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Maryland outlines overdose patterns, opioid settlement spending and federal grant reliance
Summary
DLS and the Department of Health discussed Maryland's overdose fatality trends, opioid settlement and grant funding, and how the state directs settlement proceeds through the opioid restitution fund and competitive grants to local jurisdictions and nonprofits.
Maryland Department of Health officials and Department of Legislative Services analysts briefed the Health and Social Services Subcommittee on Jan. 29 about overdose mortality trends, federal grant support for prevention and treatment, and how opioid-settlement proceeds are being used in the state.
Overdose trends and disparities: DLS presented CDC-derived data showing Maryland's overdose fatalities followed national trends through 2023 and 2024; although there was a small decrease between 2023 and 2024 overall rates remain high. DLS flagged disparities: the largest rate increase between 2022 and 2023 occurred among Black men over age 55, and aggregated increases were highest among Hispanic males, according to calendar-year comparisons cited by DLS. Baltimore City had the highest number of overdose fatalities and the highest fatality rate in the December 2023–November 2024 window, and several smaller jurisdictions exceeded the state average for fatality rate.
Federal grants and state spending: DLS summarized federal funding from the Substance Abuse and Mental Health Services Administration (SAMHSA), including the State Opioid Response grant and the Substance Abuse Block Grant. The State Opioid Response grant supports opioid-specific abatement and is currently in a multi-year grant cycle for Maryland; MDH had submitted an application for year 4 of the grant. The department has also used COVID-related stimulus funds to augment substance-abuse services funding in recent years. DLS asked MDH to clarify which behavioral-health initiatives were delayed and resulted in a fiscal 2025 negative deficiency of about $30 million.
Opioid settlement funds and the opioid restitution fund: DLS reviewed settlement receipts and the opioid restitution fund. As of the close of fiscal 2024, Maryland had received $158.4 million into the state opioid restitution fund across fiscal 2023–24, while local jurisdictions had received $42.8 million directly from settlement awards. DLS noted the state and local receipts have funded competitive and block grants to local governments and nonprofits, with limited use for data initiatives. DLS asked MDH for details on program delays that led to re-budgeting and for planned uses of settlement funds.
MDH response and distribution strategy: MDH officials said the state is moving to be more data-driven in directing resources, including releasing an opioid data dashboard with ZIP-code-level detail to target resources to the communities most affected. Secretary Laura Herrera Scott said the State Opioid Response team will manage settlement funds and planned a 2025 RFP for local grants. She said local partners in Baltimore receive significant funding through multiple streams, and the department aims to match funds to geographic needs as indicated by the data.
Other funding issues discussed: DLS also briefed the subcommittee on the cigarette restitution fund's revenue decline and recent cost-containment decisions that altered CRF allocations for Medicaid and other programs, and asked MDH and DBM to consider a BRFAA amendment to waive a statutory requirement for CRF uses in fiscal 2026 to align accounting and appropriations.
