In Baltimore, the rate of overdose deaths has reached unprecedented levels, surpassing any other major city in the United States.
Over the past six years, we have tragically lost nearly 6,000 lives. The death rate during this period was almost twice as high as any other major city, surpassing even the toll of the prescription pill crisis in Appalachia, the height of rural meth labs in the Midwest, and the crack epidemic in New York.
Ten years ago, the number of drug-related deaths in this area was 700 lower each year. As the fatalities started to increase due to the powerful synthetic opioid fentanyl, Baltimore’s initial efforts to combat the crisis were praised as a model for the nation. The city established ambitious targets, made Narcan widely available, explored strategies to encourage individuals to seek treatment, and intensified public awareness campaigns.
City leaders were consumed by other urgent issues, such as gun violence and the pandemic, which diverted their attention from addressing the opioid overdose crisis. As a result, numerous initiatives aimed at combating overdoses came to a standstill, according to an investigation conducted by The New York Times and The Baltimore Banner.
Health officials started sharing limited data with the public. The increasing number of overdoses was rarely addressed or questioned by City Council members. The mayor, deputy mayor, and multiple council members were unaware of the city’s significantly worse status compared to other cities of similar size. However, they recently became aware of this when they were presented with data compiled by reporters from Times/Banner.
The city’s response to the overdose crisis has undergone a significant shift in recent years. The urgency that once drove officials to take immediate action seems to have waned. In comparison to previous years, the goals set for overdose prevention efforts have become fewer and less ambitious. The task force responsible for managing the crisis, which used to meet monthly, has only convened twice in 2022 and three times in 2023. Consequently, there has been a decline in the number of individuals revived by emergency workers, a decrease in the availability of medication to address opioid addiction through Medicaid, and a drop in the enrollment of individuals in publicly funded treatment programs.
During an interview, Mayor Brandon Scott stood by the city’s response to the issue. He acknowledged that Baltimore has been grappling with drug addiction for many years. While the analysis may shed light on the magnitude of the problem, it will not alter his administration’s approach.
Scott acknowledges that addressing this issue requires significant resources, and it is an area where they are actively working and will continue to put in more effort.
Other city leaders and health experts were alarmed when they were presented with the mortality figures.
“The numbers are truly alarming,” expressed Dr. Laura Herrera Scott, who has been serving as Maryland’s health secretary since 2023. She further emphasized, “We have not effectively allocated the necessary resources to the appropriate locations.”
The response to overdoses in Baltimore was thoroughly examined by journalists from the Times and The Banner. They carefully reviewed numerous government documents and conducted interviews with over 100 health officials, treatment providers, and individuals who have struggled with addiction. Through this comprehensive research, it became evident that the city’s leaders had failed to fully comprehend the magnitude of the crisis at hand.
State and city agencies are responsible for tracking deaths and reporting the total numbers to the U.S. Centers for Disease Control and Prevention. However, in Maryland and Baltimore, officials have chosen not to release more specific information about overdoses, often citing concerns about medical privacy. This lack of transparency has had a negative impact on public awareness of the epidemic and the ability to respond effectively, according to former city employees and community workers.
The Office of the Chief Medical Examiner in the state initially declined to release complete autopsy reports. However, following a successful lawsuit by The Banner, the agency was compelled to disclose the information. The reports now include details on the individuals who passed away, the location of their deaths, and the causes of death.
The individuals who were lost in Baltimore came from various backgrounds and professions, including a line cook, lawyer, bus driver, engineer, machinist, teacher, restaurant owner, carpenter, veteran, physician, salesperson, and admissions coordinator for an addiction recovery center. Among them were retirees and individuals who were currently unemployed.
Tragically, there have been cases where the victims were extremely young. According to the reports, since 2020, at least 13 children under the age of 4 have lost their lives due to drug exposure. Moreover, it is disheartening to note that black men between the ages of 50 and 70 experienced the highest mortality rates.
The public was oblivious to the majority of overdose deaths, despite a few cases making headlines.
The city has been confronted with a range of challenges, including a shrinking population, policing tensions, City Hall turnover, surging shootings, and the ongoing impact of COVID-19. As a result, there has been a notable rise in deaths.
A Perilous Elevation
Baltimore has consistently maintained one of the highest rates of fatal overdoses among major cities in the United States for nearly thirty years. However, during most of that time, the city’s death rate was relatively similar to the national average. Unfortunately, the current situation stands in stark contrast to this trend.
Baltimore has been grappling with a drug problem for quite some time, and officials have attempted to combat it through arrests and aggressive policing. However, the city has also taken a pioneering approach to address addiction by implementing innovative public health strategies. As early as 1994, the Baltimore Health Department was one of the first in the country to establish a legal syringe exchange program, aimed at curbing the transmission of HIV and other blood-borne diseases.
In 2006, the city and state invested millions of dollars to improve the availability of buprenorphine, a highly effective treatment for opioid addiction. As a result, there was a significant decrease in fatal overdoses, and Baltimore appeared to be making progress in addressing its heroin problem.
During that period, pharmaceutical companies flooded pharmacies nationwide with highly addictive pain medications. Each week, Baltimore alone received around 400,000 opioid pills such as oxycodone. This influx of drugs not only expanded the illegal drug market but also made it more accessible for individuals to become addicted to opioids or experience relapses. The situation was exacerbated by patients from both within and outside the city who resorted to selling their prescription pills in Baltimore.
Last week, the mayor’s office released a written statement claiming that the surge in fentanyl cases is a direct result of the excessive supply of pills from drug manufacturers and distributors. They also criticized The Times and The Banner for their coverage, accusing them of wrongly placing blame on the city’s response to the crisis.
The allegation made against the drug manufacturers resonates with a lawsuit filed by the city against multiple companies, scheduled to go to trial in September. However, Baltimore experienced a less severe prescription pill crisis compared to other parts of the country. Records from the Drug Enforcement Administration reveal that Baltimore received only one-fifth of the pills per capita compared to certain areas. Moreover, CDC and state data indicate that oxycodone was responsible for a relatively small number of deaths in the city.
The death rate stayed relatively low until the mid-2010s, when fentanyl started to saturate illegal drug markets nationwide.
Dealers have started adulterating heroin with fentanyl, a synthetic opioid that is significantly more potent and can be produced using inexpensive chemical compounds. Furthermore, fentanyl is now being mixed with cocaine, pressed into counterfeit prescription pills, and sold independently. According to drug-testing data, it has become nearly impossible to purchase illegal opioids in Maryland that haven’t been laced with fentanyl and other harmful additives like xylazine, which reduces the effectiveness of naloxone, commonly known as Narcan. As a result, the availability of pure heroin has drastically diminished in recent times.
In 2010, the overdose death rate in the city was at its lowest point in nearly 20 years, with only 29 deaths per 100,000 residents. However, over the next five years, this rate not only doubled but also doubled again, reaching 190 deaths per 100,000 residents by 2021. Tragically, an average of three individuals were losing their lives to drug overdoses every single day.
In the midst of a turbulent era
In 2014, Mayor Stephanie Rawlings-Blake took action by establishing a task force to address the disturbing increase in overdose deaths.
Dr. Leana Wen, the city’s health commissioner, took proactive measures to combat the opioid crisis. One of her initiatives involved distributing Narcan, a life-saving medication, to the public even before it became available without a prescription. Additionally, the Health Department provided extensive training to both police officers and the general public on how to administer Narcan effectively. To further support individuals struggling with addiction, a crisis stabilization center was established, offering immediate help after an overdose. Moreover, the department implemented an alert system to dispatch aid groups to areas with high overdose rates. In an effort to streamline access to treatment, a real-time capacity tracker was also introduced to assist patients and healthcare providers in locating available treatment slots.
The city took proactive measures to address the issue by implementing comprehensive strategies and placing emphasis on raising public awareness. They launched a website called DontDie.org, which aimed to effectively communicate the severity of fatal overdoses through impactful billboards and bus stop advertisements. The website was designed to leave a lasting impression on individuals, highlighting the urgency and gravity of the situation.
The city’s Law Department resisted the sharing of overdose data among agencies, often citing HIPAA, the federal law that safeguards patients’ medical information. Wen recalled that obtaining the necessary data to analyze overdose trends and treatment required significant effort and was only possible due to her team’s unwavering dedication to the subject.
As overdose deaths continued to rise, the next mayor, Catherine Pugh, faced criticism for expressing her concerns about the increasing number of treatment centers in local neighborhoods.
In October 2018, Wen left the agency, followed by Pugh’s resignation the following year amidst a corruption scandal. Pugh became the second mayor to face criminal charges in a decade.
When Scott was elected in November 2020, he stepped into the role of mayor amid the ongoing COVID pandemic. Prior to his election, an interim mayor had held the position for a year. As the former City Council president, Scott had long advocated for supervised drug consumption sites as a means to reduce overdose deaths. However, such sites have never received approval in Maryland.
Only 6 out of 160 addiction service providers ever posted their wait times, rendering the capacity tracker virtually unused. Regrettably, the city has decided to abandon this initiative.
The “Don’t Die” public awareness campaign has also faced challenges. The website ceased functioning around February 2023, as indicated by the Internet Archive. Additionally, the Health Department stopped providing updates on overdose pages on their website, and this hiatus lasted for several years.
Scattered Efforts
The efforts to address the issue have been scattered and disjointed. Various individuals and organizations have made attempts to tackle the problem, but there has been a lack of coordination and collaboration. This fragmented approach has hindered progress and made it difficult to achieve meaningful results.
Instead of working together towards a common goal, different parties have pursued their own agendas and priorities. This has resulted in duplication of efforts, wasted resources, and a lack of focus. With everyone working in isolation, there is little synergy and collective impact.
Furthermore, the scattered efforts have made it challenging to track progress and measure the effectiveness of interventions. Without a unified approach, it is difficult to determine what works and what doesn’t, making it challenging to scale up successful initiatives and learn from failures.
To address the issue effectively, there is a need for better coordination and collaboration among all stakeholders. This includes government agencies, non-profit organizations, community groups, and individuals. By aligning their efforts and working towards a shared vision, it is possible to achieve greater impact and make a meaningful difference.
To foster collaboration, it is important to establish clear channels of communication and mechanisms for sharing information and best practices. Regular meetings, workshops, and conferences can serve as platforms for exchange and learning. Additionally, the use of technology and digital platforms can facilitate collaboration and enable real-time sharing of data and insights.
By coming together and pooling resources, stakeholders can leverage each other’s strengths and expertise. This can lead to more effective interventions, improved outcomes, and sustainable solutions. It is only through collective action that we can overcome the challenges and make a lasting impact on the issue at hand.
In conclusion, the scattered efforts to address the issue have been ineffective and have hindered progress. To achieve meaningful results, there is a need for better coordination and collaboration among all stakeholders. By working together towards a shared vision, we can overcome the challenges and make a lasting impact.
Baltimore takes a comprehensive approach to addressing the issue of drug overdoses, involving multiple city agencies and community organizations. Many of these entities receive government funding to support their efforts. When there is a suspected overdose, emergency workers promptly respond to the scene and administer life-saving measures to revive individuals. A dedicated team is deployed to administer Narcan and distribute informational pamphlets to individuals in the vicinity. Additionally, Johns Hopkins doctors collaborate with the city by operating a mobile medical clinic from a van, ensuring that medical assistance is readily available to those in need.
Every year, both the state and federal governments allocate a significant amount of money to address drug addiction in Baltimore. In fact, Medicaid’s spending on treatment programs experienced remarkable growth in recent years, reaching a staggering $245 million by June.
Behavioral Health System Baltimore (BHSB), a publicly funded nonprofit organization with its board led by the city health commissioner, has been instrumental in providing grants for drug and mental health treatment. With the majority of its funds coming from state and federal sources, BHSB allocates over $50 million annually for these services. Although the organization does not specifically track its spending on addiction and mental health separately due to overlapping services, a comprehensive analysis conducted by The Times/Banner reveals a decrease of approximately $5.5 million in funding specifically designated for drug treatment between 2019 and 2023. It is important to note that this decline is partially attributed to Medicaid’s recent inclusion of certain services.
The city Health Department is responsible for coordinating all these efforts. They oversee the state-mandated Overdose Prevention Team, which is responsible for sharing data, identifying problems, and developing a citywide strategy. In recent years, the team has reduced its meetings to just a few times a year. In 2020, amidst the pandemic, they released a concise three-year plan with a focus on taking action and providing information on how people can obtain Narcan. However, there have been no updates or new plans published since then.
According to a statement from the Health Department, the committee has various working groups that meet regularly. However, the department did not disclose specific details such as the frequency of these meetings or the goals that have been accomplished. The department cited an ongoing lawsuit involving the pharmaceutical industry as the reason for not providing further information.
According to budget documents, the department’s workforce dedicated to addressing drug addiction and mental health consisted of only three full-time positions in 2022. However, this number increased to six in 2023 with the allocation of state funding.
The city only covers the cost of one of these positions. Its expenditure on the Health Department’s mental health and addiction budget has been relatively low, averaging $1.5 million per year since 2016. It’s important to note that this figure doesn’t take into account the expenses associated with overdose prevention programs run by other agencies or other divisions within the Health Department. Additionally, the staffing figures mentioned here may not include employees dedicated to these programs.
The City Council last received an update on overdose deaths from the department in 2020. The data provided at that time reflected the years 2017 and 2018, during which the fatality rate was 25% lower than the current rate.
Dr. Letitia Dzirasa, the former health commissioner who served as deputy mayor from 2019 to 2023, acknowledged that Baltimore had the highest COVID-19 infection rate in Maryland and surpassed other major cities in the region. However, she was unaware of its national ranking among all counties. On the other hand, Dr. Ihuoma Emenuga, the current health commissioner, declined multiple interview requests.
According to state data, the city’s public treatment system, which assists individuals without insurance or who are economically disadvantaged with addiction, witnessed a significant decrease of nearly 5,500 patients, representing a 16% decline from 2020 to 2023. Interestingly, despite this decline, the funding allocated to the system experienced a considerable increase. Additionally, there was a notable reduction in the number of Medicaid patients utilizing opioid addiction treatment medications, which have traditionally played a crucial role in Baltimore’s response to the opioid crisis.
According to state officials, the declines in medication payments could be attributed to the pandemic and a policy change in 2020 that enabled Medicare to provide coverage for such payments.
In 2023, there was a significant decrease in the number of individuals being revived from overdoses each year by emergency workers, with a drop of nearly 1,000 compared to 2018. However, during the same period, there was a notable increase in overdose-related deaths.
According to Herrera Scott, the health secretary, it is important for Maryland’s overdose response to be grounded in a comprehensive understanding of the data. She recognized that the department had faced difficulties with data sharing in the past, but assured that the state is now utilizing data to more effectively focus its initiatives. Additionally, the state intends to release information about deaths in specific neighborhoods, further emphasizing the importance of data-driven strategies.
During his annual State of the City address in March, Scott announced the formation of an overdose prevention Cabinet. This initiative was prompted by inquiries from reporters about the escalating number of overdoses in the city. While the administration did not provide many specifics, it did mention that the Cabinet would consist of key city officials.
