She introduced HR 5629 in late 2025. The bill states, “To provide that the final rule of the Department of Health and Human Services titled, ‘Medications for the Treatment of Opioid Use Disorder’ except for the portion of the final rule relating to accreditation of opioid treatment programs, shall have no force or effect.”

SAMHSA’s 2024 final rule sped up the timetable for methadone patients to “earn” take-home medication. It allowed patients to receive up to seven days of take-home doses during the first 14 days of treatment, and to receive 28 doses within a month. When implemented, this has been life-changing for people who would previously have been tied to daily clinic visits, with all the disruption and surveillance that entails.

Houchin’s bill would roll back all of this progress as the opioid-involved overdose crisiscontinues.

SAMHSA’s 2024 made permanent the loosening of restrictions that was temporarily introduced during the COVID-19 pandemic. It additionally allowed patients to be admitted to an opioid treatment program (OTP) without having to show at least a one-year history of opioid dependence, and permitted initiation of treatment with methadone or buprenorphine via telehealth.

Houchin’s bill would roll back all of this progress as the opioid-involved overdose crisis continues.

In March, the House Energy and Commerce Subcommittee on Health held a hearing on the bill. Houchin stated: “Medications like methadone are effective for some, but are also associated with serious risks, including respiratory depression, cardiac complications, potential for misuse and diversion and dangerous interactions with other substances, particularly in today’s environment where illicit drugs are increasingly potent and unpredictable.” She also falsely claimed that methadone-related overdose deaths increased during the pandemic as a result of SAMHSA allowing more take-home medication.

Her statement is classic scaremongering and ignores decades of evidence that show the efficacy of methadone—and crucially, that its use reduces overdose deaths by over 50 percent. The medication is the gold standard of treatment, has been studied for over 40 years, and is used safely by millions of people around the world.

The problem with methadone isn’t diversion or dangerous interactions, it’s accessibility. The medication is locked inside of clinics that make it difficult to enter and to stay in treatment because of rigid rules like daily dosing, constant urine testing, mandatory counseling and limiting take-home medication.

Houchin’s questions insinuated that strict regulations were needed to decrease methadone-involved deaths and stop diversion. Those DEA talking points have been debunked.

At the hearing, Rep. Houchin questioned Dr. Yngvild Olsen, the former director of SAMHSA’s Center for Substance Abuse Treatment, who was centrally involved in writing the updated guidelines. Houchin was openly hostile to Olsen, instructing her to answer questions with only a yes or a no.

Her questions insinuated that strict regulations were needed to decrease methadone-involved overdose deaths and stop diversion. Those Drug Enforcement Administration talking points have been debunked by numerous studies, conducted during and after the pandemic.

Though the updated SAMHSA rules relaxed some restrictive regulations, here’s the catch: They are only recommendations, and are unenforceable. It’s up to each OTP to decide if they want to enact any of them. Many do not, especially when it comes to more take-home bottles.

So why is Rep. Houchin pushing a bill that repeals unenforceable regulations? Her office did not respond to Filter’s requests for comment.

The Drug Policy Alliance is among many organizations that support the updated SAMHSA guidelines and warn of deadly consequences from Houchin’s bill.

“Nullifying these parts of the final rule would have devastating impacts on people trying to access medication by reinstating barriers to treatment.”

“The Drug Policy Alliance opposes HR 5629, which would nullify updated rules that the communities we represent fought for,” Daniel Fishbein, policy manager for DPA’s Office of Federal Affairs, told Filter. “Nullifying these parts of the final rule would have devastating impacts on people trying to access medication across the country by reinstating barriers to treatment for opioid use disorder.”

“Currently, 80 percent of US counties do not have an OTP, meaning many people who are prescribed methadone must travel hours and wait in line just to get one daily dose,” Fishbein continued. “Eliminating take-home doses could make it impossible for someone who relies on this lifesaving medication to continue care—putting people’s recovery at risk, throwing them into painful withdrawal, and potentially driving them back into the illicit market.”

The American Association for the Treatment of Opioid Use Disorder (AATOD), the trade organization that represents OTP interests, submitted a Statement for the Record expressing “serious concerns” about HR 5629. Over 25 organizations signed on.

“We oppose the elimination of the SAMHSA regulations,” AATOD President Mark Parrino told Filter. “The Congresswoman [Houchin] does not seem to like methadone treatment.”

AATOD’s opposition should be seen in light of the fact that updated regulations make it easier for more people to enter treatment, which increases clinic profits. For AATOD, the SAMHSA guidelines don’t really matter; clinics retain total control over patients and a monopoly on the dispensing of methadone.

The American Society of Addiction Medicine sent a conciliatory letter to Rep. Houchin, stating it is ready to work with her and, “collaborative revisions are needed to make HR 5629 great.”

The Legal Action Center sent a strongly worded statement opposing HR 5629 and urged Congress not to pass the legislation. The American Society of Addiction Medicine (ASAM) sent a conciliatory letter directly to Rep. Houchin, stating it is ready to work with her and, “collaborative revisions are needed to make HR 5629 great.” ASAM recommended she endorse the Modernizing Opioid Treatment Access Act, a flawed bill that limits office-based prescribing of methadone to a small group of specialists and would increase racial disparities in access to the medication.

Houchin’s bill is an extraordinary intrusion into the medical practice of providing medication for opioid use disorder. But so are the involvements of SAMSHA; of the DEA, which registers and regulates OTP; and of the 50 State Opioid Treatment Authorities that license clinics and often enact yet more inhumane regulations.

Current regulations in Houchin’s home state of Indiana are among the most restrictive in the nation. The maximum number of take-home methadone doses permitted there is 14. The number of clinics allowed to operate in the Hoosier state is capped at 27. And opening an OTP requires a “certificate of need” demonstrating why it should be opened—which allows not-in-my-back-yard (NIMBY) groups to mobilize against new clinics.

Opioid treatment programs, highly stigmatized and siloed off from mainstream medical care, are vulnerable to attempts by right-wing politicians to repeal even modest reforms.

Houchin voted for the passage of the “One Big Beautiful Bill” that will cut nearly 1 trillion from Medicaid over 10 years. Medicaid is the largest payer for substance use disorder treatment in the United States, and around 40 percent of people with opioid use disorder rely on the program for health coverage.

Opioid treatment programs, because they are highly stigmatized and siloed off from mainstream medical care, are vulnerable to attempts by right-wing politicians like Houchin to repeal even modest reforms and to keep methadone locked in carceral clinics where patients are surveilled and punished for any rule infraction.

The only way to end these legislative attacks on people who take methadone and to free them from opioid treatment prisons is to end the separate and unequal clinic system, allow all health care providers to prescribe methadone, and integrate the medication into health care and community settings.  

Photograph by Helen Redmond

The Influence Foundation, which operates Filter, previously received a restricted grant from DPA. Filter‘s Editorial Independence Policy applies.

The post Federal Bill Would Roll Back Modest Progress on Methadone Access appeared first on Filter.

The score, which uses a machine learning approach called cognitive computing, is one of many innovative artificial intelligence tools that strive to reduce drug-related risks. But the first external evaluation of the model, recently published in the Journal of General Internal Medicine, found discouraging—if not dangerous—results.

Comparing Epic’s risk score to reality for over 700,000 patients, the evaluation reports that the model did accurately rule out low-risk patients. But it only caught around 8 percent of the patients who did go on to experience an overdose or receive an OUD diagnosis.

The Opioid Risk Score aims to facilitate overdose prevention and enhance primary care physicians’ efforts to detect and treat OUD as early as possible. Since it uses information already available in a patient’s electronic health record (EHR), the Opioid Risk Score could be a lightweight yet powerful addition to physicians’ toolkits.

“Basically, they’re trying to predict if a patient comes into a primary care appointment, what level of risk they are for developing opioid use disorder or having an overdose in the next year,” study co-author Dr. Stephanie Hooker, of HealthPartners Institute, told Filter. “If you know who might be at higher risk, you can appropriately direct the resources to try to prevent overdoses or to treat people who have opioid use disorder.”

Over 2,000 patients experienced an overdose or OUD diagnosis, but Epic’s system only flagged 185 of them as high-risk.

To test the model’s accuracy, the researchers pulled patient data from three health care systems—two rural sites in Pennsylvania and along the Minnesota-North Dakota border, plus an urban hospital system in Minneapolis. They compared Epic’s prediction to the actual outcome for 704,764 patients across 92 primary care clinics.

The model struggled to correctly identify high-risk patients, producing a concerning amount of false positives and false negatives.

“Most of those people [flagged as high-risk] didn’t go on to have an ‘event’—a diagnosis of opioid use disorder or overdose. That’s the false positive rate,” Hooker explained. “The false negative rate is that most of the people who do go on to have an event are classified as not being at risk.”

Hooker believes the false negative rate is particularly concerning. Over 2,000 patients experienced an overdose or OUD diagnosis, but Epic’s system only flagged 185 of them as high-risk.

The Achilles heel of Epic’s model may be its reliance on EHR data. Integrating with a patient’s medical records is a seamless design, but health data give only a partial perspective on a person’s life circumstances.

“EHR data is somewhat limited … Sometimes the things that we have easily available may not be the most salient predictors.”

Filter reached out to Epic, but representatives were not able to provide comment by publication time.

“EHR data is somewhat limited in terms of the things that we collect regularly on people. Sometimes the things that we have easily available may not be the most salient predictors,” Hooker said. “We don’t have a lot of data on social situations or other risk factors that might be more related to actually developing a substance use disorder or having an overdose.”

Design choices made by engineers removed from health care settings may also impair the model. For example, the risk score was designed with an intentionally high tolerance for false positives. Physicians should expect only one out of every 10 people flagged as high-risk to experience an adverse outcome.

“I think in clinical practice, that’s too high,” Hooker said. “A clinician wants to know, ‘If I’m going to use this tool, is it actually going to improve my decision-making to an extent that I’m not wasting my time?’”

Another salient issue is that the risk score treats overdose and OUD diagnosis as a combined outcome.

“What that does is kick everybody with existing opioid use disorder out of the model—you can’t predict overdoses in people who have OUD, because [OUD itself is] an outcome,” Hooker said. “So that’s the main issue, I think—that those people are not included in this risk model.”

To improve future performance, Epic could consider developing separate models for OUD and overdose, or reducing the system’s tolerance for false positives. But on a more fundamental level, Hooker believes that health care companies need to think critically about developing AI tools, and test them thoroughly.

”What are the reasons we would actually want to implement something like this, before we do it? And is it going to improve patient care?” she asked. “In this case, I think that the model was just put out there.”

“Any tool that could affect a patient’s treatment should face a lot more scrutiny. The bar needs to be raised.”

Dr. Nicole Fitzgerald, a postdoctoral research fellow at Columbia University’s Mailman School of Public Health who specializes in the early detection of emerging drug trends and risks, was also alarmed that Hooker’s study was the first real test of Epic’s model.

“Any tool that could affect a patient’s treatment should face a lot more scrutiny,” she told Filter.  “The bar needs to be raised in terms of the requirements for external validation before widespread deployment of these models in commercial health systems.”

Fitzgerald also pointed out weaknesses with the data and math that underlie the Opioid Risk Score. The “training data” used to calibrate the model are from 2015 to 2018—a period largely out of sync with the contemporary drug landscape. Additionally, the mathematical formula that turns these data into a score is relatively rudimentary.

“Other machine learning approaches are more adaptive, multisource and real-time,” she explained. “The way that people are using opioids—and the opioids themselves—have changed dramatically over the last couple years, and the opioid overdose crisis has evolved. That’s not captured here.”

Despite the shortcomings of individualized risk predictions, data-driven approaches to harm reduction—including, but not limited to, machine learning and artificial intelligence—still hold promise.

“Right now, the applications showing the most promise are operating at the population and drug supply level—not necessarily at the level of an individual clinical prediction,” Fitzgerald said. 

Wastewater testing is one such intervention. It provides a passive, anonymous indicator of local drug consumption that can inform where and how community organizations provide safer use supplies. Machine learning may also supercharge drug checking by speeding up mass spectrometry.

“There is value in this technology, so I’m hoping we can deploy these tools where they’re most valuable and least harmful.”

Most importantly, these population-level innovations capitalize on the enormous predictive power of machine learning without introducing as many risks to the individuals and communities who use them.

“When a wastewater alert algorithm produces a false positive, a public health team might just end up deploying some resources slightly earlier than necessary, or distributing naloxone when they might not have needed to, but that’s a net benefit to the community,” Fitzgerald explained. “But when an EHR-embedded risk score produces a false positive, a patient’s clinical care may be impacted. They could be stigmatized … or denied pain treatment. Those are real clinical harms.”

Ultimately, effective implementation of AI boils down to the same principles that already guide harm reduction efforts: weighing the potential benefits and harms, making decisions in consultation with the community, and designing solutions based on evidence rather than stigma.

“There is value in this technology, so I’m hoping we can deploy these tools where they’re most valuable and least harmful,” Fitzgerald concluded.

Photograph (cropped) by Elen Sher on Unsplash

The post Primary Care “Opioid Risk Scores” Poorly Predict Individual OD Risk appeared first on Filter.

On December 17, 2025, Phoenix City Council voted 8-1 to approve the ban. The ordinance makes it a Class 1 misdemeanor to sell or exchange syringes, distribute harm reduction kits or hold events for the purpose of providing medical care in parks without prior city approval. It was due to take effect on March 30. But on March 3, the council accepted a request to push it back to June 1.

District 7 Councilmember Anna Hernandez was the only vote in opposition to the original ordinance. “The foundational issue here is that we do not have enough shelter space or housing for folks to live and folks don’t have health care access,” she told local media outlet CALÓ News in February. “So mixing those two things together and now making a barrier for these providers to provide that care, I think is going to be detrimental to this community.”

“They are consistently pointing to neighbors who have logged complaints about litter, medical supplies and discarded syringes.”

Shot in the Dark (SITD), a Phoenix-based volunteer harm reduction provider, has opposed the ban from the start. Member Brian Thoi explained how SITD does mostly outdoor distribution. They don’t have a fixed office location, so the volunteers set up folding tables or tents in places that are easily accessible to people in need, handing out supplies and receiving used supplies.

“We’re trying to get some concrete answers from the city,” Thoi told Filter. “They are consistently pointing to neighbors who have logged complaints about litter, medical supplies and discarded syringes in the parks, as well as feeling uncomfortable being in the presence of medical services provided to people in the park.”

Distribution of sterile syringes, naloxone, fentanyl test strips and other supplies by harm reduction organizations was only authorized in Arizona by a 2021 bill. State law allows cities, counties and private organizations to “establish and operate a prevention program,” with requirements that they provide safe needle disposal, syringes in “sufficient” quantities to prevent reusing or sharing, referrals to substance use treatment and mental health care by request, and education on overdose prevention, peer recovery and prevention of bloodborne disease.

Several state and local organizations have come out against the Phoenix ban. The ACLU of Arizona put out a call to action, inviting supporters to urge the city council to vote no on the ordinance. After it passed, the ACLU condemned the result.

“Outreach in parks is often people’s first, and only link to detox, treatment, or housing,” said Darrell Hill, policy director for the ACLU of Arizona, in a statement. “By targeting healthcare and aid workers trained to meet people where they are, the city is eliminating one of the most effective pathways into recovery.”

As Thoi explained, the council initially passed the ordinance with a 90-day delay, and a council member added an instruction to city staff to research policy issues and potential legal conflicts created by the ban. Confirmation of the new delay to June 1 means, Thoi said, “We are looking at the next few months to engage deeper into advocacy with city council and staff.”

“Participants have maybe interpreted it to mean harm reduction services are banned throughout the city. People have been letting us know they won’t be going out to our sites any more.”

Though the ban is not yet in place, Thoi stressed that it is already harming his organization’s work and the people they serve.

“It’s taking time and energy away from running our programs and services and being put instead into engaging with city staff,” he said. “What we’ve been seeing from a lot of our participants is they’ve heard the reporting on this, and maybe interpreted it to mean harm reduction services are banned throughout the city of Phoenix.”

That confusion has severe consequences. “People have been contacting our info line and letting us know they won’t be going out to our sites any more,” Thoi said, “because they have heard we have been banned or they’re not expecting us to be there.”

“If you want to make a permit system for having events in the park, and don’t want to give me a permit, that’s one thing,” he added. “But to ban harm reduction as a solution to these issues, I wonder what the knock-on effects of this will be. Are we going to see other cities take on these sorts of bans that will affect our work in other parts of the Valley?”

The ban is the latest Phoenix action targeting people experiencing homelessness, in the wake of the 2024 Supreme Court Grants Pass decision, which ruled that city and state governments have the constitutional right to evict people from outdoor encampments even if no shelter beds are available. The city council voted in May 2024 to ban camping within 500 feet of schools, public parks and other locations.

“It will lead to more overdose in the parks, and more 911 calls of people passed out or even dead.”

Based on Phoenix’s January 2025 point-in-time count, homelessness increased 3 percent from 2024-2025, largely driven by an increase in people living unsheltered (up 28 percent). The Maricopa Association of Governments noted that federal funding meanwhile expired for 1,000 shelter beds in the region, as rental costs increased and access to elder care and mental health care services remained limited.

Phoenix has seen a slight downtick in overdose deaths. According to Maricopa County data, deaths decreased 3.5 percent from 2023-2024, but were still higher than in 2020. Restricting vulnerable people’s access to harm reduction resources and referrals threatens this slow progress.

The impending parks ban has also activated other providers. Claudia McCormick-Vargas, a volunteer with Street Medicine, leads outreach in city parks with students from Arizona State University to deliver pet food to unhoused pet owners.

“We asked our students, is there a need, can we help?” she told Filter. “They told us they often see homeless people with their pets at harm reduction clinics on Friday afternoons. That’s how we started helping out. I started to see all the good work that both our students and the harm reduction group Shot in the Dark was doing with our homeless population. I thought it was great that our students were providing medical care and SITD was providing harm reduction supplies.”

The ban, she said, “will have a big impact. These are volunteers that have built a presence and relationships meeting homeless people where they’re at. People trust them and look for them. If this ordinance goes through I don’t see how it will be helpful with the homeless population in our parks. It will lead to more overdose in the parks, and more 911 calls of people passed out or even dead.”

Living on the street can be dangerous anywhere. But in Phoenix, brutal summer heat can kill in a matter of hours. The past several years have seen record high temperatures, with hundreds of heat-related deaths recorded in summer 2025. The climate crisis cruelly intersects with both homelessness and drug use: An estimated 40 percent of deaths were of unhoused people, and two thirds of cases involved drug use.

“Some of the needs I’ve seen are just basic hygiene and water,” McCormick-Vargas said. Despite being asked for it, “We’re not allowed to bring food. Some of the needs I see are for needles, condoms or lighters. In the summer people need to keep their electrolytes up if they’re outside.”

“We’re not going to let ourselves be pushed out of our community just because of some nosy neighbors.”

Thoi said that if the ban ultimately takes effect, his organization will have to adapt in ways that could expose volunteers and the people they serve to more risk.

“The reality is, even though it would be sad for us to be excluded from the parks, we will continue to operate as we have in the past,” he said. “We will just be subject to being in places that aren’t as safe. We’ll be in canal paths and vacant lots instead of a well-lit, maintained place that’s accessible to public transit and for people with disabilities. We’ll be pushed further out into the margins to places where maybe it’s dangerous for our participants and volunteers to operate.”

They’re sure of one thing, however: “We’re not going to let ourselves be pushed out of our community just because of some nosy neighbors.”

Photograph via City of Phoenix

The post Impending Parks Ban Looms Over Phoenix Harm Reduction Efforts appeared first on Filter.

Harm reduction and recovery support haven’t always been priorities on campus. The student-led group that runs these programs, Recovery at Cal, was largely dormant until 2021, when a passionate group of students fought to bring it back to life.

“We identified three pillars … of what the program would require to be substantial and supported meaningfully,” co-founder Johnny Smith, who graduated from Berkeley in 2024, told Filter. “Those three things were having full-time staffing, some sort of recurring institutional funding and a fixed, dedicated private space.”

Drawing on Berkeley’s success, student advocates continue to urge the highest levels of university leadership to implement these pillars across all 10 University of California campuses.

California’s flagship universities aren’t the only schools reckoning with growing demand for harm reduction and recovery programs. Across the United States, colleges have steadily implemented opioid overdose trainings, naloxone distribution programs and other initiatives aimed at helping students navigate an uncertain drug supply.

Across a broad range of institutions, the pathway for implementing strong programming was strikingly similar.

A new study published in the American Journal of Health Education interviewed 25 university leaders to understand how colleges build support for this programming and what makes their initiatives successful. It reports that advocacy by students and staff, thoughtful collaborations with community partners and state policies mandating that colleges provide overdose prevention resources have driven the rapid expansion of campus harm reduction efforts.

“A growing number of schools are implementing overdose prevention policies or expanding access to naloxone on their campus,” study co-author Christina Freibott, of Boston University, told Filter. “Either there’s state policies requiring them to do so, or there’s advocacy … from the student level or the community level to have these resources available.”

The researchers selected their sample of 25 schools to maximize representation, interviewing upper-level student health staff from public and private universities with enrollment ranging from less than 3,000 to over 20,000 students. They also included community colleges and specialized schools, such as an arts college.

Even across such a broad range of institutions, the “pathway” for implementing strong programming, as Freibott calls it, was strikingly similar.

“A lot of schools have really creative and impactful collaborations with community-based organizations … That was the next step before implementing a more in-house program.”

Like at Berkeley, student advocacy was often the first step. Once students identified a need and rallied to fill it, universities tended to bring in external partners such as community organizations, to distribute resources or host training sessions.

“A lot of schools have really creative and impactful collaborations with community-based organizations that provide overdose prevention training or have access to naloxone that they can distribute throughout the school,” Freibott explained. “That was the next step before implementing a more in-house program, or something that [the universities] took ownership of themselves.”

For many schools, the biggest challenge to establishing these initial partnerships was convincing students and staff, particularly those in control of the budget, that such resources are necessary on campus.

“[T]here’s a perception that college students are sort of immune or not a population of major concern for opioid overdose,” Freibott said. “A lot of administrators that I spoke to were tasked with shifting the narrative.”

In an attempt to increase awareness, schools often reframed opioid overdose as “poisoning.” That’s language that many harm reductionists argue promotes punitive narratives about drug use or assigns blame unjustly.

Freibott acknowledged the problems of this approach, though she added that when “poisoning” language mirrors how many universities already talk to their students about the risks of alcohol, it “often helped just sort of flip a switch in people’s brains.”

Recent legislation, however, has decreased reliance on such tactics in some places. More state policies than previously require that publicly-funded higher education institutions provide naloxone access and overdose education to students and staff.

“It sort of removes the need to garner that internal support,” Freibott said. “Schools are finding it very helpful as a way to sort of reference, ‘Well, we’re doing this because the state requires it.’”

It’s still not enough. While most states now allow schools and staff to carry and administer naloxone, only a minority mandate it—though in 2024 alone, at least a dozen passed laws to increase access in settings including higher education.

“It’s so critical that it’s a student-led initiative that welcomes institutional support … that really makes up the most effective dynamic.”

The extent of these policies also varies. While Florida requires that universities maintain a supply of naloxone in all residence halls, for example, California’s Campus Opioid Safety Act mandates that university students also receive “educational and prevention information.” Maryland is another state that mandates both stocking naloxone on campus and providing students with overdose prevention education.

Advocates hope that the adoption of more state-level policies will help protect campus harm reduction, amid the Trump Administration’s systematic defunding of both higher education and harm reduction programs.

“[This study] happened before some of that federal shift happened, so it’s not yet known how that may affect the state-level policies, but I do know that a growing number of states are implementing these policies,” Freibott said.

Even as state policies push more universities to establish overdose-related programming, student support remains essential to their success. Reflecting on the impact of Recovery at Cal, Smith urged universities to embrace a bottom-up approach, deploying their institutional staff and funding in service of student-driven programming.

“It’s so critical that it’s a student-led initiative that welcomes institutional support,” he said. “It’s that sort of synergy that really makes up the most effective dynamic.”

Photograph (cropped) of UC Berkeley campus by Mizzlbrd via Wikimedia Commons/Creative Commons 2.0

The post Campus Harm Reduction Fueled by Student Advocacy, Some State Policies  appeared first on Filter.

Close to $1 trillion will be cut from Medicaid over 10 years, under the One Big Beautiful Bill Act that President Trump signed in July 2025. Medicaid is the biggest payer for substance use disorder treatment in the United States, and around 40 percent of people with opioid use disorder rely on the program for health coverage.

Specific cuts and further threats apply to naloxone provision, medications for opioid use disorder, harm reduction research and much more. 

Then in January, the administration abruptly slashed $2 billion from Substance Abuse and Mental Health Services Administration (SAMHSA) grants to public health and social programs, including harm reduction—before reversing the decision the very next day. The impacts on scrambling providers were still real.

“As far as scaling up to meet the community’s need, that’s not the conversations providers are having. It’s really about survival mode.”

The Legal Action Center (LAC) works for health justice, advocating for the rights of people impacted by criminalization, substance use disorders and HIV. To help get a sense of the current damage and future prospects, Filter spoke with Gabrielle de la Guéronnière, LAC’s vice president of health and justice policy. Our interview has been edited for length and clarity.

Tana Ganeva: What’s your overview of the situation with the cuts, and how they threaten access to care and harm reduction for people who use drugs? 

Gabrielle de la Guéronnière: We’ve been very concerned. It’s been a very challenging time for people who are running programs on the ground. People are trying to help people stay healthy and stay alive, and there has been a lot of confusion from the administration in a number of different ways, and a lot of really concerning, harmful rhetoric that’s very stigmatizing toward the people who are being served by those programs and toward people working in those programs.

Suggesting that these are dangerous services, that they are not evidence-based, that they are ineffective, and that they shouldn’t receive support—when we know that they are evidence-based. They are extremely effective in preventing infectious disease, and also in connecting people who would like substance use disorder treatment and recovery services to those services. 

So it’s been a very difficult, challenging time. 

TG: What was it like for programs that were told, if only for one day, that their grants were going to be cut under the January SAMHSA defunding decision?

GdlG: Programs received notification that grant funds would be terminated immediately—and we know that people lost their jobs because of that, because programs were told that this was happening, that funding would not be coming. And so in very real terms, we know that there were programs that were impacted. 

When you think about how difficult this work is, when we know how many people are at risk for overdose and are at risk for all kinds of other health problems, the focus should be what [harm reduction programs] need and doing what they do best, which is providing those critical health services, because they are health services.

Instead, providers are worrying about how they’re going to keep the doors open. As far as potential expansion or scaling up to meet the community’s need, that’s not the conversations people are having. 

It’s really about survival mode. It’s hard to forecast. And nonprofits need to forecast. It’s very difficult. 

“We are very worried with what we’ve seen with the work requirements for Medicaid … They are forecasting that millions of people will lose health coverage.”

TG: Without being in the administration’s heads—a scary place—can you guess why, having yanked the SAMHSA funding, they then reinstated it?

GdlG: I think one positive thing has been that there are a lot of people in both parties who understand the value and the need for funding for these services around the country. 

We immediately saw that policy change, literally overnight, because there were all kinds of stakeholders who weighed in with their members of Congress, and talked about how critical these dollars were, both substance use funding, and mental health dollars that help people in their community to get healthy, to maintain their health, to prevent all of the different harms that could occur if someone’s disconnected from care and services and supports and medications. 

TG: Then there are the massive cuts to Medicaid over 10 years. What do you make of that, and what is LAC doing to try to mitigate the impacts?

GdlG: We’re extremely concerned about the Medicaid cuts. We do a lot of work with people who have substance use disorders, have mental health conditions, have histories of incarceration, and face a lot of stigma and discrimination in the job market. 

We are very worried, too, with what we’ve seen with the work requirements—as different states have tried work requirements, and attaching that to Medicaid—that people who are working often lose coverage, because the administrative burden is really difficult. 

So they are forecasting that millions of people will lose health coverage. We’re extremely concerned about that, and doing a lot of work to try to engage with decision-makers, and states and localities and stakeholders, to try to help people to maintain coverage. It’s so critical to helping people stay safe and alive. 

TG: In the wake of all this, do you envision a spike in overdose deaths? 

GdlG: I worry about that. There are many people who worry about that, that people are vulnerable, and if you make it harder for them to be able to access health care, it’s going to make it more difficult for them to stay healthy. Our whole health care system is very unaffordable and it’s a very challenging time with the economy and getting jobs. So we’re worried about it. We’re very worried about it. 

“There are a number of things that states can do to try to minimize the burden on individuals … There are ways that you can create systems to protect people.” 

 

TG: Looking ahead, in terms of these and potential further cuts, what are your worst fears? And do you see any more encouraging signs?  

GdlG: We were pleased that the conferenced fiscal-year 2026 Labor, Health and Human Services, and Education bill, which President Trump signed into law, increases SAMHSA funding by $65 million over last year’s levels. We appreciate the continued strong bipartisan support in Congress for treatment, prevention and recovery services.

We continue to be extremely concerned about the administration’s repeated attempts to claw back Congressionally appropriated funds which have created huge uncertainty and upset for community-based programs providing life-saving services in our communities.

We are also extremely concerned about the administration’s continued negative, inaccurate rhetoric and damaging actions related to harm reduction services. Harm reduction strategies and interventions are evidence-based health services that are effective in meeting the health-care needs of people who use drugs, and connecting people who need and want it to substance use disorder services, medications and support in treatment and recovery. 

Precluding the use of federal dollars for critical harm reduction services will make it more difficult for community programs to keep their doors open, will make communities less healthy, and will put more people at risk for overdose.

TG: What’s the best realistic outcome in the next couple of years? What can be done to adapt?

GdlG: There are a number of things that states can do to try to minimize the burden on individuals. There are different systems they can set up, so if they have data about a person’s health history or work history, they can use that data to demonstrate that that person qualifies for an exemption to the work requirements [for certain Medicaid enrollees]. 

There are a number of provisions that create exemptions—for people who are in certain kinds of substance use to start treatment, or people who have recently reentered from incarceration, or a person who has a chronic, serious health condition. There are certain protections there, so there are ways that you can create systems to protect people. 

There are also wonderful people in our field, who will be working to really protect people and ensure that people are able to demonstrate what they need to, to maintain coverage. It’s really going to take all of us working together to make sure people can continue to access coverage and care.

Photograph by Nikolaos Dimou via Pexels

The post “Survival Mode” Amid Trump’s Health Care and Harm Reduction Cuts appeared first on Filter.

The state opioid response (SOR) grants totaled $1.485 billion, and appear to have gone to the same 58 recipients as in 2024, in the exact same amounts. The largest individual SOR grant was $105,677,209 awarded to the California State Department of Health Care Services. Six grants of $500,000, the smallest amount, were awarded to health departments in four US territories, the Federated States of Micronesia and the Republic of Palau.

The Tribal opioid response (TOR) grants total $63 million and also appear to have gone to the same 139 recipients as in 2024, also in the exact same amounts. The largest TOR grant, by a significant margin, was $9,044,061 to the Northwest Portland Area Indian Health Board; only a small handful of recipients received more than $1 million, and the average grant was for less than $500,000. The smallest was $118,108 awarded to Scotts Valley Band of Pomo Indians. 

On September 23, SAMHSA announced that eligible recipients would receive a total of $18 million in supplemental funding through the Substance Use Prevention, Treatment and Recovery Services Block Grant.

SAMHSA “strategic priorities”

Earlier in September, SAMHSA announced new “strategic priorities” that explicitly renounce housing-first and harm reduction models and target drug users who don’t have housing, as the administration has increasingly done since an executive order in July.

“SAMHSA grants will prioritize evidence-based programs and deprioritize programs that fail to achieve adequate outcomes, including so-called ‘harm reduction,’” the agency stated. “Additionally, SAMHSA will not support drug injection sites for illegal drugs, or so called ‘safe consumption sites,’ or the use or distribution of illegal drugs and associated paraphernalia.”

The agency detailed at length its intention to “increase competition among grantees” and ensure that funding went to programs that rejected the “housing first” model, and Community Behavioral Health Clinics that embraced civil commitment. It stated that priority would be given to grantees that met five main criteria: “enforce prohibitions on open illicit drug use”; “enforce prohibitions on urban camping and loitering”; “enforce prohibitions on urban squatting”; civil commitment; and surveilling people on sex offender registries, particularly those with no fixed address.

The strategic priorities also reference a letter to state partners “ending harm reduction,” which the administration published in July days after the executive order. The letter declared that overdose reversal would no longer be conflated with other forms of harm reduction, stating explicitly that no federal funding could be used to purchase syringes, safer smoking pipes, “drug paraphernalia,” sterile water, saline, ascorbic acid or “any other supplies to promote or facilitate drug use.”

The primary effect this will have is creating more confusion and fear around which services are eligible for funding, or legal to offer in the first place. The bans themselves are redundant—syringe service programs (SSP) have never been able to use these funds to purchase syringes. While it’s a misconception that no funds from any federal agency can be spent on syringes, that’s essentially the effect because no federal funds from SAMHSA can be spent on syringes. The ban also already extends to “drug preparation equipment.” Glass pipes for safer smoking were explicitly excluded from the funding in 2022 under the Biden administration.

“SAMHSA will no longer be sidetracked by misguided policies, investments in unsupported clinical interventions, and any unlawful focus on specific populations,” the agency stated in its strategic-priorities announcement, referencing its intent to also defund diversity, equity and inclusion initiatives. “Lasting sobriety and recovery will be tenets of our work to ensure a return to a productive, fulfilling and healthy life for every citizen.”

Top image (cropped) via Madison County, New York. Inset graphic via Substance Abuse and Mental Health Services Administration.

The post SAMHSA Awards Opioid Response Grants Amid New “Strategic Priorities” appeared first on Filter.

On August 14, the city accepted an offer from Baltimore City Circuit Court Judge Lawrence P. Fletcher-Hill in a landmark case that will leave it with $152 million in its lawsuit against opioid distributors McKesson and Cencora (formerly AmerisourceBergen), though appeals are still possible. The city had initially sought billions of dollars to fund a comprehensive abatement plan.

“This award still dwarfs the original amount the City would have received, had we not brought this separate litigation on behalf of our city,” Mayor Brandon Scott (D) said in a statement. “This is also the only successful jury verdict and the only successful judgment against either of these companies.”

Baltimore officials took the deal quickly; they had until August 22 to make a decision.

The mayor’s office did not respond to Filter’s questions about the deal’s potential impact on overdose prevention plans, but they will undoubtedly take a hit. The mayor instead focused on the smaller windfall the city did manage to secure.

“Generations of Baltimoreans have lost loved ones to substance use as a direct result of the opioids that Big Pharma pushed on our neighborhoods,” he said. “While no amount of money can ever undo that harm, this award will help us expand our recovery programs, prevent future overdose deaths, and finally break the cycle of substance abuse in Baltimore.”

The deal reached by Fletcher-Hill and the city came from a ruling on August 8, when the judge offered the city just $100 million of the $5.2 billion in abatement funds it had hoped for. He also reversed a $266 million jury verdict for “public nuisance” damages last year, leaving only $52 million of that on the table.

At issue, the judge said, was that the city failed to prove that the two opioid distributors were responsible for 97 percent of the opioid-related damages Baltimore had experienced, which was at the crux of its lawyers’ arguments in court.

Baltimore officials took the deal quickly; they had until August 22 to make a decision.

“There isn’t any amount of money that can give us back those we’ve lost … But this money, if put into the right hands, can bring significant changes to the communities most affected.”

Candy Kerr, spokesperson for the Baltimore Harm Reduction Coalition, also took an optimistic tone after the city announced it had accepted the judge’s offer, asserting that adding “any
substantial amount of money” to the city’s war chest was a “win.”

“I’m relieved for this to be the end of one chapter and the beginning of another,” Kerr told Filter. “To be clear: There isn’t any amount of money that can give us back those we’ve lost, and without systemic change, no amount of money will end the racist War on Drugs. But this money, if put into the right hands, can bring significant changes to the communities most affected.”

The case, which began in 2018, has dragged on with multiple delays. It all stems from the city’s risky decision to pursue litigation independently rather than join statewide lawsuits.

The city put together a comprehensive abatement plan, based on billions in additional funding, that called for increasing investments in its harm reduction and treatment infrastructure—including implementing overdose prevention centers (OPC), something organizations such as the Baltimore Harm Reduction Coalition have demanded for years.

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.

Lawyers for the city had argued that the plan was necessary because McKesson and Cencora recklessly peddled prescription opioids and misled the public about their addictive potential for years, which created an addiction and overdose crisis that Baltimore has struggled to deal with to this day.

The city has seemingly already scaled down its goals for redressing the overdose crisis compared to what was laid out in the abatement plan.

Even though the city has recently seen record declines in overdose deaths, like elsewhere in the United States, it has still struggled with the highest fatal overdose rate of any major US city, with thousands dying in the past decade.

As that decline in deaths continues, the city has seemingly already scaled down its goals for redressing the overdose crisis compared to what was laid out in the abatement plan.

Earlier this in August, the mayor’s new Office of Overdose Response wrapped up a campaign that entailed going into the community to garner input on its draft strategic plan to address the overdose crisis, which has proven to be less ambitious than the abatement plan introduced in court.

The new plan aims to reduce fatal overdoses by just 40 percent by 2040, without explicitly calling for OPC but potentially allowing for their implementation.

Whatever the contents of the plan, the harsh truth is it will have significantly less money to fund it than was once anticipated.

When factoring in a handful of settlements with other opioid manufacturers and distributors reached in 2024, the city’s total earnings from opioid-related lawsuits have reached nearly $580 million.

Issues may also arise over whether the funds will be used for supplantation, which would entail using the funds to replace existing expenditures rather than for new programs.

That may seem like a game-changing sum, but that is to be placed into a trust and allocated over 15 years. For comparison, that’s less than the annual budget for the Baltimore Police Department. Attorneys’ fees will also likely take a chunk out of the total.

Issues may also arise over whether the funds will be used for supplantation, which would entail using the funds to replace existing expenditures rather than for new programs. The practice could become more likely if President Donald Trump succeeds in slashing funding for local health departments. Nearly half of the Baltimore City Health Department’s funding comes from the federal government.

Concerns about supplantation already raised red flags among some Opioid Restitution Advisory Board members earlier in 2025, when the city used $3.3 million of the roughly $37 million in funds earmarked for the overdose crisis in the fiscal year budget to cover the costs of health department programs that had typically been bankrolled by general fund dollars.

Public health experts overwhelmingly oppose this practice, and the Johns Hopkins Bloomberg School of Public Health has also published guiding principles for restitution funds, stating that jurisdictions should “use the dollars to supplement rather than supplant existing funding.”

Additional concerns surfaced over just how much power the advisory board has. Though the board was touted as an imperative part of a new chapter in the city’s response to the overdose crisis, decisions about how money is allocated are ultimately left up to the mayor.

Under the current fiscal year budget, nearly $20 million went directly to community organizations that provide harm reduction and addiction treatment services. Yet the vast majority of that grant money was for 22 organizations named in settlements reached with opioid manufacturers and distributors in 2024, leaving the advisory board with just $2 million to allocate at its discretion.

The remainder of the nearly $37 million would be allocated to city agencies—again without the input of board members.

Photograph of the Baltimore City Circuit Court Elijah E. Cummings Courthouse by Logan Hullinger

The post Baltimore Accepts Offer for Fraction of the Opioid Settlement It Sought appeared first on Filter.

The August 8 decision was not a complete surprise. In a June ruling, Baltimore City Circuit Court Judge Lawrence P. Fletcher-Hill had indicated the city would not receive nearly as much as it had hoped. He found the city’s lawyers failed to prove their claim that opioid distributors McKesson and Cencora (formerly AmerisourceBergen) were responsible for 97 percent of opioid-related damages the city has experienced. In that ruling, Fletcher-Hill rejected the city’s $5.2 billion request for abatement and said he would allow for a new trial, effectively reversing a 2024 jury verdict that won the city $266 million for “public nuisance” damages.

Under an arrangement between the judge and the city, Baltimore now has until August 22 to decide whether to accept the proposed abatement award in addition to watered-down public nuisance damages, or opt for a new trial completely. If the city takes the deal, it will walk away with a total of about $152 million.

“The Court concluded … that these two Defendants were responsible, at most, for just under 20% of the total amount of past and future damages claimed by the City.”

“The Court concluded, based on the evidence presented to the jury, that the largest verdict that would not be considered legally excessive would be premised on a conclusion that these two Defendants were responsible, at most, for just under 20% of the total amount of past and future damages claimed by the City,” Fletcher-Hill wrote in his August 8 ruling.

It is not immediately clear whether the city plans to challenge the abatement ruling. Regardless of the outcome, Baltimore is still guaranteed to receive hundreds of millions of dollars from previous opioid settlements and the ongoing case.

“We have received the court’s abatement ruling and are considering all options at this time,” the office of Mayor Brandon Scott (D) said in a statement. “We remain committed to securing justice for all Baltimore residents disproportionately impacted by the opioid crisis. We will respond in due time in the appropriate judicial forum.”

The city has argued that the pharmaceutical giants recklessly peddled prescription opioids and misled the public about their addictive potential, leaving Baltimore with a growing addiction and overdose crisis that has claimed thousands of lives, at a rate higher than any other major city in the United States.

The projected abatement funds have been the cornerstone of the city’s plans to address the crisis. Officials put together a 15-year, five-point plan to use billions of dollars to bolster Baltimore’s harm reduction and treatment infrastructure—including by opening overdose prevention centers (OPC).

“If the City believes this [OPC] approach is valuable, it is up to City leaders both to resolve the legal issues … and to convince the community that these sites are valuable and appropriate.”

In the August 8 ruling, Fletcher-Hill directly addressed the city’s plans for the facilities, noting the fact that they remain illegal under state law after numerous failed attempts to pass legislation legalizing the sites in the General Assembly in recent years.

“The concept is extremely controversial. Defendants even argue that this feature could not be ordered by the Court because the sites are not legal under Maryland law,” Fletcher-Hill wrote.

“Without making any determination whether this strategy is valuable from a public health perspective, the Court will not require this feature in the abatement plan,” he continued. “If the City believes this approach is valuable, it is up to City leaders both to resolve the legal issues with this type of site and to convince the community that these sites are valuable and appropriate.”

Baltimore already has numerous harm reduction and treatment programs, but expert witnesses who testified at trial said the current level of services is inadequate and must be expanded. The model used by the city estimates that more than 32,500 residents at any given time have opioid use disorder.

Under the plan, the city could reduce overdoses by 50 percent and triple the number of people in treatment, witnesses said.

In the month leading up to the judge’s latest ruling, officials held numerous public hearings and listening sessions about the overdose crisis.

The city’s aim to reduce opioid prescriptions by 55 percent is controversial, however—given damaging implications for pain patients, and the relationship between a national crackdown on opioid prescribing and the overdose crisis reaching unprecedented levels. Some advocates argue that opioid lawsuits themselves contribute to a harmful chilling effect on prescribing.

In the month leading up to the judge’s latest ruling, officials held numerous public hearings and listening sessions about the overdose crisis. This ended more than a year of relative silence on the issue, as the mayor’s administration had argued that public discourse might jeopardize the litigation.

Public hearings were held by Baltimore City Council members, while the mayor’s new Office of Overdose Response held four community listening sessions specifically to garner feedback on its draft strategic plan to address the crisis. That sweeping plan has proved to be less ambitious than the abatement plan presented in court; it aims to reduce fatal overdoses 40 percent by 2040, without explicitly calling for OPC.

At least one Council member has recently reiterated his support of city-sanctioned OPC—the kind of step taken by New York City—when efforts seeking state authorization have repeatedly failed. But the plan makes no mention of the facilities. To date, the mayor has refused to use his powers to unilaterally open the sites.

The plan does, however, state that one of the city’s priorities is to “increase access to a full array of low-barrier harm reduction services (including naloxone distribution, drug checking, syringe service programs, and other evidence-based strategies.” The latter phrase might include OPC.

It’s unclear just how much the judge’s ruling on the case, which dates back to 2018 and has faced numerous delays, will impact the city’s overdose prevention plans—though city officials have conceded it will make things significantly more difficult.

Baltimore will likely have to adjust its plans to operate on almost $215 million less, depending on whether it accepts the judge’s proposal or opts for a new trial.

After the $266 million jury verdict in November, based on the “public nuisance” caused by the companies’ practices, the city had expected its overdose prevention war chest to come to nearly $670 million, excluding any abatement dollars. Now, Baltimore will likely have to adjust its plans to operate on almost $215 million less, depending on whether it accepts the judge’s proposal or opts for a new trial.

The city asserted in court that the overdose crisis was largely caused by “pill mills” dishing out opioids they received from companies like Cencora and McKesson. But defense attorneys said the city failed to identify faults in the companies’ practices. They also questioned the legitimacy of the city’s statistical model estimating OUD prevalence, which underpins the cost estimates for its abatement plan, and suggested the plan did not factor in existing overdose prevention programs that may already be funded.

The city’s witnesses responded that funding for existing programs will run out, while the plan focused on fully funding initiatives over 15 years by putting the funds in a trust that accrues interest. They dismissed concerns regarding the statistical model and emphasized that the severity of the crisis demands a response of equivalent ambition.

Though Baltimore’s fatal overdose rate remains the highest in the nation, according to city officials, the number of deaths in the city has continued to decline, in line with trends seen nationwide.

Preliminary data recently published by the Maryland Department of Health showed the city recorded 777 deaths in 2024, a fall of nearly 26 percent from 2023. Subsequent monthly data suggest the downward trend has continued, with fewer than 600 deaths in the 12-month period ending in June.

While the trajectory is positive, the crisis continues to have a disproportionate impact on older Black men, and people living in areas such as West Baltimore.

Photograph of Baltimore City Circuit Court Elijah E. Cummings Courthouse by Logan Hullinger

The post Judge Offers Baltimore $100 million for OD Crisis—Far Less Than City Sought appeared first on Filter.

Baltimore City Circuit Court Judge Lawrence P. Fletcher-Hill said the city failed to prove that it needed McKesson and Cencora (formerly AmerisourceBergen), to pay $5.2 billion to cover the costs of redressing the damages they allegedly caused.

The city had previously argued that it needed the money because the pharmaceutical giants recklessly peddled prescription opioids and misled the public about their addictive potential, leaving Baltimore with a growing addiction and overdose crisis that has claimed thousands of lives.

“The court is struck by the fact that the City did not present any evidence of any unreasonable conduct by either Defendant after about 2019,” Fletcher-Hill wrote in the ruling. “The City also chose not to ask for an injunctive relief to change the practices of either Defendant in the future. Rather, any abatement remedy will be to deal only with the ongoing effects of Defendants’ conduct in the past.”

While the judge rejected the sum the city requested for abatement, his ruling indicates that the court will still make a decision on the final amount. But first, the city must decide by July 7 if it will accept or contest a massive cut to $266 million it won in a jury verdict in the first phase of the trial.

“The Court finds that the verdict rendered is grossly excessive in light of the evidence and is shocking to the Court.”

Fletcher-Hill wrote that the jury’s decision was predicated on the flawed assertion that 97 percent of opioid-related damages were caused by the two companies. In light of that, he instead proposed that the two defendants pay just under $52 million. McKesson would pay the bulk of that, at $37.4 million.

“The Court finds that the verdict rendered is grossly excessive in light of the evidence and is shocking to the Court,” Fletcher-Hill wrote.

Fletcher-Hill’s much-anticipated ruling came after lawyers for the city and companies wrapped up their arguments in the second phase of the trial in December; he delayed his decision twice in recent months.

In November, in the first phase of the trial, a jury ordered the companies to pay the city more than $266 for the “public nuisance” caused by their practices. That brought the city’s anticipated litigation-funded overdose prevention war chest to nearly $670 million, but the city will now likely have to adjust its plans to operate on roughly $200 million less.

“This decision is disappointing to say the least. We are evaluating the decision and considering all of our options,” Baltimore Mayor Brandon Scott said in a statement. “Even with today’s decision, the settlements we’ve reached through this process far exceed what our city would have gained through the global settlement—making it clear that we made the right decision to continue this fight alone.”

The plan entails increasing the city’s treatment capacity, augmenting harm reduction initiatives and opening overdose prevention centers.

The city had hoped the $5.2 billion 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 pregnant women; and monitoring and implementation.

The plan entails increasing the city’s treatment capacity, augmenting harm reduction initiatives and opening overdose prevention centers, which advocates have said are long overdue.

Baltimore already has numerous harm reduction and treatment programs, but those who testified said the current level of services is inadequate and must be expanded. The model used by the city estimates that more than 32,500 people at any given time have opioid use disorder.

The city could reduce overdoses by 50 percent and triple the number of people in treatment under the plan, witnesses said.

However, the city’s aim to reduce opioid prescriptions by 55 percent is deeply controversial—part of what some advocates say is a chilling effect that’s exacerbated by opioid lawsuits themselves.

While many people who use fentanyl or heroin began with pharmaceutical opioids, the vast majority of people who are prescribed opioids do not develop opioid use disorder (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 overdose crisis was largely caused by “pill mills” that dished out millions of opioids they received from companies such as Cencora and McKesson.

The ruling comes on the heels of a historic drop in overdose deaths in Baltimore, which has been the worst-impacted major city in the United States.

Defense attorneys, however, 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 that estimated OUD prevalence, which is largely what its cost estimates are based on, and why the plan did not factor in existing overdose prevention programs that may already be funded.

The city’s witnesses grew impatient with the defense, persistently arguing that funding for existing programs will run out, and that the plan focuses on fully funding initiatives over 15 years by putting the funds in a trust that accrues interest. Those on the stand dismissed concerns regarding the statistical model, and emphasized that the severity of the crisis requires an equally ambitious plan to address it.

With the final outcome of the case yet to be determined, it’s unclear to what extent the June 12 decision will impact the city’s overdose prevention initiatives. But funding for those initiatives looks certain to be far less than the city had hoped.

The ruling comes on the heels of a historic drop in overdose deaths in Baltimore, which has been the worst-impacted major city in the United States.

Data recently published by the Maryland Department of Health showed the city recorded 775 deaths in 2024, a decrease of nearly 26 percent from the year prior. Subsequent monthly data seem to indicate that the downward trend has continued.

The last time Baltimore saw fewer than 800 overdose deaths was in 2017. Though the numbers are preliminary and subject to change, the decline has prompted both newfound optimism and a recognition that more work must be done—above all in marginalized populations where the crisis remains at a devastating level.

Photograph of the Baltimore City Circuit Court Elijah E. Cummings Courthouse by Logan Hullinger

The post Judge Rejects Baltimore’s $5.2 Billion Lawsuit Request to Address OD Crisis appeared first on Filter.

Now, armed with a $200,000 grant from the OneOhio Recovery Foundation, SOAR is reimagining how to best collect and communicate this crucial information.

Much of the funding—which comes from the controversial foundation created to distribute Ohio’s opioid settlement funds—will go towards modernizing the existing technology. But SOAR also plans to expand its investment in a less conventional approach: deploying community outreach workers, who collect and distribute information in person.

“They build the trust with the community. The participants they serve, they know.”

While other alert systems have increasingly moved towards automation, usually by feeding emergency medical services data to powerful algorithms designed to predict overdose spikes, SOAR (for which I previously served as director of operations) has maintained its commitment to a bottom-up approach. It employs eight outreach workers in strategic locations across Ohio, each tasked with keeping a pulse on the community’s needs, verifying alerts and distributing harm reduction supplies.

Tonja Catron, SOAR’s executive director, told Filter that the community-based knowledge of people who use drugs is the “frontline of defense” against overdose. SOAR’s outreach workers, who are deeply embedded in these communities and have their own lived experiences of substance use, provide a space for people to safely share time-sensitive information about the drug supply.

“They build the trust with the community,” Catron said. “The participants they serve, they know. So they are always gonna … report to them first.”

In the age of algorithms and artificial intelligence, SOAR’s commitment to boots-on-the-ground information gathering may seem old-fashioned. However, Catron argues that it keeps the organization in alignment with harm reduction’s core principle of elevating the voice of people who use drugs.

“These are coming from real people, and most of our alerts are coming from people who use drugs,” she said. “It’s not coming from a computer system, just analyzing trends and putting that out. It’s coming firsthand from drug users.”

By leveraging the community’s collective expertise, SOAR often gets word of overdose spikes or high-risk substances before public health catches on. This allows its outreach workers to respond to risks quickly.

health departments’ alert systems have increasingly focused on automated, algorithmic methods.

“When we send out those alerts, then we have people that are ready to meet the community with naloxone or test strips or linkage to care,” Catron explained.

An added benefit of this strategy is the financial support it provides to outreach workers. Most have provided services to their communities on a volunteer basis for years, paying for supplies themselves. For those who have been justice system-involved, working for SOAR can also bolster their resumes for future employment opportunities.

This community-based approach is quite different from the recent trajectory of health departments, whose alert systems have increasingly focused on automated, algorithmic methods.

For example, a study recently published in the journal Addiction found that non-fatal overdose data can be used to predict fatal overdose surges. This allows under-resourced health departments to more effectively mobilize support, since non-fatal overdose data is more quickly and easily available.

“The processing time that it takes to get the fatal data varies a lot depending on local capacity,” lead study author Thomas Patton, a researcher at the University of California San Diego Department of Medicine, told Filter. “These [nonfatal] data are at least routinely available.”

The study found that both methods were quite reliable in highly populated areas, though their accuracy declined in smaller counties.

Using emergency department and emergency medical services data from California and Florida, the research team tested two overdose detection algorithms commonly used by health departments. The algorithms use different mathematical approaches, but both were designed to automatically detect “aberrations”—substantial deviations from the number of overdoses that would be considered “normal” in an area at a given time.

The study found that both methods were quite reliable in highly populated areas, though their accuracy declined substantially in smaller counties.

“We didn’t see one method really dominate over the other,” Patton said, emphasizing the value of enlisting multiple detection strategies—including cutting-edge techniques like wastewater surveillance—when possible.

A major benefit of this approach is that most health departments already have access to emergency medical data, which is usually reported in real time. Implementing an alert system based on the “aberration detection methods” proposed in the paper would be relatively cheap and simple.

On the other hand, Patton also highlighted the importance of community-led reporting initiatives like SOAR’s bad batch alerts, calling them “inseparable” from these algorithmic approaches. Without information from the community, health departments might be relying on the wrong indicators.

“We don’t know, as drug use evolves and changes over time, what’s gonna come up next,” he explained. “We might not have the data needed.”

Grassroots organizations, however, are more hesitant to collaborate with health departments, reflecting ongoing tensions between the two groups. Catron said SOAR is far more willing to share health department information with its subscribers than it is to share its own reports with health departments.

Unless public health systems can build more trust with grassroots communities, it’s unclear whether the two approaches can converge.

“Anytime a coroner sends us a report, we’re sure to send it out,” she said. But when it comes to sharing information provided by SOAR’s subscribers, “There’s not a lot of trust there still with public health.”

This stems from the relationships between public health and law enforcement. To ensure people feel comfortable submitting reports, SOAR avoids partnerships with any perceived risk of bringing law enforcement into the loop.

While SOAR’s model is powerful, it has its limitations. It takes time to build the large network of community informants, outreach workers and institutional connections necessary for a successful system. It’s also expensive; SOAR has been awarded over half a million dollars of funding to build and maintain its text message alerts and app (which was discontinued in 2024) since 2020.

SOAR plans to continue expanding its network of community outreach workers, and invites organizations in other states to reach out for more information about implementing the system in their communities.

For many municipalities, algorithmic solutions that leverage existing public health data are currently the only viable option for warning the public about potential overdose spikes. As Patton and his team show, innovative new techniques, such as using non-fatal indicators, can greatly enhance the timeliness of alerts in low-capacity places.

Community-driven and algorithmic alert systems have each shown value, and each continue to receive significant private and public funding. But unless public health systems can build more trust with grassroots communities, it’s unclear whether the two approaches can converge.

Photograph of SOAR workers and volunteers courtesy of the SOAR Initiative

The post Community “Bad Batch” Alerts Contrast With Algorithmic OD Prevention appeared first on Filter.