What if, during the mass overdose event in Penn North this summer, word had circulated of a bad batch out there, so other buyers might beware?
What if on any given day, rather than injecting alone, users could go to a safe, supervised site where if anything went wrong, someone could administer oxygen or naloxone?
That is what Ohio and Providence, Rhode Island, have done with the kind of money starting to flow into Baltimore from settling lawsuits against opioid manufacturers, distributors and retailers blamed for fueling the national epidemic that has claimed more than 800,000 lives.
While other jurisdictions joined in a global settlement and started receiving their share of a more than $50 billion payout several years ago, Baltimore litigated on its own and only recently began getting funds that, depending on the outcome of appeals, could exceed $500 million.
Such staggering sums — albeit before accounting for legal fees, and spread out over multiple years — often provide cash-strapped state and local governments with significant resources to fight addiction. But they also create concerns that, as with the earlier and even more lucrative $246 billion tobacco industry settlement, the money could end up diverted to other uses or otherwise spent without having much to show for it.
“My biggest fear in all of this is one that we don’t know where the money went,” said Sara Whaley, the city’s executive director of overdose response. “In five years, we look at our bank account and it’s empty, and we go, whoa… ‘Where did the money go?’”
To avoid that, Baltimore is in the midst of a planning process to determine how to best spend the bounty in a city with a long history of drug addiction. With annual reports and a dashboard currently under construction, the city has pledged transparency, “so that there’s real-time data to see where the money went, how much money we have … and what it’s doing,” Whaley said.
Nationwide, overdose fatalities have been trending downward for the past several years, a time that coincides with when state and local governments began receiving settlement money. While it’s too early to definitively credit the funding with the declines, at least one study indicates the spending is associated with reductions in opioid overdose deaths.
Located in the northeast corner of Maryland, tiny Cecil County has traditionally had an overdose fatality rate that far outstripped state and national averages. But between 2022 and 2024, the county saw a 60% reduction in overdose deaths, said Lauren Levy, who until recently was the county’s health officer.
Levy, now in the same post for Harford County, said Cecil took a “broad-spectrum approach” to combating its overdose problem by partnering with organizations in the community. It has expanded, for example, the availability of “peer recovery specialists” who are embedded in the hospital to help those brought in for an overdose navigate the available options of treatment and mental health assistance.
Whatever jurisdictions do with their opioid funds, Levy said, “it has to be tailored to your particular jurisdiction.”
Jennifer Tuerke, executive director of the Elkton-headquartered Voices of Hope recovery community, said Cecil is largely rural but bisected by I-95, giving it access to the drug markets in larger cities on the corridor but not necessarily to their treatment facilities.
The grants from the opioid settlement funds have provided things like vehicles the group uses to transport users “who can’t just get an Uber” to recovery and other programs, “saturate” the county with the overdose-reversing drug naloxone, and expand service hours for those in a crisis.
“If someone needed help at 2 a.m. on a Sunday morning, there wasn’t anything for them,” Tuerke said. “Where do you go? They would just end up arrested or in a hospital where they’re told to call this number on Monday.”
In Baltimore, Whaley said the city is being cautious about how it disburses its opioid funds. Under the terms of its settlement, $87 million of it will go to 22 programs and organizations in the community in the form of grants. The city has been working with those groups to make sure the way the money is used aligns with Baltimore’s overall goals and strategy, she said.
Other funds will go to city agencies, while still others will be spent on needs that are identified and put out for competitive bid, Whaley said.
“Every day there are a thousand things I would love to invest in, but we don’t have an endless supply of money,” she said. “All of this has to work together in a tapestry of funding. And so when I hear a really cool idea, my first thought can’t be, ‘Here’s a check.’”
The money will allow the city to invest in initiatives that it might have considered in the past but were dropped or went unfunded.
“The opioid settlement funding opens a financial pathway that didn’t exist before,” said Brandon Marshall, an epidemiology professor at the Brown University School of Public Health.
Marshall is leading a study that will gauge the effectiveness of a new safe consumption site that has opened in Providence. It’s the nation’s first state-sanctioned site for supervised drug use, although New York City has had two such sites since 2021 that opened under a mayoral executive order.
The center offers safe usage areas, which are equipped with clean needles, alcohol swabs, fentanyl test strips and other supplies, as well as a broader range of health and treatment services.
“My belief, and the evidence supports this, is that overdose prevention centers are most effective as part of a comprehensive response,” Marshall said.
In roughly the first eight months of the year, the Overdose Prevention Center received 3,374 visits by 474 unique participants, according to statistics released by the state. Staff intervened on 61 overdoses, using naloxone eight times, and emergency services only had to respond once, the statistics show.
A survey showed that 78% of the center’s users would have taken their drugs alone without it, meaning they might not have been helped in the event of an overdose. The center’s users also availed themselves of other services offered there, such as counseling sessions and nurse visits.
“It’s definitely exceeded expectations,” said Rachel Ferrara, who directs the city’s human services division.
The idea has long been discussed in Baltimore, where Mayor Brandon Scott has previously voiced his support, and elsewhere, but it can be a hard sell among those who say it encourages illegal drug use.
“I would love to see us do this in Baltimore,” Whaley said. “There’s a lot of things to consider how that happens, but the mayor and our team are really supportive of comprehensive evidence-based services.”
Whaley, who in her previous work at the Johns Hopkins Bloomberg School of Public Health co-authored a set of principles on how to effectively use opioid funds, said Baltimore has a history of piloting harm reduction programs that initially were controversial.
“Harm reduction programs like syringe service programs were also, at one point, controversial and … Baltimore was one of the first to have [one],” she said. “And now they’re pretty commonplace.”
Have a news tip? Contact Jean Marbella at [email protected], 410-332-6060, or @jeanmarbella.bsky.social.
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