Overview

Opioid overdoses have been one of the most deadly public health epidemics in our nation's history, leading to more than 80,000 deaths annually in the United States. In the last two decades, Baltimore has been disproportionately impacted, with more than half a billion opioid pills permeating the Baltimore area between 2006 and 2019, driving an increase in overdose deaths. Public health experts have estimated that more than 80% of Baltimore’s opioid use disorder cases between 2010 and 2021 began with prescription opioids, leading residents to turn to illicit drugs.

Baltimore City makes up 9% of Maryland’s population but, now through the first seven months of 2024, represents 44% of Maryland’s overdose deaths. Annually, Baltimore has an average of more than 2 overdose deaths per day.

In response, in 2018, Baltimore City initiated legal action against various pharmaceutical manufacturers and distributors for their role in creating the opioid epidemic in Baltimore City by failing to take reasonable steps to prevent the diversion of their highly addictive prescription opioids. The City then opted out of the global settlement that would have provided the City with much less restitution money than it deserved, and decided instead to pursue its litigation against some of the largest pharmaceutical companies in the world.

That decision has paid off. As of September 2025, the City has reached settlements and awards totaling $579.9 million (before legal fees and repayment of litigation costs).

Executive Order Issued By Mayor Scott

On August 29, 2024, Mayor Scott released an Executive Order establishing the City’s approach to managing the restitution funds received, including provisions that:  

  1. Establish a separate Baltimore City Opioid Restitution Fund
  2. Establish a trust fund that will sustain the impact of these funds for at least 15 years
  3. Create positions in the Mayor’s Office including an Executive Director of Overdose Response and an Opioid Restitution Program Manager
  4. Establish a Restitution Advisory Board
  5. Outline key documents that the City will publish for accountability and transparency 

Want to learn more? Read the full executive order or the overview of the executive order. If you have comments or questions, please contact us at overdoseresponse@baltimorecity.gov.

Community Engagement

Part of the Mayor’s Executive Order charged the city government with developing a City Overdose Response Strategy to guide the efforts to address the opioid and overdose epidemic through programs, interventions, and funding. 

On December 17, 2024, the City published a draft Community Engagement Plan per the executive order. The Community Engagement Plan outlines a two-step approach to ensure the City’s Overdose Response Strategy reflects the current needs and gaps in services. The City also opened a public feedback period to gather input on the draft. That feedback period closed on March 15, 2025. Public feedback was incorporated into an updated version of the Community Engagement Plan, which was approved by the Restitution Advisory Board on July 30, 2025. View the final Community Engagement Plan.

As part of this engagement, the City hosted four Community Listening Sessions in July and August of 2025 to hear directly from residents about the overdose crisis and their recommendations for addressing it. These Community Listening Sessions took place in Cherry Hill, Penn North, Park Heights, and East Baltimore. See the presentation slides from these Community Listening sessions.

Public Transparency and Accountability Plan 

To ensure that the public could readily access information about the use of the ORF, Mayor Scott’s Executive Order also called for the City to release a Transparency and Accountability Plan. The Mayor’s Office of Overdose Response prepared a draft of this plan, which was released on December 17, 2024 and was open for public comment until March 15, 2025. With input and support from the Restitution Advisory Board, the Accountability and Transparency Plan was finalized and adopted on July 30, 2025. It includes expectations for information the City should include as part of its annual reporting on the use of the ORF. 

Consistent with expectations for annual reporting and the publication of information via dashboards established in the Transparency and Accountability Plan, the City published its annual report detailing how dollars from the Opioid Restitution Fund were used during Fiscal Year 2025. 

In addition, the Mayor's Office of Recovery Programs, with support from the Mayor's Office of Overdose Response, published a dashboard that provides detailed, regularly updated information about investments the City has made to date. The dashboard includes information about the total funds obtained, awarded, and allocated. It also includes organization-specific information about funded projects at City agencies and community-based organizations, including descriptions of each project, the approved use with which it aligns, the total amount committed, and the total amount spent to date. A future iteration of the Dashboard currently being prepared will also include organization-specific reporting on standard performance measures being provided to MORP and BCMOOR as part of commitments and grant awards.