaviors associated with violence consistently, time and time again, even after being given the chance to change their life, accountable," Scott said. "We will not tolerate groups like this one that ignore the strategy's mandate to put down the guns, contribute to the proliferation of illegal narcotics on our streets and continue to do harm in our community."
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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.
"Do Harm Reduction Interventions for Substance Use Lower or Raise Trust in Government?" asks a new UPenn study:
In the experiment, participants were randomly assigned a role of either mayor or resident of a rural Appalachian town and given information about whether residents considered the local government to be supportive of harm reduction and substance use reduction policies. Then, they were asked to estimate the level of trust that community residents have in their local government.
Once again, the researchers found evidence that support for comprehensive drug policies increases trust in local government, both among participants assigned to play authorities and those assigned to play residents, and regardless of political ideology. They also found evidence that this was because comprehensive drug policies enhanced perceptions of governmental effort, and engendered optimism about future improvement of drug-related issues.
“Our findings highlight the nuanced perceptions of comprehensive drug policy within Appalachian and Midwestern communities,” said Liu, the lead author. “Despite concerns that harm reduction policies might inadvertently promote drug use, residents trust local authorities more when the authorities promote these policies. These insights should alleviate the common fears of policymakers that prevent these life-saving policies from being implemented in their local communities.”
Click here to read the full study.
