Starting in 2026, Baltimore will begin spending in earnest the hundreds of millions of dollars it won in settlements with opioid companies.
The city still ranks as one of the highest in the nation for opioid overdose deaths, with nearly 800 in 2024 and more than 500 to date in 2025.
But many are wondering how the windfall of money will be spent in the coming years and if the funds will actually find a way to the people who truly need it.
A case study
In 2025 three mass overdoses hit West Baltimore’s Penn North neighborhood in three months, leading to more than 40 people hospitalized and massive responses from first responders and the city.
The area has been fetishized by local and national media as the epicenter of Baltimore’s opioid crisis, bringing reporters from far away to gawk at residents in the area as they go about their lives and leaving many frustrated that attention comes to the neighborhood only after dozens of people simultaneously collapsed from overly potent batches of opioids.
At Gethsemane Baptist Church just blocks from those incidents, neighbors are wondering what’s next for their neighborhood after the attention and if the resources.
Pastor Terrence Rogers has presided over funerals of those who have overdosed, handed out naloxone and opened the churches doors to those in need.
“I'm from this community. I love this community. I'm invested in this community,” Rogers said sitting in the office of the church.
Rogers calls Penn North a gem of Baltimore, with small businesses, a theater, and tight knit community.
But it’s also been hit hard by addiction, something he says is a symptom of systemic neglect.
“For years, this community has gone under invested in, but we have to stabilize and rebuild this community after decades of disinvestment,” Rogers said. “It’s poor infrastructure, they've had limited access to quality health care for years, there's been neglect for years. There’s been predatory systems for years, profit driven responses, right? Pharmaceutical industries. We're talking about exploitation, right? It is horrible. They prioritize billing over healing, it is only exposing what we've always known about this community, right?”
A generational opportunity
Penn North is just one neighborhood that hopes to see change as money is now flowing into Baltimore to atone for the opioid crisis that cost thousands of lives.
The city sued drug distributors and manufacturers like McKesson, CVS, Walgreens, Johnson and Johnson and the Sackler family independently because of the outsize impact of the opioid crisis on the city.
Instead of taking a $64 million global settlement, the city won more than half a billion dollars in court cases and settlements. About 40% of that will go to legal fees, but the rest is unfettered money that the city can use completely at its discretion.
In November, Baltimore used some of the first of those funds to set up free naloxone kits and instructional videos in its subways.
The city paired with the Maryland Peer Advisory Council (MPAC), a community organization to set up what are called ONEboxes.
The boxes, which are purple and white and look like first-aid kits, are affixed to the wall of the station. Once opened, the boxes have the reversal drug, personal protection equipment and a screen inside. The screen plays a video when the box is open, which instructs people in English and Spanish on how to use naloxone.
“The sites that we're creating are called purple sites,” said Tiffany Scott, president and CEO of MPAC. “We have one at Shake & Bake Family Fun Center, one in the library and other places too, such as businesses. We want to put them where people thrive, you know, and you know, and even if they're not thriving, just create a place where you can get access to it.”
Sarah Whaley, Baltimore’s director of Overdose Response, says two million dollars is being allocated for grants that will be given out by the Opioid Restitution Fund Community Grant Process, which focuses on community organizations like MPAC.
“They are the ones that are on the ground,” Whaley said. “These are people with lived and living experience, and so they are really in tune to what individuals who might have a substance use disorder, or what family members of a loved one with a substance use disorder like really in tune with what those individuals need in terms of support and connection to services.”
Baltimore set a legal framework and a plan for how the money can be used, focusing on harm reduction and reducing overdoses, but also expanding services for housing and healthcare.
The 2025 to 2027 strategic plan sets out a series of priorities to slow overdoses and reduce addiction.
The first of those priorities is to address disparities in the city’s overdose crisis by increasing access to harm reduction services, bolstering training, diverting people away from the criminal justice system and ensuring people have support upon leaving incarceration.
Further priorities include expanding ways people can get addiction care and finding ways to reduce the illegal drug supply.
The plan then goes on to address effective ways to develop non-emergency responses to people with substance use disorder and behavioral health needs and then coordinating housing, transportation and other assistance programs for people with substance use disorder.
Baltimore’s 2026 budget has $37 million allocated to begin the plan.
That money will expand the city’s mobile health clinic by 25 positions and build out triage services for emergency medical services.
Three million will expand the city’s homeless shelters and $18 million will go to specific non-profits focused on drug addiction.
Will people be left behind?
Hearing that the city has these funds at its disposal leads many dealing with substance abuse and lack of shelter wondering when they will see a difference.
Many feel spurned by the city and left behind after funds in the past went to the development of high-end or to whiter, richer neighborhoods.
“You can't keep waiting for tragedy to happen to come around here and try to try to make a difference,” said Larry Collins, a Penn North resident. “This is one of the worst areas of Baltimore City. It's definitely been forgotten, if not the area, the people, right?”
Andre Taylor, a resident of Penn North, said the overdoses this year were an effect of criminalizing poverty, and fears that the incident will give police more of an excuse to crack down on people and push them out of the neighborhood.
“The bottom line is, they're changing this area. Go down a little bit further, towards 83 on the left hand side, it has brand new housing starting at $300,000,” Taylor said. He added that a few years ago that area was called Murder Mall because of the amount of violence.
“Now in that area you go up and spit wrong, and the cops looking at you crazy,” Taylor said. “They're working their way up this area. They're taking, these urban areas like this, clean them up and turn them back over to the more richer people. That's what it is. Baltimore's been doing this for years.”
Tass lives farther in West Baltimore and has experience with addiction. We are only using her first name to protect her medical privacy.
“The police been cracking down more for nonsense,” she said. “Nobody's trying to help. Nobody. They are just trying to get them out of the neighborhood instead of trying to place them somewhere. They don't care. They place them in jail for little nonsense.
Tass says she wants to see hands-on care and investment in neighborhoods to address the systemic issues that feed addition.
