Mayor Brandon Scott laid out a detailed, multiyear plan Thursday for how he plans to use hundreds of millions of opioid settlement funds to stem Baltimore’s rampant overdose crisis.
In a sprawling executive order, Scott laid the groundwork for the city to begin spending money, with designs on slowing the death toll in a city where in recent years an average of three people have died from overdoses every day. So far, Baltimore has received $242.5 million from pharmaceutical companies, and officials expect hundreds of millions more will follow.
Thursday’s announcement is Scott’s first, in-depth public discussion of the city’s response to the overdose crisis since his administration clamped down on conversation and canceled public hearings about the topic at City Hall earlier this summer, citing pending lawsuits against pharmaceutical firms. In May, The Baltimore Banner and The New York Times published the first in a series of articles examining the scope of the issue, which found the city is experiencing the highest rate of overdose deaths of any major city in America.
Among the first expenditures is $20 million to the city Health Department to bolster work that’s already underway. Close to $40 million had already been earmarked for various nonprofits for substance use programs. Tens of millions — the exact amount is unclear — will go to attorneys, with more to be paid upon each future settlement or victory at trial.
The remainder of the money, an amount that could rival the $641 million the city received in federal pandemic aid, will be put into an investment trust with a minimum of 5% to be spent each year.
The trust, which one senior official compared to a college endowment, will be spent over at least a 15-year period, a slow drip of cash that city officials believe will be more sustainable in the long run than throwing gobs of money at the problem in the short term.
Flanked by supporters and City Council members, Scott stood in the rotunda of City Hall on Thursday morning and laid out his plan — the location meant to match the significance of the announcement. By eschewing joint settlements other governments reached with pharmaceutical companies, Scott took a gamble. It looks to have paid off.
“Over the course of the last two decades, the actions of major pharmaceutical companies have absolutely shredded our progress” by flooding communities with pills, the mayor said. “While we cannot undo the harm that has been done or bring back the lives that we lost, we can — and we are — taking decisive action to address this epidemic and prevent further loss of life.”
Under the mayor’s plan, spending decisions for the funds will go through multiple layers of review before final approval.
A new “Restitution Advisory Board” will make recommendations, which then will go before an “Overdose Cabinet” for review before the mayor makes the final call. Community organizations, health care providers and any city agency can apply for money from the trust fund, with the first allocations expected in July at the start of the next budget cycle.
The city will begin soliciting applications for membership on the Restitution Advisory Board Thursday. The board, expected to consist of 13 to 17 voting members, will include appointees by the mayor and several other top administration officials; two members of the City Council; and representatives from Baltimore’s public health and drug-impacted communities.
But some of the money already allocated was done so in secrecy, without any formal application process. As part of its settlement agreements with Cardinal Health, Allergan and CVS, the city stipulated that some of the funds, ranging from $1 million to $5 million, would go to select organizations.
In a call with reporters, officials declined to explain how those groups were chosen, saying that doing so could endanger ongoing settlement negotiations with other pharmaceutical companies.
Not all of the money will hit the city’s coffers, either. A large portion will go to Susman Godfrey, the law firm hired by the city to lead its opioid litigation for the last six years. Attorneys received $20 million, nearly half, of the first settlement with Allergan. Scott administration officials would not say how much of the total pot private attorneys will receive going forward, only that they are to be paid on a sliding scale with the high end being one-third of the settlement totals, plus expenses.
The firm took the case on a contingency basis, meaning its attorneys would only be paid if the city won, and has fronted all costs to date. A trial with remaining defendants in the city’s case is scheduled for Sept. 16.
The city has not published an overdose prevention plan since 2020. Scott’s executive order mandates a new plan be developed every two years. The city will also create a public dashboard tracking spending and provide annual progress reports to the City Council. The overdose director position should be filled by the end of the year, according to the administration.
The city is also without a permanent leader for its Health Department; Scott fired his health commissioner in July after learning she was the subject of a criminal investigation.
Public health experts have stressed the need for a clear process to ensure transparency on how opioid settlements in Baltimore, and elsewhere, are allocated. And having the money is not a guarantee things will improve.
“I know there’s an urgency to this issue, obviously that’s a total understatement,” said Regina LaBelle, director of the Addiction and Public Policy Initiative at Georgetown University Law Center. “I really believe it needs to be done in a really thoughtful way.”
Around the country, settlement money has begun to flow into state and local jurisdictions in recent years, as governments have reached joint settlements with multiple big pharmaceutical companies. Baltimore is one of relatively few jurisdictions nationwide that gambled by opting out of a joint settlement, betting that it could bring in more money by going it alone.
But experts in overdose prevention said many other jurisdictions have so far struggled to spend their money effectively.
Robin Pollini, professor at the West Virginia University School of Public Health, pointed to the challenges of taking such a large influx of cash and investing it in proven solutions that reach the most affected communities. Some in West Virginia have been scratching their heads about seemingly limited impacts from its settlement windfall so far, Pollini said, when state laws there make it difficult to bolster strategies such as administering methadone or distributing syringes.
Evaluating whether opioid settlement money is making a difference might look complex, but for Pollini, who began studying overdose deaths as a student at Johns Hopkins, the metrics that matter are relatively simple: Are overdose hospitalizations going down? Are deaths?
“My measurement is: To what extent did it reduce suffering?” she said.
