A Baltimore judge will soon decide the fate of a landmark opioid lawsuit. The beleaguered city hopes to obtain billions of dollars to redress an overdose crisis that has killed thousands of residents in the last decade. Harm reduction in Baltimore—including long-awaited overdose prevention centers—could receive an enormous funding boost as a result.
On December 17, the second phase of a trial at the crux of years-long litigation between the city and pharmaceutical companies came to a close. Baltimore City Circuit Court Judge Lawrence P. Fletcher-Hill is now expected to issue a written ruling as early as February.
The city is seeking $5.2 billion from McKesson and Cencora, formerly called AmerisourceBergen, to abate an addiction and overdose crisis it contends was fueled by the companies recklessly peddling prescription opioids and misleading the public about their addictive potential.
“The goal isn’t just for people not to die from overdose and to be in a treatment program, it’s for people to be able to do the things they want to do in their life — to get their house back, their kids back and to be productive members of society,” said Dr. Joshua Sharfstein, an expert witness helping guide the city’s overdose response who also serves as director of the Bloomberg American Health Initiative.
The city had initially sought as much as $11 billion, but amended the lawsuit, tailoring its plan to focus on only those who have struggled with pharmaceutical opioids or have opioid use disorder (OUD).
The plan includes increasing the city’s treatment capacity, augmenting harm reduction initiatives and opening overdose prevention centers.
The money would fund a 15-year, five-point abatement plan, which calls for increased investments in treatment; harm reduction; education; services for special populations, such as during pregnancy; and monitoring and implementation.
The plan includes increasing the city’s treatment capacity, augmenting harm reduction initiatives and, perhaps most notably, opening overdose prevention centers.
The city could reduce fatal overdoses by 50 percent under the plan, expert witnesses said, as well as tripling the number of people in treatment.
Baltimore currently suffers the highest fatal overdose rate among large cities in the United States. The model used by the city projects that 6,000 lives would be saved under the plan by 2038.
The city’s experts said in court that its current level of services is inadequate and must be expanded. The model estimates that more than 32,500 residents at any given time have OUD.
Controversially, the plan also aims to drastically reduce the amount of opioids prescribed in the city, projecting a 55 percent decrease.
While many people who use fentanyl or heroin began with pharmaceutical opioids, the vast majority of people who are prescribed opioids do not develop OUD. Nationally, a crackdown on opioid prescribing has been implicated in driving the overdose crisis to unprecedented levels. It has also been hugely detrimental to pain patients—a phenomenon that has spurred lawsuits elsewhere.
The city predicated much of its legal argument on the assertion that the opioid-involved overdose crisis was largely caused by “pill mills.”
Even so, the city predicated much of its legal argument on the assertion that the opioid-involved overdose crisis was largely caused by “pill mills” dishing out millions of opioids received from companies such as Cencora and McKesson.
In response, the defense’s attorneys said that the abatement plan failed to identify any faults in the companies’ practices. They also questioned the legitimacy of the city’s statistical model estimating opioid use disorder prevalence, which is largely what its cost estimates are based on, and why the plan did not factor in existing programs in the city that may already be funded.
The defense’s expert witnesses noted that the plan didn’t include a needs assessment, and argued that it failed to take into account “substantial” third-party funding for OUD programs or the “significant” coverage Medicaid provides for treatment.
“You have to know what funding exists before you move forward,” said Stephenie Colston, who runs a Florida-based consulting firm, adding that conducting a needs assessment and factoring in the city’s treatment capacity are “essential.”
There were 785 overdose deaths in Baltimore in the 12-month period ending in October, according to the latest preliminary data.
The first phase of the trial began in September. After an eight-week hearing, jurors ruled that the two companies must pay Baltimore $266 million for the “public nuisance” created by the opioid-involved crisis. It’s unclear if the ruling will be appealed.
When factoring in that money, the city is slated to receive nearly $670 million from opioid lawsuits in 2024. So far, the city has earmarked $107 million for local opioid remediation programs, as stipulated by settlement agreements with five companies.
All remaining funds will be disbursed through a governance structure that Mayor Brandon Scott (D) unveiled in August. Scott said he hopes the windfall will bolster harm reduction efforts and drive down the death rate.
There were 785 overdose deaths in Baltimore in the 12-month period ending in October, according to the latest preliminary data from the Maryland Department of Health. That equates to 134 deaths per 100,000 people when using 2020 US Census data.
Although the number dwarfs those of other Maryland jurisdictions, the data still put the city on a path to end 2024 with the lowest death toll in years. Experts have said they are cautiously optimistic about further reductions, as national rates also fall.
Photograph of Baltimore City Circuit Court Elijah E. Cummings Courthouse by Logan Hullinger